COC Coding, Billing & Reimbursement 1

Question 1

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

Accepted Answer

HCPCS Level II L-codes

Answer

HCPCS Level II L-codes are the alphanumeric codes specifically designated for billing orthotic and prosthetic devices to Medicare and other payers.

Question 2

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

Accepted Answer

Pricing, Data Analysis and Coding

Answer

PDAC stands for Pricing, Data Analysis and Coding, the Medicare contractor that verifies appropriate HCPCS code assignments for DME and O&P items.

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

An Advance Beneficiary Notice (ABN) must be signed by the Medicare beneficiary before service when the provider believes Medicare may deny coverage, giving the patient the option to receive the item and pay out of pocket.

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

An LCD defines Medicare coverage criteria, coding guidance, and documentation requirements for specific items or services within a Medicare Administrative Contractor's jurisdiction.

Question 5

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

Accepted Answer

Box 17b

Answer

The referring physician's NPI number is entered in Box 17b of the CMS-1500 claim form, adjacent to Box 17 which contains the referring provider's name.

COC - Certified Orthotic and Prosthetic Practitioner Practice Test

COC - Certified Orthotic and Prosthetic Practitioner Practice Test

COC Coding, Billing & Reimbursement 1