CPC - Certified Professional Coder HCPCS Level II Codes Questions and Answers 1 — Questions and Answers
Question 1: A physician administers an injection of a specific chemotherapy drug in the office. Which section of HCPCS Level II would contain the code for the drug itself?
- A codes (Medical and Surgical Supplies)
- E codes (Durable Medical Equipment)
- J codes (Drugs Administered Other Than Oral Method) (Correct answer)
- L codes (Orthotic and Prosthetic Procedures)
Correct answer: J codes (Drugs Administered Other Than Oral Method)
J codes are used to report specific drugs and their dosages that are administered through non-oral routes, such as injections and infusions. A codes are for supplies, E codes for DME, and L codes for orthotics/prosthetics.
Question 2: A patient is fitted for and receives a new, standard manual wheelchair for home use. Which HCPCS Level II modifier must be appended to the wheelchair code to indicate that it is new equipment?
- RR (Rental)
- UE (Used equipment)
- LT (Left side)
- NU (New equipment) (Correct answer)
Correct answer: NU (New equipment)
The modifier NU is specifically used to designate new durable medical equipment (DME). The RR modifier indicates the equipment is being rented, and UE indicates it is used. LT is an anatomical modifier specifying the left side of the body.
Question 3: The maintenance of the HCPCS Level II code set, including the addition, deletion, and revision of codes, is managed by which organization?
- American Medical Association (AMA)
- Centers for Medicare & Medicaid Services (CMS) (Correct answer)
- World Health Organization (WHO)
- American Hospital Association (AHA)
Correct answer: Centers for Medicare & Medicaid Services (CMS)
The Centers for Medicare & Medicaid Services (CMS) is responsible for maintaining the HCPCS Level II code set. The American Medical Association (AMA) maintains CPT (HCPCS Level I).
Question 4: A podiatrist performs routine foot care by trimming a patient's toenails. This service is considered statutorily non-covered by Medicare. Which modifier should be appended to the procedure code to inform Medicare that the service is statutorily excluded and will not be covered?
- GA (Waiver of liability statement on file)
- GY (Item or service statutorily excluded) (Correct answer)
- GZ (Item or service expected to be denied as not reasonable and necessary)
- 59 (Distinct procedural service)
Correct answer: GY (Item or service statutorily excluded)
The GY modifier is used to inform Medicare that an item or service is statutorily excluded or does not meet the definition of a Medicare benefit. This indicates the service is never covered. The GA modifier is used when a service might be denied as not reasonable and necessary and an ABN is on file. GZ is used when denial is expected but no ABN was obtained. Modifier 59 is a CPT modifier.
Question 5: Which of the following HCPCS Level II code ranges is designated for temporary national codes for professional services and procedures that do not yet have a permanent CPT or national code?
- J codes
- L codes
- G codes (Correct answer)
- E codes
Correct answer: G codes
G codes are temporary codes used by CMS to identify professional healthcare procedures and services that are under review or do not have a CPT code. They are often used for new or emerging technologies and services. J codes are for drugs, L codes are for orthotics/prosthetics, and E codes are for durable medical equipment.
Question 6: A diabetic patient is supplied with a blood glucose monitor for home use, as well as a box of test strips. How would these two items be categorized and coded within HCPCS Level II?
- Both items are considered supplies and are reported with A codes.
- The monitor is durable medical equipment (E code) and the test strips are supplies (A code). (Correct answer)
- The monitor is a supply (A code) and the test strips are durable medical equipment (E code).
- Both items are considered durable medical equipment and are reported with E codes.
Correct answer: The monitor is durable medical equipment (E code) and the test strips are supplies (A code).
The blood glucose monitor is considered Durable Medical Equipment (DME) and is reported with an E code. The disposable test strips are categorized as Medical and Surgical Supplies and are reported with an A code (e.g., A4253).
CPC - Certified Professional Coder HCPCS Level II Codes Questions and Answers 1
A physician administers an injection of a specific chemotherapy drug in the office.
Which section of HCPCS Level II would contain the code for the drug itself?