Day 4 - Reimbursement - Insertion

  1. The AWP for Testopel is ____ /pellet.

  2. ICD9 codes are designations given to the diseases that doctors treat and CPT codes are designations given to procedures they conduct in their offices.


  3. The NDC number is not required on Testopel Medicare/Medicaid claims.

  4. ICD9 codes are alphaneumeric codes given to:
    • every diagnosis, description of symptoms and cause of death

  5. Although typical medicare reimbursement for medications that fall under a medical benefit is ASP+6%, Testopel has been reimbursed at _________ across MAC's.
  6. Both J and S codes are examples of ____
    HCPCS codes

  7. For hypogonadism several different codes are frequently used including:
    257.2 other testicular hypofunction
    257.8 other testicular dysfunction
    257.9 Unspecified

  8. Following adequate anesthesia, ____ is used to make a 4mm incision.
    11 blade scalpel

  9. Once the area on the upper outer quadrant of the posterior gluteal region is appropriately marked, what should be used to anesthesize the area?
    2% lidocaine with epi
  10. To begin Testopel insertion the patient should be in what position?
    Lateral jack knife or fetal position
  11. What is a J code?
    J codes are used for injectable or implantable drugs that ordinarily can't be easily self administered.
  12. Post Testopel insertion, patients may go swimming after 24 hours
    False - 72 hours

  13. Once the trocar has been advanced, the sharp stylet is removed and the Testopel pellets are placed in the trocar well using forceps.

  14. Once the Testopel pellets are advanced with the stylet and the trocar is removed, the incision is closed with dissolvable sutures.
    False - Steri strips and Tegaderm
  15. ASP refers to:
    Average Selling Price to all purchasers in US
  16. What is the J code assigned for Testopel?
  17. What is the CPT code for Testopel?

  18. Once the initial incision is made, a _____ is introduced at a _____ angle to reach the subcutaneous tissue.
    trocar, 30 degrees
  19. What is an S code?
    S codes are temporary national codes that are used for non-medicare payers
  20. The S code for Testopel?

  21. It is possible for 2 physicians to be reimbursed different amounts for a Testopel insertion under the CPT code 11980 by the same insurance company.

  22. Testopel can be treated as a medical or pharmacy benefit.
  23. CPT codes are numbers that are assigned to:
    • medical, surgical and diagnostic services provided by a medical practitioner

  24. The WAC for Testopel (the amount doctors pay before any volume discount) is ____/pellet.

  25. Examples of services/items that would be covered under a medical benefit where your physician bills the insurance company directly are:
    • in office procedures
    • supplies
    • nurse time/Dr time
    • injectable drugs administered under dr supervision
Card Set
Day 4 - Reimbursement - Insertion
Day 4 Homestudy