COC Coding, Billing & Reimbursement

Question 1

Which coding system is primarily used when billing orthotic and prosthetic devices to Medicare?

Accepted Answer

HCPCS Level II L-codes

Answer

CPT codes

Answer

ICD-10-CM codes

Answer

DRG codes

Question 2

What does the acronym PDAC stand for in the context of O&P billing?

Accepted Answer

Pricing, Data Analysis and Coding

Answer

Prosthetic Device Approval Commission

Answer

Primary Documentation and Claims

Answer

Prosthetic and Device Authorization Center

Question 3

Which document must a Medicare beneficiary sign if an O&P item may not be covered by Medicare?

Accepted Answer

Advance Beneficiary Notice (ABN)

Answer

Certificate of Medical Necessity (CMN)

Answer

Prior Authorization Request

Answer

Assignment of Benefits Form

Question 4

What is the primary purpose of a Local Coverage Determination (LCD) in O&P billing?

Accepted Answer

To define Medicare coverage criteria and coding guidance for specific items within a region

Answer

To establish national payment rates for all private payers

Answer

To authorize prior approval for high-cost prosthetic devices

Answer

To determine the beneficiary's annual cost-sharing responsibility

Question 5

On the CMS-1500 claim form, where is the referring physician's NPI number typically entered?

Accepted Answer

Box 17b

Answer

Box 24j

Answer

Box 33a

Answer

Box 21

Question 6

Which Medicare functional classification (K-level) is assigned to a patient who has the potential to ambulate with variable cadence as a community ambulator?

Accepted Answer

K3

Answer

K1

Answer

K2

Answer

K4

Question 7

Which HCPCS modifier is appended to a claim to indicate that an O&P service was performed on the right side of the body?

Accepted Answer

-RT

Answer

-LT

Answer

-50

Answer

-GX