COBGC Certified Obstetrics and Gynecology Coder Exam — Questions and Answers

Question 1: A patient returns to an OB/GYN practice for the first time in four years. She is best classified as:

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

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

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

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

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

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 4: A patient has a $2,000 annual deductible and has met $1,600 so far this year. Her OB visit charge is $500. What is her patient responsibility for this visit?

$400 — the remaining deductible balance (Correct answer)
$500 — the full charge applies to her deductible
$100 — only 20% coinsurance applies
$0 — deductible is considered met

Correct answer: $400 — the remaining deductible balance

With $400 remaining on the deductible ($2,000 minus $1,600), the first $400 of the $500 charge is applied to the deductible; any coinsurance applies to the remaining $100.

Question 5: A physician documents 'patient is G3P2' in an obstetric note. What does 'P2' represent?

Two prior term deliveries (Correct answer)
Two prior cesarean sections
Two prior live births
Two previous pregnancies regardless of outcome

Correct answer: Two prior term deliveries

In standard obstetric terminology, 'P' (para) refers to the number of deliveries at or beyond 20 weeks gestation, not the number of pregnancies or live births.

Question 6: Which modifier is required when billing Medicare for a surgical procedure performed during the global period of a previous surgery by the same physician?

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

Correct answer: Modifier -79

Modifier -79 indicates an unrelated procedure or service performed by the same physician during the postoperative period of a prior surgery.

Question 7: A commercial payer's explanation of benefits (EOB) shows a 'COB adjustment' on a claim for an OB delivery. What does this indicate?

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
The provider is not credentialed with this payer
The claim was paid under a global obstetric contract rate

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 8: 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?

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

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

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

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 10: Which coding guideline helps determine whether a procedure should be bundled or separately coded?

National Correct Coding Initiative (NCCI) (Correct answer)
International Classification of Diseases (ICD)
Current Procedural Terminology (CPT)
Healthcare Common Procedure Coding System (HCPCS)

Correct answer: National Correct Coding Initiative (NCCI)

The National Correct Coding Initiative (NCCI) is a set of coding guidelines developed by CMS to promote correct coding methodologies and prevent improper coding. NCCI edits identify code pairs that should not be billed together (mutually exclusive) or services that are typically performed together and should be bundled into a single code, thus determining whether a procedure should be bundled or separately coded.

Question 11: The global obstetric package for vaginal delivery (CPT 59400) includes how many antepartum visits?

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

Correct answer: 13 visits

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

Question 12: 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:

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

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 13: A 'Code Also' instruction in ICD-10-CM means:

The additional code must always be sequenced first
The additional code is optional and rarely used
The code being referenced is deleted and replaced by the instructed code
Two codes may be required to fully describe a condition, but sequencing depends on the reason for the encounter (Correct answer)

Correct answer: Two codes may be required to fully describe a condition, but sequencing depends on the reason for the encounter

A 'Code Also' note alerts the coder that two codes may be required and that sequencing depends on the circumstances of the encounter.

Question 14: Which CPT code describes a dilation and curettage (D&C) for non-obstetric therapeutic purposes?

59870
58120 (Correct answer)
59812
58100

Correct answer: 58120

CPT 58120 describes a therapeutic D&C unrelated to pregnancy; obstetric D&C codes fall in the 598XX range.

Question 15: The puerperium is defined in ICD-10-CM as the period:

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

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 16: Which ICD-10-CM code category covers preterm labor?

O62
O47
O65
O60 (Correct answer)

Correct answer: O60

Category O60 (Preterm labor) is used to report labor occurring before 37 completed weeks of gestation.

Question 17: Which modifier indicates the same procedure was repeated by the same physician on the same day?

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

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

Modifier 54
Modifier 52
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 19: Which document serves as the primary source for coding decisions and provides detailed information about the services rendered?

Insurance Policy
Medical Record (Correct answer)
Referral Form
Patient Consent Form

Correct answer: Medical Record

The medical record is the definitive and most comprehensive source of information regarding a patient's health history, diagnoses, treatments, and services received. It serves as the primary document from which medical coders extract all necessary details to accurately assign codes for diagnoses and procedures, ensuring proper billing and compliance.

Question 20: Which decidual layer lies directly beneath the chorionic villi at the placental implantation site?

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

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

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

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 22: What is the global obstetric package?

International coding standards
A single visit code
A bundled code covering antepartum care, delivery, and postpartum care (Correct answer)
Only delivery charges

Correct answer: A bundled code covering antepartum care, delivery, and postpartum care

The global OB package bundles routine prenatal visits, delivery, and postpartum follow-up into one comprehensive code.

Question 23: A gynecologic oncologist evaluates a new inpatient with suspected ovarian cancer and documents high-complexity MDM. Since Medicare eliminated consultation codes, the correct code is:

99215
99223 (Correct answer)
99255
99245

Correct answer: 99223

For Medicare patients, inpatient consultation code 99255 is replaced by initial hospital care code 99223 when high-complexity MDM is documented.

Question 24: When an obstetrician performs a significantly more complex procedure due to unexpected intraoperative complications, which modifier is appended to the procedure code?

-59
-22 (Correct answer)
-52
-53

Correct answer: -22

Modifier -22 (increased procedural services) is used when the work required is substantially greater than typically required and must be supported by documentation.

Question 25: What is the coding for an endometrial biopsy?

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

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

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

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

58353
58555
58558
58563 (Correct answer)

Correct answer: 58563

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

Question 28: A patient is diagnosed with a left tubal ectopic pregnancy without a concurrent intrauterine pregnancy. Which ICD-10-CM code is correct?

O00.00 – Abdominal ectopic pregnancy without intrauterine pregnancy
O00.102 – Left tubal pregnancy without intrauterine pregnancy (Correct answer)
O00.10 – Tubal pregnancy without intrauterine pregnancy, unspecified side
O00.109 – Unspecified tubal pregnancy without intrauterine pregnancy

Correct answer: O00.102 – Left tubal pregnancy without intrauterine pregnancy

O00.102 specifies a left-sided tubal ectopic pregnancy without a concurrent intrauterine pregnancy, capturing the laterality required by ICD-10-CM.

Question 29: How are “excludes1” and “excludes2” notes used in ICD-10-CM coding?

To list alternative codes for a diagnosis
To indicate a code that cannot be used with another code (Correct answer)
To show the required documentation for a specific code
To provide instructions on how to report a service with a modifier

Correct answer: To indicate a code that cannot be used with another code

In ICD-10-CM coding, "Excludes1" and "Excludes2" notes provide crucial instructions on how to use codes together. An "Excludes1" note means the two conditions cannot occur together and therefore cannot be coded together. An "Excludes2" note indicates that the condition excluded is not part of the condition represented by the code, but a patient could have both conditions simultaneously, allowing both codes to be used.

Question 30: A patient at 38 weeks with a prior low transverse cesarean scar is presenting for VBAC planning. The ICD-10-CM code for the uterine scar is:

O34.219 – Maternal care for other type scar from previous cesarean delivery
O34.21 – Maternal care for scar from previous cesarean delivery (non-specific, incomplete code)
O34.211 – Maternal care for low transverse scar from previous cesarean delivery (Correct answer)
O34.212 – Maternal care for vertical (classical) scar from previous cesarean delivery

Correct answer: O34.211 – Maternal care for low transverse scar from previous cesarean delivery

O34.211 specifies maternal care for a low transverse uterine scar from a prior cesarean, the most common incision type requiring documentation for VBAC candidacy.

Question 31: Which term describes the surgical procedure for the removal of the uterus?

Laparoscopy
Hysterectomy (Correct answer)
Hysteroscopy
Colposcopy

Correct answer: Hysterectomy

The term "hysterectomy" precisely describes the surgical removal of the uterus. It combines the Greek root "hyster-" meaning uterus, with the suffix "-ectomy" meaning surgical removal. This makes it the specific medical term for this particular surgical procedure.

Question 32: 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 33: A surgeon performs a colpocleisis (Le Fort procedure). Which CPT code describes this?

57200
57260
57240
57120 (Correct answer)

Correct answer: 57120

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

Question 34: What is the fee schedule used for Medicare OB/GYN reimbursement?

Negotiated rates like commercial insurance
No fee schedule exists
A flat rate for all services
The Medicare Physician Fee Schedule based on the Resource-Based Relative Value Scale (RBRVS) (Correct answer)

Correct answer: The Medicare Physician Fee Schedule based on the Resource-Based Relative Value Scale (RBRVS)

Medicare uses the RBRVS system to assign relative values to services based on work, practice expense, and malpractice cost.

Question 35: Under Medicare's physician fee schedule, OB/GYN services are reimbursed using which payment methodology?

Resource-Based Relative Value Scale (RBRVS) (Correct answer)
Diagnosis Related Groups (DRGs)
Ambulatory Payment Classifications (APCs)
Per diem inpatient payment rates

Correct answer: Resource-Based Relative Value Scale (RBRVS)

Medicare pays physicians using the RBRVS system, which assigns relative value units (RVUs) covering physician work, practice expense, and malpractice to each service.

Question 36: What are the key components of E/M coding for OB/GYN visits?

Only the diagnosis
Only the procedures performed
Only the time spent
History, examination, and medical decision-making complexity (Correct answer)

Correct answer: History, examination, and medical decision-making complexity

E/M code selection is based on the extent of history taken, examination performed, and complexity of medical decision-making.

Question 37: 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 only; the laparoscopic attempt is not separately billable (Correct answer)
Code the laparoscopic procedure with modifier 22
Code both the laparoscopic and open approach with modifier 53
Code the open procedure with modifier 22 only

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 38: Which modifier indicates a procedure was performed on the left side only?

Modifier 50
Modifier LT (Correct answer)
Modifier RT
Modifier 51

Correct answer: Modifier LT

HCPCS modifier LT (Left Side) indicates a bilateral procedure was performed on the left side only.

Question 39: Which category of codes must be assigned as an additional code to every delivery encounter to indicate the number of livebirths and stillbirths?

O80
Z34
Z38
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 40: Under NCCI (National Correct Coding Initiative), what is the purpose of a Column 1/Column 2 edit?

To set procedure payment rates
To prevent separate billing of a component service integral to a more comprehensive procedure (Correct answer)
To identify duplicate claims
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 41: What does the combining form 'cervic/o' refer to in OB/GYN terminology?

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

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 42: Human chorionic gonadotropin (hCG) is produced by which placental cell layer?

Cytotrophoblast
Syncytiotrophoblast (Correct answer)
Fetal vascular endothelium
Decidua basalis

Correct answer: Syncytiotrophoblast

The syncytiotrophoblast is the primary source of hCG, which maintains the corpus luteum and supports progesterone production in early pregnancy.

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 24 (Correct answer)
Modifier 25
Modifier 57
Modifier 79

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

59400
59410
59412 (Correct answer)
59414

Correct answer: 59412

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

Question 45: Which CPT code describes laparoscopic removal of adnexal structures, including salpingectomy?

58720
58700
58670
58661 (Correct answer)

Correct answer: 58661

CPT 58661 covers laparoscopic removal of adnexal structures, which includes the fallopian tube (salpingectomy) and/or ovary.

Question 46: Which CPT code is used for postpartum care only when the physician did not provide antepartum care or perform the delivery?

59515
59430 (Correct answer)
59410
59400

Correct answer: 59430

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

Question 47: What modifiers are used in obstetric coding?

Only modifier 26
No modifiers apply
Only modifier 25
Modifier 22 (increased services), 52 (reduced services), and 59 (distinct procedural service) (Correct answer)

Correct answer: Modifier 22 (increased services), 52 (reduced services), and 59 (distinct procedural service)

OB modifiers adjust codes when services differ from the standard global package.

Question 48: What does the suffix '-rrhea' mean in OB/GYN terminology?

Surgical removal
Flow or discharge (Correct answer)
Rupture
Inflammation

Correct answer: Flow or discharge

'-rrhea' means flow or discharge, as seen in terms like menorrhea (menstrual flow) and leukorrhea (white vaginal discharge).

Question 49: The medical term for an ectopic pregnancy implanted in the fallopian tube is:

Tubal pregnancy (Correct answer)
Ovarian pregnancy
Cornual pregnancy
Interstitial pregnancy

Correct answer: Tubal pregnancy

A tubal pregnancy is the most common form of ectopic pregnancy, occurring within the fallopian tube.

Question 50: Which HCPCS modifier indicates that a PA, NP, or CNS acted as assistant surgeon?

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

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 51: Which federal law mandates that group health plans cover maternity and newborn care for a minimum of 48 hours following a vaginal delivery?

The Affordable Care Act (ACA)
COBRA
HIPAA
The Newborns' and Mothers' Health Protection Act (NMHPA) (Correct answer)

Correct answer: The Newborns' and Mothers' Health Protection Act (NMHPA)

The NMHPA of 1996 prohibits group health plans from restricting hospital stays for mothers and newborns to less than 48 hours after a vaginal delivery or 96 hours after a cesarean section.

Question 52: An embryo transfer (CPT 58974) is initiated but cannot be completed due to cervical stenosis preventing catheter passage. Which modifier should be appended?

Modifier 22
Modifier 59
Modifier 53 (Correct answer)
Modifier 52

Correct answer: Modifier 53

Modifier 53 (Discontinued Procedure) is used when a procedure is started but must be terminated due to circumstances such as cervical stenosis preventing completion of the embryo transfer.

Question 53: A patient at 28 weeks has gestational diabetes mellitus controlled by diet only. Which ICD-10-CM code is most specific?

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

Correct answer: O24.410

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

Question 54: Which of the following best describes the correct coding for bilateral tubal ligation performed via laparoscopy using fulguration?

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

Correct answer: 58670

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

Question 55: A patient's prenatal record is subpoenaed for a legal proceeding. The OB practice should:

Refuse all subpoenas on HIPAA grounds
Require a signed patient authorization before complying with any court order
Release the records immediately as subpoenas override HIPAA
Consult legal counsel and follow applicable state law before releasing records (Correct answer)

Correct answer: Consult legal counsel and follow applicable state law before releasing records

A subpoena alone may not constitute sufficient legal authority under HIPAA; the practice should obtain legal guidance to determine whether a court order, authorization, or protective order is required.

Question 56: When coding a radical hysterectomy with bilateral lymphadenectomy, what is the correct approach for the lymphadenectomy?

Use an unlisted procedure code
Report it with modifier 51
Bill it separately using an add-on code (Correct answer)
It is bundled into the radical hysterectomy code

Correct answer: Bill it separately using an add-on code

Pelvic lymphadenectomy performed with radical hysterectomy is reported separately using the appropriate lymphadenectomy add-on or standalone code.

Question 57: How do commercial payers differ from Medicare in OB coding?

Only Medicare covers OB services
All payers follow identical rules
Commercial payers have no rules
Commercial payers may have different global package rules, covered services, and prior authorization requirements (Correct answer)

Correct answer: Commercial payers may have different global package rules, covered services, and prior authorization requirements

Each commercial payer may have unique policies for OB service coverage, authorization, and billing.

Question 58: 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 59: Which statement is true regarding ICD-10-CM coding of trimesters in obstetric cases?

Trimester must always be documented by the coder based on gestational age
The second trimester begins at 13 weeks 0 days and ends at less than 28 weeks (Correct answer)
The third trimester ends at 36 weeks and 0 days
Trimester is counted from the first day of the last menstrual period

Correct answer: The second trimester begins at 13 weeks 0 days and ends at less than 28 weeks

The second trimester is defined in ICD-10-CM as beginning at 13 weeks 0 days and ending before 28 weeks 0 days.

Question 60: Preimplantation genetic testing (PGT) requires biopsy of 7 embryos. Which CPT code applies?

89290
89255
89291 (Correct answer)
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 61: When calculating total physician time for E&M billing, which of the following does NOT count?

Reviewing outside records before the visit
Time a medical assistant spends taking vital signs (Correct answer)
Care coordination activities performed after the visit
Documenting the encounter in the EHR after the visit

Correct answer: Time a medical assistant spends taking vital signs

Only time personally spent by the billing physician or qualified clinician counts; time spent by support staff such as medical assistants is excluded.

Question 62: Which modifier is appended to indicate a procedure was performed on the left side when a bilateral code does not exist?

Modifier 50
Modifier 52
Modifier LT (Correct answer)
Modifier RT

Correct answer: Modifier LT

Modifier LT (Left side) is used to identify procedures performed on the left side of the body when no bilateral-specific code exists.

Question 63: 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 64: Which ICD-10-CM code category covers placenta previa?

O45
O46
O44 (Correct answer)
O43

Correct answer: O44

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

Question 65: 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?

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

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

59514
59400
59515
59510 (Correct answer)

Correct answer: 59510

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

Question 67: How is coding for fertility procedures handled?

Specific codes for IVF procedures, egg retrieval, embryo transfer, and associated monitoring (Correct answer)
Only ICD codes are used
One code covers all fertility treatments
Fertility is not covered by medical coding

Correct answer: Specific codes for IVF procedures, egg retrieval, embryo transfer, and associated monitoring

Fertility treatments have detailed code sets covering each step of the assisted reproduction process.

Question 68: How is the trimester designated in OB ICD-10 codes?

Through the 4th, 5th, or 6th character specifying first, second, or third trimester (Correct answer)
By a separate modifier
Trimester is not coded
Only the delivery date matters

Correct answer: Through the 4th, 5th, or 6th character specifying first, second, or third trimester

ICD-10-CM pregnancy codes include trimester specificity as part of the code itself.

Question 69: What does the term 'gravida' specifically indicate in obstetric history notation?

Number of live births
Number of term deliveries
Total number of pregnancies (Correct answer)
Number of miscarriages

Correct answer: Total number of pregnancies

'Gravida' (from Latin 'gravidus' meaning heavy) refers to the total number of times a woman has been pregnant, regardless of outcome.

Question 70: Which ICD-10-CM code is reported for an encounter specifically for fertility testing?

Z31.41 (Correct answer)
Z31.0
Z31.49
N97.9

Correct answer: Z31.41

Z31.41 is the ICD-10-CM code for an encounter for fertility testing, used when a patient presents for an infertility workup.

Question 71: 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 76
Modifier 58
Modifier 79

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 72: How are laparoscopic gynecologic procedures coded?

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

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

O11.2 – Pre-existing hypertension with superimposed pre-eclampsia, second trimester
O10.012 – Pre-existing essential hypertension, second trimester
O13.2 – Gestational hypertension without significant proteinuria, second trimester (Correct answer)
O14.02 – Mild to moderate pre-eclampsia, 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 74: Which CPT code describes intrauterine embryo transfer following IVF?

89255
58974 (Correct answer)
58976
89268

Correct answer: 58974

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

Question 75: Which ligament provides primary support preventing uterine prolapse?

Round ligament
Uterosacral and cardinal ligaments (Correct answer)
Infundibulopelvic 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 76: For a pregnant patient covered by both her own employer plan and her spouse's plan, which plan is primary for her maternity services?

The spouse's plan because it covers dependents
The patient's own insurance plan (Correct answer)
Medicare, if the patient qualifies by age
The plan with the higher lifetime maximum benefit

Correct answer: The patient's own insurance plan

Under coordination of benefits (COB) rules, a patient's own insurance is always primary for services she personally receives.

Question 77: Medicare does NOT cover which of the following fertility-related services?

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

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

O10
O11
O14
O13 (Correct answer)

Correct answer: O13

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

Question 79: Which modifier is appended to indicate the physician provided only the intrapartum (delivery) portion of obstetric care?

Modifier 22
Modifier 56
Modifier 55
Modifier 54 (Correct answer)

Correct answer: Modifier 54

Modifier 54 indicates surgical (delivery) care only was provided, without antepartum or postpartum management.

Question 80: In the cardinal movements of labor, which sequence correctly describes the progression?

Descent, engagement, flexion, internal rotation, extension, expulsion, external rotation
Engagement, descent, flexion, internal rotation, extension, external rotation, expulsion (Correct answer)
Engagement, flexion, descent, internal rotation, extension, external rotation, expulsion
Engagement, flexion, internal rotation, descent, extension, external rotation, expulsion

Correct answer: Engagement, descent, flexion, internal rotation, extension, external rotation, expulsion

The seven cardinal movements are: engagement, descent, flexion, internal rotation, extension, external rotation (restitution), and expulsion — occurring as the fetal head negotiates the birth canal.

Question 81: In OB/GYN documentation, the phrase 'as above' used to describe a physical examination finding is considered:

Sufficient if co-signed by the supervising physician
Incomplete documentation that may not support the code billed (Correct answer)
A valid cross-reference as long as it refers to the same encounter
Acceptable shorthand that meets documentation requirements

Correct answer: Incomplete documentation that may not support the code billed

Payers and auditors generally reject 'as above' or 'see above' as insufficient documentation because the specific findings must be recorded to support level of service coding.

Question 82: A patient presents for an elective (induced) termination of pregnancy with no complications. Which ICD-10-CM code category applies?

O07 – Failed attempted termination of pregnancy
O04 – Complications following (induced) termination of pregnancy
Z33.2 – Encounter for elective termination of pregnancy (Correct answer)
O03 – Spontaneous abortion

Correct answer: Z33.2 – Encounter for elective termination of pregnancy

Z33.2 is used for an encounter for elective termination of pregnancy without complications; O04 codes apply only when documented complications occur following termination.

Question 83: 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)
Visits are not counted
Only the first visit counts

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 84: A new obstetrics patient's office visit requires 65 minutes of total physician time on the date of service. Which code should be reported based on time?

99203
99215
99205 (Correct answer)
99204

Correct answer: 99205

CPT 99205 covers new patient visits with 60–74 minutes of total physician time on the date of service.

Question 85: Under Medicare's Correct Coding Initiative (NCCI), what does a column 1/column 2 edit indicate?

The column 1 code is always bundled into column 2
Both codes can always be billed together
The column 2 code cannot be billed with the column 1 code unless a modifier applies (Correct answer)
Only modifier 25 can override the edit

Correct answer: The column 2 code cannot be billed with the column 1 code unless a modifier applies

NCCI column 1/column 2 edits indicate that the column 2 code is bundled into the column 1 code and cannot be reported separately unless an appropriate modifier indicates a distinct service.

Question 86: What is the difference between diagnostic and therapeutic coding in gynecology?

Diagnostic procedures identify conditions; therapeutic procedures treat them — each has distinct codes (Correct answer)
They use the same codes
Only therapeutic procedures are coded
Diagnostic procedures are never coded

Correct answer: Diagnostic procedures identify conditions; therapeutic procedures treat them — each has distinct codes

The purpose of the procedure determines whether diagnostic or therapeutic codes apply.

Question 87: Under the 2021 E&M guidelines, which two elements primarily determine the level of an office/outpatient E&M service?

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

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 88: The normal umbilical cord contains how many vessels?

Two arteries and one vein (Correct answer)
Two arteries and two veins
One artery and two veins
One artery and one vein

Correct answer: Two arteries and one vein

A normal umbilical cord has two umbilical arteries (carrying deoxygenated blood from fetus to placenta) and one umbilical vein (carrying oxygenated blood to the fetus).

Question 89: Which CPT code represents the global obstetric package for antepartum care, cesarean delivery, and postpartum care?

59510 (Correct answer)
59514
59610
59400

Correct answer: 59510

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

Question 90: Which CPT code describes a diagnostic hysteroscopy without any additional surgical procedure?

58550
58555 (Correct answer)
58560
58558

Correct answer: 58555

CPT 58555 is used for a diagnostic hysteroscopy when no surgical intervention is performed during the procedure.

Question 91: When a second surgical procedure is performed during the same operative session, which modifier is typically appended to the secondary procedure?

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

Correct answer: Modifier 51

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

Question 92: How are preventive visit codes used in gynecology?

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

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 93: 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 24 (Correct answer)
Modifier 25
Modifier 57

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 94: Which Medicare administrative contractor (MAC) resource should an OB/GYN coder consult to confirm local coverage policies for a specific procedure?

The ACOG Practice Bulletins
Local Coverage Determinations (LCDs) from the relevant MAC (Correct answer)
The ICD-10-CM Official Guidelines only
The AMA CPT codebook

Correct answer: Local Coverage Determinations (LCDs) from the relevant MAC

LCDs issued by MACs establish coverage criteria, covered diagnoses, and documentation requirements for specific procedures in a geographic region.

Question 95: 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:

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

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 96: A pregnant patient at 24 weeks is known to have HIV disease (not just HIV-positive status). How should this be coded in ICD-10-CM?

Z21 for asymptomatic HIV status with O98.712 as secondary
O98.712 as the principal diagnosis with B20 as an additional code (Correct answer)
B20 as the principal diagnosis with Z34.2 as a secondary code
O98.72 for HIV disease complicating childbirth with B20 secondary

Correct answer: O98.712 as the principal diagnosis with B20 as an additional code

O98.712 (HIV disease complicating pregnancy, second trimester) is sequenced first per Chapter 15 priority rules, with B20 added as a required additional code.

Question 97: The rectouterine pouch (pouch of Douglas) is formed by peritoneal reflection between which two structures?

Ovary and fallopian tube
Posterior uterus and rectum (Correct answer)
Anterior uterus and bladder
Uterus and posterior vaginal fornix

Correct answer: Posterior uterus and rectum

The rectouterine pouch (cul-de-sac of Douglas) is the lowest point of the peritoneal cavity in females, located between the posterior uterus/upper vagina and the anterior rectum.

Question 98: Which structure is known as the "cervical canal" and connects the uterus to the vagina?

Fallopian Tubes
Endometrium
Ovaries
Cervix (Correct answer)

Correct answer: Cervix

The cervix is the lower, narrow part of the uterus that connects it to the vagina. This connection forms a canal, often referred to as the cervical canal, which allows for the passage of menstrual blood, sperm, and, during childbirth, the baby. It acts as a gateway to the uterus.

Question 99: The combining form 'vulv/o' refers to which anatomical structure?

External female genitalia (Correct answer)
Vagina
Labia majora only
Uterus

Correct answer: External female genitalia

'Vulv/o' refers to the vulva, which comprises the external female genitalia including the labia majora, labia minora, clitoris, and vaginal vestibule.

Question 100: What is prior authorization for gynecologic procedures?

Doctor licensing
Getting patient consent
Obtaining payer approval before performing certain procedures to ensure coverage (Correct answer)
Hospital admission approval

Correct answer: Obtaining payer approval before performing certain procedures to ensure coverage

Many payers require advance approval for surgical and diagnostic procedures to verify medical necessity and coverage.

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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