30 terms

Medical Insurance Billing Module 6

The CPT index is organized by alphabetical main terms representing procedures or services, organs, anatomic sites, conditions, eponyms, or abbreviations.
The separate procedure code is always reported if the procedure or service performed is included in the description of another reported code.
Single code numbers are assigned to organ or disease-oriented panels, which consist of a series of blood chemistry studies routinely ordered by providers at the same time for the purpose of investigating a specific organ or disorder. The panel is very specific, but substitutions of some tests are allowed.
HCPCS Level II temporary codes are maintained by the AMA and other members of the HCPCS National Panel, independent of permanent Level II codes.
Whenever a permanent code is established by the HCPCS National Panel to replace a temporary code, the temporary code is deleted and cross-referenced to the new permanent code.
HCPCS modifiers clarify services and procedures performed by providers.
When using the HCPCS manual, it is important to code and verify directly from the index.
When determining payer responsibility, the specific HCPCS Level II code determines whether the claim is sent to the local Medicare administrative contractor (MAC) or the regional DME MAC.
Some services must be reported by assigning both a CPT and HCPCS Level II national code. The most common scenario uses the CPT code for the administration of an injection and the HCPCS code to identify the procedure.
G codes identify professional health care procedures and services that do not have codes identified in CPT.
HCPCS Level II modifiers are alphabetic (two letters) or alphanumeric (one letter followed by one number).
CPT codes are used to report services and procedures performed on patients:
All of the above
Procedures and services submitted on a claim must be linked to the ____ that justifies the need for the service or procedure.
With what type of codes are procedures/services identified by a five-digit CPT code and descriptor nomenclature (these are codes traditionally associated with the CPT and organized within six sections)?
Category I codes
What type of codes contain "emerging technology" temporary codes assigned for data collection?
Category III codes
____ define terms and explain the assignment of codes for procedures and services located in a particular section of the CPT manual.
Physicians' services rendered in the office, home, or hospital, consultations, and other medical services are listed in which section of the CPT manual?
Evaluation and Management section
____ is defined by Medicare as equipment that can withstand repeated use in the patient's home and not in the absence of illness or injury.
Durable Medical Equipment
The HCPCS Level II coding system has which of the following characteristics?
all of the above
Permanent national codes, dental codes, miscellaneous codes, temporary codes, and modifiers are all what type of codes?
HCPCS Level II codes
What does the acronym OPPS stand for?
Outpatient prospective payment system
____ identify professional health care procedures and services that do not have codes identified in the CPT manual.
G codes
____ are used by BCBSA and the HIAA when no HCPCS Level II codes exist to report drugs, services, and supplies, but codes are needed to implement private payer policies and programs for claims processing.
S codes
___ indicate that the description to the service or procedure performed has been altered.
Which HCPCS Level II modifier would be applied to report ophthalmological examination?
Which HCPCS Level II modifier would you use to report lower right eyelid?
These codes are reported for new drugs, biologicals, and devices that are eligible for transitional pass-through payments for hospitals:
C codes
How many levels of HCPCS codes are there?
Most state Medicaid programs use what type of system to report professional services, procedures, supplies, and equipment?
Healthcare Common Procedure Coding System
What types of codes are HCPCS Level I codes?
CPT codes