AAPC Certified Professional Coder (CPC) Exam — Questions and Answers

Question 1: A patient with End-Stage Renal Disease (ESRD) on dialysis is diagnosed with anemia due to their kidney disease. According to ICD-10-CM Official Guidelines, how should this be coded and sequenced?

N18.6, D63.1 (Correct answer)
N18.6, Z99.2
D64.9, N18.9
D63.1, N18.6

Correct answer: N18.6, D63.1

ICD-10-CM guidelines for anemia associated with chronic kidney disease (CKD) instruct the coder to sequence the code for the underlying CKD first, followed by the code for the anemia. Under code D63.1 (Anemia in chronic kidney disease), there is a "Code first" instructional note for the underlying chronic kidney disease (N18.-). Therefore, N18.6 (End stage renal disease) is sequenced first, followed by D63.1.

Question 2: Which of the following procedures is defined as the full-thickness removal of a lesion, including margins, where the code selection is based on the lesion's diameter plus the narrowest margins?

Tangential biopsy
Destruction
Shave removal
Excision (Correct answer)

Correct answer: Excision

CPT defines an excision as the full-thickness removal of a lesion, including margins. The code selection for excisions (11400-11646) is determined by the excised diameter, which is the lesion's greatest diameter plus twice the narrowest margin required for complete removal.

Question 3: When selecting the correct CPT code for craniotomy with clipping of a cerebral aneurysm, the primary determinant is:

Patient's ASA physical status
Duration of the procedure
The specific artery where the aneurysm is located (Correct answer)
Whether intraoperative neuromonitoring was used

Correct answer: The specific artery where the aneurysm is located

CPT aneurysm clipping codes are differentiated by the involved artery (e.g., carotid, vertebral, anterior communicating artery), making anatomic location the key driver.

Question 4: What is the primary purpose of the HCPCS Level II code set?

To classify diseases and health problems for statistical purposes.
To identify products, supplies, and services not included in the CPT code set, such as ambulance services and DME. (Correct answer)
To provide a standardized coding system for physician and other healthcare professional services.
To report inpatient hospital procedures for Diagnosis-Related Group (DRG) assignment.

Correct answer: To identify products, supplies, and services not included in the CPT code set, such as ambulance services and DME.

The Healthcare Common Procedure Coding System (HCPCS) is divided into two levels. Level I is the CPT code set. Level II is used to report products, supplies, and services that are not found in CPT. This includes durable medical equipment (DME), prosthetics, orthotics, supplies (DMEPOS), ambulance services, and specific drugs.

Question 5: A physician in a freestanding imaging center must provide which level of supervision for a CT scan of the lumbar spine with contrast?

Direct supervision (Correct answer)
No supervision required
General supervision
Personal supervision

Correct answer: Direct supervision

According to CMS guidelines, certain complex diagnostic tests, especially those involving contrast material, require 'direct supervision'. Direct supervision means the physician must be present in the office suite and immediately available to provide assistance, though they do not need to be in the room where the procedure is performed.

Question 6: What CPT code describes a diagnostic colonoscopy with biopsy?

45384
45380 (Correct answer)
45378
45385

Correct answer: 45380

CPT 45380 describes a colonoscopy with biopsy of a single or multiple lesions.

Question 7: A patient with a previously implanted dual-chamber pacemaker presents for a pulse generator change due to battery depletion. The physician makes an incision over the old pocket, removes the existing pulse generator, tests the integrity of the existing leads, connects the leads to a new dual-chamber pulse generator, and closes the pocket. How is the removal and replacement of the pulse generator coded?

33208
33228 (Correct answer)
33235 and 33208
33233 and 33213

Correct answer: 33228

CPT® code 33228 is specifically for the removal of a permanent pacemaker pulse generator with replacement of the pulse generator; dual lead system. This single code captures both the removal of the old generator and the insertion of the new one. Reporting separate codes for removal (33233) and insertion (33213) would be incorrect, as a combination code exists. Code 33208 is for a complete new system including leads.

Question 8: What preoperative period is included in the global surgical package for a major surgery?

All visits in the 90 days before surgery
No preoperative visits are included
The one day immediately before the surgery date (Correct answer)
Visits in the 30 days before surgery

Correct answer: The one day immediately before the surgery date

For major surgical procedures, the global package includes the one day immediately before the surgery date as the preoperative period.

Question 9: An anesthesiologist is medically directing one CRNA for an anesthesia case. Which HCPCS Level II modifier should be appended to the anesthesiologist's claim?

QX
QK
QZ
QY (Correct answer)

Correct answer: QY

Modifier QY is used to indicate the medical direction of one certified registered nurse anesthetist (CRNA) by an anesthesiologist. Modifier QX is used by the CRNA to report the service with medical direction. QZ is used by the CRNA when no medical direction is provided. QK is for medical direction of two, three, or four concurrent anesthesia procedures.

Question 10: In the ICD-10-CM Tabular List, what does an "Excludes1" note signify?

The condition is an associated sign or symptom and should only be coded if it is the primary reason for the encounter.
The condition is a manifestation of an underlying disease, and an additional code is required for the etiology.
The excluded condition is not part of the condition represented by the code, but the patient may have both conditions at the same time.
The excluded code should never be used at the same time as the code above the Excludes1 note, as the two conditions are mutually exclusive. (Correct answer)

Correct answer: The excluded code should never be used at the same time as the code above the Excludes1 note, as the two conditions are mutually exclusive.

An Excludes1 note means "NOT CODED HERE!" and is used when two conditions cannot occur together. The code mentioned in the Excludes1 note should not be reported with the code under which the note appears, with a rare exception for when the two conditions are completely unrelated.

Question 11: Destruction by neurolytic agent of a peripheral nerve branch not described by a more specific CPT code (such as the greater occipital nerve) is reported with:

64605
64640 (Correct answer)
64400
64633

Correct answer: 64640

CPT 64640 describes destruction by neurolytic agent of any other peripheral nerve or branch not covered by a more specific code.

Question 12: Insertion of a spinal neurostimulator pulse generator (implantable pulse generator) is reported with which CPT code?

63685 (Correct answer)
63655
63650
64590

Correct answer: 63685

CPT 63685 describes insertion or replacement of a spinal neurostimulator pulse generator or receiver.

Question 13: A patient undergoes an open repair of a rotator cuff tear on the right shoulder and a diagnostic arthroscopy on the left knee during the same surgical session. Which modifier combination is most appropriate for the diagnostic knee arthroscopy?

-50
-RT
-51
-59, -LT (Correct answer)

Correct answer: -59, -LT

Modifier -59 is used to indicate that a procedure is distinct or independent from other non-E/M services performed on the same day. In this scenario, the knee arthroscopy is performed on a different anatomical site (left knee) than the primary procedure (right shoulder), making it a distinct service. Modifier -LT is necessary to specify that the procedure was performed on the left side of the body. While modifier -51 indicates multiple procedures, modifier -59 provides greater specificity that the procedures are separate and not bundled. Modifier -50 is for bilateral procedures, and -RT is for the right side.

Question 14: Which service is NOT included in the central nervous system assessment?

Discussion of suicidal intentions
Review of an advance care plan
Clinical dementia rating
Prescription for an opioid (Correct answer)

Correct answer: Prescription for an opioid

Explanation: A central nervous system assessment is comprised of multiple screenings that are reported with CPT codes 96105-96146 and includes, but is not limited to, the following elements: use of standardized instruments for staging and rating clinical dementia; evaluation for behavioral symptoms using standardized screening instruments; and development, updating, revision, and/or review of an Advance Care Plan. A review of high-risk medications is also included in the central nervous system assessment; however, if in the same encounter, a prescription is issued, the clinician should document and report the treatment with an appropriate E/M.

Question 15: Which of the following statements is TRUE regarding the use of J-codes in HCPCS Level II?

J-codes represent drugs that are typically administered by a healthcare professional and cannot be self-administered. (Correct answer)
J-codes are used exclusively to report services in a hospital inpatient setting.
J-codes are temporary codes used only for experimental drugs.
All J-codes represent a single, standard dosage of 1 mL per unit.

Correct answer: J-codes represent drugs that are typically administered by a healthcare professional and cannot be self-administered.

J-codes are a subset of HCPCS Level II codes used to identify specific drugs and biologicals that are administered by routes other than oral, such as injections and infusions, which are typically performed by a healthcare professional in an outpatient setting. The billing unit for J-codes varies widely by drug (e.g., per mg, per 10 mg, etc.) and is specified in the code's description.

Question 16: Which of the following best describes the primary purpose of External Cause of Morbidity codes (V00-Y99) in ICD-10-CM?

To indicate that an injury is the direct result of a catastrophic event or terrorism.
To serve as the principal (first-listed) diagnosis for an encounter.
To provide supplemental information about the cause, intent, and place of an injury or health condition. (Correct answer)
To report the nature of the patient's injury or illness.

Correct answer: To provide supplemental information about the cause, intent, and place of an injury or health condition.

External Cause codes are intended to be used as secondary codes to provide additional information. They describe how an injury or health condition occurred (cause), whether it was intentional or accidental (intent), where it happened (place), and what the patient was doing (activity). They should never be sequenced as the principal diagnosis.

Question 17: A complex repair is performed on a 3.5 cm wound on the cheek. According to CPT guidelines, which of the following would NOT be a required component to justify coding a complex repair?

Debridement of wound edges
Involvement of the vermilion border
Extensive undermining
Layered closure (Correct answer)

Correct answer: Layered closure

While an intermediate repair requires a layered closure, a complex repair is defined as requiring more than a layered closure. It includes the requirements for an intermediate repair plus at least one of the following: extensive undermining, debridement of wound edges, involvement of specific anatomical structures like the vermilion border, or placement of retention sutures. Therefore, a layered closure alone is characteristic of an intermediate repair, not a mandatory component that distinguishes a complex repair.

Question 18: Neuroplasty and transposition of the ulnar nerve at the elbow is reported with:

64719
64716
64718 (Correct answer)
64721

Correct answer: 64718

CPT 64718 specifically describes neuroplasty and/or transposition of the ulnar nerve at the elbow.

Question 19: A surgeon performs a debridement of a 30 sq cm wound on a patient's leg. The debridement extends down to and includes the muscle tissue. What are the correct CPT codes for this service?

11043
11044, 11047
11043, 11046 (Correct answer)
11042, 11045

Correct answer: 11043, 11046

CPT code 11043 describes the debridement of muscle and/or fascia for the first 20 sq cm or less. Since the wound is 30 sq cm, the add-on code +11046 is used for each additional 20 sq cm or part thereof. Therefore, 11043 is reported for the first 20 sq cm, and 11046 is reported for the remaining 10 sq cm.

Question 20: A 28-year-old patient, who is pregnant for the first time, presents for a routine prenatal visit at 22 weeks gestation. The examination is normal and there are no complaints or complications. How should this encounter be coded?

O09.892, Supervision of other high-risk pregnancies, second trimester
Z34.00, Encounter for supervision of normal first pregnancy, unspecified trimester
Z01.419, Encounter for routine gynecological examination
Z34.02, Encounter for supervision of normal first pregnancy, second trimester (Correct answer)

Correct answer: Z34.02, Encounter for supervision of normal first pregnancy, second trimester

For routine outpatient prenatal visits for a normal pregnancy without any complications, a code from category Z34 is used. The 5th character '0' indicates a first pregnancy, and the 6th character '2' specifies the second trimester. Since the patient is at 22 weeks and has a normal exam, Z34.02 is the most accurate code.

Question 21: A patient presents for a routine annual exam. The patient had breast cancer treated with a mastectomy five years ago and there is no evidence of recurrence and no ongoing treatment for the cancer. Which code category best represents the patient's resolved cancer status?

Z85.- (Personal history of malignant neoplasm) (Correct answer)
Z08 (Encounter for follow-up examination after completed treatment for malignant neoplasm)
D05.- (Carcinoma in situ of breast)
C50.- (Malignant neoplasm of breast)

Correct answer: Z85.- (Personal history of malignant neoplasm)

When a primary malignancy has been excised or eradicated and the patient is no longer receiving active treatment for it, a code from category Z85, Personal history of malignant neoplasm, is used to indicate the former site of the cancer. Using a code for active cancer (C50.-) would be incorrect as the condition is resolved.

Question 22: A surgeon performs a total ethmoidectomy (31255) on the right side. During the same operative session, the surgeon also performs a maxillary antrostomy (31256) on both the right and left sides. How should these procedures be reported?

31255-RT, 31256-50 (Correct answer)
31255-RT, 31256-LT
31255-50, 31256-50
31255-RT, 31256-RT, 31256-LT

Correct answer: 31255-RT, 31256-50

The total ethmoidectomy (31255) was performed only on the right side and should be reported with modifier -RT. The maxillary antrostomy (31256) was performed on both sides, so it should be reported once with the bilateral modifier -50. It is incorrect to apply modifier -50 to 31255 as it was a unilateral procedure.

Question 23: When a colonoscopy is discontinued after the administration of anesthesia due to a patient complication, which modifier applies to the colonoscopy code?

-52
-73
-53
-74 (Correct answer)

Correct answer: -74

Modifier -74 is used when a procedure is discontinued by the physician after anesthesia administration due to extenuating circumstances.

Question 24: Which of the following services is bundled into the primary CPT codes for cardiac ablation (e.g., 93653, 93656) and should NOT be reported separately when performed during the same session?

3D mapping
Ablation of a second, distinct arrhythmia
Intracardiac echocardiography (ICE)
A comprehensive electrophysiology (EP) study (Correct answer)

Correct answer: A comprehensive electrophysiology (EP) study

According to CPT guidelines, comprehensive electrophysiology (EP) studies (e.g., 93619, 93620) are considered an integral part of the primary cardiac ablation procedures (93653, 93654, 93656) and are not separately reportable. Services like 3D mapping or ablation of a distinct, separate arrhythmia may be reported with add-on codes under specific circumstances.

Question 25: Transforaminal epidural injection of a steroid at the cervical level (single level) with imaging guidance is reported with:

64479 (Correct answer)
64400
64490
62321

Correct answer: 64479

CPT 64479 describes injection of an anesthetic or steroid via transforaminal approach at the cervical or thoracic level, single level, with imaging guidance.

Question 26: Anesthesia time begins when the anesthesiologist starts preparing the patient for anesthesia and ends when:

The patient is transferred to the recovery room.
The patient is fully awake and alert in the PACU.
The anesthesiologist is no longer in personal attendance and the patient is safely under post-anesthesia supervision. (Correct answer)
The surgeon completes the surgical procedure.

Correct answer: The anesthesiologist is no longer in personal attendance and the patient is safely under post-anesthesia supervision.

According to the American Society of Anesthesiologists (ASA) and general coding guidelines, anesthesia time concludes when the anesthesiologist is no longer in personal attendance because the patient has been safely placed under postoperative care, typically in the Post-Anesthesia Care Unit (PACU).

Question 27: An Advance Beneficiary Notice of Noncoverage (ABN) must be obtained from a Medicare beneficiary in which of the following situations?

Before providing a service that is statutorily excluded from Medicare, such as cosmetic surgery.
For all services provided to Medicare beneficiaries to ensure payment.
When a provider believes a typically covered service may not be considered medically necessary by Medicare for a specific patient. (Correct answer)
After a service has been provided and a denial has been received from Medicare.

Correct answer: When a provider believes a typically covered service may not be considered medically necessary by Medicare for a specific patient.

An ABN is a form used to inform a Medicare beneficiary before a service is rendered that Medicare is not expected to pay for it because it is not considered "reasonable and necessary" for the patient's condition. This allows the patient to make an informed decision and agree to be financially responsible if Medicare denies the claim. ABNs are not required for services that are never covered by Medicare (statutorily excluded), although a voluntary notice may be given as a courtesy.

Question 28: An established patient presents to the office with a sore throat and fever. The physician diagnoses acute pharyngitis. The management decision involves prescribing an antibiotic. What is the level of risk associated with this patient management decision?

Moderate
Low (Correct answer)
Minimal
High

Correct answer: Low

The AMA's MDM table defines 'prescription drug management' as an example of moderate risk. However, the overall clinical scenario must be considered. An acute, uncomplicated illness like pharyngitis treated with a common antibiotic is typically considered Low Risk of morbidity from additional diagnostic testing or treatment. Moderate risk involves more significant considerations like managing a chronic illness with prescription drugs or decisions about minor surgery.

Question 29: A patient undergoes an upper GI endoscopy (EGD) with ablation of a tumor. Which CPT code applies?

43220
43239
43270
43228 (Correct answer)

Correct answer: 43228

CPT 43228 describes an EGD with ablation of a tumor, polyp, or other lesion.

Question 30: Open carpal tunnel release (decompression of the median nerve at the wrist) is reported with which CPT code?

64722
64561
29848
64721 (Correct answer)

Correct answer: 64721

CPT 64721 describes neuroplasty and/or transposition of the median nerve at the carpal tunnel (open carpal tunnel release).

Question 31: During the examination of a gastric biopsy (coded as 88305), the pathologist finds it medically necessary to perform an additional special stain to detect the presence of Helicobacter pylori microorganisms. How should this additional service be coded?

With an add-on CPT code for a special stain for microorganisms, such as 88312. (Correct answer)
With a separate CPT code for immunohistochemistry, such as 88342.
By appending modifier 22 (Increased Procedural Services) to the 88305 code.
It is included in the primary surgical pathology code (88305) and not reported separately.

Correct answer: With an add-on CPT code for a special stain for microorganisms, such as 88312.

Special stains are not included in the base surgical pathology codes (88300-88309). CPT code 88312 is used to report a Group I special stain for microorganisms (like H. pylori) and is reported in addition to the primary code for the surgical pathology examination. Modifier 22 would be inappropriate, and immunohistochemistry (88342) is a different type of staining procedure.

Question 32: A patient with a large pleural effusion requires drainage. A physician performs a percutaneous procedure, places a small-bore catheter into the pleural space to aspirate the fluid, and leaves the catheter in place for continued drainage, connecting it to a collection system. No imaging guidance was used. What is the correct CPT® code for this procedure?

32557
32556 (Correct answer)
32551
32554

Correct answer: 32556

The key phrase is "leaves the catheter in place for continued drainage," which describes the insertion of an indwelling catheter. CPT® code 32556 is for percutaneous pleural drainage with the insertion of an indwelling catheter, without imaging guidance. Code 32554 describes a thoracentesis where the needle or catheter is removed at the end of the aspiration, and 32551 is for an open tube thoracostomy, a different procedure.

Question 33: A radiologist, who is an independent contractor, interprets a chest X-ray that was performed at a hospital. The hospital owns the equipment and its employee performed the technical portion of the service. How should the radiologist report their service?

Report the CPT code with modifier TC
Report the CPT code with modifier 26 (Correct answer)
Report the CPT code with modifier 52
Report the CPT code without a modifier

Correct answer: Report the CPT code with modifier 26

Modifier 26 is used to indicate that only the professional component of a procedure was performed. In this scenario, the radiologist only provided the interpretation and report (the professional service), while the hospital provided the equipment, supplies, and technician (the technical component). Therefore, appending modifier 26 to the appropriate CPT code is correct.

Question 34: Which modifier is appended when a colonoscopy is attempted but only reaches the splenic flexure?

-53
-74
-22
-52 (Correct answer)

Correct answer: -52

Modifier -52 indicates a reduced service when the colonoscopy does not reach the intended extent (cecum).

Question 35: A patient undergoes a pre-scheduled coronary artery bypass grafting (CABG) procedure. The surgeon uses the left internal mammary artery to bypass the left anterior descending artery and also harvests and uses a saphenous vein to bypass the right coronary artery. How should this procedure be coded?

33533 for the arterial graft and 33510 for the venous graft.
33533 for the arterial graft and +33517 for the venous graft. (Correct answer)
33517 for the combined grafts.
33535 for two coronary artery grafts.

Correct answer: 33533 for the arterial graft and +33517 for the venous graft.

CPT coding for a combined arterial-venous bypass graft requires two codes. The first code is from the arterial graft series (33533-33536) to identify the arterial graft. The second code is an add-on code from the combined arterial-venous graft series (+33517-+33523) to report the number of venous grafts. In this scenario, 33533 represents one arterial graft, and +33517 is the add-on code for one venous graft used in combination with an arterial graft.

Question 36: A patient undergoes a full-thickness excisional biopsy of a 1.2 cm lesion on the neck. The operative report states that the surgeon performed a layered closure of the 1.5 cm resulting defect. How should this be coded?

Code for the excisional biopsy only, as simple closure is included.
Code for the excisional biopsy and a simple repair.
Code for the excisional biopsy and an intermediate repair. (Correct answer)
Code for a punch biopsy and a layered closure.

Correct answer: Code for the excisional biopsy and an intermediate repair.

CPT guidelines for lesion excision (codes 11400-11646) state that simple closure is included in the excision code. However, intermediate and complex repairs can be reported separately. A layered closure is defined as an intermediate repair. Therefore, both the excision of the lesion and the intermediate repair should be coded.

Question 37: How are codes selected for inpatient facility services (IFS)?

Coders and billers
Physicians and billers
Coders and chargemasters (Correct answer)
Chargemaster and physicians

Correct answer: Coders and chargemasters

Explanation: Coders are responsible for assigning the appropriate diagnosis-related group (DRG) codes based on the patient's medical records and the services provided during their hospital stay. Chargemasters are used to determine the charges associated with each service or item provided by the hospital, including procedures, tests, and medications. Therefore, both coders and chargemasters play crucial roles in selecting the codes for inpatient facility services (IFS).

Question 38: When a surgeon performs a surgical nasal/sinus endoscopy, which of the following procedures is always considered an integral part of the service and is NOT separately reportable when performed on the same side?

Control of spontaneous epistaxis
Total ethmoidectomy
Maxillary antrostomy
Diagnostic nasal endoscopy (Correct answer)

Correct answer: Diagnostic nasal endoscopy

According to CPT® Manual instructions and NCCI edits, a diagnostic endoscopy is not separately reportable with a surgical endoscopy. The surgical procedure inherently includes the diagnostic 'look-see' portion of the service on the ipsilateral side. The other procedures listed are separate surgical procedures that are not automatically bundled.

Question 39: A healthy 45-year-old patient undergoes anesthesia for a procedure on their lower abdomen. The CPT code for the surgical procedure crosswalks to anesthesia CPT code 00840. What is the correct Physical Status Modifier to append?

P1 (Correct answer)
P2
P4
P3

Correct answer: P1

The Physical Status Modifier P1 is used to describe a normal, healthy patient. Since the scenario describes the patient as 'healthy,' P1 is the appropriate modifier. P2 is for a patient with mild systemic disease, P3 for severe systemic disease, and P4 for severe systemic disease that is a constant threat to life.

Question 40: Which of the following is reimbursed under OPPS?

Outpatient hospital services (Correct answer)
Physician services
Inpatient services
Skilled nursing services

Correct answer: Outpatient hospital services

Explanation: The Outpatient Prospective Payment System (OPPS) reimburses hospitals for outpatient services provided to Medicare beneficiaries. This includes various outpatient procedures, tests, and treatments conducted within a hospital outpatient department.

Question 41: Which CPT code describes a diagnostic lumbar puncture (spinal tap)?

62310
62270 (Correct answer)
64415
61000

Correct answer: 62270

CPT 62270 is used for a spinal puncture (lumbar puncture) performed for diagnostic purposes.

Question 42: An interventional radiologist performs a diagnostic renal angiogram. They access the arterial system via the right common femoral artery, advance the catheter into the aorta, and then selectively guide it into the left renal artery for imaging. How is the catheter placement best described?

Second-order selective catheter placement
Global catheter placement
Non-selective catheter placement
Selective catheter placement (Correct answer)

Correct answer: Selective catheter placement

Non-selective catheter placement occurs when the catheter remains in the initial vessel accessed or is placed only into the aorta. Selective catheter placement occurs when the catheter is advanced beyond the initial vessel or aorta into a branch vessel. Since the catheter was moved from the aorta into the renal artery, it is a selective placement.

Question 43: In the Medicare Physician Fee Schedule, what indicator designates procedures to which the global surgery concept does not apply?

010
XXX (Correct answer)
000
090

Correct answer: XXX

The indicator 'XXX' means the global surgery concept does not apply to that procedure code.

Question 44: Creation of a ventriculoperitoneal (VP) shunt is reported with which CPT code?

62223 (Correct answer)
62220
62230
62225

Correct answer: 62223

CPT 62223 describes creation of a shunt including ventriculoperitoneal (VP shunt), ventriculopleural, or ventriculoatrial configurations.

Question 45: CPT code 44950 describes which digestive system procedure?

Colostomy
Appendectomy (Correct answer)
Colectomy
Ileostomy

Correct answer: Appendectomy

CPT 44950 describes an open appendectomy.

Question 46: Which of the following activities can be included when calculating the total time for selecting an E/M code?

Time spent by clinical staff performing a blood draw
General teaching time not specific to the patient's encounter
Reviewing test results and preparing for the patient's visit on the same day (Correct answer)
The provider's travel time to the clinic

Correct answer: Reviewing test results and preparing for the patient's visit on the same day

Total time for E/M coding includes both face-to-face and non-face-to-face time spent by the physician or other qualified health care professional on the day of the encounter. This includes activities like preparing to see the patient (e.g., reviewing tests), obtaining history, performing the exam, counseling, ordering medications or tests, and documenting in the health record. Time spent by clinical staff is not included.

Question 47: Posterior fossa craniectomy for decompression of a Chiari malformation is reported with which CPT code?

61315
61304
61340
61343 (Correct answer)

Correct answer: 61343

CPT 61343 describes craniectomy for posterior fossa decompression, which is the procedure performed for symptomatic Chiari malformation.

Question 48: For the permanent implantation of a spinal cord stimulator system following a successful trial, which combination of CPT codes is typically reported?

63650 alone (electrode and generator are bundled)
63661 and 63685
63685 alone (generator includes electrode)
63650 (or 63655) for electrode array AND 63685 for the pulse generator (Correct answer)

Correct answer: 63650 (or 63655) for electrode array AND 63685 for the pulse generator

Permanent spinal cord stimulator implantation requires separate codes for the electrode array (63650 percutaneous or 63655 open/laminectomy) and the pulse generator (63685), as they are distinct billable components.

Question 49: A patient has a 4.5 cm laceration on the trunk and a 3.2 cm laceration on the arm. Both wounds required a layered closure after extensive cleaning due to heavy contamination with particulate matter. How would you code the repairs?

Report two separate intermediate repair codes based on their individual lengths and locations.
Report one complex repair code because of the heavy contamination.
Report one simple repair code for the total length of both lacerations.
Report one intermediate repair code, summing the lengths of both lacerations because they are in the same anatomical group and of the same complexity. (Correct answer)

Correct answer: Report one intermediate repair code, summing the lengths of both lacerations because they are in the same anatomical group and of the same complexity.

According to CPT guidelines, when multiple wounds of the same complexity are repaired and are in locations that fall under the same code descriptor, their lengths should be summed together. The trunk and arms are grouped together for intermediate repairs (12031-12037). The total length is 4.5 cm + 3.2 cm = 7.7 cm. The correct code would be for an intermediate repair of the trunk/arms/legs measuring 7.7 cm.

Question 50: For the purpose of MDM, which of the following constitutes an 'independent historian'?

A student scribe documenting the visit
The patient themselves, if they are a reliable source
The patient's prior medical record from the same practice
A parent providing a history for a young child (Correct answer)

Correct answer: A parent providing a history for a young child

An independent historian is an individual (e.g., parent, guardian, surrogate, spouse, witness) who provides a history in addition to a history provided by the patient, or when the patient is unable to provide a complete or reliable history. A young child is often unable to provide a complete history, making the parent's input qualify under this definition. The patient's own record is not an 'independent historian'.

Question 51: CPT codes for nervous system procedures are found in which numeric range?

60000–60699
70000–76499
65000–68899
61000–64999 (Correct answer)

Correct answer: 61000–64999

CPT codes 61000–64999 cover all nervous system procedures including skull, brain, spine, and peripheral nerves.

Question 52: During a cardiac catheterization procedure, a physician performs a left heart catheterization, left ventriculography, and selective coronary angiography. Which CPT® code correctly bundles all of these services?

93456 and 93454
93451, 93454
93452
93458 (Correct answer)

Correct answer: 93458

CPT® code 93458 represents a combined left heart catheterization with coronary angiography, which includes left ventriculography when performed. This single code should be used instead of reporting the individual components separately, as CPT guidelines state to use the most comprehensive code that describes all the procedures performed.

Question 53: An interlaminar epidural steroid injection at the lumbar level performed with fluoroscopic imaging guidance is reported using:

62323 (lumbar/sacral, with imaging) (Correct answer)
62321 (cervical/thoracic, with imaging)
64483 (transforaminal lumbar, with imaging)
62322 (lumbar/sacral, without imaging)

Correct answer: 62323 (lumbar/sacral, with imaging)

CPT 62323 describes an interlaminar epidural injection at the lumbar or sacral region performed with fluoroscopic or CT imaging guidance.

Question 54: A surgeon performs a posterolateral arthrodesis at a single level, L4-L5. An autograft is harvested from the iliac crest through a separate skin incision. Which CPT® codes correctly report the arthrodesis and the bone graft?

22558, 20937
22614, 20936
22612, 20937 (Correct answer)
22612 only

Correct answer: 22612, 20937

CPT® code 22612 represents posterolateral arthrodesis, single level, in the lumbar spine. CPT® code 20937 is the correct add-on code for an autograft harvested from the iliac crest through a separate skin incision for use in a spinal surgery. Code 22614 is an add-on code for each additional vertebral segment, not the primary procedure. Code 20936 is for a local autograft obtained from the same incision. Code 22558 is for an anterior approach, not posterior.

Question 55: A patient undergoes a Keller-type bunionectomy on the right foot. During the same operative session, the surgeon also performs a correction of a hammertoe on the second digit of the same foot. Which CPT® codes and modifiers should be reported?

28292-RT, 28285-T6 (Correct answer)
28292-RT only
28299-RT
28296-RT, 28285-51-T6

Correct answer: 28292-RT, 28285-T6

CPT® code 28292 describes a Keller, McBride, or Mayo type bunionectomy. CPT® code 28285 describes the correction of a hammertoe. Since these are distinct procedures performed on the same foot, both are reportable. The anatomical modifiers provide the necessary specificity: -RT for the right foot (on the bunionectomy code) and -T6 for the second digit of the right foot (on the hammertoe correction code). 28296 is a different type of bunionectomy, and 28299 is for more complex repairs such as a double osteotomy.

Question 56: A physician's office administers a 75 mg injection of a specific drug. The HCPCS Level II code for this drug is defined in the manual as "Injection, DrugX, 25 mg". How should this service be reported to ensure compliance and accurate billing?

Report the J-code with modifier -52 (Reduced Services).
Report the J-code with one unit of service and triple the charge for the drug.
Report the J-code with three units of service in the units field of the claim. (Correct answer)
Report the J-code on three separate lines of the claim, each with one unit.

Correct answer: Report the J-code with three units of service in the units field of the claim.

To bill HCPCS Level II drug codes accurately, the total dosage administered must be converted into the number of billable units defined by the code descriptor. In this case, 75 mg was administered, and the code's unit is 25 mg. Therefore, 75 mg / 25 mg = 3 units. This is reported on a single claim line with the appropriate J-code and "3" entered in the units field.

Question 57: Which of the following statements is TRUE regarding the coding of a planned tracheostomy?

A planned tracheostomy (31600) and an emergency cricothyrotomy (31605) are reported with the same code.
CPT® code 31603 is used for all planned tracheostomies.
Age is a determining factor, with a separate code for patients younger than 2 years. (Correct answer)
A planned tracheostomy is always bundled into major neck surgeries.

Correct answer: Age is a determining factor, with a separate code for patients younger than 2 years.

CPT® coding for a planned tracheostomy is age-dependent. Code 31600 is used for a planned tracheostomy, while code 31601 is specifically for the same procedure performed on a patient younger than 2 years of age. Emergency tracheostomy codes (31603, 31605) are different from planned procedure codes.

Question 58: Stereotactic brain biopsy performed using CT/MRI guidance WITHOUT a stereotactic frame is reported with:

61510
61720
61751 (Correct answer)
61750

Correct answer: 61751

CPT 61751 describes a stereotactic biopsy of the brain with CT and/or MRI guidance performed without a stereotactic frame (frameless navigation).

Question 59: Which CPT code reports a colorectal cancer screening fecal occult blood test (guaiac method)?

82274
82270 (Correct answer)
82271
82272

Correct answer: 82270

CPT 82270 describes the colorectal cancer screening fecal occult blood test using the guaiac method.

Question 60: Which CPT code describes a proctosigmoidoscopy with biopsy?

45305 (Correct answer)
45300
45315
45308

Correct answer: 45305

CPT 45305 describes a proctosigmoidoscopy with biopsy of a single or multiple lesions.

Question 61: A pulmonologist performs a flexible bronchoscopy. During the procedure, a biopsy of a lesion is taken from the right mainstem bronchus. Subsequently, a medically necessary bronchial alveolar lavage (BAL) is performed on a different lesion in the left lower lobe. How should these services be reported?

31622, 31625, 31624
31625, 31624-59 (Correct answer)
31628, 31624-59
31625, 31624

Correct answer: 31625, 31624-59

CPT® code 31625 represents the bronchoscopy with endobronchial biopsy. CPT® code 31624 is for the bronchoscopy with bronchial alveolar lavage (BAL). According to National Correct Coding Initiative (NCCI) edits, 31624 is typically bundled into 31625. However, because the BAL was performed on a separate, distinct lesion in a different lobe (left lower lobe vs. right mainstem), it is appropriate to report both services, appending modifier -59 (Distinct Procedural Service) to 31624 to indicate it was performed at a separate anatomic site.

Question 62: Which of the following scenarios allows for the separate reporting of a cast application CPT® code (e.g., 29000-29799)?

Application of a replacement cast during the 90-day global period by the same physician who performed the initial surgery.
Application of the first cast at the time of a closed fracture reduction.
Application of a short leg cast for a severe ankle sprain when it is the only procedure performed. (Correct answer)
Application of a splint for initial stabilization in the ED before definitive fracture care.

Correct answer: Application of a short leg cast for a severe ankle sprain when it is the only procedure performed.

The application of the initial cast or splint is included in the global package for fracture care and is not separately reported. Similarly, replacement casts applied by the same physician during the global period are generally not separately billable. However, when cast application is the definitive treatment for a condition that does not have a separate surgical procedure code (such as a sprain or contusion), the cast application code itself is the reportable service.

Question 63: A podiatrist performs routine foot care for a patient with diabetes and peripheral vascular disease. These systemic conditions make the otherwise non-covered service medically necessary. Which category of HCPCS Level II modifiers is used to communicate this medical necessity to Medicare?

Service-related modifiers (-GY, -GZ)
Q modifiers (-Q7, -Q8, -Q9) (Correct answer)
Laterality modifiers (-RT, -LT)
Anesthesia physical status modifiers (-P1, -P2, -P3)

Correct answer: Q modifiers (-Q7, -Q8, -Q9)

The Q modifiers (-Q7, -Q8, -Q9) are specifically used for podiatry to indicate that routine foot care, which is normally excluded from Medicare coverage, is medically necessary due to the presence of systemic conditions that put the patient at risk. These modifiers describe the specific class of findings documented during the exam.

Question 64: Which of the following services is an example of a presumptive drug test?

A qualitative immunoassay test using a dipstick or cup that is read by direct optical observation. (Correct answer)
A quantitative test using gas chromatography-mass spectrometry (GC-MS) to identify a specific drug and its concentration.
A therapeutic drug assay to monitor the level of a prescribed medication.
A molecular pathology test to identify genetic markers for drug metabolism.

Correct answer: A qualitative immunoassay test using a dipstick or cup that is read by direct optical observation.

Presumptive drug tests (CPT codes 80305-80307) are used to detect the presence or absence of a drug class and yield a qualitative result (positive or negative). CPT 80305 specifically describes tests, such as dipsticks or cups, read by direct optical observation. Definitive tests (like GC-MS) provide quantitative results, therapeutic assays monitor prescribed drugs, and molecular tests analyze genes.

Question 65: A durable medical equipment (DME) supplier provides a Medicare patient with a new standard manual wheelchair for home use. Which HCPCS Level II modifier is required to indicate the status of the equipment?

UE - Used equipment
RR - Rental
LT - Left side
NU - New equipment (Correct answer)

Correct answer: NU - New equipment

HCPCS Level II modifiers are used to provide additional information about a service or supply. For durable medical equipment, modifier -NU is appended to the HCPCS code to specify that the item provided is new equipment. Modifier -RR is used for rentals and -UE is for used equipment.

Question 66: A neurosurgeon performs a laminectomy with spinal cord decompression at a single lumbar level without disc removal. Which CPT code is most appropriate?

63030
63012
63005
63047 (Correct answer)

Correct answer: 63047

CPT 63047 describes a laminectomy with decompression of the spinal cord or cauda equina at the lumbar level without disc removal.

Question 67: A patient presents to physical therapy status post repair of a complete rotator cuff tear in the right shoulder due to a fall. After applying ice to the shoulder for 8 minutes, the physical therapist performs a soft-tissue massage to the infraspinatus muscle that lasts 23 minutes. Just prior to discharge, the therapist spends 20 minutes instructing the patient on isokinetic exercises to help improve the range of motion. Which CPT and ICD-10-CM code(s) should be used to accurately describe the encounter?

97010, 97140, 97530, S46.011A, W19.XXXA
97110, 97140 x 2, 97010, S46.011D, W19.XXXD (Correct answer)
97110, 97140, 97010, Z48.89, S46.091A, W19.XXXA
97010, 97140 × 2, 97530, M75.121

Correct answer: 97110, 97140 x 2, 97010, S46.011D, W19.XXXD

Explanation: Although CPT code 97530 does describe therapeutic activities, the focus is directed at improving functional performance, whereas the correct CPT code 97110 works to develop a range of motion. The CPT code for a soft tissue massage (or manual therapy 97140) is based on 15-minute increments, however, anything over 8 minutes prior to or after can be counted as a unit. Based on this, the 23 minutes spent can be counted as two units. Sequencing is based on the highest RVU. Coding crosswalk for a rotator cuff tear is classified as a muscle strain, so answer B, which specifies "other injury," can be eliminated. Because the patient is in the recovery period of the injury, the seventh character would not be considered active but subsequent.

Question 68: According to CPT® guidelines, when a surgical arthroscopy is performed, which of the following procedures is typically considered an integral part of the service and is NOT reported separately for the same joint?

A major synovectomy
Diagnostic arthroscopy (Correct answer)
A partial meniscectomy in a different compartment
Abrasion arthroplasty

Correct answer: Diagnostic arthroscopy

CPT® guidelines explicitly state that a diagnostic arthroscopy (e.g., 29870 for the knee) is always included in a surgical arthroscopy when performed on the same joint during the same session. If a diagnostic scope leads to a surgical scope, only the surgical scope is reported. The other answer choices are therapeutic surgical procedures that are typically reported separately, although specific bundling rules may apply depending on the primary procedure performed.

Question 69: Which of the following is a 'Qualifying Circumstance' add-on code used in anesthesia coding?

G8
P5
99140 (Correct answer)
01999

Correct answer: 99140

CPT code 99140 represents 'Anesthesia complicated by emergency conditions' and is an add-on code used to report qualifying circumstances. 01999 is the CPT code for an unlisted anesthesia procedure. P5 is a Physical Status Modifier for a moribund patient. G8 is a HCPCS modifier for MAC on a deep, complex, or invasive procedure.

Question 70: A patient undergoes a surgical procedure where multiple anesthesia codes could potentially apply. According to AAPC guidelines, how should the coder report the anesthesia service?

Report all applicable anesthesia codes.
Report the anesthesia code for the most complex procedure with the highest base unit value. (Correct answer)
Report the anesthesia code corresponding to the primary surgical CPT code only.
Report the anesthesia code for the longest procedure.

Correct answer: Report the anesthesia code for the most complex procedure with the highest base unit value.

When multiple surgical procedures are performed during a single anesthetic administration, only the anesthesia code for the most complex procedure is reported. The complexity is determined by the base unit value assigned to the anesthesia code; the code with the highest base unit value should be used. The total time for all procedures is then reported with that single anesthesia code.

Question 71: A physician performs Mohs micrographic surgery on a patient's nose for a recurrent basal cell carcinoma. The first stage involves the removal of 5 tissue blocks. The second stage involves the removal of 3 additional tissue blocks. Which CPT codes should be reported for this procedure?

17311, 17312 (Correct answer)
17311, 17312, 17315
17313, 17314
17311 x 2

Correct answer: 17311, 17312

CPT code 17311 is used for the first stage of Mohs surgery on the head, neck, hands, feet, or genitalia, including up to 5 tissue blocks. CPT code 17312 is an add-on code for each additional stage, up to 5 tissue blocks, in the same anatomic areas. Since the procedure was on the nose (head) and involved two stages within the block limits, 17311 and 17312 are the correct codes.

Question 72: A physician orders a Comprehensive Metabolic Panel (CPT 80053). Due to a clotted specimen, the laboratory is unable to perform the total protein test, but all other 13 components of the panel are completed successfully. How should the laboratory bill for this service?

Bill for the individual CPT codes for the 13 tests that were performed. (Correct answer)
Bill for the Basic Metabolic Panel (80048) and the additional individual tests performed.
Bill for the Comprehensive Metabolic Panel (80053) with modifier 52 for reduced services.
Do not bill for any services, as the ordered panel was incomplete.

Correct answer: Bill for the individual CPT codes for the 13 tests that were performed.

According to CPT guidelines for Organ or Disease-Oriented Panels, if any component of a panel is not performed, the coder must not use the panel code. Instead, each individual test that was successfully completed should be reported with its own CPT code. Modifier 52 is not appropriate for incomplete lab panels, and billing a different panel plus add-on tests is incorrect if that combination does not accurately represent the services ordered and rendered.

Question 73: Code the following adverse effect: Initial encounter of drug-induced tremors that was caused by Cyclosporin the patient takes for anemia. The anemia is caused by a current diagnosis of colon cancer.

C18.9, D63.0, G25.1, T45.1X5A
G25.1, T45.1X5A, C18.9, D63.0 (Correct answer)
D63.0, C18.9, T45.1X5A, G25.1
T45.1X5A, G25.1, C18.9, D63.0

Correct answer: G25.1, T45.1X5A, C18.9, D63.0

Explanation: As this situation describes an adverse effect of a drug that has been correctly prescribed and properly administered, and because the anemia is caused by a malignancy, ICD-10-CM guidelines (Chapter 19) state that the adverse reaction diagnosis codes (G25.1, T45.1X5A) should be sequenced first, then the principal diagnosis of malignancy (C18.9), and then this is followed by the appropriate code for the anemia (D63.0).

Question 74: A patient undergoes a percutaneous coronary intervention (PCI). The cardiologist performs a successful balloon angioplasty in the left anterior descending (LAD) artery and then places a drug-eluting stent in the right coronary artery (RCA) during the same session. Which of the following is the correct coding?

92920-LD, 92921-RC
92933-RC, 92920-LD
92928-RC, 92920-LD (Correct answer)
92928-RC, +92929-LD

Correct answer: 92928-RC, 92920-LD

When different types of PCI are performed on separate major coronary arteries, each intervention is reported with a base code. Code 92928 is for stent placement in a single major coronary artery, and 92920 is for balloon angioplasty in a single major coronary artery. The appropriate coronary artery modifiers (-RC for right coronary, -LD for left anterior descending) are appended to specify the location of each intervention. Add-on codes are used for interventions in branches of the *same* major artery, which is not the case here.

Question 75: A patient presents for a follow-up visit for a displaced fracture of the right radial styloid process. The fracture is healing as expected, and the patient is receiving routine care for the healing fracture, such as a cast check. The initial encounter occurred two weeks ago. How should this encounter be coded?

S52.511G, Displaced fracture of right radial styloid process, subsequent encounter for fracture with delayed healing
S52.511S, Displaced fracture of right radial styloid process, sequela
S52.511A, Displaced fracture of right radial styloid process, initial encounter
S52.511D, Displaced fracture of right radial styloid process, subsequent encounter for fracture with routine healing (Correct answer)

Correct answer: S52.511D, Displaced fracture of right radial styloid process, subsequent encounter for fracture with routine healing

The ICD-10-CM guidelines for injury coding require a 7th character to indicate the episode of care. The character 'D' is used for a subsequent encounter when the patient has completed active treatment and is in the routine healing or recovery phase. Since the patient is in a follow-up visit for a healing fracture, 'D' is the correct 7th character.

Question 76: A physician performs an office consultation for a new patient and spends a total of 75 minutes on the date of the encounter. The time for a level 5 new patient office visit (99205) is 60 minutes. Which CPT® code(s) should be reported for this service?

99205 only
99205, 99417 (Correct answer)
99204, 99417
99205, 99354

Correct answer: 99205, 99417

CPT® code 99205 is appropriate for the base service as the time (75 minutes) exceeds the 60-minute threshold. CPT® add-on code +99417 is used to report prolonged office or other outpatient E/M services. It is used for each additional 15 minutes of total time spent on the date of the encounter beyond the minimum time required for the highest-level service (99205). Since the physician spent 15 minutes beyond the 60-minute threshold for 99205, reporting 99417 once is correct.

Question 77: Which modifier should be appended to an E/M service provided during the postoperative global period for a condition unrelated to the surgery?

-57
-79
-24 (Correct answer)
-25

Correct answer: -24

Modifier -24 is appended to an E/M service to indicate it was provided during the postoperative period for a condition unrelated to the original surgery.

Question 78: Which CPT code describes an open repair of an initial inguinal hernia in a patient over 6 months of age?

49505 (Correct answer)
49520
49500
49507

Correct answer: 49505

CPT 49505 describes an open repair of an initial inguinal hernia in patients older than 6 months.

Question 79: A urine specimen is sent to the lab for a suspected urinary tract infection. The lab performs a culture with a colony count, which is positive. Subsequently, a sensitivity study is performed on the isolated organism to determine antibiotic effectiveness. Which of the following is the correct way to code these services?

Report the CPT code for the culture and, if performed, a separate CPT code for the sensitivity study. (Correct answer)
Report one comprehensive code that bundles culture and sensitivity.
Report the CPT code for the definitive identification of the organism only.
Report the CPT code for urinalysis with reflex to culture.

Correct answer: Report the CPT code for the culture and, if performed, a separate CPT code for the sensitivity study.

In microbiology coding, the initial culture (e.g., CPT 87086 for a quantitative culture) is reported first. If the culture is positive and a medically necessary sensitivity study is performed, the sensitivity study (e.g., 87184) is reported as a separate and additional service. There is no single CPT code that bundles a urine culture with a sensitivity study; they are distinct procedures.

Question 80: A pathologist performs a gross and microscopic examination of a colon biopsy specimen taken during a colonoscopy. What is the appropriate CPT code for this service?

88300 - Level I - Surgical pathology, gross examination only
88309 - Level VI - Surgical pathology, gross and microscopic examination
88302 - Level II - Surgical pathology, gross and microscopic examination
88305 - Level IV - Surgical pathology, gross and microscopic examination (Correct answer)

Correct answer: 88305 - Level IV - Surgical pathology, gross and microscopic examination

CPT code 88305 is designated as Level IV surgical pathology, which includes the gross and microscopic examination of specific specimen types. The CPT manual explicitly lists "Colon, biopsy" as an example of a specimen appropriate for code 88305. Code 88302 is for less complex specimens, 88309 is for highly complex specimens like a total colectomy, and 88300 is for gross examination only without microscopy.

Question 81: Which CPT code describes a percutaneous needle biopsy of the liver?

47000 (Correct answer)
47100
47001
47010

Correct answer: 47000

CPT 47000 describes a percutaneous needle biopsy of the liver.

Question 82: When selecting an E/M service level based on Medical Decision Making (MDM), which of the following is NOT one of the three core elements?

Number and Complexity of Problems Addressed
Risk of Complications and/or Morbidity or Mortality of Patient Management
Amount and/or Complexity of Data to be Reviewed and Analyzed
Complexity of the Medically Appropriate History and/or Examination (Correct answer)

Correct answer: Complexity of the Medically Appropriate History and/or Examination

The current E/M guidelines, updated in recent years, base the level of MDM on three elements: 1) Number and Complexity of Problems Addressed, 2) Amount and/or Complexity of Data to be Reviewed and Analyzed, and 3) Risk of Complications and/or Morbidity or Mortality of Patient Management. While a medically appropriate history and examination are required, their complexity is no longer a key element in selecting the E/M code level.

Question 83: Which CPT code range covers partial colectomy with anastomosis?

44010–44050
45110–45126
44140–44160 (Correct answer)
44300–44346

Correct answer: 44140–44160

CPT codes 44140–44160 cover partial (segmental) colectomy procedures including various anastomosis configurations.

Question 84: A 72-year-old patient with severe systemic disease undergoes a complex surgical procedure under general anesthesia. The anesthesiologist personally performs the entire anesthesia service. Which combination of modifiers should be appended to the anesthesia CPT code?

P1, AA
P3, QK
P4, AA (Correct answer)
P2, QZ

Correct answer: P4, AA

The Physical Status Modifier P4 is used for a patient with severe systemic disease that is a constant threat to life. The HCPCS Level II modifier AA is used to indicate that the anesthesia service was personally performed by the anesthesiologist. P1 is for a normal healthy patient, P2 is for mild systemic disease, and P3 is for severe systemic disease without a constant threat to life. QK is for medical direction of 2-4 concurrent procedures, and QZ is for a CRNA service without medical direction.

Question 85: In the CPT manual, what does the designation '(separate procedure)' following a code description imply?

The procedure is normally part of a more extensive service and should not be billed separately if a related, larger procedure is performed. (Correct answer)
The procedure can only be reported by a different physician on the same day.
The procedure must always be billed with modifier 59.
The procedure was the only one performed during the patient encounter.

Correct answer: The procedure is normally part of a more extensive service and should not be billed separately if a related, larger procedure is performed.

The '(separate procedure)' designation means the procedure is often an integral component of a larger service. It should not be reported separately when performed along with another procedure in an anatomically related region. It can be reported if it is the only procedure performed or if it is distinct and unrelated to other procedures performed during the same encounter.

Question 86: An attending physician is perplexed by a patient's conflicting lab results and requests a formal consultation from the hospital pathologist. The pathologist reviews the patient's medical records and laboratory data, and provides a comprehensive written report with their medical interpretive judgment. Which CPT code series would be used to report this service?

88321-88325 (Consultation and report on referred slides prepared elsewhere)
80503-80506 (Pathology Clinical Consultation) (Correct answer)
88300-88309 (Surgical Pathology)
99242-99245 (Office or Other Outpatient Consultations)

Correct answer: 80503-80506 (Pathology Clinical Consultation)

The CPT code range 80503-80506 is specifically designated for pathology clinical consultations. These codes are used when a pathologist, upon the request of another physician, renders a medical interpretive judgment and provides a written report based on a review of patient records and lab findings, without evaluating a new specimen. The 88321 series is for reviewing slides from another institution, 99242-99245 involves face-to-face patient evaluation, and the 88300 series is for the examination of tissue specimens.

Question 87: A patient with symptomatic bradycardia undergoes a procedure for the insertion of a new permanent dual-chamber pacemaker system, which includes the pulse generator and transvenous electrodes in both the right atrium and right ventricle. Which CPT® code should be reported for this entire procedure?

33208 (Correct answer)
33249
33213 for the pulse generator and 33217 for the leads.
33206 for the atrial lead and 33207 for the ventricular lead.

Correct answer: 33208

CPT® code 33208 describes the insertion of a new or replacement permanent pacemaker with transvenous electrodes in both the atrium and ventricle (a dual-chamber system). This is a comprehensive code that includes the pulse generator and the placement of both leads. The other codes represent components of the procedure or a different device (33249 is for an implantable defibrillator system).

Question 88: During the global period, a patient's related postoperative office visit is billed. How should this be handled?

Bill the visit with modifier -79
The visit is included in the global package and is not billed separately (Correct answer)
Bill the visit with modifier -25
Bill the visit with modifier -24

Correct answer: The visit is included in the global package and is not billed separately

Postoperative visits directly related to the surgery are bundled into the global surgical package and cannot be reported separately.

Question 89: An established patient is seen for management of two stable chronic illnesses and one acute, uncomplicated illness. The provider performs a medically appropriate history and examination. According to the 2024 E/M guidelines, which element of Medical Decision Making (MDM) does this encounter meet?

High Number and Complexity of Problems Addressed
Low Number and Complexity of Problems Addressed
Straightforward Number and Complexity of Problems Addressed
Moderate Number and Complexity of Problems Addressed (Correct answer)

Correct answer: Moderate Number and Complexity of Problems Addressed

According to the AMA CPT® E/M guidelines, Moderate Complexity for the 'Number and Complexity of Problems Addressed' element includes '1 or more chronic illnesses with exacerbation, progression, or side effects of treatment; or 2 or more stable chronic illnesses; or 1 undiagnosed new problem with uncertain prognosis; or 1 acute illness with systemic symptoms; or 1 acute, complicated injury.' This scenario, with two stable chronic illnesses, meets the criteria for Moderate complexity.

Question 90: An established patient presents complaining of clumpy, white discharge for 3 days. A vaginal exam reveals an old tampon, which is removed. Diflucan is sent to the pharmacy, instructions are given, and the patient is told to follow up in 1 week. How would the provider code the visit?

57415, T19.2XXA, N89.8
99213, N89.8, T19.2XXA
57415, 99212-25, T19.2XXA
99213, T19.2XXA, N89.8 (Correct answer)

Correct answer: 99213, T19.2XXA, N89.8

Explanation: Although a foreign body was removed, 57415 in answers A and B cannot be reported because anesthesia was not used. The documentation supports an expanded problem-focused history and moderate-level decision-making, so the appropriate E/M would be a 99213. When comparing answers C and D, bear in mind that ICD-10-CM requires sequencing "the underlying condition first, followed by the manifestation."

Question 91: What is the correct CPT code for hemorrhoid treatment by rubber band ligation?

46230
46500
46221 (Correct answer)
46083

Correct answer: 46221

CPT 46221 describes hemorrhoidectomy by rubber band ligation, single or multiple hemorrhoids.

Question 92: A patient undergoes a CT scan of the abdomen without contrast, followed by an additional scan of the same area with IV contrast during the same session. Which of the following best describes how this should be coded?

Bill for the contrast material using a HCPCS code and the CT without contrast CPT code.
Code only the CT abdomen with contrast, as it is the more comprehensive service.
Use a single CPT code that describes a CT scan performed 'without contrast, followed by with contrast'. (Correct answer)
Code the CT abdomen without contrast, and separately code the CT abdomen with contrast.

Correct answer: Use a single CPT code that describes a CT scan performed 'without contrast, followed by with contrast'.

CPT provides specific codes for radiological studies performed without contrast, with contrast, and 'without, followed by with contrast'. When both types of scans are performed on the same anatomical area during the same encounter, the single combination code that describes both services should be used. It is incorrect to bill for the two separate scans.

Question 93: How should an incidental appendectomy performed during another abdominal procedure be coded?

Code 44950 with modifier -51
Code 44950 with modifier -52
It is not coded separately; it is included in the primary procedure (Correct answer)
Code 44950 separately without a modifier

Correct answer: It is not coded separately; it is included in the primary procedure

An incidental appendectomy is not separately reportable and is considered part of the primary abdominal procedure.

Question 94: A patient presents to the emergency department (ED) with a displaced fracture of the distal radius. The ED physician performs a closed treatment with manipulation and applies a short arm cast. The patient is instructed to follow up with an orthopedist for continued care. Which CPT® code and modifier combination should the ED physician report?

25600 and an E/M code
25505-54
29075 and an E/M code
25605-54 (Correct answer)

Correct answer: 25605-54

CPT® code 25605 correctly identifies the closed treatment of a distal radial fracture with manipulation. Since the ED physician is providing only the initial 'surgical' portion of the fracture care and not the subsequent follow-up care (which is part of the global package), modifier -54 (Surgical Care Only) is required to be appended. Code 25600 is for a similar fracture without manipulation. Code 29075 is for the cast application, which is bundled into the fracture care code when it's the initial treatment. Code 25505 is for a radial shaft fracture, not a distal radius fracture.

Question 95: Which of the following services is NOT included in the global surgical package?

Postoperative pain management related to the surgery
Complications requiring additional surgery
Intraoperative services normal to the procedure
Treatment of conditions unrelated to the surgery during the postoperative period (Correct answer)

Correct answer: Treatment of conditions unrelated to the surgery during the postoperative period

Treatment of unrelated conditions during the postoperative period is excluded from the global package and may be billed separately with modifier -24.

Question 96: Which CPT code range covers procedures on the esophagus?

42000–42299
43020–43499 (Correct answer)
45000–45999
44010–44979

Correct answer: 43020–43499

CPT codes 43020–43499 cover surgical and endoscopic procedures performed on the esophagus.

Question 97: A patient has a complete abdominal ultrasound (76700) and a complete retroperitoneal ultrasound (76770) performed during the same session by the same physician. Which modifier is most appropriately appended to the second procedure code?

Modifier 76 (Repeat Procedure by Same Physician)
Modifier 26 (Professional Component)
Modifier 59 (Distinct Procedural Service) (Correct answer)
Modifier 50 (Bilateral Procedure)

Correct answer: Modifier 59 (Distinct Procedural Service)

Modifier 59 is used to identify a procedure or service that is distinct or independent from other services performed on the same day. Since the complete abdominal and complete retroperitoneal ultrasounds are different anatomical areas and are not bundled by NCCI edits, Modifier 59 should be used on the code for the second procedure to indicate it was a separate and distinct service from the first.

Question 98: A patient undergoes surgery with anesthesia and is arousable with painful stimulation. What is the level of sedation the patient MOST likely received?

Deep sedation (Correct answer)
General anesthesia
Moderate sedation
Minimal sedation

Correct answer: Deep sedation

Explanation: Minimal, moderate, and deep sedation all allow the patient to undergo a procedure without pain and without being completely unconscious. If a patient receives minimal sedation, they are responsive after receiving verbal stimulation. Moderate sedation causes a patient to respond only after tactile stimulation. General anesthesia causes the patient to be completely unarousable, even with painful stimulation.

Question 99: Which type of DRG system uses degrees of severity of Illness and Risk of Mortality to determine the DRG?

CC/MCC-DRG
MS-DRG
APR-DRG (Correct answer)
RUG-IV

Correct answer: APR-DRG

Explanation: The APR-DRG (All Patient Refined Diagnosis Related Group) system uses degrees of severity of illness and risk of mortality to determine the DRG. This system is designed to provide a more accurate reflection of the resources required to treat patients by considering both the severity of the illness and the risk of mortality associated with the patient's condition. Other options like MS-DRG (Medicare Severity Diagnosis Related Group), CC/MCC-DRG (Complication or Comorbidity/Major Complication or Comorbidity Diagnosis Related Group), and RUG-IV (Resource Utilization Group Version IV) do not incorporate severity of illness and risk of mortality to the same extent as the APR-DRG system.

Question 100: A surgeon performs a direct laryngoscopy under general anesthesia and uses an operating microscope to excise a polyp from the vocal cord. Which CPT® code should be reported for this procedure?

31541 (Correct answer)
31525
31535
31540

Correct answer: 31541

CPT® code 31541 accurately describes a direct operative laryngoscopy with the excision of a tumor (polyp) that specifically utilizes an operating microscope or telescope. Code 31540 describes the same excision but without the use of a microscope. Code 31535 is for a biopsy, not a complete excision, and 31525 is for a diagnostic procedure only.

AAPC Certified Professional Coder (CPC) Exam

The AAPC CPC exam validates proficiency in medical coding using CPT, HCPCS Level II, and ICD-10-CM code sets, covering 17 knowledge areas and 10 medical coding case scenarios.

100

Questions

240 min

Time Limit

70%

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