CPC Certified Professional Coder MCQ 5 — Questions and Answers
Question 1: A physician documents that a patient's condition was 'due to' a prior surgery. In ICD-10-CM, how is this relationship captured?
- Using a Z code for history
- Using the appropriate complication code from the T80-T88 range (Correct answer)
- Coding only the current condition without the prior surgery
- Using the E code series
Correct answer: Using the appropriate complication code from the T80-T88 range
Postprocedural complications are reported using codes from the T80-T88 range in ICD-10-CM, which specifically classify complications of surgical and medical care.
Question 2: Which HCPCS Level II code category covers durable medical equipment (DME)?
- A codes
- E codes (Correct answer)
- L codes
- K codes
Correct answer: E codes
HCPCS Level II E codes (E0100-E8002) are used to report durable medical equipment such as wheelchairs, crutches, and hospital beds.
Question 3: When a surgeon performs a procedure and closes an incision, and separately repairs a hernia discovered incidentally during the same surgery, how should this be coded?
- Code only the primary procedure
- Code both procedures with modifier -51 on the secondary procedure (Correct answer)
- Code both procedures with modifier -59 on both
- Code only the hernia repair as it was the more complex procedure
Correct answer: Code both procedures with modifier -51 on the secondary procedure
When multiple procedures are performed at the same operative session, modifier -51 (multiple procedures) is appended to the secondary procedure code to indicate reduced reimbursement applies.
Question 4: Which of the following describes the correct use of a 'V code' equivalent in ICD-10-CM?
- S codes for sequela
- Z codes for factors influencing health status (Correct answer)
- T codes for toxic effects
- W codes for external causes
Correct answer: Z codes for factors influencing health status
ICD-10-CM Z codes (replacing ICD-9-CM V codes) report factors influencing health status and contact with health services, such as vaccination status or family history.
Question 5: A patient undergoes a diagnostic arthroscopy of the knee which is converted to a surgical arthroscopy during the same session. How should this be coded?
- Code both the diagnostic and surgical arthroscopy
- Code only the surgical arthroscopy (Correct answer)
- Code the diagnostic arthroscopy with modifier -52
- Code the surgical arthroscopy with modifier -22
Correct answer: Code only the surgical arthroscopy
When a diagnostic arthroscopy is immediately converted to a surgical arthroscopy, only the surgical arthroscopy is reported because the diagnostic scope is integral to the surgical procedure.
Question 6: Under the Outpatient Prospective Payment System (OPPS), how are hospital outpatient services reimbursed?
- Based on diagnosis-related groups (DRGs)
- Based on ambulatory payment classifications (APCs) (Correct answer)
- Based on the Medicare fee schedule for physicians
- Based on a per diem rate
Correct answer: Based on ambulatory payment classifications (APCs)
The OPPS reimburses hospital outpatient services using Ambulatory Payment Classifications (APCs), which group services with similar clinical characteristics and costs.
Question 7: A coder notices the attending physician documented 'acute-on-chronic heart failure.' How should this be coded in ICD-10-CM?
- Code only the acute heart failure
- Code only the chronic heart failure
- Code the combined acute-on-chronic heart failure with a single combination code (Correct answer)
- Code both acute and chronic separately
Correct answer: Code the combined acute-on-chronic heart failure with a single combination code
ICD-10-CM provides combination codes for acute-on-chronic heart failure (e.g., I50.23 for acute-on-chronic systolic heart failure) that capture both components in a single code.
CPC Certified Professional Coder MCQ 5
A physician documents that a patient's condition was 'due to' a prior surgery.
In ICD-10-CM, how is this relationship captured?