Coding Concepts

1. HCPCS stands for

a. Health common procedural terminology coding system
b. Healthcare common procedural coding system
c. HCFA common procedural coding system
d. Healthy common procedural coding system

2. The hospital claims are submitted to Medicare on

a. CMS-1500
b. UB-04
c. CMS-1900
d. UB-67

3. The following is an example of unbundling

a. Coding a component procedure with a comprehensive procedure in CCI
b. Coding a procedure already included in the primary code with the primary code
c. None of the above
d. Both a & b

4. NCCI edits are revised

a. Quarterly
b. Yearly
c. Biweekly
d. Biyearly

5. The following agencies are responsible for maintaining CPT codes:

a. CMS
b. CMS & AMA
c. AMA
d. CMS, AMA, American health association(AHA)

6. On April 20, 2013, it will be appropriate to bill services provided on Jan 15, 2013, using
either 2012 or 2013 CPT codes bacause of the grace period.
a. True
b. False
7. Pass through payments are:
a. Additional payments made for certain drugs, biological & medical devices
b. Payments for clinical laboratory services
c. Additional payments for clinical laboratory services
d. Various incidental services

8. Items not packaged under APC includes:

a. Blood & blood products
b. Pharmaceuticals, drugs & biologicals
c. Casting, splinting & strapping services
d. Blood & blood products, Casting, splinting & strapping services

9. Procedure codes with a status indicator of C indicates that:

a. Services are incidental
b. Pastient services that are inpatient
c. Services are paid under the partial hospitalization program
d. Ancillary services where payment is allowed under the hospital PPS system

10. Under the APC system, the reimbursement for the medical visit is reimbursed in which
manner?
a. No reimbursement, bundled into procedure performed
b. Using E/M code system levels one through five
c. Utilizing E/M coding system levels one throgh four
d. Using CPT codes from the Medicine section

11. The chargemaster for a hospital includes some of the following information:
a. Inventory list, revenue codes, CPT, HCPCS, ICD-9-CM diagnosis codes
b. Revenue codes, ICD-9-CM procedure codes, ICD-9-CM codes, description of
services & inventory listing
c. Revenue codes, CPT, HCPCS, description of services, ICD-9-CM codes
d. CPT, HCPCS codes, revenue codes & description of services
12. Observation services are:
a. Separately reimbursed under the outpatient PPS system for facilities
b. Bundled into the DRG for hospital services
c. Not paid separately
d. Paid under a fee schedule
13. Medicares Ambulatory Payment Classification system (APC) is a reimbursement
mechanism where:
a. Hospitals will be reimbursed for inpatient hospital services based on the DRG
b. Hospitals will be reimbursed for outpatient services based on a payment classification
c. Hospitals will be reimbursed for outpatient services based on a fee schedule
d. Hospitals will be reimbursed for inpatient services based on the CPT procedure code

14. When coding for E/M services in the facility:

a. The facility must follow AMA/CMS evaluation & management documentation
guidelines
b. Must establish guidelines within the facility with a protocol for coding E/M levels
c. The facility may not use E/M codes in the facility; they are reserved for professional
services
d. The facility may only bill E/M services for observation services

15. The claim for reporting outpatient facility services in the outpatient hospital is the:
a. CMS-1500
b. HCFA 1450
c. HCFA 1500
d. CMS-1450

16. The status indicator V is used to indicate:

a. Codes not recognized by the OPPS
b. A significant procedure that is not discounted with multiple procedures performed
c. Clinic or emergency department visits
d. Ancillary services

17. Expand the following abbreviations:

a. APC
b. APG
c. ASC
d. BBA
e. BBRA
f. CDM
g. CMS
h. DME
i. DRG
j. HCPCS
k. OBRA
l. OPPS