Certified Professional Coder (CPC) Exam — Questions and Answers

Question 1: Which of the following is an example of a service classified under HCPCS Level II G codes?

Dental prosthesis
Screening mammography (Correct answer)
Orthotic device fitting
Ambulance transport

Correct answer: Screening mammography

G codes are temporary codes used for procedures and services not classified elsewhere, including many CMS-defined preventive services such as screening mammography.

Question 2: A patient is brought to the OR emergently after a traumatic injury. Which qualifying circumstance add-on code reflects the emergency nature of the anesthesia?

99135
99140 (Correct answer)
99100
99116

Correct answer: 99140

CPT 99140 is the qualifying circumstance code for emergency conditions that significantly complicate anesthesia administration.

Question 3: Which suffix means 'surgical fixation' or 'to suture in place'?

-plasty
-pexy (Correct answer)
-desis
-rrhaphy

Correct answer: -pexy

-Pexy means surgical fixation or suspension of an organ, such as nephropexy (kidney fixation).

Question 4: Which type of E/M visit is used when a physician is asked by the attending to evaluate a patient and provide a written report of findings and recommendations?

Inpatient consultation — but Medicare no longer recognizes consult codes (Correct answer)
Inpatient consultation (99251–99255)
Office consultation (99241–99245)
Confirmatory consultation

Correct answer: Inpatient consultation — but Medicare no longer recognizes consult codes

Medicare eliminated consultation codes in 2010; consultations for Medicare patients are reported using the appropriate new or established patient or inpatient E/M codes.

Question 5: Which of the following statements about the Anti-Kickback Statute (AKS) is correct?

AKS prohibits offering, paying, soliciting, or receiving anything of value to induce referrals for federal program services (Correct answer)
AKS applies only to physicians, not hospitals or device manufacturers
AKS violations are strict liability and require no proof of intent
AKS safe harbors eliminate liability for any payment arrangement

Correct answer: AKS prohibits offering, paying, soliciting, or receiving anything of value to induce referrals for federal program services

The AKS broadly prohibits any remuneration intended to induce or reward referrals for items or services covered by federal healthcare programs.

Question 6: Which modifier would you apply to a CPT code for a bilateral procedure?

-50 (Correct answer)
-25
-26
-59

Correct answer: -50

Modifier -50 is specifically used to indicate that a bilateral procedure was performed during the same operative session. This modifier is appended to the CPT code for the procedure to inform payers that the service was performed on both sides of the body. This ensures appropriate reimbursement for procedures performed bilaterally, rather than being paid as a single unilateral procedure.

Question 7: A physician performs a complex repair of a 5.0 cm wound on the forehead, requiring extensive undermining and retention sutures. Which code range applies?

12031-12057
13100-13160 (Correct answer)
11760-11762
12001-12007

Correct answer: 13100-13160

Complex repairs (13100-13160) involve complicated wound closure including scar revision, extensive undermining, or the use of retention sutures.

Question 8: What is the purpose of HIPAA in healthcare?

To manage health insurance claims.
To define hospital procedures.
To protect the confidentiality of patient health records. (Correct answer)
To establish diagnostic protocols.

Correct answer: To protect the confidentiality of patient health records.

The Health Insurance Portability and Accountability Act (HIPAA) was enacted primarily to establish national standards for the protection of sensitive patient health information (PHI). Its core purpose is to ensure the confidentiality, integrity, and availability of electronic protected health information, safeguarding patient privacy. HIPAA sets rules for who can access, use, and disclose patient data.

Question 9: A radiologist performs ultrasound guidance for a central venous catheter placement and documents image storage. Which code is reported for the guidance?

76937 (Correct answer)
76536
76942
76998

Correct answer: 76937

CPT 76937 describes ultrasound guidance for vascular access requiring image documentation and report.

Question 10: A patient has a 3.0 cm laceration on her forearm and a 4.0 cm laceration on her trunk. Both wounds require layered closure of the subcutaneous tissue and superficial fascia. How would you report the wound repairs?

12034 (Correct answer)
13101, 13121
12002, 12001
12032, 12031-51

Correct answer: 12034

For intermediate repairs, CPT groups the scalp, axillae, trunk, and extremities (excluding hands and feet) into the same anatomical category. When multiple wounds of the same complexity and in the same anatomical group are repaired, their lengths are summed. In this case, the 3.0 cm forearm laceration and the 4.0 cm trunk laceration are both intermediate repairs in the same group, so their lengths are added together (3.0 cm + 4.0 cm = 7.0 cm). CPT code 12034 is for an intermediate repair of wounds in this anatomical group measuring 2.6 cm to 7.5 cm.

Question 11: A physician performs a transthoracic echocardiogram (TTE) with Doppler and color flow mapping, complete study. Which CPT code applies?

93303
93306 (Correct answer)
93308
93304

Correct answer: 93306

CPT 93306 describes echocardiography, transthoracic, real-time with image documentation, complete, with spectral Doppler echocardiography and with color flow Doppler echocardiography.

Question 12: The combining form 'oste/o' refers to:

Connective tissue
Bone (Correct answer)
Cartilage
Muscle

Correct answer: Bone

Oste/o is the combining form for bone, as in osteoporosis (porous bone) and osteomyelitis.

Question 13: Destruction of a malignant lesion of the scalp measuring 1.5 cm is reported using which code range?

17290-17296
17270-17276
17280-17286
17260-17266 (Correct answer)

Correct answer: 17260-17266

Malignant lesion destruction codes 17260-17266 apply to the trunk, arms, or legs; scalp falls under 17270-17286 (scalp, neck, hands, feet, genitalia) — code 17272 for this site/size.

Question 14: A patient is transported by air ambulance from a rural hospital to a trauma center. Which HCPCS code series is used?

R codes
T codes
A codes (Correct answer)
S codes

Correct answer: A codes

Air ambulance transportation is coded using the A code series (specifically A0430 and A0431 for fixed-wing and rotary-wing aircraft).

Question 15: Which of the following best describes a 'comorbidity' in inpatient coding?

A diagnosis present only in the ED prior to admission
A condition caused by the treatment given during the hospital stay
A pre-existing condition that, because of its presence with the principal diagnosis, increases the patient's length of stay or intensity of care (Correct answer)
An incidental finding unrelated to the patient's care

Correct answer: A pre-existing condition that, because of its presence with the principal diagnosis, increases the patient's length of stay or intensity of care

A comorbidity is a pre-existing condition that affects patient management and may qualify as a secondary diagnosis when it impacts treatment or length of stay.

Question 16: Which of the following best describes Level III surgical pathology (CPT 88307)?

Cyst or benign skin lesion simple excision
Bone marrow biopsy interpretation
Routine skin shaving with no special stains
Appendix, gallbladder, fallopian tube, testis (Correct answer)

Correct answer: Appendix, gallbladder, fallopian tube, testis

CPT 88307 covers Level VI specimens such as appendix, fallopian tube removed for non-neoplastic conditions, and testis.

Question 17: What does the suffix '-ectomy' mean in medical terminology?

Repair
Incision
Inflammation
Removal (Correct answer)

Correct answer: Removal

The suffix '-ectomy' in medical terminology consistently indicates the surgical removal or excision of an organ or part of the body. For example, an appendectomy is the removal of the appendix, and a tonsillectomy is the removal of the tonsils. This suffix is essential for understanding surgical procedures.

Question 18: The prefix 'hypo-' most commonly means:

Above normal
Through
Around
Below normal (Correct answer)

Correct answer: Below normal

Hypo- means under, below, or less than normal, as in hypoglycemia (low blood sugar).

Question 19: Under the global surgery rules, which service is NOT included in the surgical package?

Routine post-operative follow-up visits
Treatment of an unrelated condition during the post-operative period (Correct answer)
Writing post-operative orders
Local infiltration of anesthetic by the surgeon

Correct answer: Treatment of an unrelated condition during the post-operative period

Treatment of a new or unrelated condition during the global period is billed separately and is not included in the surgical package.

Question 20: A 'late effect' or 'sequela' in ICD-10-CM coding refers to:

A residual condition that remains after the acute phase of an illness or injury has resolved (Correct answer)
A condition present at the time of admission
A complication occurring during the same hospitalization
An adverse effect of a properly administered drug

Correct answer: A residual condition that remains after the acute phase of an illness or injury has resolved

Sequela describes the residual condition or late effect that persists after the acute phase of the original illness or injury is resolved.

Question 21: Which term describes the process of blood cell formation?

Hematuria
Hemolysis
Hemostasis
Hematopoiesis (Correct answer)

Correct answer: Hematopoiesis

Hematopoiesis is the production of blood cells, primarily occurring in the red bone marrow.

Question 22: The peritoneum is the membrane that lines which cavity?

Thoracic cavity
Pericardial cavity
Cranial cavity
Abdominal cavity (Correct answer)

Correct answer: Abdominal cavity

The peritoneum is the serous membrane lining the abdominal cavity and covering abdominal organs.

Question 23: In ICD-10-PCS, how many characters does every complete procedure code contain?

10
5
7 (Correct answer)
6

Correct answer: 7

Every ICD-10-PCS code is exactly 7 alphanumeric characters, each representing a specific axis of classification.

Question 24: A physician performs a colonoscopy with polypectomy by hot biopsy forceps. Which CPT code applies?

45380
45384 (Correct answer)
45385
45378

Correct answer: 45384

CPT 45384 describes colonoscopy, flexible, with removal of tumor(s), polyp(s), or other lesion(s) by hot biopsy forceps.

Question 25: What ASA physical status modifier is assigned to a healthy patient with no systemic disease?

P1 (Correct answer)
P3
P4
P2

Correct answer: P1

ASA P1 denotes a normal healthy patient with no organic, physiologic, or psychiatric disturbance.

Question 26: In ICD-10-PCS, the root operation 'Excision' differs from 'Resection' in that:

Excision is for soft tissue only; Resection is for bone
Excision uses an open approach only; Resection can be endoscopic
Excision removes a foreign body; Resection removes a tumor
Excision cuts out part of a body part; Resection cuts out all of a body part (Correct answer)

Correct answer: Excision cuts out part of a body part; Resection cuts out all of a body part

Excision involves cutting out or off a portion of a body part, while Resection involves cutting out or off the entire body part.

Question 27: Which E/M service code is reported when a physician provides critical care to a patient who is NOT in the ICU (e.g., in the ED)?

99285
99223
99291 and 99292 (Correct answer)
99468

Correct answer: 99291 and 99292

Critical care codes 99291 (first 30–74 minutes) and 99292 (each additional 30 minutes) are reported by the service provided, not the physical location.

Question 28: A physician spends a total of 65 minutes with an established patient for an office visit, which includes reviewing records, the face-to-face exam, and documenting in the EHR after the patient leaves. The time is properly documented. The highest level office visit code for an established patient, 99215, has a time threshold of 40 minutes. Which of the following is the correct way to report the prolonged service time?

Report CPT code 99354 for the additional 25 minutes.
It is not possible to report time beyond the highest level code.
Bill for two separate E/M visits on the same day.
Report CPT code 99215 and add-on code 99417. (Correct answer)

Correct answer: Report CPT code 99215 and add-on code 99417.

For prolonged office or other outpatient E/M services, when time is used for code selection and the time of the highest-level code (e.g., 99215) is exceeded by at least 15 minutes, add-on code +99417 is used to report each additional 15-minute increment. CPT codes 99354-99357 were deleted for this purpose.

Question 29: A patient presents with upper GI bleeding and undergoes an EGD with hemostasis using thermal cautery. Which CPT code is appropriate?

43239
43235
43249
43255 (Correct answer)

Correct answer: 43255

CPT 43255 describes EGD with control of bleeding by any method, including thermal cautery, injection therapy, or endoclips.

Question 30: Which organization maintains the CPT code set?

AMA (Correct answer)
CMS
WHO
AHIMA

Correct answer: AMA

The American Medical Association (AMA) is the organization responsible for developing, maintaining, and updating the CPT (Current Procedural Terminology) code set. The AMA publishes the CPT manual annually, which contains the official codes and guidelines used by healthcare professionals for reporting medical procedures and services.

Question 31: A patient undergoes a hemorrhoidectomy. In which CPT code range would the appropriate code be found?

49000-49999
44000-44799
46000-46999 (Correct answer)
45000-45999

Correct answer: 46000-46999

Hemorrhoidectomy codes are found in the 46000-46999 range, which covers procedures on the anus including hemorrhoidal tissue.

Question 32: A code listed as 'unspecified' in ICD-10-CM should be used:

Only when the documentation does not provide enough detail to assign a more specific code (Correct answer)
As the default when the condition is common
Whenever the patient has multiple diagnoses
To avoid querying the physician

Correct answer: Only when the documentation does not provide enough detail to assign a more specific code

Unspecified codes are appropriate only when clinical documentation lacks sufficient information to support a more specific diagnosis code.

Question 33: In ICD-10-CM, a 'code first' note instructs the coder to:

Use only that code and no others
Sequence a specified underlying condition before the current code (Correct answer)
Query the physician before coding
List the manifestation code first

Correct answer: Sequence a specified underlying condition before the current code

'Code first' notes appear under manifestation codes directing the coder to sequence the underlying disease or etiology before the manifestation code.

Question 34: For anesthesia CPT code 00142 (cataract surgery), what is the typical base unit value?

6 (Correct answer)
10
8
4

Correct answer: 6

CPT 00142 for anesthesia during cataract surgery carries a base value of 6 units according to the ASA Relative Value Guide.

Question 35: What is the National Correct Coding Initiative (NCCI) designed to prevent?

Missed patient appointments.
Unbundling and incorrect code combinations. (Correct answer)
Patient record duplication.
Use of outdated modifiers.

Correct answer: Unbundling and incorrect code combinations.

The National Correct Coding Initiative (NCCI) was developed by CMS to promote correct coding methodologies and prevent improper payments due to inappropriate code combinations. NCCI edits identify codes that should not be billed together (unbundling) or services that are integral to a primary procedure. This initiative ensures accurate and efficient billing practices, reducing waste and fraud in federal healthcare programs.

Question 36: A patient receives a PET scan of the skull base to mid-thigh with CT transmission scan. Which CPT applies?

78816
78814
78815 (Correct answer)
78806

Correct answer: 78815

CPT 78815 describes PET imaging skull base to mid-thigh with concurrently acquired CT for attenuation correction.

Question 37: The maintenance of the HCPCS Level II code set, including the addition, deletion, and revision of codes, is managed by which organization?

American Medical Association (AMA)
Centers for Medicare & Medicaid Services (CMS) (Correct answer)
World Health Organization (WHO)
American Hospital Association (AHA)

Correct answer: Centers for Medicare & Medicaid Services (CMS)

The Centers for Medicare & Medicaid Services (CMS) is responsible for maintaining the HCPCS Level II code set. The American Medical Association (AMA) maintains CPT (HCPCS Level I).

Question 38: A physician documents and bills for a service that was actually performed by a medical assistant without physician supervision. This is an example of:

Upcoding
Duplicate billing
Phantom billing (Correct answer)
Incident-to billing violation

Correct answer: Phantom billing

Phantom billing (also called billing for services not rendered) involves charging for services that were either not performed or not performed by the billed provider.

Question 39: When a surgeon performs a separate procedure as defined by CPT guidelines during the same operative session, how should it be coded?

It is always included in the primary procedure code
It should always be reported with modifier -59
It requires a new claim form
It should not be reported separately unless performed at a distinctly different site or for a different indication (Correct answer)

Correct answer: It should not be reported separately unless performed at a distinctly different site or for a different indication

A 'separate procedure' designation means the code is usually bundled but may be reported separately with appropriate modifier (e.g., -59) when done at a different site or for a different indication.

Question 40: Which federal agency is primarily responsible for investigating Medicare and Medicaid fraud and abuse?

Office of Inspector General (OIG) of HHS (Correct answer)
Department of Justice (DOJ) Civil Division
Centers for Medicare & Medicaid Services (CMS)
Federal Bureau of Investigation (FBI)

Correct answer: Office of Inspector General (OIG) of HHS

The OIG of HHS is the primary agency responsible for investigating fraud and abuse in HHS programs, including Medicare and Medicaid.

Question 41: A physician performs an arthroscopic partial medial meniscectomy of the knee. Which CPT code is most appropriate?

29880
29877
29870
29881 (Correct answer)

Correct answer: 29881

CPT 29881 describes arthroscopy, knee, surgical, with meniscectomy (medial OR lateral, including any meniscal shaving).

Question 42: Which regulation restricts physician self-referrals?

False Claims Act
Affordable Care Act
HIPAA
Stark Law (Correct answer)

Correct answer: Stark Law

The Stark Law, also known as the Physician Self-Referral Law, prohibits physicians from referring Medicare or Medicaid patients for certain designated health services to entities with which the physician or an immediate family member has a financial relationship. Its purpose is to prevent conflicts of interest and ensure medical decisions are based solely on patient need, not financial gain. This helps maintain the integrity of federal healthcare programs.

Question 43: What is the purpose of the anesthesia conversion factor?

It translates total anesthesia units into a dollar reimbursement amount (Correct answer)
It converts ICD-10 codes to CPT codes
It adjusts base units for geographic location only
It converts minutes directly into a flat fee

Correct answer: It translates total anesthesia units into a dollar reimbursement amount

The conversion factor is a dollar amount per unit used to calculate total anesthesia reimbursement from combined base and time units.

Question 44: When a Medicare patient requires a capped rental item that converts to a purchase, which modifier signals the month of the rental?

-NU, -UE, -RR
-KH, -KI, -KJ (Correct answer)
-GA, -GZ, -GX
-RT, -LT, -50

Correct answer: -KH, -KI, -KJ

The KH, KI, and KJ modifiers indicate the 1st, 2nd–3rd, and 4th–15th months of a capped rental, respectively, used for DME billing under Medicare.

Question 45: A patient presents with an undiagnosed new problem with uncertain prognosis. Under 2021 MDM, this falls under which level of problem complexity?

Low
Moderate (Correct answer)
High
Minimal

Correct answer: Moderate

A new problem with uncertain prognosis is classified as moderate complexity in the problems element of 2021 MDM.

Question 46: A patient has a lipoma excised from the subcutaneous tissue of the arm, measuring 3.5 cm. Which code is reported?

11400
11402 (Correct answer)
21930
11401

Correct answer: 11402

CPT 11402 covers excision of a benign lesion on the trunk/arms/legs, 1.1 to 2.0 cm — a 3.5 cm lipoma would be 11404 (3.1-4.0 cm).

Question 47: Which federal act established the national do-not-pay list and requires providers to screen employees against exclusion databases?

False Claims Act
Social Security Act Section 1128 (Correct answer)
Deficit Reduction Act
HITECH Act

Correct answer: Social Security Act Section 1128

Section 1128 of the Social Security Act grants the OIG authority to exclude individuals and entities from federal healthcare programs and maintain the exclusion database.

Question 48: Which section of the CPT codebook contains codes for anesthesia services?

20000–29999
10000–19999
99100–99140
00100–01999 (Correct answer)

Correct answer: 00100–01999

Anesthesia CPT codes are found in the range 00100–01999, organized by anatomical site of the surgical procedure.

Question 49: Under HIPAA, a 'business associate' is best defined as:

A person or entity that performs functions on behalf of a covered entity involving the use or disclosure of PHI (Correct answer)
An employee of a covered entity who handles PHI
A patient's legal representative who manages medical records
A government agency that enforces HIPAA regulations

Correct answer: A person or entity that performs functions on behalf of a covered entity involving the use or disclosure of PHI

A business associate is an external entity (not a workforce member) that creates, receives, maintains, or transmits PHI while performing services for a covered entity.

Question 50: Under the False Claims Act, qui tam provisions allow:

Coders to report fraud anonymously without legal standing
Providers to self-disclose errors to avoid penalties
CMS to audit providers without notice
Private individuals to file lawsuits on behalf of the government and share in any recovery (Correct answer)

Correct answer: Private individuals to file lawsuits on behalf of the government and share in any recovery

Qui tam provisions permit private individuals (relators/whistleblowers) to sue on the government's behalf and receive a portion of the recovered funds.

Question 51: A 3D rendering of a CT scan of the chest is performed by the radiologist interpreting the study. How is the 3D reconstruction reported?

As a separate E/M service
It is always bundled into the CT code and not separately reported
With add-on code 76377 when performed independently by a physician (Correct answer)
Using modifier -22 on the CT code

Correct answer: With add-on code 76377 when performed independently by a physician

CPT 76377 is an add-on code for 3D rendering with interpretation performed by the physician reviewing the images.

Question 52: Which CPT anesthesia code range covers procedures on the lower abdomen?

00800–00882 (Correct answer)
00100–00222
00300–00352
00700–00797

Correct answer: 00800–00882

CPT codes 00800–00882 cover anesthesia for procedures performed on the lower abdomen.

Question 53: HCPCS Level II A codes are primarily used to report which of the following?

Orthotics and prosthetics
Ambulance services and medical supplies (Correct answer)
Durable medical equipment
Drugs administered by injection

Correct answer: Ambulance services and medical supplies

A codes cover transportation services (ambulance), medical and surgical supplies, administrative/miscellaneous services, and investigational devices.

Question 54: What is the difference between ICD and CPT codes?

ICD codes track diagnoses, and CPT codes track procedures (Correct answer)
ICD codes track prescriptions, and CPT codes track treatments
ICD codes track symptoms, and CPT codes track diagnoses
ICD codes track patient behavior

Correct answer: ICD codes track diagnoses, and CPT codes track procedures

This is the core distinction between the two primary coding systems. ICD (International Classification of Diseases) codes describe the patient's medical condition or diagnosis, explaining *why* a service was performed. CPT (Current Procedural Terminology) codes, on the other hand, describe the specific medical, surgical, and diagnostic services or procedures *what* was done to treat the patient. Both are essential for complete and accurate medical billing.

Question 55: When a significant, separately identifiable problem-oriented E/M is performed on the same day as a preventive medicine service, how is it reported?

Report both codes; append modifier 25 to the problem-oriented E/M (Correct answer)
Report both codes; append modifier 59 to the preventive code
Report only the problem-oriented E/M code
Report only the preventive medicine code

Correct answer: Report both codes; append modifier 25 to the problem-oriented E/M

Both services may be billed on the same date; modifier 25 is appended to the problem-oriented E/M to indicate it is a significant, separate service.

Question 56: A patient is seen in the office and the physician spends the majority of the 25-minute visit on counseling. Under pre-2021 guidelines, what drives code selection in this scenario?

MDM complexity
Number of diagnoses
Time, when counseling dominates more than 50% of face-to-face time (Correct answer)
History and exam key components

Correct answer: Time, when counseling dominates more than 50% of face-to-face time

Under pre-2021 rules, when counseling exceeds 50% of face-to-face time, total time becomes the controlling factor for E/M level selection.

Question 57: A coding manager notices that a specific physician consistently documents level 4 visits for all patients regardless of complexity. What is the most appropriate initial compliance action?

Ignore the pattern if revenue targets are being met
Immediately report the physician to the OIG
Conduct an internal audit and provide education to the physician (Correct answer)
Change the codes to level 3 without informing the physician

Correct answer: Conduct an internal audit and provide education to the physician

The first step in compliance is internal review (audit) followed by education; punitive or external actions should follow only if internal measures fail or fraud is confirmed.

Question 58: Which organ is responsible for filtering blood and producing urine?

Liver
Adrenal gland
Spleen
Kidney (Correct answer)

Correct answer: Kidney

The kidneys filter blood to remove waste products and excess water, producing urine.

Question 59: What does 'data granularity' mean in health information management?

The encryption strength applied to health data
The speed at which data is entered into the EHR
The number of users who can access a record simultaneously
The level of detail at which data elements are defined and collected (Correct answer)

Correct answer: The level of detail at which data elements are defined and collected

Data granularity refers to the degree of detail or precision with which data is captured — for example, recording exact blood pressure values versus just 'normal.'

Question 60: Fluoroscopy performed by a radiologist as a separate service during a surgical procedure is reported using which code range?

77001-77003
76000-76001 (Correct answer)
74000-74022
73000-73140

Correct answer: 76000-76001

CPT 76000-76001 describe fluoroscopy as a separate service when not bundled into another procedure code.

Question 61: Which CPT code describes a complete abdominal ultrasound that must include real-time imaging of liver, gallbladder, spleen, pancreas, and kidneys?

76775
76700 (Correct answer)
76705
76770

Correct answer: 76700

CPT 76700 is a complete abdominal ultrasound requiring documentation of all required organs including liver, gallbladder, common bile duct, pancreas, spleen, and both kidneys.

Question 62: Initial treatment of burns covering less than 5% TBSA, with no debridement required, is reported using which CPT code?

16000 (Correct answer)
97597
16035
16020

Correct answer: 16000

CPT 16000 reports initial treatment of first-degree burns and burns with less than 5% TBSA not requiring debridement.

Question 63: Which CPT code describes a percutaneous coronary intervention (PCI) with stent placement in a single coronary vessel?

92933
92924
92928 (Correct answer)
92920

Correct answer: 92928

CPT 92928 describes percutaneous transcatheter placement of intracoronary stent(s), with coronary angioplasty when performed (single vessel).

Question 64: Which of the following services is reported using a code from the clinical pathology section, specifically the Organ or Disease-Oriented Panels (80047-80081)?

Fine needle aspiration of a cyst
Comprehensive Metabolic Panel (Correct answer)
Gross and microscopic examination of a skin biopsy
Interpretation of a chest X-ray

Correct answer: Comprehensive Metabolic Panel

The Organ or Disease-Oriented Panels (80047-80081) are a specific subsection of the Pathology and Laboratory CPT® codes. The Comprehensive Metabolic Panel (80053) is a common example from this section. Skin biopsy examination falls under surgical pathology (88300 series), chest X-ray interpretation is radiology (70000 series), and fine needle aspiration is a surgical procedure (10000 series).

Question 65: When a DME supplier provides a used item to a Medicare patient, which HCPCS modifier is appended?

-UE (Correct answer)
-KH
-NU
-RR

Correct answer: -UE

The -UE modifier (Used Durable Medical Equipment) indicates that the DME item was provided in used (not new) condition.

Question 66: When a diagnostic colonoscopy is converted to an open colectomy during the same surgical session, how should the colonoscopy be reported?

Report only the colonoscopy with modifier -22
Do not separately report the colonoscopy; report only the open colectomy (Correct answer)
Report the colonoscopy with modifier -53
Report both procedures separately with standard codes

Correct answer: Do not separately report the colonoscopy; report only the open colectomy

When an endoscopic procedure is converted to an open procedure, only the open procedure is reported; the endoscopy is considered a component of the definitive surgical approach.

Question 67: When a physician queries a coder asking for clarification on a diagnosis, the query must be:

Approved by the compliance officer before sending
Leading, to guide the physician to the most reimbursable code
Submitted only after the claim has been denied
Non-leading and based on clinical indicators present in the documentation (Correct answer)

Correct answer: Non-leading and based on clinical indicators present in the documentation

Per AHIMA and ACDIS guidelines, physician queries must be non-leading, clinically based, and not designed to prompt a specific answer for reimbursement purposes.

Question 68: Which anatomical direction term means toward the midline of the body?

Lateral
Medial (Correct answer)
Inferior
Posterior

Correct answer: Medial

Medial means toward the midline or center of the body, while lateral means away from the midline.

Question 69: Which term describes a recording or image produced by a diagnostic procedure?

-scopy
-graphy
-gram (Correct answer)
-meter

Correct answer: -gram

-Gram refers to the recorded image or tracing itself, such as electrocardiogram (ECG) or mammogram.

Question 70: Which OIG tool allows healthcare organizations to self-disclose potential fraud and abuse violations to avoid larger penalties?

Compliance Advisory Opinion
Corporate Integrity Agreement (CIA)
Self-Disclosure Protocol (SDP) (Correct answer)
Exclusion List Review

Correct answer: Self-Disclosure Protocol (SDP)

The OIG's Self-Disclosure Protocol allows providers to voluntarily disclose potential violations, typically resulting in lower multipliers and penalties than if discovered through audit.

Question 71: The medical term 'rhinorrhea' means:

Runny nose (nasal discharge) (Correct answer)
Nosebleed
Nasal polyp
Deviated septum

Correct answer: Runny nose (nasal discharge)

Rhin/o means nose and -rrhea means flow or discharge, so rhinorrhea is a runny nose.

Question 72: A physician performs closed treatment of a distal radius fracture without manipulation. Which CPT code applies?

25607
25600 (Correct answer)
25605
25624

Correct answer: 25600

CPT 25600 is closed treatment of distal radial fracture (e.g., Colles or Smith type) without manipulation.

Question 73: A patient undergoes repair of a 4.0 cm intermediate laceration of the neck and a 2.0 cm simple laceration of the hand during the same session. How are these coded?

One code for the neck only since it is more complex
Report the hand repair with modifier -59 only
Report each repair separately since they are different classifications (Correct answer)
Add the lengths together for a single intermediate repair code

Correct answer: Report each repair separately since they are different classifications

Repairs of different complexities (intermediate vs. simple) are reported separately regardless of body area.

Question 74: Which HCPCS Level II code series covers enteral and parenteral nutrition supplies?

S codes
A codes
B codes (Correct answer)
E codes

Correct answer: B codes

B codes (B4000–B9999) are specifically designated for enteral and parenteral nutrition therapy, including pumps, supplies, and nutrients.

Question 75: What does the acronym 'EHR' stand for in the context of health information management?

Electronic Hospital Record
Encoded Health Report
Enhanced Health Registry
Electronic Health Record (Correct answer)

Correct answer: Electronic Health Record

EHR stands for Electronic Health Record, a digital version of a patient's paper chart that is real-time and patient-centered.

Question 76: The femur is located in which region of the body?

Forearm
Thigh (Correct answer)
Lower leg
Upper arm

Correct answer: Thigh

The femur is the long bone of the thigh, extending from the hip to the knee.

Question 77: When reporting a full-thickness skin graft to the face, what is measured to determine the correct CPT code?

The size of the donor site only
The linear measurement of the longest defect dimension
The size of the recipient defect in square centimeters (Correct answer)
The combined area of donor and recipient sites

Correct answer: The size of the recipient defect in square centimeters

Full-thickness skin graft codes are selected based on the size of the recipient defect, not the donor site.

Question 78: A surgeon performs an open reduction and internal fixation (ORIF) of a displaced fracture of the femoral shaft. Which CPT code range covers fracture treatment of the femur?

27500–27514 (Correct answer)
24500–24516
28400–28415
25600–25624

Correct answer: 27500–27514

CPT codes 27500–27514 cover fracture and dislocation treatment of the femur (thigh region).

Question 79: What is abstracting in medical coding?

Summarizing financial statements.
Creating appointment schedules.
Extracting information from medical records for coding. (Correct answer)
Filing insurance appeals.

Correct answer: Extracting information from medical records for coding.

Abstracting in medical coding is the process of carefully reviewing and interpreting clinical documentation within the patient's health record. Coders extract all relevant information, such as diagnoses, procedures, and services rendered, to accurately assign the appropriate ICD-10-CM, CPT, and HCPCS codes. This critical step ensures that the services provided are correctly translated into codes for billing and data analysis.

Question 80: A patient is sent to a hospital's outpatient radiology department for a chest x-ray. The order specifies PA and lateral views. A radiologist who is not employed by the hospital provides the official interpretation and report. Which CPT® code(s) and modifier(s) should the radiologist report?

71046-26 (Correct answer)
71046
71046-TC
71045

Correct answer: 71046-26

CPT® code 71046 represents a radiologic examination of the chest with two views. Since the radiologist only provided the professional component (the interpretation and report) and did not own the equipment or employ the technologist, modifier -26 (Professional Component) must be appended. Modifier -TC would be used by the facility for the technical component. 71045 is for a single view.

Question 81: A physician documents a detailed history, detailed examination, and medical decision making of moderate complexity for an established office patient. Which E/M code level is most appropriate?

99212
99215
99213
99214 (Correct answer)

Correct answer: 99214

99214 requires at least 2 of 3 key components at the detailed/moderate complexity level for an established patient.

Question 82: A neoplasm that is described as 'behavior uncertain' in ICD-10-CM is coded from which column of the Neoplasm Table?

Unspecified
Malignant Secondary
Uncertain behavior (Correct answer)
Malignant Primary

Correct answer: Uncertain behavior

Neoplasms of uncertain behavior are classified to codes in the 'Uncertain behavior' column (D37–D48) when the pathologist cannot determine if the tumor is benign or malignant.

Question 83: A physician performs a fine needle aspiration (FNA) biopsy of a single, deep lymph node in the neck. The procedure is performed using ultrasonic guidance for needle placement, which is documented with permanently recorded images. How should this encounter be coded?

Report only the code for the ultrasonic guidance.
Report a single comprehensive code that includes both the FNA and the guidance.
Report only the code for the FNA biopsy.
Report the code for the FNA biopsy and the code for the ultrasonic guidance separately. (Correct answer)

Correct answer: Report the code for the FNA biopsy and the code for the ultrasonic guidance separately.

CPT® guidelines require separate reporting for the biopsy procedure and the imaging guidance used to perform it. The coder should report 10005 (Fine needle aspiration biopsy, including ultrasound guidance; first lesion) for the FNA itself, which now includes the guidance. An older rule would have been a code like 10021 for the FNA and 76942 for the ultrasound guidance. However, CPT® codes were updated to bundle these services. 10005 is the correct code for an FNA with US guidance of the first lesion.

Question 84: Which CPT code represents a diagnostic upper GI endoscopy (EGD) without any additional therapeutic procedures?

43247
43239
43200
43235 (Correct answer)

Correct answer: 43235

CPT 43235 is the base code for a diagnostic EGD covering the esophagus, stomach, and duodenum/jejunum without additional interventions.

Question 85: A physician spends 45 minutes of total time on the date of service with a new patient. Which office E/M code is reported?

99204 (Correct answer)
99205
99203
99202

Correct answer: 99204

99204 covers 45–59 minutes of total time for a new patient office visit under 2021 guidelines.

Question 86: A patient presents with three chronic conditions, each requiring ongoing management. Under 2021 MDM guidelines, how are these classified for the 'problems' element?

Stable chronic illness — supports low complexity
Acute uncomplicated illness
Multiple chronic illnesses — supports high complexity (Correct answer)
One chronic condition with exacerbation

Correct answer: Multiple chronic illnesses — supports high complexity

Multiple chronic conditions each requiring management meets the threshold for high complexity in the problems element of MDM.

Question 87: Under the 2021 E/M guidelines, which of the following counts as an independent interpretation of a test for the data element of MDM?

Reviewing a prior note from another provider
Discussing the case informally with a colleague
Ordering a lab test and reviewing the report
Independently interpreting an EKG beyond the automated reading (Correct answer)

Correct answer: Independently interpreting an EKG beyond the automated reading

Independent interpretation means the physician personally interprets a test (e.g., reads an EKG rhythm strip) in addition to any automated or technician interpretation.

Question 88: Which HIPAA rule specifically addresses the security of electronic Protected Health Information (ePHI)?

HIPAA Privacy Rule
HIPAA Breach Notification Rule
HIPAA Security Rule (Correct answer)
HIPAA Enforcement Rule

Correct answer: HIPAA Security Rule

The HIPAA Security Rule requires covered entities and business associates to implement administrative, physical, and technical safeguards to protect ePHI.

Question 89: Corporate Integrity Agreements (CIAs) are typically entered into between the OIG and a provider as a result of:

Settlement of a federal healthcare fraud investigation (Correct answer)
Annual Medicare cost report submission
Voluntary compliance program implementation
HIPAA Security Rule audit findings

Correct answer: Settlement of a federal healthcare fraud investigation

CIAs are imposed as part of civil settlement agreements requiring providers to implement specific compliance measures as a condition of continued Medicare/Medicaid participation.

Question 90: A physician provides care plan oversight of a home health agency patient for 35 minutes in a calendar month. Which code is reported?

99378
99377
99374
99375 (Correct answer)

Correct answer: 99375

99375 covers care plan oversight for home health patients when physician time is 30 minutes or more in a calendar month.

Question 91: The National Correct Coding Initiative (NCCI) edits are developed and maintained by:

The Office of Inspector General (OIG)
CMS to prevent improper Medicare payments (Correct answer)
The American Academy of Professional Coders (AAPC)
The American Medical Association (AMA)

Correct answer: CMS to prevent improper Medicare payments

CMS developed and maintains the NCCI edits to promote national correct coding methodologies and prevent improper payment of Medicare Part B claims.

Question 92: Which of the following is the primary distinction between fraud and abuse in healthcare billing?

Fraud requires intent to deceive; abuse involves improper billing practices without fraudulent intent (Correct answer)
There is no meaningful difference between fraud and abuse
Abuse results in criminal prosecution; fraud results only in civil penalties
Fraud involves billing errors; abuse involves intentional wrongdoing

Correct answer: Fraud requires intent to deceive; abuse involves improper billing practices without fraudulent intent

Fraud requires knowingly and willfully misrepresenting facts to obtain payment, while abuse refers to practices that are inconsistent with sound fiscal or business practices but lack fraudulent intent.

Question 93: Which CPT code is used for immunohistochemistry (IHC) staining for each antibody reported?

88341
88344
88342 (Correct answer)
88360

Correct answer: 88342

CPT 88342 is reported for each separately reported antibody performed on immunohistochemistry analysis.

Question 94: In ICD-10-PCS, the 'approach' character describes:

The device left in the body
The objective of the procedure
The body system being treated
The technique used to reach the operative site (Correct answer)

Correct answer: The technique used to reach the operative site

The approach character (5th character) in ICD-10-PCS defines the technique used to reach the procedure site, such as open, percutaneous, or endoscopic.

Question 95: What is the correct way to report anesthesia for a patient who has a declared brain death and is undergoing organ harvesting?

No anesthesia code is required as no living patient is present
Use ASA P4 with the emergency modifier
Use ASA P5 with qualifying circumstance 99140
Use ASA P6 which designates brain-dead organ donors (Correct answer)

Correct answer: Use ASA P6 which designates brain-dead organ donors

ASA P6 is specifically assigned to brain-dead patients undergoing procedures for organ donation.

Question 96: Which data element in the UB-04 claim form identifies the attending physician?

Field Locator 80
Field Locator 74
Field Locator 76 (Correct answer)
Field Locator 82

Correct answer: Field Locator 76

Field Locator 76 on the UB-04 identifies the attending physician by NPI and name.

Question 97: A physician excises a benign lesion from a patient's scalp. The excised diameter, including margins, is 2.3 cm. The wound is closed with a simple, single-layer suture. Which CPT code(s) should be reported?

11623
11422, 12001
11423 (Correct answer)
11423, 12001

Correct answer: 11423

CPT codes for lesion excision (11400-11646) are selected based on whether the lesion is benign or malignant, the anatomical location, and the excised diameter (lesion diameter plus margins). In this case, the lesion is benign, located on the scalp, and has an excised diameter of 2.3 cm. CPT code 11423 is for the excision of a benign lesion from the scalp, neck, hands, feet, or genitalia with an excised diameter of 2.1 to 3.0 cm. Simple (single-layer) closure is included in the lesion excision codes and is not reported separately.

Question 98: Which type of audit is conducted by an outside organization to assess a facility's compliance program objectively?

Internal audit
Prospective audit
Concurrent audit
External audit (Correct answer)

Correct answer: External audit

An external audit is performed by an independent third party to provide an objective evaluation of coding accuracy and compliance.

Question 99: A patient chart notes 'erythrocytosis.' This means an abnormal increase in:

Platelets
White blood cells
Red blood cells (Correct answer)
Plasma proteins

Correct answer: Red blood cells

Erythr/o means red, cyt/o means cell, and -osis means abnormal condition, indicating excess red blood cells.

Question 100: A new patient presents to a specialist's office. The patient was referred by the primary care physician. Under current CPT and Medicare guidelines, which code set is appropriate for the office visit?

New patient office codes 99202–99205 (Correct answer)
Outpatient observation codes 99234–99236
Consultation codes 99241–99245
Established patient office codes 99211–99215

Correct answer: New patient office codes 99202–99205

Medicare eliminated consultation codes; the new patient office E/M codes (99202–99205) are used for patients who have not been seen in the practice within three years.

Certified Professional Coder (CPC) Exam

The CPC exam assesses a medical coder's proficiency in CPT, HCPCS Level II, and ICD-10-CM coding guidelines and regulations.

100

Questions

240 min

Time Limit

70%

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