COBGC Certified Obstetrics and Gynecology Coder Exam — Questions and Answers

Question 1: A surgeon performs a colpocleisis (Le Fort procedure). Which CPT code describes this?

57240
57260
57120 (Correct answer)
57200

Correct answer: 57120

CPT 57120 describes colpocleisis (obliteration of vaginal canal), also known as the Le Fort procedure.

Question 2: When a hysteroscopy with endometrial ablation is performed, which CPT code is used?

58558
58563 (Correct answer)
58555
58353

Correct answer: 58563

CPT 58563 describes hysteroscopy with endometrial ablation (e.g., endometrial resection, electrosurgical ablation, thermoablation).

Question 3: A patient presents with an incomplete spontaneous abortion that has no associated complications. Which ICD-10-CM code applies?

O03.1 – Delayed or excessive hemorrhage following incomplete spontaneous abortion
O02.1 – Missed abortion
O03.9 – Complete or unspecified spontaneous abortion without complication
O03.4 – Incomplete spontaneous abortion without complication (Correct answer)

Correct answer: O03.4 – Incomplete spontaneous abortion without complication

O03.4 is used for incomplete spontaneous abortion with no complications; O03.9 is used only when the abortion is complete or the completion status is unspecified.

Question 4: What is the difference between new and established patient E/M codes?

The distinction does not affect coding
Only the first visit is a new patient visit
New patients have not been seen by the practice within 3 years; established patients have (Correct answer)
All patients are new

Correct answer: New patients have not been seen by the practice within 3 years; established patients have

New patient codes (99201-99205) have higher values than established patient codes (99211-99215) because they require more comprehensive evaluation.

Question 5: What is the difference between benign and malignant in gynecologic coding?

Malignant means non-cancerous
Benign means non-cancerous; malignant means cancerous — coding and treatment differ significantly (Correct answer)
They are the same
Benign is always more serious

Correct answer: Benign means non-cancerous; malignant means cancerous — coding and treatment differ significantly

The behavior of a tumor (benign vs. malignant) determines diagnosis codes, treatment codes, and care pathways.

Question 6: What CPT code represents the global cesarean delivery package after an attempted vaginal birth following a prior cesarean (VBAC attempt)?

59620
59610
59622
59618 (Correct answer)

Correct answer: 59618

CPT 59618 represents the all-inclusive global package for cesarean delivery after an attempted VBAC, including antepartum, delivery, and postpartum care.

Question 7: In ICD-10-CM, the trimester assigned to an obstetric complication is based on:

The gestational age at the time of the encounter (Correct answer)
The gestational age at onset of the complication
The date of the last menstrual period
The estimated due date

Correct answer: The gestational age at the time of the encounter

The trimester is assigned based on the number of weeks of gestation at the time of the current encounter, not the onset of the complication.

Question 8: In CPT coding, what is the purpose of using a “modifier”?

To indicate that a service was performed with special circumstances (Correct answer)
To create a new code
To delete a code from the list
To change the base code completely

Correct answer: To indicate that a service was performed with special circumstances

In CPT coding, a modifier is a two-digit code appended to a CPT code to indicate that a service or procedure was performed with special circumstances. It provides additional information about how the service was performed, such as indicating a bilateral procedure, multiple procedures, or that only a professional component of a service was rendered, without changing the basic definition of the code.

Question 9: Which anatomical term describes the os at the top of the cervical canal where it meets the uterine cavity?

External os
Cervical isthmus
Endocervical junction
Internal os (Correct answer)

Correct answer: Internal os

The internal os is the upper opening of the cervical canal that opens into the uterine cavity.

Question 10: What is the global period for most major gynecologic surgical procedures under Medicare guidelines?

30 days
0 days
90 days (Correct answer)
10 days

Correct answer: 90 days

Major gynecologic surgeries typically carry a 90-day global period under Medicare, during which routine postoperative care is bundled.

Question 11: Which claim form is used by a physician's office to bill Medicare for OB/GYN professional services?

UB-04
CMS-1450
CMS-1500 (Correct answer)
ADA Dental Claim Form

Correct answer: CMS-1500

The CMS-1500 is the standard claim form used by physicians and non-institutional providers for billing Medicare and most commercial payers.

Question 12: Which practice is considered 'unbundling' in OB/GYN coding?

Billing separate CPT codes for components of a procedure that CPT instructs should be reported with one comprehensive code (Correct answer)
Billing a global OB package instead of individual services
Reporting modifier -25 on an E/M performed the same day as a procedure
Assigning multiple diagnosis codes to one procedure

Correct answer: Billing separate CPT codes for components of a procedure that CPT instructs should be reported with one comprehensive code

Unbundling occurs when component services that CPT bundles into one comprehensive code are billed individually, typically to receive higher reimbursement—a form of fraud.

Question 13: According to ICD-10-CM guidelines, when a delivery occurs during an admission and there is a documented obstetric complication, the principal diagnosis should be:

The outcome of delivery code from category Z37
O80 for full-term uncomplicated delivery regardless of any complications documented
The obstetric complication that necessitated or resulted from the delivery (Correct answer)
Z34 for supervision of pregnancy as the overriding prenatal category

Correct answer: The obstetric complication that necessitated or resulted from the delivery

ICD-10-CM guidelines require the obstetric complication to be sequenced as principal diagnosis when it is the reason for admission or significantly affects the delivery.

Question 14: A patient develops endometritis 10 days after vaginal delivery. How should this be coded under ICD-10-CM?

O90.89
O85
N71.0
O86.12 (Correct answer)

Correct answer: O86.12

O86.12 (Endometritis following delivery) is used for postpartum endometritis because Chapter 15 codes take priority when a condition occurs within the puerperium.

Question 15: Which modifier indicates a return to the operating room during the postoperative period due to a complication related to the original procedure?

Modifier 58
Modifier 78 (Correct answer)
Modifier 79
Modifier 76

Correct answer: Modifier 78

Modifier 78 is used when a patient returns to the OR during the global period for a complication related to the initial surgery.

Question 16: Puerperal sepsis following delivery is coded as:

O90.89 – Other complications of the puerperium, not elsewhere classified
A41.9 with Z87.59 – Sepsis, unspecified organism, with personal history
O86.0 – Infection of obstetric surgical wound, superficial incision
O85 – Puerperal sepsis (Correct answer)

Correct answer: O85 – Puerperal sepsis

O85 is the specific ICD-10-CM code for puerperal sepsis; ICD-10-CM guidelines instruct coders to use O85 rather than sequencing a general sepsis code from Chapter 1.

Question 17: In ICD-10-CM, when coding a complication affecting a specific fetus in a multiple gestation pregnancy, which character position identifies the fetus number?

6th character
4th character
7th character (Correct answer)
5th character

Correct answer: 7th character

The 7th character in ICD-10-CM obstetric codes identifies the affected fetus in multiple gestation (0 = not applicable, 1–5 = individual fetuses, 9 = other fetus).

Question 18: Under NCCI (National Correct Coding Initiative), what is the purpose of a Column 1/Column 2 edit?

To set procedure payment rates
To identify duplicate claims
To prevent separate billing of a component service integral to a more comprehensive procedure (Correct answer)
To assign diagnosis codes to services

Correct answer: To prevent separate billing of a component service integral to a more comprehensive procedure

NCCI Column 1/Column 2 edits bundle the Column 2 (component) code into the Column 1 (comprehensive) code, preventing separate payment unless a valid modifier applies.

Question 19: Which CPT code describes an external cephalic version (ECV) with or without tocolysis?

59414
59400
59412 (Correct answer)
59410

Correct answer: 59412

CPT 59412 is used to report external cephalic version, the manual procedure used to turn a breech fetus.

Question 20: Preimplantation genetic testing (PGT) requires biopsy of 7 embryos. Which CPT code applies?

89291 (Correct answer)
89290
89255
89253

Correct answer: 89291

CPT 89291 covers embryo biopsy for preimplantation genetic diagnosis when more than 5 embryos are biopsied; 89290 is used for 5 or fewer.

Question 21: Which of the following services is typically BUNDLED within the global obstetric delivery package and cannot be billed separately?

Management of newly diagnosed gestational diabetes
Routine episiotomy performed during vaginal delivery (Correct answer)
Amniocentesis performed for genetic testing at 16 weeks
Treatment of a urinary tract infection diagnosed during pregnancy

Correct answer: Routine episiotomy performed during vaginal delivery

Routine episiotomy repair is considered an integral part of vaginal delivery and is included in the global obstetric delivery package.

Question 22: Which of the following best describes the correct coding for bilateral tubal ligation performed via laparoscopy using fulguration?

58670 (Correct answer)
58600 with modifier 50
58600 x2 with modifier 50
58671

Correct answer: 58670

CPT 58670 describes laparoscopy with fulguration of oviducts (with or without transection), and bilateral procedures are inherent to this code.

Question 23: What does the CPT code 58300 describe?

Cervical dilation
Removal of IUD
Insertion of IUD (Correct answer)
Endometrial biopsy

Correct answer: Insertion of IUD

CPT 58300 describes insertion of an intrauterine device (IUD).

Question 24: The fimbriae are finger-like projections located at which segment of the fallopian tube?

Isthmus
Interstitial portion
Infundibulum (Correct answer)
Ampulla

Correct answer: Infundibulum

The infundibulum is the distal funnel-shaped end of the fallopian tube; its fimbriae sweep over the ovary to capture the released oocyte at ovulation.

Question 25: A patient who delivered vaginally is seen six weeks later for her postpartum check-up only, and the delivering physician is reporting this visit separately. Which CPT code applies?

59410
59430 (Correct answer)
59425
59400

Correct answer: 59430

CPT 59430 is reported for postpartum care only when billed separately from the global OB package.

Question 26: The Bartholin's glands (greater vestibular glands) are located:

At the posterior vaginal introitus at 4 and 8 o'clock positions (Correct answer)
On either side of the clitoris
Adjacent to the urethral meatus
Within the labia minora folds

Correct answer: At the posterior vaginal introitus at 4 and 8 o'clock positions

Bartholin's glands open at the posterolateral vaginal introitus (approximately 4 and 8 o'clock positions) and secrete mucus for lubrication.

Question 27: Which hormone surge directly triggers ovulation?

Estrogen
Follicle-stimulating hormone (FSH)
Progesterone
Luteinizing hormone (LH) (Correct answer)

Correct answer: Luteinizing hormone (LH)

A midcycle LH surge from the anterior pituitary triggers final follicular maturation and rupture, releasing the oocyte.

Question 28: An Excludes2 note in ICD-10-CM means:

The excluded code replaces the code being referenced
The excluded code can never be reported with the code
The excluded condition is not part of the condition but may occur simultaneously and both codes may be reported (Correct answer)
The condition is included in the code and should not be coded separately

Correct answer: The excluded condition is not part of the condition but may occur simultaneously and both codes may be reported

An Excludes2 note means the excluded condition is not part of the condition represented by the code, so both codes may be reported together when both conditions are present.

Question 29: Which modifier indicates that only postpartum care was provided by the reporting physician?

Modifier 54
Modifier 55 (Correct answer)
Modifier 79
Modifier 56

Correct answer: Modifier 55

Modifier 55 is appended when the reporting physician provided only postpartum follow-up and did not perform the delivery.

Question 30: According to ICD-10-CM guidelines, a code from category Z3A (Weeks of gestation) should be assigned:

Only for high-risk pregnancies requiring special monitoring
As an additional code whenever applicable to provide the specific gestational age (Correct answer)
Only when the patient is in the third trimester and at risk for preterm delivery
As a principal diagnosis when gestational age is the primary reason for the encounter

Correct answer: As an additional code whenever applicable to provide the specific gestational age

Z3A codes are always secondary/additional codes used to specify the number of completed weeks of gestation; they are never sequenced as principal diagnosis.

Question 31: A patient's OB chart documents smoking status but no counseling was provided or documented. The coder wants to bill 99406 for tobacco cessation counseling. This would be:

Allowed because smoking is a universal risk factor in pregnancy
Fraudulent—services must be performed and documented before they are billed (Correct answer)
Acceptable because smoking status documents the medical necessity
Permissible if the physician verbally discussed it

Correct answer: Fraudulent—services must be performed and documented before they are billed

Billing for a service that was not performed and is not documented in the medical record constitutes healthcare fraud regardless of the service's general appropriateness.

Question 32: Which CPT code is used for postpartum care only when the physician did not provide antepartum care or perform the delivery?

59410
59515
59400
59430 (Correct answer)

Correct answer: 59430

CPT 59430 (Postpartum care) is billed when a provider furnishes only the postpartum component of obstetric care.

Question 33: Under the surgical package rule, which service is NOT included in the global surgical package for a major procedure?

Postoperative follow-up visits within the global period
Treatment of complications unrelated to the surgery (Correct answer)
Preoperative visit the day before surgery
Intraoperative services normally part of the procedure

Correct answer: Treatment of complications unrelated to the surgery

Treatment of complications that are unrelated to the original surgery is billed separately and is not part of the global surgical package.

Question 34: When coding vulvectomy procedures, what factor primarily differentiates simple from radical vulvectomy?

Skin and deep subcutaneous tissue involvement vs. skin only (Correct answer)
Bilateral vs. unilateral excision
Use of intraoperative frozen section
Anesthesia type used

Correct answer: Skin and deep subcutaneous tissue involvement vs. skin only

Radical vulvectomy involves removal of skin and deep subcutaneous tissues, while simple vulvectomy removes skin and superficial subcutaneous tissues only.

Question 35: A patient at 30 weeks is diagnosed with gestational hypertension WITHOUT significant proteinuria. Which ICD-10-CM code category applies?

O10
O11
O13 (Correct answer)
O14

Correct answer: O13

O13 (Gestational hypertension without significant proteinuria) is used for pregnancy-induced hypertension that does not meet criteria for preeclampsia.

Question 36: A patient returns to an OB/GYN practice for the first time in four years. She is best classified as:

Established patient, because she has been to the practice before
Consultation patient
New patient, because more than three years have passed (Correct answer)
Established patient if her records are still on file

Correct answer: New patient, because more than three years have passed

If more than three years have elapsed since the patient received professional services from any physician of that specialty in the group, she is classified as a new patient.

Question 37: For an E&M service to be separately billable on the same day as a minor procedure, what is required?

A significant, separately identifiable reason documented with Modifier 25 (Correct answer)
A different place of service
Only a different diagnosis code
Prior authorization

Correct answer: A significant, separately identifiable reason documented with Modifier 25

A same-day E&M is payable only when it represents a significant, separately identifiable service supported by documentation and appended with Modifier 25.

Question 38: Which ligament provides primary support preventing uterine prolapse?

Infundibulopelvic ligament
Uterosacral and cardinal ligaments (Correct answer)
Round ligament
Broad ligament

Correct answer: Uterosacral and cardinal ligaments

The cardinal (Mackenrodt's) and uterosacral ligaments are the primary structural supports that anchor the uterus and prevent prolapse.

Question 39: Which Medicaid provision allows pregnant women to begin receiving benefits immediately while their full application is still being processed?

Medicare Part B maternity benefit
CHIP (Children's Health Insurance Program)
Presumptive Eligibility (PE) Medicaid (Correct answer)
TRICARE Prime maternity coverage

Correct answer: Presumptive Eligibility (PE) Medicaid

Presumptive Eligibility Medicaid allows pregnant women who appear to meet income guidelines to begin receiving prenatal care immediately without waiting for full eligibility determination.

Question 40: A patient with abnormal uterine bleeding has outside pathology slides independently reviewed, a pelvic ultrasound ordered, and a discussion of medical versus surgical management options. Under 2021 MDM, the data complexity most likely supports:

Moderate data (Correct answer)
Limited data
Extensive data
Minimal data

Correct answer: Moderate data

Reviewing an outside independent interpretation (pathology) and ordering a diagnostic test together satisfy multiple Moderate-level data criteria.

Question 41: A patient is diagnosed with endometriosis affecting the ovaries. Which ICD-10-CM code applies?

N80.2 – Endometriosis of fallopian tube
N80.1 – Endometriosis of ovary (Correct answer)
N80.3 – Endometriosis of pelvic peritoneum
N80.0 – Endometriosis of uterus

Correct answer: N80.1 – Endometriosis of ovary

N80.1 is the ICD-10-CM code for endometriosis specifically located in the ovary, distinct from other pelvic sites.

Question 42: What are Medicare OB/GYN billing guidelines?

The same as all other payers
No specific guidelines exist
Only commercial insurance guidelines apply
Specific rules for coding and billing OB/GYN services to Medicare including global package rules and screening coverage (Correct answer)

Correct answer: Specific rules for coding and billing OB/GYN services to Medicare including global package rules and screening coverage

Medicare has specific guidelines for OB/GYN services including well-woman exams, screening frequencies, and global package requirements.

Question 43: A patient on Medicaid delivers via cesarean section. The provider wants to bill separately for the post-partum visit at 6 weeks. How do most state Medicaid programs handle this?

Post-partum visits require a separate prior authorization
It may be billed separately using the appropriate E/M code with modifier -24 (Correct answer)
It is always bundled into the global OB package and not separately payable
Medicaid never covers post-partum visits

Correct answer: It may be billed separately using the appropriate E/M code with modifier -24

Most Medicaid programs follow a global OB package concept but allow the post-partum visit to be billed separately with modifier -24 to indicate it falls within the global period but is a distinct service.

Question 44: A patient is injured in a work-related accident that causes a miscarriage. Which payer should the OB/GYN provider bill for the related treatment?

The patient's group health insurance as primary
Medicaid if the patient qualifies
Workers' compensation insurance (Correct answer)
Medicare as the insurer of last resort

Correct answer: Workers' compensation insurance

When an injury or condition is work-related and covered under workers' compensation, the workers' comp carrier is the appropriate primary payer for all treatment related to that injury.

Question 45: Which CPT code represents a total abdominal hysterectomy (TAH) with or without tube and ovary removal?

58140
58200
58150 (Correct answer)
58180

Correct answer: 58150

CPT 58150 describes a total abdominal hysterectomy with or without removal of tube(s) and/or ovary(s).

Question 46: The term 'leukorrhea' describes:

Reduced menstrual flow
Blood in the urine during pregnancy
White or yellowish vaginal discharge (Correct answer)
Bleeding between menstrual periods

Correct answer: White or yellowish vaginal discharge

'Leuko-' means white and '-rrhea' means flow/discharge, so leukorrhea refers to a white or yellowish vaginal discharge.

Question 47: An Aetna member receives an out-of-network cesarean delivery due to an emergency. How will Aetna most likely process this claim?

Pay at the out-of-network rate, leaving a larger balance for the patient
Deny the claim entirely because the provider is out-of-network
Pay at the in-network benefit level because it was an emergency (Correct answer)
Require the member to file a separate appeal before any payment is made

Correct answer: Pay at the in-network benefit level because it was an emergency

Federal law (and most state laws) require commercial insurers to cover emergency services at the in-network benefit level, regardless of whether the provider is in-network.

Question 48: What does the prefix 'multi-' indicate in the term 'multipara'?

No births
Premature birth
One birth
Many births (Correct answer)

Correct answer: Many births

'Multi-' means many, so multipara describes a woman who has delivered more than one viable infant.

Question 49: A patient with a prior cesarean successfully delivers vaginally (VBAC). The physician provided all antepartum, delivery, and postpartum care. Which CPT code applies?

59510
59618
59610 (Correct answer)
59400

Correct answer: 59610

CPT 59610 is the global obstetric package specifically for routine care including antepartum care, VBAC, and postpartum care.

Question 50: A practice bills a global OB package but the patient's prenatal care was provided by a different physician group. How should this be handled?

Use an unlisted procedure code for the partial global
Append modifier -22 to the global package code
Bill the global package anyway to maximize reimbursement
Bill only the delivery and postpartum services actually provided by the billing physician (Correct answer)

Correct answer: Bill only the delivery and postpartum services actually provided by the billing physician

When a physician does not provide the full antepartum care included in the global OB package, only the delivery and postpartum components actually rendered should be billed.

Question 51: Which CPT code describes intrauterine embryo transfer following IVF?

89268
58976
58974 (Correct answer)
89255

Correct answer: 58974

CPT 58974 is specifically designated for embryo transfer via the intrauterine route following in vitro fertilization.

Question 52: A patient undergoes laparoscopic cystectomy of a right ovarian cyst. The cyst ruptures during removal. How does this affect coding?

Downcode to a lesser procedure
Add modifier 22 for increased complexity
Use an unlisted laparoscopy code
No change; code the procedure as planned (Correct answer)

Correct answer: No change; code the procedure as planned

Intraoperative complications like cyst rupture do not change the procedure code; the surgeon's intended and completed procedure determines the code.

Question 53: What is a clean claim?

A paper claim only
Any claim that is paid
A claim submitted with all required information, correctly coded, and free of errors (Correct answer)
A claim with no diagnosis codes

Correct answer: A claim submitted with all required information, correctly coded, and free of errors

Clean claims process faster because they contain all necessary information and have no errors requiring correction.

Question 54: The global obstetric package for vaginal delivery (CPT 59400) includes how many antepartum visits?

8 visits
10 visits
13 visits (Correct answer)
7 visits

Correct answer: 13 visits

The global OB package (59400) includes 13 antepartum visits, the delivery, and postpartum care per standard payer guidelines.

Question 55: Which modifier indicates that a significant, separately identifiable E/M service was provided on the same day as a minor procedure by the same physician?

-25 (Correct answer)
-59
-24
-51

Correct answer: -25

Modifier -25 is appended to the E/M code to show it was a significant, separately identifiable service from the procedure performed on the same day.

Question 56: When a commercial payer's allowed amount is less than the patient's deductible, what amount is the patient responsible for?

Nothing, as the payer absorbs the deductible
The payer's allowed (contracted) amount (Correct answer)
The provider's full billed charge
The difference between billed charge and deductible

Correct answer: The payer's allowed (contracted) amount

Under a contracted fee schedule, the patient's financial responsibility is limited to the payer's allowed amount (not the billed charge), which is applied toward their deductible.

Question 57: A patient with a history of cervical cancer presents for routine surveillance. The physician reviews imaging showing no recurrence, manages hormone therapy, and counsels on late treatment effects. This visit most closely supports which MDM level?

Low complexity
Moderate complexity (Correct answer)
Straightforward
High complexity

Correct answer: Moderate complexity

Managing a known chronic illness (cancer surveillance), reviewing diagnostic data, and prescription drug management collectively support Moderate complexity MDM.

Question 58: Under the Anti-Kickback Statute, an OB/GYN receiving compensation from a pharmaceutical company for speaking engagements is at risk unless:

The physician discloses the arrangement to patients
The pharmaceutical product is not on formulary
The payments are labeled as 'educational grants'
The arrangement meets the requirements of the Personal Services safe harbor (Correct answer)

Correct answer: The arrangement meets the requirements of the Personal Services safe harbor

The Anti-Kickback Statute's Personal Services safe harbor requires that the arrangement be set out in a written agreement, cover only legitimate services, and provide fair market value compensation.

Question 59: A patient at 32 weeks gestation is seen in the office for supervision of a high-risk pregnancy due to advanced maternal age. Which code set applies?

O09.52 – Supervision of elderly multigravida, second trimester
O09.53 – Supervision of elderly multigravida, third trimester
O09.523 – Supervision of elderly multigravida, third trimester (Correct answer)
O09.522 – Supervision of elderly multigravida, second trimester

Correct answer: O09.523 – Supervision of elderly multigravida, third trimester

At 32 weeks gestation (third trimester), supervision of elderly multigravida is coded O09.523, which specifies the third trimester for a patient with advanced maternal age who has had prior deliveries.

Question 60: A patient attempts VBAC but requires an emergency cesarean. The physician provided only the delivery. Which CPT code applies?

59510
59620 (Correct answer)
59618
59514

Correct answer: 59620

CPT 59620 (Cesarean delivery only, following attempted vaginal delivery after prior cesarean delivery) is used when VBAC fails and results in cesarean.

Question 61: According to ICD-10-CM guidelines, when a delivery occurs and no complication is documented, which code is used?

O80 – Encounter for full-term uncomplicated delivery (Correct answer)
O00.0 – Abdominal ectopic pregnancy
O82 – Encounter for cesarean delivery without indication
Z37.0 – Single liveborn infant

Correct answer: O80 – Encounter for full-term uncomplicated delivery

O80 is assigned for a completely normal delivery with no complications, and it is the only code needed for such an encounter along with a Z37 outcome code.

Question 62: A patient at 35 weeks has premature rupture of membranes (PROM) with labor beginning within 24 hours. Which ICD-10-CM code applies?

O42.00 – PROM, onset of labor within 24 hours, unspecified weeks of gestation
O42.013 – Preterm PROM, onset of labor within 24 hours, third trimester (Correct answer)
O42.113 – Preterm PROM, onset of labor after 24 hours, third trimester
O42.10 – PROM, onset of labor after 24 hours, unspecified weeks of gestation

Correct answer: O42.013 – Preterm PROM, onset of labor within 24 hours, third trimester

35 weeks is in the third trimester (28+ weeks); labor began within 24 hours of rupture; therefore O42.013 (preterm PROM, onset within 24 hours, third trimester) is correct.

Question 63: A patient at 34 weeks gestation is hospitalized for management of severe preeclampsia. How are these inpatient services billed?

As part of the global antepartum care package
Using antepartum-only codes 59425 or 59426
Separately from the global OB package as a complication (Correct answer)
Only after delivery as part of the postpartum period

Correct answer: Separately from the global OB package as a complication

Complications of pregnancy requiring inpatient hospital care are billed separately from the global OB package using appropriate hospital visit codes.

Question 64: A gynecologist performs a colposcopy and, on the same day, provides a significant evaluation for new pelvic pain unrelated to the colposcopy indication. The E&M service should be reported with:

Modifier 25 (Correct answer)
Modifier 24
Modifier 57
Modifier 51

Correct answer: Modifier 25

Modifier 25 identifies a significant, separately identifiable E&M service provided on the same day as a minor procedure such as colposcopy.

Question 65: What is the difference between bilateral and unilateral procedures?

Unilateral means both sides
Bilateral means one side
They mean the same thing
Bilateral means both sides; unilateral means one side only (Correct answer)

Correct answer: Bilateral means both sides; unilateral means one side only

This distinction affects coding: bilateral procedures may use different codes or modifiers than unilateral procedures.

Question 66: Provider A manages a patient's antepartum care for 5 visits and then transfers care. Provider B completes the remaining antepartum visits, delivers the baby, and provides postpartum care. Which code should Provider A report?

59426
59430
59425 (Correct answer)
59400 with modifier 52

Correct answer: 59425

CPT 59425 (antepartum care only, 4–6 visits) is reported by Provider A because they delivered 4–6 antepartum visits and did not perform the delivery or postpartum care.

Question 67: According to ICD-10-CM guidelines, codes from Chapter 15 (Pregnancy, Childbirth, and the Puerperium) are used only on:

Outpatient prenatal encounter records only
Inpatient records only — they are not to be used on outpatient encounter records
The maternal medical record (Correct answer)
The newborn's medical record to document the mother's conditions affecting the infant

Correct answer: The maternal medical record

ICD-10-CM guidelines specify that Chapter 15 codes are assigned exclusively to the maternal record and are never used on the newborn's chart.

Question 68: In ICD-10-CM, what does the 7th character represent in multiple gestation obstetric codes?

The specific fetus affected (Correct answer)
Whether delivery was vaginal or cesarean
The episode of care
The trimester

Correct answer: The specific fetus affected

The 7th character in multiple gestation codes identifies which specific fetus is affected by the complication (e.g., 1 = fetus 1, 2 = fetus 2).

Question 69: How is a hysterectomy coded?

One universal code
No code differentiation exists
By the approach (abdominal, vaginal, laparoscopic) and the extent (total, subtotal, radical) (Correct answer)
Only by surgeon preference

Correct answer: By the approach (abdominal, vaginal, laparoscopic) and the extent (total, subtotal, radical)

Hysterectomy coding requires identifying both the surgical approach and the extent of the procedure.

Question 70: What is the appeals process for denied claims?

A formal process to challenge payer denials by providing additional documentation or arguing coding accuracy (Correct answer)
Billing the patient directly
Resubmitting the same claim unchanged
Accepting all denials as final

Correct answer: A formal process to challenge payer denials by providing additional documentation or arguing coding accuracy

Appeals involve reviewing the denial reason and submitting additional information or arguments to overturn the decision.

Question 71: A second-degree perineal laceration occurring during vaginal delivery is coded as:

O70.0 – First degree perineal laceration during delivery
O70.1 – Second degree perineal laceration during delivery (Correct answer)
O71.0 – Rupture of uterus before onset of labor
O70.2 – Third degree perineal laceration during delivery

Correct answer: O70.1 – Second degree perineal laceration during delivery

O70.1 represents a second-degree perineal laceration that involves the perineal body muscles but does not extend to the anal sphincter.

Question 72: When obstetric care is transferred from one provider to another midway through pregnancy, how should the receiving physician bill for services?

Bill only for the specific services actually provided by that physician (Correct answer)
Split the global package fee equally with the transferring physician
Bill using an unlisted maternity care procedure code
Bill the full global OB package code (e.g., 59400 or 59510)

Correct answer: Bill only for the specific services actually provided by that physician

When care is split between providers, each bills only for services personally rendered; the receiving physician uses antepartum-only codes or appropriate delivery/postpartum codes.

Question 73: Modifier 25 is appended to an E&M code to indicate what?

A bilateral service
A significant, separately identifiable E&M on the same day as a procedure (Correct answer)
An unrelated procedure
A reduced E&M service

Correct answer: A significant, separately identifiable E&M on the same day as a procedure

Modifier 25 indicates the E&M service was significant, separately identifiable, and above and beyond the care associated with the same-day procedure.

Question 74: When a surgeon performs both a cystoscopy and a hysteroscopy during the same operative session, how should these be coded?

Report the hysteroscopy only with modifier 22
Report both without any modifier
Report only the primary procedure; bundle the secondary
Report both procedures with modifier 51 on the lesser procedure (Correct answer)

Correct answer: Report both procedures with modifier 51 on the lesser procedure

When two distinct endoscopic procedures are performed during the same session, report both with modifier 51 appended to the secondary (lesser) procedure.

Question 75: Which CPT code represents antepartum-only care when a provider furnishes 7 or more visits but does not perform the delivery or postpartum care?

59400
59426 (Correct answer)
59425
59430

Correct answer: 59426

CPT 59426 covers antepartum-only care of 7 or more visits when another provider will handle delivery and postpartum services.

Question 76: Which ICD-10-CM code category covers placenta previa?

O46
O44 (Correct answer)
O45
O43

Correct answer: O44

Category O44 covers placenta previa and is further subdivided by the presence or absence of hemorrhage.

Question 77: Which modifier indicates the physician provided only antepartum (preoperative) care and did not perform the delivery?

Modifier 52
Modifier 54
Modifier 56 (Correct answer)
Modifier 55

Correct answer: Modifier 56

Modifier 56 is appended when the physician provided only preoperative or antepartum care management without performing the delivery.

Question 78: When a second surgical procedure is performed during the same operative session, which modifier is typically appended to the secondary procedure?

Modifier 22
Modifier 59
Modifier 51 (Correct answer)
Modifier 80

Correct answer: Modifier 51

Modifier 51 indicates multiple procedures performed during the same surgical session, triggering reduced payment for secondary procedures.

Question 79: Which decidual layer lies directly beneath the chorionic villi at the placental implantation site?

Decidua basalis (Correct answer)
Decidua capsularis
Decidua vera
Decidua parietalis

Correct answer: Decidua basalis

The decidua basalis underlies the implanted blastocyst and forms the maternal component of the placenta, contributing to the basal plate.

Question 80: Medicare does NOT cover which of the following fertility-related services?

In vitro fertilization (IVF) (Correct answer)
Hysteroscopy to remove a uterine polyp
Diagnostic laparoscopy to evaluate pelvic pain
Ultrasound for abnormal uterine bleeding

Correct answer: In vitro fertilization (IVF)

Medicare explicitly excludes coverage of infertility treatments including IVF; diagnostic procedures for other conditions that may incidentally affect fertility can still be covered.

Question 81: What is coding for high-risk pregnancy?

Same codes as normal pregnancy
Only ICD codes change
Additional codes for conditions like gestational diabetes, preeclampsia, or multiple gestation (Correct answer)
No additional codes needed

Correct answer: Additional codes for conditions like gestational diabetes, preeclampsia, or multiple gestation

High-risk conditions require additional diagnosis and procedure codes beyond the routine OB package.

Question 82: Which CPT code represents the global obstetric package for antepartum care, vaginal delivery, AND postpartum care?

59410
59425
59430
59400 (Correct answer)

Correct answer: 59400

CPT 59400 represents the complete global obstetric package including antepartum care, vaginal delivery, and postpartum care.

Question 83: A physician orders an MRI pelvis for a patient with pelvic pain. The commercial payer requires a 'peer-to-peer' review. What does this process involve?

The coder calls the payer to dispute a coding error
The billing department submits additional codes to support the claim
The patient appeals the denial in writing
The ordering physician speaks directly with the payer's medical reviewer to justify the clinical necessity of the service (Correct answer)

Correct answer: The ordering physician speaks directly with the payer's medical reviewer to justify the clinical necessity of the service

A peer-to-peer review is a phone consultation between the requesting clinician and the payer's medical director to discuss clinical criteria and justify the medical necessity of a requested service.

Question 84: What does the combining form 'cervic/o' refer to in OB/GYN terminology?

The cervix of the uterus only
Either the neck or the cervix of the uterus (Correct answer)
The lower uterine segment
The vaginal canal

Correct answer: Either the neck or the cervix of the uterus

'Cervic/o' derives from the Latin 'cervix' meaning neck and can refer to the neck or the cervix (neck of the uterus) depending on context.

Question 85: What does the combining form 'oophor/o' refer to?

Cervix
Ovary (Correct answer)
Fallopian tube
Uterus

Correct answer: Ovary

'Oophor/o' is the combining form for ovary, as seen in oophorectomy (surgical removal of an ovary).

Question 86: A patient is diagnosed with a complete (classical) hydatidiform mole. Which ICD-10-CM code applies?

O01.9 – Hydatidiform mole, unspecified
O01.0 – Classical hydatidiform mole (Correct answer)
O02.0 – Blighted ovum and nonhydatidiform mole
O01.1 – Incomplete and partial hydatidiform mole

Correct answer: O01.0 – Classical hydatidiform mole

O01.0 represents a classical (complete) hydatidiform mole, which is genetically distinct from partial moles (O01.1) and requires pathological confirmation.

Question 87: What does 'colposcopy' involve?

Visual examination of the cervix and vagina (Correct answer)
Biopsy of the uterine lining
Removal of cervical polyps
Surgical repair of the vagina

Correct answer: Visual examination of the cervix and vagina

'Colpo-' means vagina and '-scopy' means visual examination, so colposcopy is examination of the vagina and cervix using a colposcope.

Question 88: Which modifier indicates the same procedure was repeated by the same physician on the same day?

Modifier 91
Modifier 59
Modifier 76 (Correct answer)
Modifier 77

Correct answer: Modifier 76

Modifier 76 is appended when the same physician repeats the same procedure on the same day; Modifier 77 is used when a different physician repeats it.

Question 89: When coding an obstetric complication in ICD-10-CM, how should the episode of care be specified?

Using a HCPCS modifier to denote the episode
Using the 5th character to indicate antepartum, childbirth, or postpartum
By adding a note in the medical record rather than a code character
Using the 7th character where applicable to identify the trimester or episode (Correct answer)

Correct answer: Using the 7th character where applicable to identify the trimester or episode

Many ICD-10-CM Chapter 15 codes require a 7th character (or a specific character position) to identify whether the complication occurred antepartum, during childbirth, or postpartum.

Question 90: An OB/GYN practice's compliance officer receives an anonymous hotline complaint about potential billing fraud. The compliance-appropriate response is to:

Immediately self-report to the OIG without first investigating
Discard it because anonymous complaints are unreliable
Investigate the complaint promptly and document findings (Correct answer)
Share the complaint with the accused physician for comment before investigation

Correct answer: Investigate the complaint promptly and document findings

Compliance programs must have a process to promptly investigate all complaints, including anonymous ones, and document the investigation and its outcome.

Question 91: A physician performs a laparoscopic myomectomy to remove four uterine fibroids. How is this coded?

58546 only for four or more fibroids
58545 once, regardless of fibroid count
58545 + 58546 as an add-on (Correct answer)
58550 with modifier 22

Correct answer: 58545 + 58546 as an add-on

CPT 58545 is for laparoscopic myomectomy of 1–4 intramural myomas, and 58546 (add-on) is used when 5 or more myomas total are removed.

Question 92: According to ICD-10-CM guidelines, the first trimester is defined as:

Up to 13 weeks 6 days
Weeks 1 through 12
Fewer than 12 completed weeks
Less than 14 weeks 0 days (Correct answer)

Correct answer: Less than 14 weeks 0 days

ICD-10-CM defines the first trimester as less than 14 weeks 0 days from the first day of the last menstrual period.

Question 93: Under the 2021 E&M guidelines, 'total time' for office/outpatient visits includes:

Face-to-face contact with the patient only
All physician time spent on the date of service, including pre- and post-visit activities (Correct answer)
Time spent by nurses and medical assistants rooming the patient
Only chart review and documentation time

Correct answer: All physician time spent on the date of service, including pre- and post-visit activities

Total time encompasses all physician/qualified clinician time on the date of service—pre-visit preparation, the face-to-face encounter, and post-visit work such as documentation and care coordination.

Question 94: A patient's IVF cycle is canceled prior to oocyte retrieval due to poor ovarian response. How should coding be handled?

Report 58970 with modifier 74
Report 58970 with modifier 52
Report only the monitoring and evaluation services actually rendered (Correct answer)
Report 58970 with modifier 53

Correct answer: Report only the monitoring and evaluation services actually rendered

When an IVF cycle is canceled before retrieval begins, only the services actually performed (monitoring ultrasounds, labs, E/M visits) are coded; the intended retrieval procedure is not reported.

Question 95: In OB/GYN surgical billing, what does the global surgical period encompass?

Only the surgery itself
Only the preoperative workup
The period covered by the patient's insurance
Pre-operative, intra-operative, and post-operative care bundled into one payment (Correct answer)

Correct answer: Pre-operative, intra-operative, and post-operative care bundled into one payment

The global surgical period bundles all pre-operative, intra-operative, and post-operative care into a single reimbursement within a defined timeframe (0, 10, or 90 days).

Question 96: A patient is diagnosed with a missed abortion at 10 weeks. Which ICD-10-CM code category applies?

O02.1 (Correct answer)
O06
O03
O04

Correct answer: O02.1

O02.1 (Missed abortion) is used when a fetal demise occurs before 20 weeks without passage of the products of conception.

Question 97: Under the 2021 MDM guidelines, which of the following falls under the 'Amount and/or Complexity of Data' element?

Number of current medications listed in the chart
Vital signs documented during the visit
Length of the presenting complaint
Reviewing external records and ordering or reviewing diagnostic tests (Correct answer)

Correct answer: Reviewing external records and ordering or reviewing diagnostic tests

The data element encompasses ordering/reviewing tests, reviewing external records, and independent interpretation of results—not medication lists or vital signs.

Question 98: ICD-10-CM code N97.0 classifies female infertility associated with which condition?

Cervical factor
Anovulation (Correct answer)
Uterine anomaly
Tubal blockage

Correct answer: Anovulation

N97.0 specifically classifies female infertility associated with anovulation, meaning the failure to release an egg during the menstrual cycle.

Question 99: What is the coding for colposcopy procedures?

Specific CPT codes based on whether biopsy, endocervical curettage, or LEEP is performed (Correct answer)
One code for all colposcopies
No code exists
Only ICD codes are used

Correct answer: Specific CPT codes based on whether biopsy, endocervical curettage, or LEEP is performed

Colposcopy codes vary depending on the specific diagnostic or therapeutic procedures performed.

Question 100: A GYN patient receives a well-woman preventive exam and also has a new complaint of abnormal uterine bleeding addressed in the same visit. How should this be reported?

Bill only the problem-oriented E/M code for the entire visit
Bill both the preventive medicine code and an E/M code with modifier -25 (Correct answer)
Bill only the preventive medicine code for the entire visit
Bill a single unlisted code for the combined preventive and problem service

Correct answer: Bill both the preventive medicine code and an E/M code with modifier -25

When a significant, separately identifiable problem-oriented E/M is provided on the same day as a preventive medicine service, both may be billed with modifier -25 appended to the E/M code.

COBGC Certified Obstetrics and Gynecology Coder Exam

The COBGC (Certified Obstetrics and Gynecology Coder) Exam is administered by the American Academy of Professional Coders (AAPC) and validates expertise in OB/GYN medical coding. It tests knowledge of obstetric and gynecologic CPT procedure coding, ICD-10 diagnosis coding, evaluation and management, payer-specific guidelines, modifiers, reimbursement and billing, OB/GYN anatomy and physiology, medical terminology, and compliance with documentation requirements.

100

Questions

120 min

Time Limit

70%

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