CPT Documentation & Record Keeping 3

Question 1

A prior authorization for a prosthetic device expires before delivery is completed. What is the correct action?

Accepted Answer

Request a new or extended authorization before delivery

Answer

Delivering and billing for a device after prior authorization has expired can result in claim denial and fraud allegations; a new authorization must be obtained.

Question 2

Which HCPCS code category is used for most lower-limb prosthetic devices billed to Medicare?

Accepted Answer

L codes

Answer

L codes (L5000–L5999) are the HCPCS Level II codes designated for lower-limb prosthetic devices.

Question 3

What is the purpose of a functional outcomes assessment tool like the PLUS-M in prosthetic documentation?

Accepted Answer

To objectively measure the patient's prosthetic mobility

Answer

The PLUS-M (Prosthetic Limb Users Survey of Mobility) quantifies a patient's functional mobility, supporting clinical justification in the medical record.

Question 4

When a prosthetic component is replaced under warranty, which documentation is still required?

Accepted Answer

A new prescription and updated medical necessity documentation

Answer

Even warranty replacements require updated documentation including a new or reaffirmed prescription and evidence of continued medical necessity.

Question 5

In prosthetic records, 'episode of care' documentation typically ends when:

Accepted Answer

The patient achieves functional goals or is discharged

Answer

An episode of care is closed when the patient achieves stated functional goals or is formally discharged from prosthetic care.

(CPT) Certified Prosthetic Technician Practice Test

(CPT) Certified Prosthetic Technician Practice Test

CPT Documentation & Record Keeping 3