HCPCS Level II Coding Flashcards

When a drug has both a CPT and a HCPCS Level II code, which should be used for outpatient hospital coding?

Answer: HCPCS Level II code, as it is more specific for the drug

HCPCS Level II drug codes (J-codes) provide more specific information about the drug dose and route and are preferred for outpatient drug billing.

Which HCPCS Level II code letter represents orthotics?

Answer: L

HCPCS Level II 'L' codes cover orthotic and prosthetic procedures and services.

A patient receives 250 mg of a drug, but the HCPCS code describes 50 mg per unit. How many units are reported?

Answer: 5

When the drug amount exceeds the per-unit dose in the code descriptor, divide the total dose by the unit dose — 250 ÷ 50 = 5 units.

HCPCS Level II modifiers are used to:

Answer: Provide additional information about a service or supply

HCPCS Level II modifiers supply additional details about services, equipment, or supplies, similar to CPT modifiers but specific to Level II codes.

Which HCPCS Level II code letter covers vision services?

Answer: V

HCPCS Level II 'V' codes cover vision services, including hearing and speech-language pathology.

What is the purpose of 'S' codes in HCPCS Level II?

Answer: Temporary codes used by non-Medicare payers for services not in CPT

'S' codes are temporary HCPCS Level II codes used by Medicaid and private payers for services not classifiable with CPT or other HCPCS codes.