CPCA Exam — Questions and Answers

Question 1: A dermatologist excises a squamous cell carcinoma from the scalp and repairs the wound with an adjacent tissue transfer. How should the repair be billed?

Bill separately with modifier 59
Bill separately without a modifier (Correct answer)
It is bundled into the excision code
Bill separately with modifier 51

Correct answer: Bill separately without a modifier

Adjacent tissue transfer or rearrangement repairs are separately billable from excision codes without an additional modifier because they are not considered bundled services.

Question 2: A patient asks a dermatology practice to amend an entry in their medical record they believe is incorrect. What is the practice required to do?

Review the request and respond within 60 days, accepting or denying with written explanation (Correct answer)
Refer the patient to their physician only
Delete the original entry immediately
Accept the amendment automatically

Correct answer: Review the request and respond within 60 days, accepting or denying with written explanation

HIPAA gives patients the right to request amendments, and covered entities must respond within 60 days, providing written denial reasons if applicable.

Question 3: How many units of CPT 11951 would be reported if a patient receives 12 cc of hyaluronic acid filler in a single session?

12 units of 11951
2 units of 11951
7 units of 11951 (Correct answer)
1 unit of 11951

Correct answer: 7 units of 11951

CPT 11950 covers the first 5 cc; each additional 1 cc is 11951, so 12 − 5 = 7 cc = 7 units of 11951.

Question 4: Which of the following best describes the primary function of the procerus muscle in facial expression?

Creates horizontal wrinkles at the root of the nose (Correct answer)
Closes the eyelids
Pulls the corners of the mouth laterally
Elevates the eyebrows

Correct answer: Creates horizontal wrinkles at the root of the nose

The procerus is a pyramid-shaped muscle located between the eyebrows. Its main function upon contraction is to pull the medial part of the eyebrows downward, which results in the formation of transverse (horizontal) wrinkles over the bridge of the nose.

Question 5: A physician administers a newly FDA-approved injectable biologic that does not yet have a specific HCPCS Level II code. Which of the following codes would be most appropriate to use for billing the drug supply?

J3590 (Unclassified biologics) (Correct answer)
C9399 (Unclassified drugs or biologicals)
99070 (Supplies and materials)
J9999 (Not otherwise classified, antineoplastic drugs)

Correct answer: J3590 (Unclassified biologics)

HCPCS code J3590 is designated for 'Unclassified biologics' and is the appropriate code to use when a specific code has not yet been assigned to a new biologic drug. J3490 is for unclassified drugs in general, but J3590 is more specific for biologics. J9999 is for chemotherapy drugs, C9399 is for hospital outpatient use, and 99070 is a CPT code for supplies not typically used for separately billable drugs.

Question 6: What is the correct code for basal cell carcinoma of the skin of the right ear?

C44.221
C44.219
C44.212
C44.211 (Correct answer)

Correct answer: C44.211

C44.211 represents basal cell carcinoma of the skin of the right ear and external auricular canal.

Question 7: A lab report reads: 'WBC 14.2 K/uL (ref: 4.5–11.0), Neutrophils 88% (ref: 50–70%), Bands 12% (ref: 0–5%).' A coder reviewing this for sepsis criteria notes a 'left shift.' What does a 'left shift' indicate?

An elevation in lymphocytes indicating a viral infection
An increase in immature neutrophils (bands), suggesting acute infection or inflammation (Correct answer)
A shift in red blood cell morphology indicating anemia
A decrease in total white blood cell count

Correct answer: An increase in immature neutrophils (bands), suggesting acute infection or inflammation

A left shift refers to the release of immature neutrophils (bands) into circulation, indicating the bone marrow is working overtime during infection or sepsis.

Question 8: An employee's workstation, locker, or city-owned car may be searched at any time, with or without the employee's knowledge, according to city policy. An employee of the city has reported that the elected City Controller was seen smoking marijuana behind the city building and putting a baggie containing a green leafy substance in his desk about an hour ago. As a result of this report, Officer Randy is asked by his supervisor to search the City Controller's desk. Officer Randy presented the secretary with a documented copy of the city policy when she refused to permit the search on behalf of the City Controller. The City Controller was on a job site checking a city-owned warehouse when the secretary contacted him. He gave the secretary instructions to decline the search because he is an elected politician. Officer Randy pushed his way through the City Controller's desk, past the secretary. Nothing suspicious was discovered. The event resulted in the secretary breaking her arm. The city worker who complained to the city controller was well known to harbor strong feelings against the city controller because he had fired him the month before for being late. <br> <br> Being an elected person, the City Controller declines to allow the search. Which of the following best expresses his position?

That the police officer has merely a copy of the policy, not the policy itself
He's done nothing wrong
There's nothing incriminating in his desk
That he is not a city employee (Correct answer)

Correct answer: That he is not a city employee

The City Controller's instruction to decline the search was explicitly stated as 'because he is an elected politician.' This indicates his position is that, as an elected official, he is not considered a 'city employee' and therefore not subject to the city's employee search policy.

Question 9: A patient is diagnosed with atopic dermatitis of the upper limbs. Which code applies?

L20.81 (Correct answer)
L20.82
L20.89
L20.9

Correct answer: L20.81

L20.81 is the code for atopic dermatitis of the hands and upper limbs.

Question 10: A secondary rhinoplasty requiring major revision of the bony pyramid and cartilages is performed. Which CPT code is most appropriate?

30430
30450 (Correct answer)
30435
30462

Correct answer: 30450

CPT 30450 describes a secondary rhinoplasty requiring major revision, including work on the bony and cartilaginous structures.

Question 11: A coder is reporting destruction of cutaneous vascular lesions covering 8 sq cm via laser. Which CPT code applies?

17108
17107
17106 (Correct answer)
17110

Correct answer: 17106

CPT 17106 reports destruction of cutaneous vascular proliferative lesions with a total treatment area less than 10 sq cm.

Question 12: What document must a patient sign to authorize the release of their PHI to a third party not involved in treatment, payment, or operations?

Assignment of Benefits
HIPAA Authorization Form (Correct answer)
Notice of Privacy Practices
ABN Form

Correct answer: HIPAA Authorization Form

A signed HIPAA Authorization Form is required before disclosing PHI for purposes outside of treatment, payment, and healthcare operations.

Question 13: Which ICD-10-CM code category is most commonly linked to laser treatment for actinic keratosis to support medical necessity?

L81.1
L85.8
L70.0
L57.0 (Correct answer)

Correct answer: L57.0

ICD-10-CM code L57.0 (Actinic keratosis) is the primary diagnosis code used to establish medical necessity for laser destruction of premalignant sun-damaged skin lesions.

Question 14: When coding wound repair, which three variables are required to select the correct CPT code?

Width, wound etiology, and anesthesia type
Surgeon experience, repair time, and suture type
Total length, complexity (simple/intermediate/complex), and anatomical location (Correct answer)
Depth, patient age, and number of layers

Correct answer: Total length, complexity (simple/intermediate/complex), and anatomical location

Wound repair CPT codes are determined by the combined length of wounds in the same complexity category, the repair complexity (simple, intermediate, or complex), and the anatomical location of the repair.

Question 15: During a PCI DSS audit, an assessor reviews cardholder data flows. What document is commonly used to map where cardholder data is stored, processed, and transmitted?

Risk Register
System Security Plan (SSP)
Business Impact Analysis (BIA)
Data Flow Diagram (DFD) (Correct answer)

Correct answer: Data Flow Diagram (DFD)

A Data Flow Diagram (DFD) visually maps where cardholder data enters, moves through, and exits an environment, which is essential for defining the PCI DSS scope.

Question 16: Students can get help seeking part-time work through the university's Career Services Center, and there are listings for open positions _____ the office entrance.

From
With
Of
Beside (Correct answer)

Correct answer: Beside

'Beside' means next to or at the side of, which accurately describes the typical location for job listings in relation to an office entrance. The listings would usually be posted physically near the entrance for easy visibility and access by students. The other prepositions do not convey this spatial relationship as effectively.

Question 17: A facial epidermal chemical peel is performed to treat fine wrinkling. Which CPT code applies?

15788 (Correct answer)
15793
15789
15792

Correct answer: 15788

CPT 15788 describes a chemical peel of the facial area at the epidermal level.

Question 18: What is the correct plural of 'bacterium'?

Bacterias
Bacteriums
Bacteriae
Bacteria (Correct answer)

Correct answer: Bacteria

'Bacteria' is the Latin plural of 'bacterium,' following the Latin -um to -a pluralization rule.

Question 19: What does the prefix 'hyper-' mean?

Below normal / deficient
Above normal / excessive (Correct answer)
Before / in front of
Around / surrounding

Correct answer: Above normal / excessive

'Hyper-' means above normal or excessive, as in hypertension (high blood pressure).

Question 20: A patient has a malignant melanoma excised with a 2 cm margin from the right cheek. The surgeon also excises a basal cell carcinoma from the left cheek during the same session. What modifier is added to the second excision code?

Modifier RT/LT
Modifier 50
Modifier 25
Modifier 51 (Correct answer)

Correct answer: Modifier 51

Modifier 51 is appended to the secondary procedure to indicate multiple procedures were performed at the same session.

Question 21: When a patient's insurance covers only medically necessary procedures, what ICD-10-CM code would NOT support coverage for botulinum toxin facial injections?

G51.3 (hemifacial spasm)
G24.5 (blepharospasm)
Z41.1 (encounter for cosmetic surgery) (Correct answer)
G51.4 (facial myokymia)

Correct answer: Z41.1 (encounter for cosmetic surgery)

Z41.1 indicates a purely cosmetic encounter with no underlying medical condition, which payers exclude from medical benefit coverage.

Question 22: Which element is MOST critical when documenting medical necessity for a prior authorization request?

Clinical indicators that support the requested service (Correct answer)
Insurance plan's formulary tier for the drug
The provider's billing history for the service
Patient's preferred treatment option

Correct answer: Clinical indicators that support the requested service

Clinical indicators—such as diagnosis, severity, prior treatment failures, and objective findings—form the core of any medical necessity documentation.

Question 23: Blepharoplasty CPT codes are found under which CPT Surgery subsection?

Eye and Ocular Adnexa (Correct answer)
Nervous System
Integumentary System
Musculoskeletal System

Correct answer: Eye and Ocular Adnexa

Blepharoplasty codes (67900 series) are located in the Eye and Ocular Adnexa section of CPT because the procedure involves the eyelids, which are classified under ocular structures.

Question 24: In medical documentation, what does the abbreviation 'PRN' stand for?

Primary renal notation
Pro re nata (as needed) (Correct answer)
Per rectum now
Patient requires nursing

Correct answer: Pro re nata (as needed)

PRN is Latin for 'pro re nata,' meaning a medication or treatment is given as needed.

Question 25: An emergency department note states: 'Patient arrived via EMS in extremis with a GCS of 6. Immediate intubation performed for airway protection.' What does a GCS of 6 indicate?

Normal neurological function with pain-related scoring only
Severe impairment of consciousness, indicating critical neurological status (Correct answer)
Mild confusion with intact airway reflexes
Moderate sedation appropriate for procedural anesthesia

Correct answer: Severe impairment of consciousness, indicating critical neurological status

The Glasgow Coma Scale (GCS) ranges from 3 (deep coma) to 15 (normal); a score of 6 indicates severe impairment of consciousness.

Question 26: A laser is used to destroy 10 benign lesions other than skin tags or vascular lesions. Which CPT code is correct?

17110 (Correct answer)
17111
17000
17106

Correct answer: 17110

CPT 17110 reports destruction of benign lesions (other than skin tags or vascular lesions) when up to 14 lesions are treated in a single session.

Question 27: Which term describes the maximum amount a payer will reimburse for a specific service based on fee schedule data?

Deductible
Allowed amount (Correct answer)
Billed charge
Copayment

Correct answer: Allowed amount

The allowed amount is the maximum the payer will pay for a covered service under their fee schedule.

Question 28: Which word is the correct plural form of 'diagnosis'?

Diagnosis
Diagnoses (Correct answer)
Diagnosees
Diagnosises

Correct answer: Diagnoses

Words ending in '-sis' form their plural by changing '-sis' to '-ses', giving 'diagnoses'.

Question 29: An intact breast implant is removed without replacement. Which CPT code is reported?

19330
19325
19342
19328 (Correct answer)

Correct answer: 19328

CPT 19328 describes removal of an intact mammary implant.

Question 30: The medical term 'xeroderma' refers to which skin condition?

Abnormal dryness (Correct answer)
Yellowing of the skin
Excessive oiliness
Excessive sweating

Correct answer: Abnormal dryness

Xeroderma means abnormally dry skin, derived from the Greek 'xero' (dry) and 'derma' (skin).

Question 31: Which code represents total body surface area (TBSA) burned when 30-39% of body surface has third-degree burns?

T32.33
T31.33 (Correct answer)
T31.39
T31.30

Correct answer: T31.33

T31.33 indicates 30-39% total body surface burned with 30-39% third-degree burns.

Question 32: A progress note reads: 'The wound measures 3.5 cm in length with serous drainage and mild erythema at the margins. No induration or crepitus noted.' The coder must identify the wound condition. What does 'serous drainage' indicate?

Purulent infection requiring antibiotics
Bleeding from wound edges
Clear or slightly yellow fluid, typically non-infectious (Correct answer)
Necrotic tissue formation

Correct answer: Clear or slightly yellow fluid, typically non-infectious

Serous drainage is thin, watery, and clear or slightly yellow, which is generally a normal part of wound healing.

Question 33: Which of the following is an example of a compensating control in a compliance framework?

Hiring additional staff to review logs manually
Documenting a policy acknowledging a known risk
Implementing encryption in place of an unachievable technical requirement (Correct answer)
Purchasing cyber insurance to cover potential losses

Correct answer: Implementing encryption in place of an unachievable technical requirement

A compensating control is an alternative measure implemented when a primary required control cannot be met, such as using encryption to substitute for a specific technical safeguard.

Question 34: A patient undergoes excision of a cyst on the neck and a separate excision of a lipoma on the back in the same session. Which modifier is required on the second procedure?

Modifier 51 (Correct answer)
Modifier 22
Modifier 59
Modifier 52

Correct answer: Modifier 51

Modifier 51 is appended to the second and subsequent procedures when multiple surgical procedures are performed at the same session by the same surgeon.

Question 35: Modifier -59 is applied in surgical coding to indicate:

A bilateral procedure performed on both sides
A procedure repeated by the same physician on the same day
A distinct procedural service not ordinarily reported together with another procedure on the same day (Correct answer)
A reduced or discontinued service

Correct answer: A distinct procedural service not ordinarily reported together with another procedure on the same day

Modifier -59 identifies a distinct procedural service that is separate and independent from another procedure performed on the same date, used to override an NCCI (National Correct Coding Initiative) edit when clinically appropriate.

Question 36: When the same surgeon performs a subsequent related procedure on a patient who is still within the global period of an initial procedure, which modifier is used?

-58 (Correct answer)
-79
-52
-76

Correct answer: -58

Modifier -58 indicates a staged or related procedure performed by the same physician during the postoperative period of the original procedure, allowing separate billing for planned subsequent operative stages.

Question 37: A patient receives 50 mg of diphenhydramine HCl injection. The HCPCS code J1200 covers up to 50 mg. How many units are billed?

1 unit (Correct answer)
2 units
0.5 units
As documented by the physician

Correct answer: 1 unit

Since exactly 50 mg was administered and J1200 covers up to 50 mg, 1 unit is reported.

Question 38: Which ICD-10-CM code best supports medical necessity for botulinum toxin injections treating hemifacial spasm?

L57.0
M79.1
G51.3 (Correct answer)
R11.0

Correct answer: G51.3

G51.3 is the ICD-10 code for hemifacial spasm, which is a recognized covered indication for chemodenervation.

Question 39: For a CPCA candidate, which element is most critical to review when auditing a facial injection claim for upcoding?

Whether the patient signed an aesthetic consent form
Volume of material documented in the operative note versus units billed (Correct answer)
The ZIP code of the facility
The brand name of the filler product

Correct answer: Volume of material documented in the operative note versus units billed

Upcoding audits focus on whether the quantity of material billed matches what is documented in the clinical record.

Question 40: When is it most appropriate to use 'history of' in diagnosis documentation for medical necessity?

When the condition is actively being treated
When the provider is unsure of the current status
When documenting a resolved condition relevant to current care (Correct answer)
As a substitute for a current confirmed diagnosis

Correct answer: When documenting a resolved condition relevant to current care

'History of' appropriately signals a resolved condition that provides relevant clinical context, not an active diagnosis driving current treatment.

Question 41: What is a 'clean claim' in medical billing?

A claim submitted on paper rather than electronically
A claim with all required information to be processed without additional information requests (Correct answer)
A claim for a patient with no outstanding balance
A claim that has been paid in full

Correct answer: A claim with all required information to be processed without additional information requests

A clean claim contains all required fields and information needed for the payer to adjudicate it without delay or additional requests.

Question 42: Which standard provides a framework for information security management systems (ISMS) and is frequently used as a basis for compliance audits?

NIST SP 800-61
COBIT 5
ISO/IEC 27001 (Correct answer)
ITIL v4

Correct answer: ISO/IEC 27001

ISO/IEC 27001 is the internationally recognized standard for establishing, implementing, maintaining, and continually improving an ISMS.

Question 43: Which sentence correctly uses a colon?

The diagnosis included: three conditions, diabetes, hypertension, and obesity.
The diagnosis included three: conditions diabetes, hypertension, and obesity.
The diagnosis: included three conditions diabetes, hypertension, and obesity.
The diagnosis included three conditions: diabetes, hypertension, and obesity. (Correct answer)

Correct answer: The diagnosis included three conditions: diabetes, hypertension, and obesity.

A colon is correctly used after a complete independent clause to introduce a list.

Question 44: Which CPT code reports a rhytidectomy of the neck with platysmal tightening?

15827
15825 (Correct answer)
15826
15824

Correct answer: 15825

CPT 15825 specifically describes rhytidectomy of the neck with platysmal tightening (platysmal flap).

Question 45: Which type of documentation is LEAST effective in supporting medical necessity for a complex surgical procedure?

Operative report detailing findings and technique
Generic templated note with no patient-specific details (Correct answer)
Imaging reports confirming the pathology
Pre-operative evaluation with risk stratification

Correct answer: Generic templated note with no patient-specific details

Generic templates lacking patient-specific clinical details fail to demonstrate individualized medical necessity and are frequently cited in denials and audits.

Question 46: What does the suffix '-scopy' indicate?

Surgical incision
Visual examination (Correct answer)
Abnormal condition
Recording of

Correct answer: Visual examination

'-scopy' means visual examination, as in 'colonoscopy' (visual examination of the colon).

Question 47: What does the suffix '-ectomy' mean?

Surgical incision
Visual examination
Surgical removal (Correct answer)
Creation of an opening

Correct answer: Surgical removal

'-ectomy' means surgical removal, as in 'appendectomy' (removal of the appendix).

Question 48: When a physician performs a separate evaluation and management (E/M) service on the same day as a facial injection, which modifier should be added to the E/M code?

Modifier 57
Modifier 52
Modifier 25 (Correct answer)
Modifier 51

Correct answer: Modifier 25

Modifier 25 indicates a significant, separately identifiable E/M service was provided on the same day as a procedure.

Question 49: What is the purpose of a compliance risk register?

To document, prioritize, and track identified compliance risks and their mitigation status (Correct answer)
To list all third-party vendors and their contractual obligations
To store copies of all regulatory correspondence received by the organization
To record all employee disciplinary actions related to policy violations

Correct answer: To document, prioritize, and track identified compliance risks and their mitigation status

A compliance risk register is a structured document that captures identified compliance risks, their likelihood and impact, assigned owners, and the status of mitigation efforts.

Question 50: A patient receives adalimumab 40 mg via subcutaneous injection. Which HCPCS code is reported?

J0217
J0170
J0129
J0135 (Correct answer)

Correct answer: J0135

J0135 is the HCPCS code for adalimumab injection, 20 mg, so 40 mg = 2 units of J0135.

Question 51: A patient presents with a second-degree burn of the left palm. Which code is correct?

T23.352A
T23.252A (Correct answer)
T23.202A
T23.152A

Correct answer: T23.252A

T23.252A represents a second-degree burn of the left palm, initial encounter.

Question 52: Which CPT code reports a primary rhinoplasty that includes major septal repair?

30420 (Correct answer)
30430
30400
30410

Correct answer: 30420

CPT 30420 describes primary rhinoplasty including major septal repair.

Question 53: In dermatology, modifier 25 is appended to an E/M service code when:

The patient is seen for a follow-up within the global period
The E/M is performed on a different date than the procedure
A significant, separately identifiable E/M is performed on the same day as a minor procedure (Correct answer)
The E/M involves a new patient

Correct answer: A significant, separately identifiable E/M is performed on the same day as a minor procedure

Modifier 25 signals that a significant, separately identifiable evaluation and management service was provided on the same day as a procedure.

Question 54: A pathology report reads: 'Gross examination reveals a 2.3 cm firm, irregular mass with ill-defined borders. Microscopic examination shows pleomorphic cells with frequent mitotic figures.' What does 'pleomorphic' suggest about the cells?

The cells show signs of normal differentiation
The cells are arranged in glandular patterns
The cells are uniform in size and shape
The cells vary widely in size and shape, suggesting malignancy (Correct answer)

Correct answer: The cells vary widely in size and shape, suggesting malignancy

Pleomorphic cells vary in size and shape, which is a hallmark of malignant (cancerous) tissue.

Question 55: A new patient presents for a comprehensive full-body skin examination due to a family history of melanoma. During this extensive evaluation, the dermatologist identifies a highly suspicious 0.8 cm nevus on the patient's back and performs a shave biopsy in the same visit. How should the services be coded to ensure proper reimbursement for both the distinct evaluation and the minor procedure?

Bill only for the shave biopsy as the exam is included.
Append modifier 25 to the E/M code. (Correct answer)
Report the E/M code and the biopsy code with no modifiers.
Append modifier 59 to the E/M code.

Correct answer: Append modifier 25 to the E/M code.

Modifier 25 is used to indicate that a significant, separately identifiable Evaluation and Management (E/M) service was performed by the same physician on the same day as a minor surgical procedure. The comprehensive full-body skin exam is a distinct and separate service from the work involved in performing the shave biopsy itself.

Question 56: When coding for hyaluronic acid filler injected into the nasolabial folds, which CPT code category is most appropriate?

Chemodenervation (64612)
Incision and drainage (10060)
Soft tissue augmentation (e.g., 11950-11954) (Correct answer)
Destruction of benign lesion (17000)

Correct answer: Soft tissue augmentation (e.g., 11950-11954)

Soft tissue augmentation codes (11950-11954) cover injectable filler materials placed into subcutaneous tissue.

Question 57: Which skin appendage is responsible for producing the oily substance that lubricates skin and hair?

Apocrine sweat gland
Sebaceous gland (Correct answer)
Merocrine gland
Eccrine sweat gland

Correct answer: Sebaceous gland

Sebaceous glands produce sebum, an oily substance that lubricates the skin and hair and is secreted into the hair follicle.

Question 58: What does the prefix 'tachy-' mean?

Large
Small
Fast / rapid (Correct answer)
Slow

Correct answer: Fast / rapid

'Tachy-' means fast or rapid, as in tachycardia (rapid heart rate).

Question 59: Which of the following best describes a compliance gap analysis?

An investigation into a specific security incident
A review of all financial transactions over a fiscal year
A comparison between current security controls and required standards (Correct answer)
A vulnerability scan of all networked systems

Correct answer: A comparison between current security controls and required standards

A gap analysis compares an organization's current state against required compliance standards to identify areas needing remediation.

Question 60: A coder reviews 48 charts in a 6-hour workday. What is the average time spent per chart in minutes?

7.5 minutes (Correct answer)
6 minutes
10 minutes
8 minutes

Correct answer: 7.5 minutes

Total minutes = 6 × 60 = 360; time per chart = 360 ÷ 48 = 7.5 minutes.

Question 61: Modifier 76 in dermatology is used when:

A procedure is performed on the same lesion in a subsequent encounter
A procedure is staged and planned
A different physician repeats a procedure during the global period
The same physician repeats the same procedure on the same day (Correct answer)

Correct answer: The same physician repeats the same procedure on the same day

Modifier 76 is appended when the same physician repeats the same procedure or service on the same date.

Question 62: Which statement BEST describes the relationship between ICD-10-CM specificity and medical necessity?

Specificity matters only for inpatient claims
Code specificity only affects reimbursement rates, not necessity determinations
Less specific codes are preferred to avoid audit risk
Greater code specificity provides clearer clinical context that supports medical necessity (Correct answer)

Correct answer: Greater code specificity provides clearer clinical context that supports medical necessity

Highly specific ICD-10-CM codes communicate the precise nature and severity of a condition, giving payers the clinical detail needed to validate that a service is necessary.

Question 63: How long must a covered entity retain HIPAA-related policies and procedures?

10 years
3 years
5 years
6 years (Correct answer)

Correct answer: 6 years

HIPAA requires covered entities to retain documentation of policies, procedures, and actions for at least 6 years from creation or last effective date.

Question 64: A provider injects a soft tissue filler into the patient's nasolabial folds for cosmetic augmentation. The total volume of the filler material injected is 4.5 cc. How should this service be coded?

11950
11951 (Correct answer)
11954
11952

Correct answer: 11951

The CPT® codes for subcutaneous injection of filling material are based on the volume injected. Code 11951 is defined as 'Subcutaneous injection of filling material (eg, collagen); 1.1 to 5.0 cc'. Since 4.5 cc falls within this range, 11951 is the correct code. 11950 is for 1.0 cc or less, 11952 is for 5.1 to 10.0 cc, and 11954 is for over 10.0 cc.

Question 65: When a compounded injectable drug has no specific HCPCS code, which code is most appropriate?

J3490
J9999
J3590 (Correct answer)
C9399

Correct answer: J3590

J3590 (Unclassified biologics) is used for compounded injectables without a specific HCPCS code; J3490 covers unclassified drugs.

Question 66: When coding excision of benign lesions of the skin, which CPT range is used?

11200–11201
11300–11313
11400–11471 (Correct answer)
17000–17004

Correct answer: 11400–11471

CPT codes 11400–11471 are used for excision of benign lesions, with selection based on the lesion's anatomical location and the excised diameter including margins.

Question 67: When coding a burn, which 7th character indicates the encounter is for aftercare of a healing burn?

A
S
E
D (Correct answer)

Correct answer: D

The 7th character 'D' indicates a subsequent encounter for a healing burn in ICD-10-CM.

Question 68: Which metric is most useful for tracking the effectiveness of a compliance remediation program over time?

Number of third-party vendors onboarded per quarter
Mean time to remediate (MTTR) identified compliance findings (Correct answer)
Total IT budget allocated to compliance activities
Total number of employees trained on security awareness

Correct answer: Mean time to remediate (MTTR) identified compliance findings

Mean time to remediate (MTTR) measures how quickly an organization resolves identified compliance findings, directly reflecting the effectiveness of the remediation process.

Question 69: A dermatologist performs photodynamic therapy (PDT) for extensive actinic keratoses on a Medicare patient's face. The Local Coverage Determination (LCD) for this service specifies that medical necessity is supported only after a trial and failure of topical therapies. The physician's note, however, only mentions the patient's preference for PDT. What is the likely outcome of this claim?

The claim will be denied because the documentation fails to meet the specific medical necessity criteria outlined in the LCD. (Correct answer)
The claim will be automatically approved if a diagnosis of actinic keratosis is present.
The claim will be paid without issue because PDT is a covered service.
The claim will be paid at a reduced rate due to insufficient documentation.

Correct answer: The claim will be denied because the documentation fails to meet the specific medical necessity criteria outlined in the LCD.

Payer policies, especially Medicare's Local Coverage Determinations (LCDs), provide specific rules for coverage. Failure to document that these specific criteria have been met (in this case, the failure of conservative therapy) will almost certainly lead to a denial for lack of medical necessity, even if the service itself is generally covered for the condition.

Question 70: When a payer bundles two separately billed services into one payment, what edit system is typically responsible?

NCCI (National Correct Coding Initiative) edits (Correct answer)
HIPAA transaction rules
The ABN process
LCD guidelines

Correct answer: NCCI (National Correct Coding Initiative) edits

NCCI edits are CMS-developed code pairs that prevent inappropriate billing of two codes that should not be reported together.

Question 71: A patient with numerous actinic keratoses on the face undergoes photodynamic therapy (PDT). The physician's staff applies a photosensitizing drug, which incubates for 60 minutes. The physician then personally administers blue light therapy to activate the drug. How should the physician's service for the PDT session be reported?

96573 (Photodynamic therapy... with local application and incubation... per day) (Correct answer)
17000 and 17003 (Destruction of premalignant lesions)
96999 (Unlisted special dermatological service or procedure)
96567 (Photodynamic therapy... by patient application of light source)

Correct answer: 96573 (Photodynamic therapy... with local application and incubation... per day)

CPT code 96573 accurately describes the complete PDT service performed in the office, which includes the application of the photosensitizing drug, the required incubation period, and the subsequent light therapy administered by the physician or qualified healthcare professional. Code 96567 is incorrect because it specifies the patient applies the light source. The 17000 series codes are for other methods of destruction, not PDT.

Question 72: What is the maximum civil monetary penalty per violation category under HIPAA for willful neglect not corrected?

$50,000
$100,000
$10,000
$1,900,000 per calendar year per violation category (Correct answer)

Correct answer: $1,900,000 per calendar year per violation category

For willful neglect not corrected, HIPAA penalties can reach $1,919,173 per calendar year per violation category (adjusted for inflation).

Question 73: An operative report states: 'The patient underwent arthroscopic debridement of the right knee with partial medial meniscectomy. The chondral surfaces were inspected and found to be intact.' What does 'debridement' mean in a surgical context?

Injection of anti-inflammatory agents into a joint
Reconstruction of damaged tissue with grafts
Closure of a wound using sutures or staples
Removal of damaged, necrotic, or foreign tissue to promote healing (Correct answer)

Correct answer: Removal of damaged, necrotic, or foreign tissue to promote healing

Debridement is the surgical removal of devitalized, damaged, or contaminated tissue to allow healthy tissue to heal.

Question 74: What is the ICD-10-CM code for an unstageable pressure ulcer of the sacral region?

L89.150 (Correct answer)
L89.159
L89.151
L89.154

Correct answer: L89.150

L89.150 represents an unstageable pressure ulcer of the sacral region.

Question 75: An employee's workstation, locker, or city-owned car may be searched at any time, with or without the employee's knowledge, according to city policy. An employee of the city has reported that the elected City Controller was seen smoking marijuana behind the city building and putting a baggie containing a green leafy substance in his desk about an hour ago. As a result of this report, Officer Randy is asked by his supervisor to search the City Controller's desk. Officer Randy presented the secretary with a documented copy of the city policy when she refused to permit the search on behalf of the City Controller. The City Controller was on a job site checking a city-owned warehouse when the secretary contacted him. He gave the secretary instructions to decline the search because he is an elected politician. Officer Randy pushed his way through the City Controller's desk, past the secretary. Nothing suspicious was discovered. The event resulted in the secretary breaking her arm. The city worker who complained to the city controller was well known to harbor strong feelings against the city controller because he had fired him the month before for being late. <br> <br> Based on the passage, which of the following statements is accurate?

The city worker who reported the crime actually saw what he reported
The city worker's report of a crime is reliable
Before the officer inspected the drawer, the City Controller removed the bag of marijuana.
The city worker had a motive to harm the reputation of the City Controller (Correct answer)

Correct answer: The city worker had a motive to harm the reputation of the City Controller

The passage clearly states that 'The city worker who complained to the city controller was well known to harbor strong feelings against the city controller because he had fired him the month before for being late.' This directly reveals a personal grudge and a motive for the worker to potentially harm the City Controller's reputation through the complaint.

Question 76: Which code represents tinea pedis (athlete's foot)?

B35.1
L30.3
B36.0
B35.3 (Correct answer)

Correct answer: B35.3

B35.3 is the ICD-10-CM code for tinea pedis (dermatophytosis of the foot).

Question 77: For Medicare patients, which modifier must be appended to an E/M code billed on the same day as a minor dermatological procedure to ensure separate payment?

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

Correct answer: Modifier 25

Modifier 25 must be appended to the E/M code to indicate it is a significant, separately identifiable service from a minor procedure performed on the same day.

Question 78: Which framework is most commonly used by US federal agencies to categorize information systems based on the potential impact of a security breach?

COBIT 2019
NIST FIPS 199 (Correct answer)
CIS Controls v8
ISO/IEC 27001

Correct answer: NIST FIPS 199

NIST FIPS 199 establishes security categorization standards for federal information and information systems using Low, Moderate, and High impact levels.

Question 79: A patient presents for destruction of multiple actinic keratoses. Five lesions are treated. How are the additional lesions (beyond the first) coded?

Each is billed with a separate CPT code and modifier 51
Each additional lesion requires modifier 59
Additional lesions are included in the base code without separate billing
Additional lesions are reported with add-on codes (Correct answer)

Correct answer: Additional lesions are reported with add-on codes

CPT includes add-on codes (e.g., 17003) for each additional actinic keratosis destroyed beyond the first two, which do not require modifier 51.

Question 80: A patient has a healed pressure ulcer of the left hip that has since resolved, but the current encounter documents its history. How should this be coded?

L89.229
Z96.641
Z87.39 (Correct answer)
L89.222

Correct answer: Z87.39

Z87.39 (personal history of other musculoskeletal disorders) or appropriate personal history code is used once a pressure ulcer has completely healed.

Question 81: Which word correctly completes the sentence: 'The patient _____ comply with the treatment plan.'?

does not to
did no
did not (Correct answer)
did not to

Correct answer: did not

'Did not' is the correct negation for a simple past tense verb phrase.

Question 82: Modifier 22 in dermatology is used to indicate:

Increased procedural services beyond what is usually required (Correct answer)
Bilateral procedures
A reduced service level
A procedure performed on a newborn

Correct answer: Increased procedural services beyond what is usually required

Modifier 22 is appended when the work required to perform the procedure is substantially greater than typically required, justifying additional reimbursement.

Question 83: Which of the following is an example of de-identified health information under HIPAA?

A fax with the patient name blacked out but date of birth visible
An electronic record with the name replaced by a patient ID number
A data set with all 18 HIPAA identifiers removed (Correct answer)
A patient report with initials and ZIP code

Correct answer: A data set with all 18 HIPAA identifiers removed

De-identified information has had all 18 HIPAA identifiers removed or undergone statistical expert determination that re-identification risk is very small.

Question 84: When a physician uses a qualified surgical assistant during an aesthetic procedure, which modifier is typically appended to the assistant's claim?

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

Correct answer: -80

Modifier -80 (Assistant Surgeon) is reported by the assistant surgeon's provider to indicate that a qualified physician assisted the primary surgeon during the procedure.

Question 85: Bilateral upper eyelid blepharoplasty is performed during the same session. How should this be reported?

15822 on two separate lines without modifier
15822 and 15820 on separate lines
15822 reported once (bilateral is included in the descriptor)
15822 with modifier 50 (Correct answer)

Correct answer: 15822 with modifier 50

Bilateral blepharoplasty is reported with CPT 15822 and modifier 50 to indicate the procedure was performed on both upper eyelids.

Question 86: Collagen injections for soft tissue augmentation are reported using CPT 11950 for the initial how many cc of material?

1 cc
10 cc
3 cc
5 cc (Correct answer)

Correct answer: 5 cc

CPT 11950 covers the first 5 cc of injectable material for soft tissue augmentation.

Question 87: Which ICD-10-CM code describes seborrheic dermatitis of the scalp?

L20.81
L21.9
L21.0 (Correct answer)
L21.1

Correct answer: L21.0

L21.0 specifically identifies seborrheic capitis, or seborrheic dermatitis of the scalp.

Question 88: What is the 'minimum necessary' standard under HIPAA?

The minimum documentation required for billing
The smallest claim amount that can be submitted
The fewest staff allowed access to patient records
Using only the minimum PHI needed to accomplish the intended purpose (Correct answer)

Correct answer: Using only the minimum PHI needed to accomplish the intended purpose

The minimum necessary standard requires covered entities to limit PHI use and disclosure to only what is needed for a specific purpose.

Question 89: A patient receives a non-ablative fractional laser treatment on their full face to improve skin texture. This procedure heats the underlying dermal tissue to stimulate collagen production without removing the epidermal layer. Which of the following is the most appropriate CPT® code to report?

17110 (Destruction of benign lesions... up to 14 lesions)
17999 (Unlisted procedure, skin, mucous membrane and subcutaneous tissue) (Correct answer)
96900 (Actinotherapy (ultraviolet light))
15780 (Dermabrasion; total face)

Correct answer: 17999 (Unlisted procedure, skin, mucous membrane and subcutaneous tissue)

There is no specific CPT code for non-ablative laser resurfacing. Unlike ablative procedures, it is not analogous to dermabrasion (15780) because the epidermis remains intact. Therefore, the correct code is 17999, the unlisted procedure code for the skin. The claim must be submitted with comprehensive documentation detailing the service performed.

Question 90: The stratum granulosum is named for the granules it contains. What do these granules primarily contain?

Lipid droplets only
Keratohyalin (Correct answer)
Melanin
Glycogen

Correct answer: Keratohyalin

The stratum granulosum contains keratohyalin granules that play a key role in the formation of the skin's barrier.

Question 91: A CPCA is reviewing audit logs and notices that log entries have timestamps that are inconsistent with each other. What is the most likely root cause?

An insider threat attempting to cover their tracks
Lack of time synchronization across systems using NTP (Correct answer)
A denial-of-service attack on the logging server
Misconfigured firewall blocking log transmission

Correct answer: Lack of time synchronization across systems using NTP

Inconsistent timestamps across systems are typically caused by lack of synchronized clocks, which is addressed by implementing NTP (Network Time Protocol).

Question 92: A provider sees 18 patients on Monday, 22 on Tuesday, and 16 on Wednesday. What is the average number of patients seen per day?

56
18.67 (Correct answer)
19
20

Correct answer: 18.67

Total patients = 18 + 22 + 16 = 56; average = 56 ÷ 3 ≈ 18.67.

Question 93: Which of the following injectable drugs is reported using HCPCS code J0696?

Cefazolin sodium
Cefepime HCl
Ceftazidime
Ceftriaxone sodium (Correct answer)

Correct answer: Ceftriaxone sodium

J0696 is the HCPCS code for ceftriaxone sodium injection, 250 mg.

Question 94: A patient is diagnosed with a stage 3 pressure ulcer of the right heel. Which ICD-10-CM code applies?

L89.612
L89.613 (Correct answer)
L89.614
L89.610

Correct answer: L89.613

L89.613 is the correct code for a stage 3 pressure ulcer of the right heel in ICD-10-CM.

Question 95: A brow lift and blepharoplasty are performed by the same surgeon during the same operative session. How should these be reported?

Report only the brow lift as the primary and higher-valued procedure
Report both procedures with modifier 51 on the secondary procedure (Correct answer)
Report only the blepharoplasty because it has a higher relative value
Report both procedures with modifier 59 on each

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

When two distinct procedures are performed during the same session by the same surgeon, both are reported with modifier 51 appended to the secondary procedure.

Question 96: What is the role of InterQual criteria in medical necessity determination?

They provide evidence-based clinical benchmarks payers use to evaluate appropriateness of care (Correct answer)
They establish credentialing standards for providers
They define HIPAA privacy requirements
They set Medicare reimbursement rates

Correct answer: They provide evidence-based clinical benchmarks payers use to evaluate appropriateness of care

InterQual criteria are evidence-based guidelines used by payers and utilization management professionals to assess whether a level of care or service meets medical necessity standards.

Question 97: A radiology report states: 'Chest X-ray demonstrates bilateral infiltrates with air bronchograms consistent with consolidation. No pleural effusion identified.' What condition do bilateral infiltrates with consolidation most likely represent?

Pulmonary embolism
Pneumonia (Correct answer)
Pneumothorax
Pleural effusion

Correct answer: Pneumonia

Bilateral infiltrates with consolidation and air bronchograms are classic radiographic signs of pneumonia.

Question 98: Under GDPR, what is the maximum timeframe an organization has to notify the supervisory authority of a personal data breach?

72 hours (Correct answer)
48 hours
7 days
24 hours

Correct answer: 72 hours

GDPR Article 33 requires organizations to notify the competent supervisory authority of a personal data breach within 72 hours of becoming aware of it.

Question 99: A provider's AR balance is $85,000. They collect $12,500 in week 1 and $9,800 in week 2. What is the remaining AR balance?

$22,300
$75,200
$62,700 (Correct answer)
$72,500

Correct answer: $62,700

Total collected = $12,500 + $9,800 = $22,300; remaining AR = $85,000 − $22,300 = $62,700.

Question 100: What is the term for the shedding or scaling of the outer layers of the epidermis?

Excoriation
Exfoliation (desquamation) (Correct answer)
Erosion
Exudation

Correct answer: Exfoliation (desquamation)

Desquamation (exfoliation) is the normal or pathological shedding of the outermost layers of the stratum corneum.

CPCA Exam

The CPCA Exam exam validates essential knowledge and skills required for certification or licensure in this field.

100

Questions

120 min

Time Limit

70%

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These practice questions were written with AI tools. They are not real exam questions. Exam facts are checked against the official sources listed below. Not reviewed by a subject-matter expert. Editorial policy

Sources & references

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knowledgebase.policeapp.com — Passing score, score release · verified Oct 2026
policeapp.com — Eligibility, fees, renewal, retake fee, retake policy, score validity · verified Oct 2026
cpcanet.org — Test delivery · verified Oct 2026