CPC - ICD-10-CM and HCPCS Level II Coding (14% of the exam) - Section 4.2

Assign HCPCS Level II codes for supplies, drugs, durable medical equipment, and services not represented in CPT, including the correct units and modifiers.

Select HCPCS Level II (alphanumeric) codes for items CPT does not describe - injectable and infused drugs reported by units of the J-code dosage, durable medical equipment, prosthetics, orthotics, and supplies - and append the relevant HCPCS modifiers. Recognise when a HCPCS code replaces a CPT code for a specific payer and how to calculate drug units from the documented dose against the code descriptor.

HCPCS Level IIJ-code drug unitsDurable medical equipmentHCPCS modifiers

Practice question for this objective

Free sampleICD-10-CM and HCPCS Level II Codingmedium

HCPCS is a two-level coding system. Level I is the CPT code set maintained by the American Medical Association. Which category of items and services does HCPCS Level II report that Level I CPT does not?

AEvaluation and management office visits selected by history, examination, and medical decision making complexity.
BSupplies, injectable drugs, durable medical equipment, and certain services not represented by a CPT code. Correct
CSurgical procedures of the integumentary and musculoskeletal systems performed in a theatre setting.
DAnaesthesia services reported with base units plus time units for the surgical procedure supported.

HCPCS Level II reports supplies, non-oral drugs, DME, and services that Level I CPT does not describe. Level I CPT describes physician procedures and services, so a second level was needed to code the tangible products and non-physician services, such as DME and injectable drugs, that CPT leaves out.

Why A is wrong: Tempting because these are everyday billable services, but E/M visits are defined and reported with Level I CPT codes, not with HCPCS Level II.

Why B is correct: Correct: HCPCS Level II was created precisely to report products and services, such as supplies, non-oral drugs, and DME, that Level I CPT does not describe.

Why C is wrong: Tempting because coders assign these constantly, but operative procedures live in the CPT Surgery section, which is Level I, not Level II.

Why D is wrong: Tempting because anaesthesia uses a unit-based method, but anaesthesia codes are Level I CPT, and their base plus time units are unrelated to HCPCS Level II.

See more CPC practice questions, answers explained.

Exam traps in ICD-10-CM and HCPCS Level II Coding

Answers that look right on this material and are not. Each one is a distractor from a different question in the CPC bank for this domain.

One unit of J1885, treating the single injection as one billable service regardless of the milligrams given.
Why it is wrong: Tempting because only one injection was performed, but J-code units follow the milligram amount in the descriptor, not the number of injections, so one unit understates the dose.
The CPT Category I code, because CPT takes precedence over HCPCS Level II for physician services
Why it is wrong: This reflects the common assumption that CPT outranks HCPCS, but Medicare instructs coders to use the more specific national code when one exists rather than defaulting to CPT.
40 units, entering the number of milligrams administered directly into the units field.
Why it is wrong: Tempting because 40 is the dose given, but the units field counts multiples of the descriptor amount, not raw milligrams, so this overstates the drug fourfold.

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