COBGC Certified Obstetrics and Gynecology Coder Exam — Questions and Answers

Question 1: Which Z37 code represents the delivery of twins, both liveborn?

Z37.61
Z37.3
Z37.2 (Correct answer)
Z37.0

Correct answer: Z37.2

Z37.2 (Twins, both liveborn) is the outcome of delivery code assigned when both twins are born alive.

Question 2: What is the global period assigned to most major gynecologic surgeries, such as an abdominal hysterectomy?

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

Correct answer: 90 days

Most major surgical procedures carry a 90-day global period during which routine pre- and postoperative care is bundled into the procedure reimbursement.

Question 3: A second-degree perineal laceration occurring during vaginal delivery is coded as:

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

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 4: The term 'nullipara' describes a woman who:

Has never delivered a viable infant (Correct answer)
Has had multiple miscarriages
Has had one live birth
Is currently pregnant for the first time

Correct answer: Has never delivered a viable infant

'Nulli-' means none and '-para' means to bear (children), so nullipara refers to a woman who has never delivered a viable infant.

Question 5: When a procedure is performed during the global period of a prior surgery for an unrelated condition, which modifier is used?

Modifier 58
Modifier 78
Modifier 79 (Correct answer)
Modifier 24

Correct answer: Modifier 79

Modifier 79 indicates the service is unrelated to the original procedure and performed during its postoperative global period.

Question 6: A patient at 34 weeks has complete placenta previa with active hemorrhage. Which ICD-10-CM code is correct?

O44.33 – Partial placenta previa with hemorrhage, third trimester
O44.10 – Complete placenta previa with hemorrhage, unspecified trimester
O44.03 – Complete placenta previa without hemorrhage, third trimester
O44.13 – Complete placenta previa with hemorrhage, third trimester (Correct answer)

Correct answer: O44.13 – Complete placenta previa with hemorrhage, third trimester

34 weeks is in the third trimester; the hemorrhage subcategory of complete placenta previa is O44.1; combined with trimester designation, the code is O44.13.

Question 7: Which CPT code covers thawing of cryopreserved sperm/semen, reported per aliquot?

89352
89354
89353 (Correct answer)
89356

Correct answer: 89353

CPT 89353 specifically covers thawing of cryopreserved sperm/semen per aliquot, used when frozen sperm is prepared for use in ART.

Question 8: The infundibulopelvic (suspensory) ligament of the ovary transmits:

The ovarian artery, vein, and nerves (Correct answer)
Lymphatic channels from the uterine fundus
The round ligament and ovarian vasculature
The uterine artery and parametrial vessels

Correct answer: The ovarian artery, vein, and nerves

The infundibulopelvic ligament (suspensory ligament of the ovary) carries the ovarian artery, vein, lymphatics, and nerve supply to the ovary.

Question 9: A patient is 10 weeks pregnant with her first pregnancy and presents for a routine prenatal visit with no complications. The principal ICD-10-CM code is:

Z34.81 – Encounter for supervision of other normal pregnancy, first trimester
Z34.00 – Encounter for supervision of normal first pregnancy, unspecified trimester
O09.011 – Supervision of very young primigravida, first trimester
Z34.01 – Encounter for supervision of first trimester of first normal pregnancy (Correct answer)

Correct answer: Z34.01 – Encounter for supervision of first trimester of first normal pregnancy

Z34.01 applies to supervision of a normal first pregnancy in the first trimester (under 14 weeks); Z34.8x is reserved for second and subsequent normal pregnancies.

Question 10: A surgeon performs a LAVH (laparoscopically assisted vaginal hysterectomy) with removal of tubes and ovaries. Which code set best describes this?

58553 + 58661
58550 + 58661
58552
58554 (Correct answer)

Correct answer: 58554

CPT 58554 describes LAVH with removal of tube(s) and/or ovary(s) for a uterus greater than 250 grams.

Question 11: 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:

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

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

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

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

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

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 14: In the COBGC exam context, 'gestation' refers to:

The postpartum recovery period
The process of labor and delivery
The period of fetal development from conception to birth (Correct answer)
The process of implantation only

Correct answer: The period of fetal development from conception to birth

Gestation refers to the period of fetal development from conception to birth, typically about 40 weeks in humans.

Question 15: Which CPT code is used when thawing cryopreserved embryos prior to a frozen embryo transfer (FET)?

89352
89354 (Correct answer)
89353
89356

Correct answer: 89354

CPT 89354 covers thawing of cryopreserved embryo(s) per aliquot, which is reported before performing a frozen embryo transfer.

Question 16: Which modifier is used to report a gynecologic procedure performed bilaterally during the same operative session?

-50 (Correct answer)
-51
-22
-59

Correct answer: -50

Modifier -50 identifies bilateral procedures performed during the same operative session and typically results in 150% of the single-procedure payment rate.

Question 17: An Excludes2 note in ICD-10-CM means:

The condition is included in the code and should not be coded separately
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 excluded code replaces the code being referenced

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 18: Which preventive medicine code is used for a new female patient aged 40–64 presenting for her annual well-woman examination?

99396
99386 (Correct answer)
99385
99395

Correct answer: 99386

CPT 99386 covers comprehensive preventive medicine for a new patient aged 40–64; established patients in the same age range use 99396.

Question 19: What are Medicare OB/GYN billing guidelines?

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)
No specific guidelines exist
The same as all other payers

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 20: CPT code 59430 is used for which obstetric service?

Vaginal delivery only
Postpartum care only (Correct answer)
Antepartum care only
Cesarean with postpartum care

Correct answer: Postpartum care only

CPT 59430 reports postpartum care only, when the billing provider did not perform the delivery.

Question 21: 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?

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

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 22: 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 23: A patient has a Bartholin's gland cyst marsupialization. Which CPT code applies?

56440 (Correct answer)
56441
56420
56442

Correct answer: 56440

CPT 56440 is the correct code for marsupialization of Bartholin's gland cyst.

Question 24: A surgeon performs a laparoscopic bilateral salpingo-oophorectomy. Which CPT code is most appropriate?

58925
58700
58661 (Correct answer)
58720

Correct answer: 58661

CPT 58661 describes laparoscopic removal of adnexal structures (partial or total oophorectomy and/or salpingectomy).

Question 25: When a surgeon performs both a cystoscopy and a hysteroscopy during the same operative session, how should these be coded?

Report both without any modifier
Report the hysteroscopy only with modifier 22
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 26: Which HCPCS modifier indicates that a PA, NP, or CNS acted as assistant surgeon?

Modifier 81
Modifier AS (Correct answer)
Modifier 82
Modifier 80

Correct answer: Modifier AS

HCPCS modifier AS is used specifically when a physician assistant, nurse practitioner, or clinical nurse specialist serves as assistant at surgery.

Question 27: What is the difference between bilateral and unilateral procedures?

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

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 28: A physician performs a cesarean delivery but did not provide antepartum or postpartum care. Which CPT code applies?

59510
59515
59514 (Correct answer)
59618

Correct answer: 59514

CPT 59514 (Cesarean delivery only) is reported when the physician performs only the delivery, without antepartum or postpartum care.

Question 29: The fallopian tube is divided into which four anatomical segments from proximal to distal?

Interstitial, isthmus, ampulla, infundibulum (Correct answer)
Infundibulum, ampulla, isthmus, interstitial
Ampulla, isthmus, interstitial, fimbriae
Isthmus, ampulla, infundibulum, fimbriae

Correct answer: Interstitial, isthmus, ampulla, infundibulum

From uterus outward, the four segments are interstitial (within the uterine wall), isthmus (narrow), ampulla (wide, site of fertilization), and infundibulum (funnel-shaped opening with fimbriae).

Question 30: A patient has a uterine leiomyoma (fibroid) described as intramural in location. The correct ICD-10-CM code is:

D25.2 – Subserosal leiomyoma of uterus
D25.1 – Intramural leiomyoma of uterus (Correct answer)
D25.0 – Submucous leiomyoma of uterus
D25.9 – Leiomyoma of uterus, unspecified

Correct answer: D25.1 – Intramural leiomyoma of uterus

D25.1 identifies a leiomyoma within the myometrium (uterine wall), as distinguished from submucous (D25.0, toward the uterine cavity) and subserosal (D25.2, toward the serosa).

Question 31: A patient undergoes a cesarean section due to a breech-presenting fetus at 39 weeks with no other documented complications. What is the principal ICD-10-CM diagnosis?

O32.1XX0 – Maternal care for breech presentation, single fetus (Correct answer)
O34.219 – Maternal care for unspecified scar from previous cesarean delivery
O80 – Encounter for full-term uncomplicated delivery
O82 – Encounter for cesarean delivery without indication

Correct answer: O32.1XX0 – Maternal care for breech presentation, single fetus

The indication for the cesarean (breech presentation, O32.1XX0) is sequenced as principal diagnosis; O82 is reserved for cesarean deliveries with no documented clinical indication.

Question 32: What is the coding for an endometrial biopsy?

Only coded when performed in the OR
Same as a Pap smear
CPT code 58100 for endometrial sampling performed in the office or outpatient setting (Correct answer)
No specific code exists

Correct answer: CPT code 58100 for endometrial sampling performed in the office or outpatient setting

Endometrial biopsies have specific codes based on the setting and technique used.

Question 33: What does the CPT code 58300 describe?

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

Correct answer: Insertion of IUD

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

Question 34: The term 'colporrhaphy' describes a surgical procedure involving the:

Incision of the vulva
Repair of the vaginal wall (Correct answer)
Excision of vaginal cysts
Removal of the cervix

Correct answer: Repair of the vaginal wall

Colporrhaphy is the surgical suturing or repair of a defect in the vaginal wall.

Question 35: Which CPT code describes a cesarean delivery only, without antepartum or postpartum care?

59514 (Correct answer)
59510
59515
59520

Correct answer: 59514

CPT 59514 is used when the physician performs only the cesarean section without providing pre- or post-delivery care.

Question 36: What modifier should be appended when the same surgeon performs a diagnostic laparoscopy that leads to an immediate therapeutic laparoscopy during the same session?

No modifier needed; only report the therapeutic procedure (Correct answer)
Modifier 22
Modifier 51
Modifier 59

Correct answer: No modifier needed; only report the therapeutic procedure

When a diagnostic laparoscopy converts to a therapeutic procedure, only the therapeutic (surgical) laparoscopy is reported, as the diagnostic portion is bundled.

Question 37: Which CPT code represents the global obstetric care package for a planned cesarean delivery, including antepartum and postpartum care?

59510 (Correct answer)
59400
59514
59515

Correct answer: 59510

CPT 59510 covers routine obstetric care including antepartum care, cesarean delivery, and postpartum care as a global package.

Question 38: The term 'cervical ectropion' (ectopy) describes:

Eversion of columnar epithelium from the endocervix onto the ectocervix (Correct answer)
Complete prolapse of the cervix through the vaginal opening
Abnormal squamous metaplasia at the transformation zone
Inward displacement of the squamocolumnar junction into the endocervical canal

Correct answer: Eversion of columnar epithelium from the endocervix onto the ectocervix

Cervical ectropion occurs when columnar epithelium from the endocervical canal everts and appears on the visible ectocervix, creating a red, irregular-appearing area.

Question 39: Which CPT code represents the global obstetric package for antepartum care, cesarean delivery, and postpartum care?

59400
59610
59510 (Correct answer)
59514

Correct answer: 59510

CPT 59510 is the global package for cesarean delivery, including antepartum and postpartum care.

Question 40: When a Medicare beneficiary is also covered by an employer group health plan (EGHP) through a spouse's employer, which payer is primary for an OB/GYN procedure?

The payer with the higher allowed amount is primary
The EGHP is primary; Medicare is secondary (Correct answer)
Medicaid coordination rules apply instead
Medicare is always primary for beneficiaries over 65

Correct answer: The EGHP is primary; Medicare is secondary

Under Medicare Secondary Payer (MSP) rules, an active employer group health plan is primary over Medicare when the group has 20 or more employees.

Question 41: What does the term 'tocodynamometry' measure in obstetric care?

Uterine contraction frequency and duration (Correct answer)
Cervical dilation rate
Fetal heart rate patterns
Fetal position and presentation

Correct answer: Uterine contraction frequency and duration

'Toco-' means labor/childbirth, 'dynamo-' means force/power, and '-metry' means measurement, so tocodynamometry measures uterine contraction strength.

Question 42: Which HCPCS Level II code category is used to report injectable drugs administered in the OB/GYN office, such as Rho(D) immune globulin?

E codes (durable medical equipment)
J codes (drugs administered other than oral method) (Correct answer)
G codes (temporary procedures and services)
Q codes (temporary codes for specific services)

Correct answer: J codes (drugs administered other than oral method)

HCPCS Level II J codes represent drugs administered other than by the oral method, including injections given in a physician's office.

Question 43: A patient two weeks post-cesarean presents with wound dehiscence requiring evaluation and debridement. To bill a separate E&M during the global period for this complication, the coder appends:

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

Correct answer: Modifier 24

Modifier 24 is appended to indicate the E&M service addresses an unrelated or complicated condition (wound dehiscence) during the global postoperative period.

Question 44: Under the Anti-Kickback Statute, an OB/GYN receiving compensation from a pharmaceutical company for speaking engagements is at risk unless:

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

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

CHIP (Children's Health Insurance Program)
Presumptive Eligibility (PE) Medicaid (Correct answer)
Medicare Part B maternity benefit
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 46: A patient at 28 weeks has gestational diabetes mellitus controlled by diet only. Which ICD-10-CM code is most specific?

E11.9
O24.810
O24.010
O24.410 (Correct answer)

Correct answer: O24.410

O24.410 (Gestational diabetes mellitus in pregnancy, diet controlled) is the correct code for GDM managed with diet alone.

Question 47: Eclampsia occurring during the postpartum (puerperal) period is coded as:

O15.03 – Eclampsia in the third trimester
O90.4 – Postpartum acute kidney failure
O15.2 – Eclampsia in the puerperium (Correct answer)
O15.9 – Eclampsia, unspecified as to time period

Correct answer: O15.2 – Eclampsia in the puerperium

O15.2 specifically identifies eclampsia occurring in the puerperium (postpartum period), distinct from eclampsia in pregnancy or labor.

Question 48: Which pelvic diameter is the most clinically critical for assessing safe vaginal delivery?

Obstetric conjugate (Correct answer)
Transverse diameter of the outlet
True conjugate
Diagonal conjugate

Correct answer: Obstetric conjugate

The obstetric conjugate (from the inner surface of the pubic symphysis to the sacral promontory) is the shortest AP diameter of the pelvic inlet and is the critical measurement for engagement of the fetal head.

Question 49: Which CPT code describes a hysteroscopy with removal of a submucous leiomyoma?

58563
58562
58561 (Correct answer)
58558

Correct answer: 58561

CPT 58561 describes hysteroscopy with removal of leiomyomata.

Question 50: Under the 2021 E&M guidelines, which two elements primarily determine the level of an office/outpatient E&M service?

History and physical examination
Medical decision making or total time on the date of service (Correct answer)
Chief complaint and review of systems
Number of diagnoses and medications reviewed

Correct answer: Medical decision making or total time on the date of service

The 2021 guidelines removed history and exam as level-determining factors; the level is now driven by Medical Decision Making or total physician time on the date of service.

Question 51: What is coding for high-risk pregnancy?

Same codes as normal pregnancy
Additional codes for conditions like gestational diabetes, preeclampsia, or multiple gestation (Correct answer)
Only ICD codes change
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 52: Which modifier indicates that only postpartum care was provided by the reporting physician?

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

Correct answer: Modifier 55

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

Question 53: Which category of codes must be assigned as an additional code to every delivery encounter to indicate the number of livebirths and stillbirths?

Z34
Z38
O80
Z37 (Correct answer)

Correct answer: Z37

A code from category Z37 (Outcome of delivery) must always be assigned on the maternal record for each delivery encounter.

Question 54: A commercial payer's explanation of benefits (EOB) shows a 'COB adjustment' on a claim for an OB delivery. What does this indicate?

The provider is not credentialed with this payer
The claim was paid under a global obstetric contract rate
Coordination of Benefits rules were applied because the patient has more than one insurance policy (Correct answer)
The claim was denied due to a coding error

Correct answer: Coordination of Benefits rules were applied because the patient has more than one insurance policy

A COB adjustment on an EOB means the payer has applied coordination of benefits rules because the patient has dual coverage, adjusting payment based on what the primary payer already paid.

Question 55: What is the difference between benign and malignant in gynecologic coding?

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

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

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

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

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

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

Modifier 78 (Correct answer)
Modifier 58
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 59: The global obstetric package for vaginal delivery (CPT 59400) includes how many antepartum visits?

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

Correct answer: 13 visits

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

Question 60: Which ICD-10-CM chapter contains the majority of codes used for obstetric conditions?

Chapter 16 – Certain conditions originating in the perinatal period
Chapter 18 – Symptoms, signs and abnormal clinical findings
Chapter 14 – Diseases of the genitourinary system
Chapter 15 – Pregnancy, childbirth, and the puerperium (Correct answer)

Correct answer: Chapter 15 – Pregnancy, childbirth, and the puerperium

Chapter 15 (O00–O9A) is the primary chapter for coding conditions related to pregnancy, childbirth, and the puerperium.

Question 61: What does the term "upcoding" refer to in the context of compliance and coding?

Coding for more expensive services than were actually provided (Correct answer)
Correctly coding all services provided to a patient
Coding for services provided at a lower level than necessary
Coding for services not provided

Correct answer: Coding for more expensive services than were actually provided

Upcoding is a fraudulent practice in healthcare where providers intentionally submit claims for services that are more complex or expensive than what was actually provided or medically necessary. This unethical practice leads to higher reimbursement than deserved and is a serious violation of compliance regulations, often resulting in penalties.

Question 62: A patient is 20 weeks pregnant and diagnosed with gestational hypertension without significant proteinuria. Which ICD-10-CM code is correct?

O14.02 – Mild to moderate pre-eclampsia, second trimester
O11.2 – Pre-existing hypertension with superimposed pre-eclampsia, second trimester
O13.2 – Gestational hypertension without significant proteinuria, second trimester (Correct answer)
O10.012 – Pre-existing essential hypertension, second trimester

Correct answer: O13.2 – Gestational hypertension without significant proteinuria, second trimester

O13.2 is used for gestational (pregnancy-induced) hypertension without significant proteinuria occurring in the second trimester (14–27 weeks).

Question 63: Which OIG compliance guidance element focuses on training and education of staff on fraud and abuse laws?

Response to detected offenses
Monitoring and auditing
Effective lines of communication
Training and education programs (Correct answer)

Correct answer: Training and education programs

The OIG's Seven Elements of an Effective Compliance Program include training and education to ensure all relevant staff understand applicable laws and billing requirements.

Question 64: In a donor egg IVF cycle, under which patient's account is oocyte retrieval (CPT 58970) typically billed?

Neither — it is bundled into a global donor fee
Both recipient and donor using modifier 59
The egg donor (Correct answer)
The recipient patient

Correct answer: The egg donor

In a donor egg cycle, CPT 58970 is billed under the egg donor's account because she is the patient who physically undergoes the oocyte retrieval procedure.

Question 65: Which modifier indicates a service or procedure is distinct and independent from other services performed on the same day?

Modifier 91
Modifier 25
Modifier 59 (Correct answer)
Modifier 57

Correct answer: Modifier 59

Modifier 59 identifies a procedure as distinct or independent from other services on the same date, often used to bypass NCCI bundle edits.

Question 66: The ICD-10-CM instruction 'Use additional code' means:

The original code is invalid without a secondary code
An additional code should be assigned to provide more detail or specify an associated condition (Correct answer)
The additional code is optional and only used if it changes reimbursement
The additional code must be sequenced before the primary code

Correct answer: An additional code should be assigned to provide more detail or specify an associated condition

A 'Use additional code' instruction directs the coder to assign a secondary code to provide more complete information about the patient's condition, such as an organism or causal substance.

Question 67: How are preventive visit codes used in gynecology?

Only for patients under 40
They replace all other codes
Preventive codes are not used in gynecology
For annual well-woman exams including breast and pelvic examinations, separate from problem-oriented visits (Correct answer)

Correct answer: For annual well-woman exams including breast and pelvic examinations, separate from problem-oriented visits

Preventive visit codes cover routine wellness exams; if a problem is also addressed, a separate E/M code with modifier 25 may be added.

Question 68: According to ICD-10-CM general coding guidelines, when a condition qualifies for both a Chapter 15 (obstetric) code and a code from another chapter, the sequencing rule is:

The non-obstetric chapter code takes priority and is sequenced as principal diagnosis
Chapter 21 (Z codes) takes priority for preventive and supervision encounters
Both codes are sequenced equally with no official priority rule specified
Chapter 15 codes have sequencing priority and are used as the principal or first-listed diagnosis (Correct answer)

Correct answer: Chapter 15 codes have sequencing priority and are used as the principal or first-listed diagnosis

ICD-10-CM guidelines explicitly state that Chapter 15 codes have sequencing priority over codes from other chapters when the patient is pregnant and the condition relates to or complicates the pregnancy.

Question 69: Pre-existing essential hypertension complicating pregnancy is reported from which ICD-10-CM category?

O10 (Correct answer)
O11
I10
O13

Correct answer: O10

Category O10 covers pre-existing hypertension complicating pregnancy, childbirth, and the puerperium; I10 is not used alone during pregnancy.

Question 70: Which ICD-10-CM chapter contains codes for pregnancy, childbirth, and the puerperium?

Chapter 16
Chapter 11
Chapter 15 (Correct answer)
Chapter 14

Correct answer: Chapter 15

ICD-10-CM Chapter 15 (codes O00–O9A) covers conditions related to pregnancy, childbirth, and the puerperium.

Question 71: Which CPT code describes intrauterine embryo transfer following IVF?

89255
58976
89268
58974 (Correct answer)

Correct answer: 58974

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

Question 72: Which CPT code is used for intrauterine insemination (IUI)?

58322 (Correct answer)
58974
58321
89268

Correct answer: 58322

CPT 58322 describes artificial insemination via the intrauterine route (IUI), while 58321 is reserved for the intracervical route.

Question 73: CPT code 59025 describes which obstetric monitoring service?

Amniocentesis
Fetal non-stress test (NST) (Correct answer)
Chorionic villus sampling
Contraction stress test

Correct answer: Fetal non-stress test (NST)

CPT 59025 represents a fetal non-stress test, used to assess fetal well-being in high-risk pregnancies.

Question 74: 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?

59425 (Correct answer)
59430
59426
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 75: In OB/GYN surgical billing, what does the global surgical period encompass?

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

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

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

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 77: How are laparoscopic gynecologic procedures coded?

Same codes as open surgery
Using specific laparoscopic CPT codes distinct from open procedure codes (Correct answer)
Laparoscopic procedures are not coded separately
Only by adding modifier 51

Correct answer: Using specific laparoscopic CPT codes distinct from open procedure codes

Laparoscopic procedures have their own code sets reflecting the different technique and resources.

Question 78: Which term describes excessive vomiting during pregnancy leading to dehydration and weight loss?

Hyperemesis gravidarum (Correct answer)
Emesis gravidarum
Nausea gravidarum
Pernicious vomiting

Correct answer: Hyperemesis gravidarum

Hyperemesis gravidarum is severe, persistent nausea and vomiting of pregnancy causing dehydration, electrolyte imbalance, and >5% weight loss.

Question 79: Which initial hospital care code requires high-complexity Medical Decision Making or 75 or more minutes of physician time?

99222
99223 (Correct answer)
99224
99221

Correct answer: 99223

CPT 99223 represents initial hospital care requiring high-complexity MDM or 75+ minutes of total physician time on the date of service.

Question 80: In CPT coding, what is the purpose of using a “modifier”?

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

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 81: Which CPT codes are used when billing antepartum visits separately, outside of the global OB package?

59400 and 59410
99213 and 99214
59430 and 59440
59425 and 59426 (Correct answer)

Correct answer: 59425 and 59426

CPT 59425 covers 4-6 antepartum visits and 59426 covers 7 or more antepartum visits when reported separately from the global package.

Question 82: Which ICD-10-CM code is assigned as the principal diagnosis when a patient is admitted in normal full-term labor and delivers a single healthy infant with no complications?

Z34.90
O80 (Correct answer)
O09.90
Z37.0

Correct answer: O80

O80 (Encounter for full-term uncomplicated delivery) is the principal diagnosis when delivery is entirely without complication; Z37.0 is added as an additional code.

Question 83: When a second surgical procedure is performed during the same operative session, which modifier is typically appended to the secondary procedure?

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

Correct answer: Modifier 51

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

Question 84: When a claim is denied for 'lack of medical necessity,' what is the most appropriate first step for the billing team?

Submit a formal appeal with supporting clinical documentation (Correct answer)
Write off the balance as uncollectible
Bill the patient for the full amount immediately
Rebill with a different procedure code

Correct answer: Submit a formal appeal with supporting clinical documentation

The correct response to a medical necessity denial is to file an appeal within the payer's defined timeframe, submitting clinical documentation that supports the medical necessity of the service.

Question 85: How are antepartum visits counted for global OB coding?

All visits are coded separately
By tracking the total number of visits to determine which global package code applies (Correct answer)
Only the first visit counts
Visits are not counted

Correct answer: By tracking the total number of visits to determine which global package code applies

The number of antepartum visits determines which modifier or standalone code is used.

Question 86: What does the term 'placenta previa' literally indicate in its Latin roots?

Placenta that has separated prematurely
Placenta attached to the posterior wall
Placenta going before (covering the cervix) (Correct answer)
Placenta with abnormal blood vessels

Correct answer: Placenta going before (covering the cervix)

'Previa' comes from Latin 'praevius' meaning going before, indicating the placenta precedes the baby by covering the cervical os.

Question 87: 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?

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

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 88: The puerperium is defined in ICD-10-CM as the period:

From delivery through 3 months postpartum
From conception through delivery
From delivery through 6 weeks postpartum (Correct answer)
From delivery through 28 days postpartum

Correct answer: From delivery through 6 weeks postpartum

The puerperium (postpartum period) is defined as the period from delivery through 6 weeks (42 days) after delivery.

Question 89: A commercial payer's contract includes a 'most favored nation' (MFN) clause. How does this affect OB/GYN billing rates?

MFN clauses only apply to hospital outpatient facilities, not physician practices
The provider must charge this payer a rate no higher than the lowest rate it accepts from any other commercial payer (Correct answer)
The provider must bill the payer at the highest rate charged to any other payer
The provider can negotiate higher rates for complex OB procedures only

Correct answer: The provider must charge this payer a rate no higher than the lowest rate it accepts from any other commercial payer

A most favored nation clause requires the provider to give this payer rates at least as low as the lowest rate offered to any other payer, preventing tiered pricing that disadvantages the contracting payer.

Question 90: What does 'colposcopy' involve?

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

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 91: Modifier 24 appended to an E&M service code during the global OB period indicates that the service is:

A reduced or eliminated service
An unrelated E&M performed during a postoperative global period (Correct answer)
A prolonged service beyond the typical time
A significant E&M performed on the same day as a procedure

Correct answer: An unrelated E&M performed during a postoperative global period

Modifier 24 signals that the E&M service is unrelated to the original procedure or delivery and is performed during the postoperative or global period.

Question 92: When coding a laparoscopic-assisted procedure that was converted to an open procedure due to intraoperative complications, which coding guideline applies?

Code the open procedure with modifier 22 only
Code the open procedure only; the laparoscopic attempt is not separately billable (Correct answer)
Code both the laparoscopic and open approach with modifier 53
Code the laparoscopic procedure with modifier 22

Correct answer: Code the open procedure only; the laparoscopic attempt is not separately billable

When a laparoscopic procedure is converted to open, only the open procedure is coded because the laparoscopic attempt is considered part of the open approach.

Question 93: When billing a commercial payer for a vaginal delivery with an episiotomy repair, how is the episiotomy typically handled?

Billed separately with CPT 59300 and a multiple-procedure modifier
Billed with a -22 modifier for increased complexity
Billed only if the repair took longer than 30 minutes
Bundled into the vaginal delivery code and not separately billable (Correct answer)

Correct answer: Bundled into the vaginal delivery code and not separately billable

Episiotomy and its repair are considered integral to the vaginal delivery procedure and are bundled into the global obstetric or delivery code by virtually all payers.

Question 94: What documentation supports medical necessity for E/M services?

Only the patient's name
Chief complaint, history of present illness, review of systems, and clinical findings supporting the diagnosis (Correct answer)
Only the diagnosis code
A brief note is sufficient

Correct answer: Chief complaint, history of present illness, review of systems, and clinical findings supporting the diagnosis

Thorough documentation of the clinical encounter supports the medical necessity of the service level billed.

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

Treatment of unrelated medical conditions during pregnancy (Correct answer)
Postpartum care up to 6 weeks
Antepartum care visits
Delivery services

Correct answer: Treatment of unrelated medical conditions during pregnancy

The global OB package covers routine antepartum, delivery, and postpartum care, but treatment of conditions unrelated to the pregnancy is billed separately.

Question 96: A patient who had a cesarean delivery is seen two weeks postoperatively for treatment of a urinary tract infection unrelated to her surgery. The appropriate modifier to append to the E&M code is:

Modifier 59
Modifier 25
Modifier 57
Modifier 24 (Correct answer)

Correct answer: Modifier 24

Modifier 24 is required to indicate that the E&M service (UTI management) is unrelated to the global surgical/OB period.

Question 97: A patient is diagnosed with a complete (classical) hydatidiform mole. Which ICD-10-CM code applies?

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

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

O13 (Correct answer)
O10
O14
O11

Correct answer: O13

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

Question 99: Under the ACA, health plans offered through the Marketplace (Exchange) must cover which category of OB/GYN services as essential health benefits?

Only emergency OB services
All OB/GYN services including fertility treatments and cosmetic procedures
Preventive gynecology only
Maternity and newborn care as one of the ten essential health benefit categories (Correct answer)

Correct answer: Maternity and newborn care as one of the ten essential health benefit categories

The ACA requires all Marketplace plans to cover the ten essential health benefits, of which 'maternity and newborn care' is one, ensuring minimum OB coverage across all qualifying plans.

Question 100: Blue Cross Blue Shield plans often use which concept to bundle related gynecologic services performed on the same day, preventing separate billing?

Medically Unlikely Edits (MUEs)
Mutually exclusive edits (MUEs)
Claim bundling or 'same-day surgery' bundling policies (Correct answer)
Advance Beneficiary Notices (ABNs)

Correct answer: Claim bundling or 'same-day surgery' bundling policies

BCBS and other commercial payers apply claim bundling policies that combine multiple related procedures performed on the same day into a single allowable, preventing double-billing.

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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