Chapter 20 — Exercises

How to use these. Section C — the units arithmetic — is the one that matters. Everything else in this chapter is navigation and rules; units are the thing that costs money on both sides.

Show the division. Every time. A units answer without arithmetic is a guess.

Section A — Structure and families (items 1–10)

A.1 What are the two levels of HCPCS?

A.2 Who maintains Level II, and what does the answer mean for what it costs you?

A.3 How often does Level II update? What failure does an annual update process produce?

A.4 What is the format of a Level II code?

A.5 Distinguish a permanent code from a temporary code.

For each item, name the letter family:

A.6 Injectable drugs.

A.7 Wheelchairs and hospital beds.

A.8 Orthotics and prosthetics.

A.9 Codes established for state Medicaid agencies.

A.10 Codes established by non-Medicare payers, which Medicare does not recognize.

Section B — Ambulance modifiers (items 11–14)

B.11 What does the first character of an ambulance modifier identify? The second?

B.12 Decode RH.

B.13 Decode SH.

B.14 Why does the chapter call this the clearest illustration in the book of what a modifier is?

Section C — J-code units (items 15–26)

Show the arithmetic for every item.

C.15 Descriptor "per 40 mg." Dose administered 40 mg. Units?

C.16 Descriptor "per 40 mg." Dose administered 120 mg. Units?

C.17 Descriptor "per 10 mg." Dose administered 100 mg. Units?

C.18 Descriptor "per 25 mg." Dose administered 75 mg. Units?

C.19 Descriptor "per 100 mg." Dose administered 75 mg. Units? What is the limitation you have just met?

C.20 A 40 mg code and an 80 mg code both exist. 80 mg was administered. What do you report, and what is the error to avoid?

C.21 A 100 mg vial is opened and 60 mg is administered. What is the units question and what is the waste question?

C.22 State the two directions of the units error and the financial consequence of each.

C.23 Which chapter's edits are specifically built to catch too-many-units?

C.24 A drug has no specific J-code. What three things must the claim supply that the code does not?

C.25 Why do unclassified drug codes price manually, and why should they be temporary?

C.26 Separately payable Part B drugs are generally paid based on what, plus what? How often does that figure change?

Section D — Waste (items 27–34)

D.27 What does JW assert? What does JZ assert?

D.28 Why does JZ exist? What was ambiguous before it?

D.29 Do JW and JZ apply to multi-dose vials? Explain.

D.30 A 40 mg single-dose vial is used to administer 30 mg. What lines go on the claim, and what arithmetic check applies?

D.31 A 100 mg single-dose vial, 75 mg administered, descriptor "per 25 mg." Give both lines and the check.

D.32 Same facts, but a multi-dose vial. Now what?

D.33 Where must the waste be documented, and why is the claim not sufficient?

D.34 "We always bill the rest of the vial." Explain what is wrong with this in one sentence, using the chapter's language.

Section E — DMEPOS (items 35–42)

E.35 State the four-part test for durable medical equipment. Name what each clause excludes.

E.36 What must generally be in the supplier's possession before a DMEPOS claim is submitted?

E.37 An audit finds a valid written order and repays the claim anyway. What was missing?

E.38 State the general lesson of E.37 in one sentence.

E.39 Distinguish NU, UE, and RR.

E.40 What is a capped rental arrangement, and what must be tracked over its months?

E.41 What must be documented over time for a rented item, and why is "an item rented for a year is a claim made twelve times" the useful framing?

E.42 What does competitive bidding limit, and how does it relate to §20.10's theme?

Section F — G, Q, S, T (items 43–48)

F.43 Name the three reasons a G-code gets created. Give an example of each from this book.

F.44 Why does G2212 exist when 99417 already did?

F.45 G0105 and G0121 describe an identical procedure. What differs?

F.46 Which letter family is most likely to be terminated out from under a charge master? Why?

F.47 Which two families does Medicare not recognize?

F.48 Chapter 17 §17.8's casting materials are which family?

Section G — NDC (items 49–54)

G.49 What does an NDC identify? What does a J-code identify? Why is that distinction the source of the problem?

G.50 Are the NDC quantity and the HCPCS units the same number? Explain.

G.51 Name the four causes of NDC rejections.

G.52 A practice changed drug suppliers last quarter and the charge master still carries the old NDC. Is this a formatting problem?

G.53 The chapter says the fix is not training. What is it?

G.54 Why does that fix work when training does not?

Section H — Payability (items 55–60)

H.55 Name four things that are generally never separately payable.

H.56 Name four things that sometimes are.

H.57 State the four distinct reasons a valid code does not pay.

H.58 Which of the four is the only one where the medical record can change the answer?

H.59 A payer says you are billing them for a surgical tray. Write your response, and say what you would not do.

H.60 When both CPT and HCPCS have a code, what question do you ask first? Name the three ways organizations handle it and say which works.

Section I — The Encounter (items 61–64)

I.61 Account 10-4471's line 3 is J1030 with one unit. Show the arithmetic and name the sentence in Figure 4.2 that makes it possible.

I.62 Should the line carry JW or JZ? Explain, and say what the claim currently carries.

I.63 (Chapter 17) The note documents 3 mL of 1% lidocaine. J-codes describe drugs. Why is it not on the claim? State the general principle.

I.64 J1030's allowed amount is \$6.28 against an \$18.00 charge. Name what determines each number, and say which chapter owns the second.