AAPC - American Academy of Professional Coders HCPCS Level II and Compliance Questions and Answers

Question 1

A physician's office administers a 75 mg injection of a specific drug.
The HCPCS Level II code for this drug is defined in the manual as "Injection, DrugX, 25 mg".
How should this service be reported to ensure compliance and accurate billing?

Accepted Answer

Report the J-code with three units of service in the units field of the claim.

Answer

Report the J-code with modifier -52 (Reduced Services).

Answer

Report the J-code on three separate lines of the claim, each with one unit.

Answer

Report the J-code with one unit of service and triple the charge for the drug.

Question 2

What is the primary purpose of the HCPCS Level II code set?

Accepted Answer

To identify products, supplies, and services not included in the CPT code set, such as ambulance services and DME.

Answer

To classify diseases and health problems for statistical purposes.

Answer

To provide a standardized coding system for physician and other healthcare professional services.

Answer

To report inpatient hospital procedures for Diagnosis-Related Group (DRG) assignment.

Question 3

An Advance Beneficiary Notice of Noncoverage (ABN) must be obtained from a Medicare beneficiary in which of the following situations?

Accepted Answer

When a provider believes a typically covered service may not be considered medically necessary by Medicare for a specific patient.

Answer

After a service has been provided and a denial has been received from Medicare.

Answer

Before providing a service that is statutorily excluded from Medicare, such as cosmetic surgery.

Answer

For all services provided to Medicare beneficiaries to ensure payment.

Question 4

A durable medical equipment (DME) supplier provides a Medicare patient with a new standard manual wheelchair for home use. Which HCPCS Level II modifier is required to indicate the status of the equipment?

Accepted Answer

NU - New equipment

Answer

RR - Rental

Answer

UE - Used equipment

Answer

LT - Left side

Question 5

Which of the following statements is TRUE regarding the use of J-codes in HCPCS Level II?

Accepted Answer

J-codes represent drugs that are typically administered by a healthcare professional and cannot be self-administered.

Answer

J-codes are used exclusively to report services in a hospital inpatient setting.

Answer

All J-codes represent a single, standard dosage of 1 mL per unit.

Answer

J-codes are temporary codes used only for experimental drugs.

Question 6

A podiatrist performs routine foot care for a patient with diabetes and peripheral vascular disease. These systemic conditions make the otherwise non-covered service medically necessary. Which category of HCPCS Level II modifiers is used to communicate this medical necessity to Medicare?

Accepted Answer

Q modifiers (-Q7, -Q8, -Q9)

Answer

Laterality modifiers (-RT, -LT)

Answer

Anesthesia physical status modifiers (-P1, -P2, -P3)

Answer

Service-related modifiers (-GY, -GZ)