Chapter 20 — Quiz

26 questions. Answers and explanations are in the instructor guide.

1. HCPCS Level II is maintained by:

  • A. The American Medical Association
  • B. CMS
  • C. The National Center for Health Statistics
  • D. A consortium of commercial payers

2. Compared with CPT, HCPCS Level II is:

  • A. Also copyrighted and sold
  • B. Published free
  • C. Available only to enrolled providers
  • D. Available only by subscription

3. HCPCS Level II updates:

  • A. Annually on January 1
  • B. Quarterly
  • C. Whenever CPT updates
  • D. Continuously

4. Injectable drugs are found in which letter family?

  • A. A
  • B. E
  • C. J
  • D. Q

5. Which two families does Medicare NOT recognize?

  • A. G and Q
  • B. S and T
  • C. E and L
  • D. A and B

6. In an ambulance modifier, the first character identifies:

  • A. The level of service
  • B. The origin
  • C. The destination
  • D. The payer

7. A code's descriptor reads "per 10 mg" and 100 mg was administered. Units:

  • A. 1
  • B. 10
  • C. 100
  • D. Depends on the vial size

8. A 40 mg code and an 80 mg code both exist. 80 mg is administered. You should report:

  • A. The 40 mg code, two units
  • B. The 80 mg code, one unit
  • C. Either; they are equivalent
  • D. The 40 mg code, one unit

9. A descriptor reads "per 100 mg" and 75 mg was administered. Units:

  • A. 0.75
  • B. 1
  • C. 0
  • D. 75

10. Reporting one unit of a 40 mg code for a 200 mg dose produces:

  • A. A denial
  • B. A five-fold underpayment that pays and is invisible
  • C. A medically unlikely edit
  • D. A rejection at the clearinghouse

11. An unclassified drug code requires the claim to supply:

  • A. Nothing additional; the code is sufficient
  • B. The drug name, dose, and route in the narrative, and generally the NDC
  • C. Only the NDC
  • D. A copy of the medication order

12. Separately payable Part B drugs are generally paid based on:

  • A. The practice's acquisition cost
  • B. Average sales price plus a percentage add-on
  • C. The chargemaster amount
  • D. A fixed national rate set annually

13. Modifier JW reports:

  • A. A drug administered by a nurse
  • B. Drug amount discarded and not administered to any patient
  • C. A waived laboratory test
  • D. A drug given in a facility

14. Modifier JZ reports:

  • A. Zero drug amount discarded
  • B. A drug given by injection
  • C. A drug requiring prior authorization
  • D. A multi-dose vial

15. JZ exists because:

  • A. Payers wanted more modifiers
  • B. A claim with no JW line was ambiguous between "nothing wasted" and "waste not reported"
  • C. JW was retired
  • D. It replaced a CPT modifier

16. JW and JZ apply to:

  • A. All vials
  • B. Multi-dose vials only
  • C. Single-dose containers
  • D. Oral medications

17. A 40 mg single-dose vial is used to administer 30 mg. The claim's drug line and JW line units must:

  • A. Be equal
  • B. Add up to the container
  • C. Be reported on separate claims
  • D. Both be one unit

18. In DMEPOS billing, a valid written order in the supplier's file:

  • A. Establishes medical necessity
  • B. Is evidence that an order was written; the medical record must independently support the need
  • C. Replaces the need for a medical record
  • D. Is optional if the item was delivered

19. Modifier RR identifies equipment that is:

  • A. New and purchased
  • B. Used and purchased
  • C. Rented
  • D. Repaired

20. Under a capped rental arrangement:

  • A. Rental continues indefinitely
  • B. The item is rented for a defined number of months, after which ownership generally transfers or the arrangement converts
  • C. Only new equipment may be rented
  • D. The beneficiary pays the full cost

21. G2212 exists because:

  • A. CPT had no prolonged services code
  • B. CMS adopted a different threshold than CPT's and needed a code to carry it
  • C. 99417 was deleted
  • D. Commercial payers requested it

22. G0105 and G0121 differ by:

  • A. The instrument used
  • B. The physician's specialty
  • C. The beneficiary's risk status, which determines the coverage rule
  • D. The facility type

23. An NDC identifies:

  • A. A dosage of a drug
  • B. A labeler, product, and package size
  • C. A therapeutic class
  • D. The administering provider

24. The NDC quantity and the HCPCS units on the same line:

  • A. Must always match
  • B. Are frequently different numbers in different units of measure, and that is correct
  • C. Are both optional
  • D. Must both be one

25. A4550, the surgical tray code, is:

  • A. Invalid
  • B. Valid but generally not separately payable, because the tray is a usual supply
  • C. Payable only in facilities
  • D. Payable with modifier 59

26. Which of the four reasons a valid code does not pay is the ONLY one where the medical record can change the answer?

  • A. Bundled into another service
  • B. Not a benefit at all
  • C. Not recognized by that payer
  • D. Not medically necessary as documented