HCPCS EXAM WITH COMPLETE SOLUTIONS
CPT, HCPCS Level II and HCPCS Level III codes are all HIPAA-approved National Codes Sets.
a.) True
b.) False
b: False.
HCPCS Level III codes are not included in the HIPAA-approved National Code Sets. They will be
eliminated on Dec. 31, 2003.
In most cases, which modifier is needed for an emergency room case when reporting both a CPT
surgery code and evaluation and management (E/M) code?
a.) 52
b.) 59
c.) 25
c: Modifier -25 is appended to the ED E/M code. Modifier -25 identifies significant, separately
identifiable E/M services on the same day of the procedure or other services. In most instances,
patients that come to the ED do not present to have a procedure performed. The patient first needs
to be evaluated by a physician.
HCPCS Level II "A" codes represent:
a.)Transportation services, including ambulance
b.)Durable medical equipment
c.)Temporary medical and surgical supplies
a: HCPCS Level II A codes are used to report transportation services, including ambulance.
CPT codes and HCPCS Level II codes are updated by CMS annually.
a.) True
b.) False
b: False. HCPCS Level II codes are updated by CMS. CPT codes are not. CPT codes are updated by
AMA.
A flexible diagnostic colonoscopy is performed. During the procedure, a polyp is removed from one
area and a lesion is removed from another. Both the polyp and the lesion are removed by snare
technique. Which of the following would be the appropriate code selection?
a) 45378-59, 45385, 45385-59
b) 45385, 45385-59
c) 45385
d) 45378-59, 45385
c: Only code 45385 is reported.
The diagnostic colonoscopy is not coded separately. Notice the separate procedure designation. The
diagnostic colonoscopy is included in the code for any definitive procedure performed.
45385 is not reported twice because the description of the code indicates "with removal of tumor(s),
polyp(s), or other lesion(s) by snare technique." Therefore, all tumors, polyps or lesions removed
using this technique are reported only once.
The same CCI edits are used by CMS for editing both physician and hospital outpatient services.
, a) True
b) Fals
b: False.
The CCI edits used by CMS to edit physician and hospital outpatient services are not the same. CMS
uses the most current version of CCI edits to edit physician services. The CCI edits used by CMS to edit
hospital outpatient services are included in the Outpatient Code Editor (OCE) and is one release
behind. Also, the CCI edits included in the OCE do not include the entire CCI table.
On April 15, 2003, it was appropriate to bill services provided on March 15, 2003, using either 2002 or
2003 HCPCS codes because of the grace period.
a) True
b) False
b: False.
On April 15, 2003, it is not appropriate to bill services provided on March 15, 2003, using either 2002
or 2003 HCPCS codes. The three-month grace period is intended to allow providers time to implement
the new codes. After April 1st, all claims for services after January 1st must include the new codes.
The patient presents to the ED with multiple lacerations. Simple repairs of a 2 cm laceration of the leg
and a 3 cm laceration of the back are performed. Another 3 cm laceration of the back was repaired
but first required extensive cleaning to remove gravel before the single layer closure was performed.
Which of the following would be the appropriate code selection for the laceration repairs?
a) 12004
b) 12001, 12002-59, 12002-59
c) 12002, 12032
d) 12001, 12002-59, 12032
c: Codes 12002 and 12032 are assigned.
The length of the leg and back wounds are added together because they are both simple repairs from
anatomical sites that are grouped together. Code 12002 is assigned. Even though the second 3 cm
laceration of the back was a single layer closure, extensive cleansing and removal of gravel were
required before the wound could be sutured. Code 12032 is assigned. Please refer to the note in the
beginning of the Integumentary/Repair section for instructions.
Modifier -52 is used to report the elective cancellation of a procedure that does not require
anesthesia because the physician is unavailable.
a) True
b) False
b: False.
A code for the intended procedure with modifier -52 is not assigned if a procedure is electively
cancelled because the physician is unavailable. Other services provided to the patient may be billed.
Where do you find HCPCS level II codes?
a) They are at the back of the ICD-9 book.
b) The are in Appendix D of the CPT book.
c) The are only available from Medicare.
d) They are in their own book: HCPCS level II.
d) They are in their own book: HCPCS level II.
HCPCS level II codes main difference with CPT codes is:
CPT, HCPCS Level II and HCPCS Level III codes are all HIPAA-approved National Codes Sets.
a.) True
b.) False
b: False.
HCPCS Level III codes are not included in the HIPAA-approved National Code Sets. They will be
eliminated on Dec. 31, 2003.
In most cases, which modifier is needed for an emergency room case when reporting both a CPT
surgery code and evaluation and management (E/M) code?
a.) 52
b.) 59
c.) 25
c: Modifier -25 is appended to the ED E/M code. Modifier -25 identifies significant, separately
identifiable E/M services on the same day of the procedure or other services. In most instances,
patients that come to the ED do not present to have a procedure performed. The patient first needs
to be evaluated by a physician.
HCPCS Level II "A" codes represent:
a.)Transportation services, including ambulance
b.)Durable medical equipment
c.)Temporary medical and surgical supplies
a: HCPCS Level II A codes are used to report transportation services, including ambulance.
CPT codes and HCPCS Level II codes are updated by CMS annually.
a.) True
b.) False
b: False. HCPCS Level II codes are updated by CMS. CPT codes are not. CPT codes are updated by
AMA.
A flexible diagnostic colonoscopy is performed. During the procedure, a polyp is removed from one
area and a lesion is removed from another. Both the polyp and the lesion are removed by snare
technique. Which of the following would be the appropriate code selection?
a) 45378-59, 45385, 45385-59
b) 45385, 45385-59
c) 45385
d) 45378-59, 45385
c: Only code 45385 is reported.
The diagnostic colonoscopy is not coded separately. Notice the separate procedure designation. The
diagnostic colonoscopy is included in the code for any definitive procedure performed.
45385 is not reported twice because the description of the code indicates "with removal of tumor(s),
polyp(s), or other lesion(s) by snare technique." Therefore, all tumors, polyps or lesions removed
using this technique are reported only once.
The same CCI edits are used by CMS for editing both physician and hospital outpatient services.
, a) True
b) Fals
b: False.
The CCI edits used by CMS to edit physician and hospital outpatient services are not the same. CMS
uses the most current version of CCI edits to edit physician services. The CCI edits used by CMS to edit
hospital outpatient services are included in the Outpatient Code Editor (OCE) and is one release
behind. Also, the CCI edits included in the OCE do not include the entire CCI table.
On April 15, 2003, it was appropriate to bill services provided on March 15, 2003, using either 2002 or
2003 HCPCS codes because of the grace period.
a) True
b) False
b: False.
On April 15, 2003, it is not appropriate to bill services provided on March 15, 2003, using either 2002
or 2003 HCPCS codes. The three-month grace period is intended to allow providers time to implement
the new codes. After April 1st, all claims for services after January 1st must include the new codes.
The patient presents to the ED with multiple lacerations. Simple repairs of a 2 cm laceration of the leg
and a 3 cm laceration of the back are performed. Another 3 cm laceration of the back was repaired
but first required extensive cleaning to remove gravel before the single layer closure was performed.
Which of the following would be the appropriate code selection for the laceration repairs?
a) 12004
b) 12001, 12002-59, 12002-59
c) 12002, 12032
d) 12001, 12002-59, 12032
c: Codes 12002 and 12032 are assigned.
The length of the leg and back wounds are added together because they are both simple repairs from
anatomical sites that are grouped together. Code 12002 is assigned. Even though the second 3 cm
laceration of the back was a single layer closure, extensive cleansing and removal of gravel were
required before the wound could be sutured. Code 12032 is assigned. Please refer to the note in the
beginning of the Integumentary/Repair section for instructions.
Modifier -52 is used to report the elective cancellation of a procedure that does not require
anesthesia because the physician is unavailable.
a) True
b) False
b: False.
A code for the intended procedure with modifier -52 is not assigned if a procedure is electively
cancelled because the physician is unavailable. Other services provided to the patient may be billed.
Where do you find HCPCS level II codes?
a) They are at the back of the ICD-9 book.
b) The are in Appendix D of the CPT book.
c) The are only available from Medicare.
d) They are in their own book: HCPCS level II.
d) They are in their own book: HCPCS level II.
HCPCS level II codes main difference with CPT codes is:
