HCPCS (Level II) and CPT (Level 1)
Coding Review Quiz Must Be Reviewed
Patricia Maccariella, RRA, CCS
For those of you taking the CCS-P examination, this issue of CCS Prep! will address the use of HCPCS level II coding. Remember to study HCPCS level II coding across all specialties as any one
of them could be on the test. Do NOT assign codes for HCPCS level III codes, which are local codes.
"HCPCS" is an acronym for HCFA (Health Care Financing Administration) Common Procedure Coding System, which was developed in 1983. HCFA found that level I codes (CPT) were not enough to report all medical services and supplies. The HCPCS level II system is used to accomplish this. There are more than 3,000 HCPCS Level II codes contained in the 1999 manual. They begin with a letter (A through V) and are followed by four numeric digits. They are grouped by the type of service or supplies that they represent, and are updated by HCFA annually. The HCPCS level II codes are not only required for Medicare and Medicaid patients, but are being increasingly used by private insurance carriers to describe services and supplies.
Modifiers are also a part of the HCPCS Level II codes. They are two alphabetic or alphanumeric numbers. i.e., (AA-VP) or (F1-F9). Modifiers will be used for testing in Part I (multiple choice portion) of the examination only.
Take the following quiz on HCPCS coding to test your knowledge. Try to answer the questions from memory before referring to the HCPCS level II codebook. Remember, codebooks are used only in Part II of the examination.
1. J codes (J0000-J8999) are used for which purpose?
a) For all administered drugs
b) For all drugs that can be injected subcutaneously, intramuscularly or intravenously
c) For durable medical equipment (DME)
2. HCPCS level II modifiers F1 through F4 involve which anatomic area?
a) Eyelid (upper, lower, right and left)
b) Digit of foot
c) Digit of hand
3. HCPCS code G0101, (cervical or vaginal cancer screening, pelvic and clinical breast examination) cannot be used with an E/M service code on the same day.
4. What modifier is used by Medicare for reimbursing monitored anesthesia care?
a) 47 anesthesia by a surgeon
b) AA anesthesia services performed personally by anesthesiologist
c) QS monitored anesthesia care service
5. What is the description of code J1940?
a) Dynamic adjustable toe extension/flexion device
b) AFO, molded to patient model, plastic
c) Injection, Lasix, up to 20mg.
6. Temporary codes assigned by HCFA to procedures, services and supplies before a permanent code is assigned in HCPCS level II are called:
a) Q codes
b) T codes
c) G codes
How did you do? Answering the above questions can be challenging when not using your books. Below are some questions relating to CPT level I coding for physician offices. The answers are listed at the end of the column.
7. What are the codes for a patient presenting at the physician office for Norplant insertion? (Diagnosis, Procedure, HCPCS level II code)
a) V72.3 (Gynecological exam), 11975 (Implant contraceptive capsules) and A4260 (Levonorgestrel implants and supplies)
b) V25.5 (Implant subdermal contraception), 11975, A4260
c) V72.3, V25.5, 11975, A4260 and 88141 (Cytopathology, cervical or vaginal, interpretation by physician.
8. Two surgeons, both primary, perform removal of lens material, pars plana approach, with vitrectomy. This should be coded as follows:
a) 66852 (pars plana removal of lens with/without vitrectomy) by surgeon A and 67036 (vitrectomy, mechanical pars plana approach) by surgeon B.
b) Only one surgeon can bill 66852
c) Each surgeon reports 66852 with modifier 62 (two surgeons) and submits the operative report.
9. An attending physician refers her patient to an orthopedic surgeon for care and treatment of a fractured ankle. The patient follows up and the orthopedic surgeon manages his care. Which area does the orthopedic surgeon code from for the first visit?
a) 99241-99245 for office and other outpatient consultations
b) 99271-99275 for confirmatory consultations
c) 99201-99205 for new patient, office or other outpatient visit
10. A patient is seen for dysfunctional uterine bleeding and requires a hysteroscopy with an endometrial biopsy. The physician performs a problem focused history, expanded problem focused exam and low medical decision making to assess a breast cyst found by the patient just before her doctor visit. To correctly report the code (s):
a) Assign only the CPT procedure code for the hysteroscopy and biopsy. The evaluation of the breast cyst is included with the CPT surgery code.
b) Assign the surgical CPT procedure code and the appropriate E/M code with modifier 25 amended
c) Assign the surgical CPT procedure code with modifier 57 amended and the appropriate E/M code. *
Patricia Maccariella is manager of coding review services at United Audit Systems Inc. (UASI), a national consulting company offering multifaceted HIM, coding and business office management services, headquartered in Cincinnati.
ANSWERS: 1. b, (see the introduction to j codes in the 1999 HCPCS Level II book); 2. c, (see modifier descriptions F1-F9 as these denote each digit of both hands); 3. b, False. As of Jan. 1, 1999, the CCI update allows G0101 to be billed with an E/M visit if the visit is separate from the G0101 service. When both services occur at the same encounter for distinct reasons, modifier 25 should be used with the E/M code on the claim; 4. c, 5. c, (Lasix is another term for furosemide); 6. a, Q codes are temporary codes for HCPCS level II inclusion. G codes are temporary codes being considered for inclusion in the CPT level I code book; 7. b, (V25.5, 11975, A4260) There is no documented evidence of a gynecological examination being performed; 8. c, 66852-62 by both surgeons. Medicare pays 125 percent of the normal Medicare Fee Schedule and divides the payment equally (50/50) between the two surgeons. A well-documented operative report with indications is necessary; 9. c, Referrals for care are considered new patients, initial outpatient visit for the consultant. "Referral" and "consult" are not synonymous. A consult occurs when the attending asks only for an opinion and the consult provides this and returns the patient to the attending for management; 10. b.