AAPC Certified Professional Coder (CPC) Exam — Questions and Answers

Question 1: When a surgeon performs two separate procedures during the same operative session, which modifier is most commonly appended?

-22
-59
-25
-51 (Correct answer)

Correct answer: -51

Modifier -51 indicates multiple procedures performed during the same session by the same provider.

Question 2: What does the etiology/manifestation convention require in ICD-10-CM?

Two codes are required: the underlying disease first, followed by the manifestation code (Correct answer)
Manifestation codes may stand alone when the etiology is unknown
Only one code is needed when a condition has both an etiology and manifestation
The manifestation code is always sequenced before the etiology code

Correct answer: Two codes are required: the underlying disease first, followed by the manifestation code

The etiology/manifestation convention requires two codes, with the underlying disease (etiology) sequenced first and the manifestation code listed second; manifestation codes cannot be principal diagnoses.

Question 3: A coder must assign HCPCS codes for Medicare Advantage plans. Which statement is true?

Medicare Advantage plans may require HCPCS Level II codes for DME and drugs (Correct answer)
Medicare Advantage uses ICD-10 codes instead of HCPCS
Only S-codes are used for Medicare Advantage billing
Medicare Advantage plans are prohibited from using HCPCS Level II codes

Correct answer: Medicare Advantage plans may require HCPCS Level II codes for DME and drugs

Medicare Advantage (MA) plans follow Medicare billing guidelines and typically require HCPCS Level II codes for DME, drugs, and other covered services.

Question 4: Which HCPCS Level II code range covers vision services including eyeglasses and contact lenses?

V2000-V2999 (Correct answer)
E0100-E0199
S0500-S0596
A9000-A9999

Correct answer: V2000-V2999

V-codes (V0000-V2999) cover vision services including spectacles, contact lenses, and vision-related aids.

Question 5: Which CPT code describes the simple repair of a 2.5 cm laceration of the trunk?

12011
12004
12002 (Correct answer)
12001

Correct answer: 12002

CPT 12002 covers simple repair of superficial wounds of the scalp, neck, axillae, external genitalia, trunk, and/or extremities, 2.6–7.5 cm — for 2.5 cm, CPT 12001 (up to 2.5 cm) applies.

Question 6: Which modifier can a physician use when giving a service in a hospital that is both technical and professional?

91
26 (Correct answer)
59
51

Correct answer: 26

Modifier 26 is used to indicate the professional component of a service. This modifier is applied when a physician provides only the professional interpretation and report for a diagnostic test or procedure, while the technical component (e.g., equipment, supplies, technical staff) is provided by the hospital or another entity. This distinguishes the physician's cognitive work from the facility's resources.

Question 7: What does the abbreviation 'NEC' mean in ICD-10-CM?

Not Entered in Category
Not Elsewhere Classified (Correct answer)
Not Entirely Coded
No Established Criteria

Correct answer: Not Elsewhere Classified

NEC stands for 'Not Elsewhere Classified,' used when the provider's documentation is specific but no dedicated code exists for that specificity.

Question 8: Which CPT code range covers Surgery of the Musculoskeletal System?

10000–19999
20000–29999 (Correct answer)
30000–32999
40000–49999

Correct answer: 20000–29999

CPT codes 20000–29999 cover musculoskeletal system surgeries including bones, joints, and soft tissues.

Question 9: A plastic surgeon performs a rhomboid flap to close a 10 sq cm defect on the cheek. This is reported under which CPT code category?

Split-thickness skin graft codes
Adjacent tissue transfer/rearrangement codes (Correct answer)
Skin substitute graft codes
Free skin graft codes

Correct answer: Adjacent tissue transfer/rearrangement codes

A rhomboid flap is a type of local flap classified under adjacent tissue transfer or rearrangement (CPT 14000-14350).

Question 10: A coder sees a note that a patient received 'moderate sedation' administered by the performing physician during a colonoscopy. How should the moderate sedation be coded?

It is bundled into the colonoscopy code and not coded separately (Correct answer)
Separately with codes 99151-99153
As an anesthesia service using 00810
With modifier -47

Correct answer: It is bundled into the colonoscopy code and not coded separately

For procedures where moderate sedation is included in the procedure's work (as indicated by a bull's-eye symbol in CPT), it is bundled and not reported separately.

Question 11: A neonatologist provides initial care to a normal newborn in the hospital. Which code family is most appropriate?

99221–99223
99460–99462 (Correct answer)
99477–99480
99281–99285

Correct answer: 99460–99462

Newborn care codes 99460–99462 are used for initial and subsequent care of normal newborns in a hospital or birthing center.

Question 12: Which qualifying circumstance code is used when anesthesia is provided for a patient of extreme age, such as a neonate?

99135
99100 (Correct answer)
99116
99140

Correct answer: 99100

Code 99100 is reported for anesthesia for patients of extreme age, including neonates and patients under 1 year or over 70 years.

Question 13: Under HIPAA, which of the following is NOT considered Protected Health Information (PHI)?

Patient's ZIP code combined with treatment records
De-identified health information (Correct answer)
Patient's date of birth linked to a diagnosis
Patient's name on a prescription

Correct answer: De-identified health information

De-identified health information that has been properly stripped of all 18 HIPAA identifiers is not considered PHI.

Question 14: A Corporate Integrity Agreement (CIA) is typically entered into between a healthcare provider and which federal agency?

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

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

CIAs are agreements between the OIG of HHS and healthcare providers as an alternative to exclusion from federal healthcare programs.

Question 15: What is the purpose of the NCCI (National Correct Coding Initiative) edits?

To prevent improper payment of procedure code pairs that should not be billed together (Correct answer)
To approve new CPT codes annually
To set reimbursement rates for Medicare
To define medical necessity for outpatient visits

Correct answer: To prevent improper payment of procedure code pairs that should not be billed together

NCCI edits are CMS-developed code pair edits that prevent unbundling by identifying procedure combinations that should not be reported together.

Question 16: What direction word relates to the side of the body, based on the anatomic position?

Proximal
Lateral (Correct answer)
Medial
Distal

Correct answer: Lateral

In anatomical position, 'lateral' describes a position or direction away from the midline of the body, towards the side. For example, the ears are lateral to the nose. This contrasts with 'medial,' which means towards the midline.

Question 17: According to ICD-10-CM guidelines, when should signs and symptoms be coded in addition to a confirmed diagnosis?

Only for inpatient admissions
Only when the physician documents both the sign and the diagnosis separately
When the sign or symptom is not routinely associated with the confirmed diagnosis (Correct answer)
Always, for every outpatient encounter

Correct answer: When the sign or symptom is not routinely associated with the confirmed diagnosis

Signs and symptoms that are NOT integral to (routinely associated with) a confirmed diagnosis should be coded as additional codes.

Question 18: When a patient has a confirmed diagnosis, the coder should code:

Both the diagnosis and all associated signs and symptoms
Only the chief complaint
The confirmed diagnosis (Correct answer)
Signs and symptoms related to the diagnosis

Correct answer: The confirmed diagnosis

When a definitive diagnosis has been confirmed, code the confirmed diagnosis rather than the signs and symptoms.

Question 19: Which of the following is the correct sequencing rule for inpatient coding of a complication that arose during the stay?

Always list the complication as the principal diagnosis
List the complication first only if it required surgical intervention
Complications are never coded separately during inpatient stays
Sequence the condition that prompted admission as principal diagnosis; the complication is secondary (Correct answer)

Correct answer: Sequence the condition that prompted admission as principal diagnosis; the complication is secondary

The condition that prompted admission after study is the principal diagnosis; complications that develop during the stay are coded as additional diagnoses.

Question 20: An endoscope is inserted through the vocal cords, oropharynx, and beyond the trachea into the bronchus during a _________ procedure. This procedure can be carried out for either therapeutic or diagnostic purposes.

Tracheoscopy
Laryngoscopy
Bronchoscopy (Correct answer)
Oropharyngoscopy

Correct answer: Bronchoscopy

A bronchoscopy is a procedure where an endoscope is inserted through the mouth or nose, past the vocal cords and trachea, and into the bronchi (the main air passages of the lungs). This allows for direct visualization of the airways beyond the trachea for diagnostic or therapeutic purposes, matching the description provided.

Question 21: What does the modifier -25 indicate when appended to an E/M code?

Repeat procedure by the same physician
Bilateral procedure
Significant, separately identifiable E/M service on the same day as a procedure (Correct answer)
Reduced services

Correct answer: Significant, separately identifiable E/M service on the same day as a procedure

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

Question 22: Which HCPCS Level II code is right for the Speech Language Pathology MIPS specialty set?

G4026
G4034 (Correct answer)
G4013
G4029

Correct answer: G4034

HCPCS Level II G-codes are used to report services, procedures, and supplies that are not covered by CPT codes but are needed for Medicare and other payers. G4034 is a specific MIPS (Merit-based Incentive Payment System) quality measure code designated for Speech-Language Pathology, often related to functional communication measures for conditions like dysphagia.

Question 23: When coding an inpatient admission on the same day as an outpatient E/M visit at the same facility, how should the services be reported?

Report only the initial hospital care code (99221–99223), incorporating all services from that date (Correct answer)
Report only the outpatient E/M code with modifier -57
Report both the outpatient E/M and the initial hospital care code
Report the outpatient E/M and add modifier -25 to the hospital code

Correct answer: Report only the initial hospital care code (99221–99223), incorporating all services from that date

When a patient is admitted the same day as an outpatient visit, all services are combined and only the initial inpatient code is reported.

Question 24: When coding an endoscopy, which principle applies if the scope is advanced beyond a specific anatomical landmark?

Report separate codes for each segment examined
Report the code for the most distal site reached (Correct answer)
Report all anatomical sites examined
Report only the initial insertion site

Correct answer: Report the code for the most distal site reached

For endoscopic procedures, the correct code is based on the most distal (furthest) anatomical site reached during the procedure.

Question 25: A highly claustrophobic 45-year-old patient requires general anesthesia administered by an anesthesiologist to undergo an MRI of the lumbar spine. Which CPT code should be reported for the anesthesia service?

01992
00630
01922 (Correct answer)
01991

Correct answer: 01922

CPT code 01922 is the correct code for 'Anesthesia for non-invasive imaging or radiation therapy'. An MRI is a non-invasive imaging procedure, and although it doesn't always require anesthesia, it is medically necessary in this case due to the patient's severe claustrophobia. Code 00630 is for procedures on the lumbar spine, which is incorrect as the MRI itself is a radiological procedure, not a surgical one.

Question 26: A physician performs a procedure and also provides the anesthesia. Which modifier should be appended to the anesthesia code?

-47 (Correct answer)
-QK
-AA
-QZ

Correct answer: -47

Modifier -47 indicates anesthesia by the surgeon, meaning the operating physician personally administered the anesthesia.

Question 27: Under HIPAA, which of the following is NOT considered Protected Health Information (PHI)?

De-identified health information (Correct answer)
Patient's date of birth linked to a diagnosis
Patient's name on a prescription
Patient's ZIP code combined with treatment records

Correct answer: De-identified health information

De-identified health information that has been properly stripped of all 18 HIPAA identifiers is not considered PHI.

Question 28: A patient with morbid obesity undergoing anesthesia has a BMI of 45. Which factor may influence anesthesia coding?

No additional coding is required as BMI is not a factor
Modifier 22 may be appended to indicate increased complexity (Correct answer)
Additional base units are automatically added
A separate obesity code must be listed first

Correct answer: Modifier 22 may be appended to indicate increased complexity

Modifier 22 may be appended when morbid obesity significantly increases the complexity and risk of the anesthesia service.

Question 29: What is the purpose of modifier -58 in surgical coding?

Decision for surgery made at the same visit
Unplanned return to OR for an unrelated procedure
Procedure performed by a different physician
Staged or related procedure by the same physician during the postoperative period (Correct answer)

Correct answer: Staged or related procedure by the same physician during the postoperative period

Modifier -58 is used when a staged or planned related procedure is performed during the global period of the original surgery.

Question 30: Which HCPCS Level II code range is used to report durable medical equipment (DME)?

K0000–K9999
A0000–A9999
L0000–L9999
E0100–E9999 (Correct answer)

Correct answer: E0100–E9999

HCPCS Level II E-codes (E0100–E9999) are designated for durable medical equipment such as wheelchairs, walkers, and hospital beds.

Question 31: What is the primary focus of the federal Anti-Kickback Statute (AKS)?

To ensure all patients receive stabilizing treatment in an emergency, regardless of ability to pay.
To protect the privacy and security of patient health information.
To prohibit offering or receiving remuneration to induce referrals for items or services covered by federal healthcare programs. (Correct answer)
To prevent improper billing for services not rendered.

Correct answer: To prohibit offering or receiving remuneration to induce referrals for items or services covered by federal healthcare programs.

The Anti-Kickback Statute (AKS) is a criminal law that prohibits knowingly and willfully offering, paying, soliciting, or receiving anything of value (remuneration) to induce or reward referrals for items or services payable by federal healthcare programs like Medicare. It is intended to prevent medical decisions from being compromised by improper financial incentives.

Question 32: Which section of the CPT codebook contains Evaluation and Management (E/M) codes?

Section II
Section III
Section I (Correct answer)
Section IV

Correct answer: Section I

E/M codes (99202–99499) are found in Section I of the CPT codebook.

Question 33: Since his surgery 4 months ago, a patient has been complaining of pain. When the doctor checks the shoulder, he or she finds a metal clamp that was left over from a previous surgery. For an arthroscopy, the doctor sends him to a surgeon who works outside of a hospital. The doctor takes the clamp off and closes the hole. What CPT code(s) needs to be used by the doctor?

29805, 29819
29805, 23333
29819-78
29819 (Correct answer)

Correct answer: 29819

CPT code 29819 describes an 'Arthroscopy, shoulder, surgical; with removal of loose body or foreign body.' The scenario clearly states the doctor performs an arthroscopy to remove a metal clamp (foreign body) from the shoulder. Therefore, 29819 is the most appropriate code for this procedure. Modifier -78 is not needed as this is a new procedure by a different surgeon, and the other codes (29805, 23333) do not accurately represent an arthroscopic foreign body removal.

Question 34: Which HCPCS Level II code range is used for durable medical equipment (DME)?

L codes
E codes (Correct answer)
A codes
V codes

Correct answer: E codes

HCPCS Level II E codes (E0100–E9999) are designated for durable medical equipment.

Question 35: Which of the following best describes 'medical necessity' in the context of Medicare billing compliance?

Services that are reasonable and necessary for diagnosis or treatment of illness or injury (Correct answer)
Services covered by all insurance plans
Any service requested by the patient
Services the physician believes are appropriate regardless of guidelines

Correct answer: Services that are reasonable and necessary for diagnosis or treatment of illness or injury

Medicare defines medical necessity as services or items that are reasonable and necessary for the diagnosis or treatment of illness, injury, or to improve functioning.

Question 36: When coding an open fracture treatment, what does the CPT definition of 'open treatment' mean?

The skin overlying the fracture is broken
The patient has a compound injury
The fracture fragments are displaced
The fracture site is surgically opened for visualization (Correct answer)

Correct answer: The fracture site is surgically opened for visualization

In CPT terminology, 'open treatment' means the fracture site is surgically opened and exposed, regardless of whether the overlying skin is intact.

Question 37: Which of the following is an observation Z code category for a medical observation encounter for suspected diseases and conditions that have been ruled out?

Z04
Z03 (Correct answer)
Z05
Z02

Correct answer: Z03

Z03 is the ICD-10-CM Z code category for 'Medical observation and evaluation for suspected diseases and conditions ruled out.' This category is used when a patient is admitted for observation due to a suspected condition that, after evaluation, is determined not to be present. The other Z codes (Z05, Z02, Z04) refer to other types of observation or examinations.

Question 38: What is the maximum number of characters an ICD-10-CM code can have?

8
6
5
7 (Correct answer)

Correct answer: 7

ICD-10-CM codes have a maximum of 7 characters: a 3-character category followed by up to 4 additional alphanumeric characters.

Question 39: Skin substitute grafts used in wound care are coded based on which two factors?

Surgeon technique and graft material brand
Number of graft layers and wound etiology
Graft size and anatomical location (Correct answer)
Wound depth and patient age

Correct answer: Graft size and anatomical location

Skin substitute graft CPT codes are selected based on the size of the graft (in sq cm) and the anatomical location (trunk/extremities vs. face/scalp/hands/feet).

Question 40: Which chapter of ICD-10-CM contains codes for neoplasms?

Chapter 3 (D50–D89)
Chapter 4 (E00–E89)
Chapter 2 (C00–D49) (Correct answer)
Chapter 1 (A00–B99)

Correct answer: Chapter 2 (C00–D49)

Chapter 2 of ICD-10-CM (codes C00–D49) covers all neoplasms, including malignant, benign, in situ, and neoplasms of uncertain behavior.

Question 41: Which CPT code range is used for anesthesia services related to obstetric procedures?

01958–01969 (Correct answer)
01996
00900–00952
00800–00882

Correct answer: 01958–01969

CPT codes 01958–01969 cover anesthesia for obstetric procedures including vaginal delivery and cesarean delivery.

Question 42: Planning and discussing therapies based on the Adaptive Behavior Protocol with a group of seven patients. Which CPT code should be used?

97153
97157
97156
97154 (Correct answer)

Correct answer: 97154

CPT code 97154 is designated for 'Group adaptive behavior treatment by protocol, administered by technician or aide under the direction of a physician or other qualified healthcare professional, face-to-face with patient(s); each 15 minutes.' The scenario describes planning and discussing therapies based on an Adaptive Behavior Protocol with a group of seven patients, which perfectly aligns with the definition of this code for group-based adaptive behavior treatment.

Question 43: What does an 'Excludes2' note in ICD-10-CM mean?

Only one of the two conditions may be coded per encounter
The excluded condition is completely forbidden from use with this code
The excluded condition is not included here, but both conditions may coexist and be coded simultaneously (Correct answer)
The excluded code must be sequenced after this code

Correct answer: The excluded condition is not included here, but both conditions may coexist and be coded simultaneously

An Excludes2 note means the excluded condition is not included in the current code, but a patient may have both conditions at the same time, in which case both codes may be assigned.

Question 44: Which CPT code describes the repair of a wound using tissue adhesive (e.g., Dermabond) without sutures?

99213
12001
G0168 (Correct answer)
12002

Correct answer: G0168

HCPCS code G0168 is used specifically for wound closure using tissue adhesive only, when no suturing is performed.

Question 45: A coder assigns separate CPT codes for each component of a procedure that should be reported with a single comprehensive code. This practice is known as:

Unbundling (Correct answer)
Upcoding
Overcoding
Fragmentation

Correct answer: Unbundling

Unbundling is the practice of billing separately for services that should be reported together under one comprehensive CPT code.

Question 46: What does the HCPCS Level II G-code range primarily represent?

Temporary procedures and professional services (Correct answer)
Dental procedures
Durable medical equipment
Vision services

Correct answer: Temporary procedures and professional services

G-codes (G0000-G9999) are temporary codes used for procedures and professional services not classified elsewhere.

Question 47: Which modifier indicates that an anesthesiologist personally performed the anesthesia without a CRNA?

AD
QK
QZ
AA (Correct answer)

Correct answer: AA

Modifier AA indicates anesthesia services performed personally by an anesthesiologist.

Question 48: What is a combination code in ICD-10-CM?

A code used only when two chronic conditions coexist
A single code that classifies two diagnoses, a diagnosis with a complication, or a diagnosis with an associated manifestation (Correct answer)
A code that combines a diagnosis with a CPT procedure code
A code that links two unrelated diagnoses on the same claim

Correct answer: A single code that classifies two diagnoses, a diagnosis with a complication, or a diagnosis with an associated manifestation

A combination code is one code that captures multiple clinical concepts simultaneously, such as a condition and its associated complication or manifestation.

Question 49: A compliance officer discovers that a coder has been consistently assigning higher-level E/M codes without supporting documentation. The FIRST step should be to:

Conduct an internal investigation and education (Correct answer)
Terminate the coder immediately
Refund all overpayments immediately without investigation
Report the coder to law enforcement

Correct answer: Conduct an internal investigation and education

The first step in addressing potential compliance issues is to conduct an internal investigation and provide education before taking more drastic action.

Question 50: Controlled hypotension induced during anesthesia to reduce surgical bleeding is reported with which qualifying circumstance?

99135 (Correct answer)
99140
99100
99116

Correct answer: 99135

Code 99135 is used for anesthesia complicated by utilization of controlled hypotension.

Question 51: How should a physician report drug administration by intravenous infusion lasting 2 hours and 15 minutes?

A single code covering up to 3 hours
Initial hour code plus a partial-hour additional code
Initial hour code plus one additional hour code
Initial hour code plus two additional hour codes (Correct answer)

Correct answer: Initial hour code plus two additional hour codes

Infusion coding uses the initial hour code plus an additional hour code for each full 30 minutes beyond the first hour; 2h15m = initial + 2 additional units.

Question 52: Which CPT code range is used for nuclear medicine diagnostic procedures?

79000–79999
78000–78999 (Correct answer)
76000–76999
77000–77999

Correct answer: 78000–78999

Nuclear medicine diagnostic imaging procedures are reported using CPT codes 78000–78999.

Question 53: When a patient has both an acute and a chronic form of the same condition, how should ICD-10-CM codes be sequenced?

Code only the acute condition; chronic is assumed to be included
Code only the chronic condition; acute is assumed to be a flare
Code both, sequencing the acute condition first (Correct answer)
Code both, sequencing the chronic condition first

Correct answer: Code both, sequencing the acute condition first

Per ICD-10-CM guidelines, when both acute and chronic forms exist, both are coded with the acute (subacute) condition sequenced first.

Question 54: Which code set is used exclusively for inpatient hospital procedure coding?

HCPCS Level II
ICD-10-CM
ICD-10-PCS (Correct answer)
CPT

Correct answer: ICD-10-PCS

ICD-10-PCS (Procedure Coding System) is used exclusively by hospitals for coding inpatient procedures.

Question 55: A dermatologist performs three separate punch biopsies on a patient during the same office visit: one on the arm, one on the back, and one on the chest. How would these procedures be reported?

11104 x 3
11104, 11105, 11105 (Correct answer)
11104, 11104-59, 11104-59
11106, 11107 x 2

Correct answer: 11104, 11105, 11105

CPT® code 11104 is reported for the first punch biopsy of a single lesion. Add-on code +11105 is used for each additional punch biopsy performed on separate/additional lesions during the same encounter. Therefore, the first biopsy is coded with 11104, and the two additional biopsies are coded with 11105 twice.

Question 56: What is the purpose of the 'Table of Drugs and Chemicals' in ICD-10-CM?

To cross-reference NDC codes with ICD-10-CM codes
To provide drug interaction warnings
To help coders identify poisoning, adverse effect, and underdosing codes for substances (Correct answer)
To list approved medications for each diagnosis

Correct answer: To help coders identify poisoning, adverse effect, and underdosing codes for substances

The Table of Drugs and Chemicals assists coders in selecting the correct codes for poisonings, adverse effects, and underdosing by substance and intent.

Question 57: What is a frozen section in pathology coding?

Permanent tissue processing for final diagnosis
Cytology of fluid specimens
Rapid intraoperative tissue analysis used to guide surgical decisions (Correct answer)
Immunohistochemical staining of archival tissue

Correct answer: Rapid intraoperative tissue analysis used to guide surgical decisions

A frozen section is an intraoperative rapid tissue analysis that provides the surgeon with a preliminary pathology result during the procedure.

Question 58: Which of the following is a safe harbor under the Anti-Kickback Statute?

Personal services and management contracts that meet specific criteria (Correct answer)
Offering gifts to physicians who refer patients
Providing free services to patients with deductibles
Paying a referring physician a percentage of collected revenues

Correct answer: Personal services and management contracts that meet specific criteria

Personal services and management contracts meeting specific criteria are recognized safe harbors under the AKS regulations.

Question 59: In ICD-10-CM fracture coding, what does the 7th character 'A' indicate?

Initial encounter for fracture (Correct answer)
Anatomical fracture site
Acute open fracture
Subsequent encounter with routine healing

Correct answer: Initial encounter for fracture

The 7th character 'A' designates the initial encounter, used while the patient is actively receiving treatment for the fracture.

Question 60: When diabetes mellitus type is not documented in the medical record, what is the ICD-10-CM default?

Gestational diabetes mellitus
Type 2 diabetes mellitus (Correct answer)
Type 1 diabetes mellitus
Secondary diabetes mellitus

Correct answer: Type 2 diabetes mellitus

Per ICD-10-CM guidelines, when the type of diabetes mellitus is not documented, the default assignment is Type 2 diabetes mellitus.

Question 61: In CPT, what does a bullet (•) symbol next to a code indicate?

The code requires a modifier
The code has been revised
The code is new for the current year (Correct answer)
The code has been deleted

Correct answer: The code is new for the current year

A bullet (•) symbol in the CPT codebook indicates that the code is new for the current edition.

Question 62: Experiencing tiredness and neck swelling, a 39-year-old lady was examined. What cardiovascular symptoms are most indicative of hypothyroidism among the following?

Increased cardiac output
Atrial fibrillation
Bradycardia (Correct answer)
Tachycardia

Correct answer: Bradycardia

Hypothyroidism, a condition characterized by insufficient thyroid hormone production, typically leads to a general slowing of metabolic processes in the body. One of the most indicative cardiovascular symptoms of this metabolic slowdown is bradycardia, which is a slower-than-normal heart rate. The patient's reported tiredness and neck swelling further support a diagnosis of hypothyroidism.

Question 63: For anesthesia coding purposes, the total anesthesia time begins when?

When the patient is moved to the recovery room
When the patient enters the operating room
When the anesthesiologist begins preparing the patient for induction (Correct answer)
When the surgical incision is made

Correct answer: When the anesthesiologist begins preparing the patient for induction

Anesthesia time starts when the anesthesiologist begins preparing the patient for the induction of anesthesia in the operating room area.

Question 64: A 23-year-old woman is currently being treated for anemia by her doctor. She had an appendectomy one week ago. Her hemoglobin level was 13.4 g/dL before surgery. Her lab results showed a 10.3 g/dL level today, and the doctor deduced that she lost a significant amount of blood during her appendectomy. Prior to the surgery, she had no history of anemia. What is the accurate anemia diagnosis for this patient?

D64.89
D50.00
D64.9
D62 (Correct answer)

Correct answer: D62

The patient developed anemia acutely after an appendectomy, with a significant drop in hemoglobin from 13.4 g/dL to 10.3 g/dL, and no prior history of anemia. This clinical picture indicates acute blood loss anemia. ICD-10 code D62 specifically represents 'Acute posthemorrhagic anemia,' which accurately describes anemia resulting from sudden, significant blood loss, such as that experienced during surgery.

Question 65: A 35-year-old man who has internal hemorrhoids visits the doctor to have the hemorrhoids removed. Through an anoscope, the ligator and alligator forceps have been inserted. The doctor locates the largest hemorrhage and uses a rubber band to ligate it at the base. Which CPT code is appropriate to use?

46999
46221 (Correct answer)
46250
46255

Correct answer: 46221

CPT code 46221 specifically describes 'Hemorrhoidectomy, internal, by rubber band ligation(s); one or more hemorrhoids.' The scenario details the use of a ligator and alligator forceps to ligate the largest hemorrhage with a rubber band, which perfectly matches this code. This code covers the procedure regardless of the number of hemorrhoids ligated in a single session.

Question 66: What is the correct code sequence when a surgeon performs an unplanned return to the OR during the global period?

Append modifier -76
Append modifier -78 (Correct answer)
Append modifier -79
No modifier needed

Correct answer: Append modifier -78

Modifier -78 is used for an unplanned return to the operating room for a related procedure during the postoperative period.

Question 67: The femur head is received in a cup-shaped depression on the hip joint called the:

Medial malleolus
Acetabulum (Correct answer)
Trochlea
Calcaneus

Correct answer: Acetabulum

The acetabulum is a deep, cup-shaped socket located on the lateral aspect of the hip bone (pelvis). It serves as the articulation point for the head of the femur, forming the hip joint. This ball-and-socket joint allows for a wide range of motion in the lower limb, crucial for walking, running, and other movements.

Question 68: When an anesthesiologist medically directs two concurrent cases, which modifier does the anesthesiologist use?

QY (Correct answer)
AA
AD
QK

Correct answer: QY

Modifier QY is used when a physician medically directs one CRNA, while QK is used when directing 2–4 concurrent CRNA cases.

Question 69: ICD-10-CM Z codes are primarily used to represent:

Symptoms without a definitive diagnosis
Factors influencing health status and reasons for encounters not due to illness or injury (Correct answer)
External causes of morbidity and injury
Neoplasm diagnoses and tumor staging

Correct answer: Factors influencing health status and reasons for encounters not due to illness or injury

Z codes capture reasons for encounters such as preventive screenings, immunizations, history of conditions, and other factors affecting health status that are not diseases or injuries.

Question 70: A patient's mother calls the office and the physician spends 8 minutes on the phone addressing a new problem. The decision was made to see the patient. Which code applies?

No code — telephone services are bundled (Correct answer)
99441
99442
99421

Correct answer: No code — telephone services are bundled

Telephone E/M codes are not reported if the call results in a decision to see the patient within 24 hours, as the call is bundled into the visit.

Question 71: For outpatient coding, how should a diagnosis documented as 'possible' or 'probable' be coded?

Code the signs, symptoms, or other definitive reason for the visit instead (Correct answer)
Code the condition as if confirmed
Append a special uncertainty modifier to the diagnosis code
Leave the encounter without a diagnosis code

Correct answer: Code the signs, symptoms, or other definitive reason for the visit instead

For outpatient encounters, uncertain diagnoses ('possible,' 'probable,' 'suspected') must NOT be coded as confirmed; instead, code the documented signs, symptoms, or other definitive findings.

Question 72: When is it appropriate to use an unspecified ICD-10-CM code?

When the medical record lacks sufficient information to assign a more specific code (Correct answer)
Only when the condition is still being worked up and no diagnosis is confirmed
Never — coders must always query the physician for additional detail
Only as a secondary diagnosis, never as the principal diagnosis

Correct answer: When the medical record lacks sufficient information to assign a more specific code

Unspecified codes are valid when the medical record documentation genuinely does not support assignment of a more specific code.

Question 73: Where is the decimal point placed in an ICD-10-CM code?

After the 2nd character
After the 3rd character (Correct answer)
After the 5th character
After the 4th character

Correct answer: After the 3rd character

The decimal point in an ICD-10-CM code is always placed after the 3rd character (the category), separating the category from the etiology/anatomic site/severity characters.

Question 74: What does the abbreviation ICD-10-CM stand for?

International Coding of Diagnoses, 10th Revision, Clinical Manual
Internal Classification of Diseases, 10th Revision, Coding Manual
International Classification of Diseases, 10th Revision, Clinical Modification (Correct answer)
International Classification of Diagnoses, 10th Revision, Clinical Method

Correct answer: International Classification of Diseases, 10th Revision, Clinical Modification

ICD-10-CM stands for International Classification of Diseases, 10th Revision, Clinical Modification — the U.S. diagnostic coding system.

Question 75: What does the global surgical package typically include?

Anesthesia services only
Only the surgical procedure itself
Only post-operative visits
Pre-op, intra-op, and post-op care (Correct answer)

Correct answer: Pre-op, intra-op, and post-op care

The global surgical package includes preoperative evaluation, the surgical procedure, and routine postoperative care within the global period.

Question 76: Under the Medicare anesthesia payment formula, what does the conversion factor represent?

The percentage of the surgical fee paid for anesthesia
The ratio of base units to time units
The number of minutes per time unit
The dollar amount paid per anesthesia unit (Correct answer)

Correct answer: The dollar amount paid per anesthesia unit

The conversion factor is a dollar amount per anesthesia unit used to calculate the total anesthesia payment.

Question 77: Which statute imposes civil monetary penalties on any person who knowingly presents a false or fraudulent claim to a federal health care program?

False Claims Act (Correct answer)
Stark Law
Anti-Kickback Statute
Civil Monetary Penalties Law

Correct answer: False Claims Act

The False Claims Act (31 U.S.C. § 3729) imposes civil liability for submitting false or fraudulent claims to the federal government.

Question 78: An anesthesiologist begins preparing a patient for surgery in the operating room at 08:00. The surgical procedure starts at 08:30 and finishes at 10:00. The anesthesiologist transfers care of the patient to the PACU nurse at 10:15. What is the total reportable anesthesia time?

105 minutes
120 minutes
135 minutes (Correct answer)
90 minutes

Correct answer: 135 minutes

According to CPT guidelines, anesthesia time begins when the anesthesiologist starts preparing the patient for anesthesia in the operating room or an equivalent area. Time ends when the anesthesiologist is no longer in personal attendance, which is when the patient is safely placed under postoperative care. In this scenario, the time starts at 08:00 and ends at 10:15, for a total of 135 minutes.

Question 79: Modifier -51 is used to indicate:

A procedure was repeated on the same day
A procedure required additional physician work
A procedure was performed by two surgeons
Multiple procedures were performed during the same operative session (Correct answer)

Correct answer: Multiple procedures were performed during the same operative session

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

Question 80: This divides into three parts: the medulla oblongata, the pons, and the midbrain:

Brainstem (Correct answer)
Diencephalon
Cerebrum
Cerebellum

Correct answer: Brainstem

The brainstem is a crucial part of the brain that connects the cerebrum and cerebellum to the spinal cord, serving as a relay center for information. It is anatomically divided into three main parts: the medulla oblongata, the pons, and the midbrain. These structures are essential for regulating many involuntary functions vital for survival, such as breathing, heart rate, and consciousness.

Question 81: What does unbundling refer to in surgical coding?

Reporting a lesser procedure than performed
Using multiple modifiers on a single claim
Billing component parts of a procedure separately when a comprehensive code exists (Correct answer)
Combining two procedures into one code

Correct answer: Billing component parts of a procedure separately when a comprehensive code exists

Unbundling is the improper practice of billing separately for services that should be included in a single comprehensive CPT code.

Question 82: What does a 'Code First' instruction in ICD-10-CM direct the coder to do?

Assign this code as the first secondary diagnosis
Use this code before any Z-code on the claim
Always list this code as the principal diagnosis regardless of circumstances
Sequence the underlying etiology before the manifestation code (Correct answer)

Correct answer: Sequence the underlying etiology before the manifestation code

A 'Code First' note instructs the coder to sequence the underlying condition (etiology) before the manifestation code, following the etiology/manifestation convention.

Question 83: To identify possible issues, what document should providers review annually?

OIG Work Plan (Correct answer)
Advance Beneficiary Notice
OPPE
American Medical Association Fact Sheet

Correct answer: OIG Work Plan

The OIG (Office of Inspector General) Work Plan is an annual document that outlines the OIG's priorities for audits, evaluations, and investigations for the upcoming year. Healthcare providers should review this plan to identify areas of focus for potential fraud, waste, and abuse, allowing them to proactively assess and address compliance risks within their own operations.

Question 84: A patient has 25 skin tags removed by snipping from the neck and trunk. How is this reported?

11200 only
11201 only
11200 x 25
11200 plus 11201 for the additional lesions (Correct answer)

Correct answer: 11200 plus 11201 for the additional lesions

CPT 11200 covers removal of up to 15 skin tags; CPT 11201 is an add-on code reported for each additional 10 skin tags (or part thereof) beyond the first 15.

Question 85: A 38-year-old woman goes to the doctor because she has been bleeding from her uterus for 17 days. The doctor discovered a mass that was 3 x 4 cm in size. On the right vaginal mucosa, the mass was firm and irregular. A biopsy was done, and a small piece of the mass's tissue was taken out and sent to the lab. What CPT code is needed?

57100 (Correct answer)
58100
57105
56605

Correct answer: 57100

CPT code 57100 is for a 'Biopsy of vaginal mucosa; incisional (separate procedure).' The scenario describes a biopsy of a 3x4 cm mass on the right vaginal mucosa, where a small piece of tissue was taken. This precisely matches the description for an incisional biopsy of the vaginal mucosa. The other codes (57105, 56605, 58100) are for more extensive vaginal procedures, vulvar biopsies, or endometrial biopsies, respectively, and are not appropriate here.

Question 86: Which ICD-10-CM chapter covers mental, behavioral, and neurodevelopmental disorders?

Chapter 18 (R00–R99)
Chapter 6 (G00–G99)
Chapter 5 (F01–F99) (Correct answer)
Chapter 4 (E00–E89)

Correct answer: Chapter 5 (F01–F99)

ICD-10-CM Chapter 5, codes F01–F99, covers mental, behavioral, and neurodevelopmental disorders.

Question 87: In the Surgery section, what is a 'separate procedure' designation?

A procedure requiring a different surgeon
A procedure always billed independently
A procedure requiring prior authorization
A procedure not billable when performed with a related, more comprehensive service (Correct answer)

Correct answer: A procedure not billable when performed with a related, more comprehensive service

A 'separate procedure' code should not be reported when it is performed as an integral part of a more comprehensive procedure.

Question 88: When coding a sequela (late effect) condition in ICD-10-CM, what is the correct sequencing?

Code only the original injury or illness
Sequence the nature of the sequela first, followed by the sequela cause code (Correct answer)
Code only the original injury with the 7th character for sequela
Do not code resolved past conditions

Correct answer: Sequence the nature of the sequela first, followed by the sequela cause code

For sequela coding, the residual condition (nature of the sequela) is sequenced first, followed by the sequela code identifying the original cause, with limited exceptions.

Question 89: What organization administers the CPC (Certified Professional Coder) credential?

CMS
AMA
AAPC (Correct answer)
AHIMA

Correct answer: AAPC

The AAPC (American Academy of Professional Coders) administers the CPC exam and credential.

Question 90: What ICD-10-CM placeholder character is used to keep a code at its required number of digits when a character is not applicable?

Z
X (Correct answer)
9
0 (zero)

Correct answer: X

The letter 'X' is the placeholder character in ICD-10-CM used to allow for future expansion and to keep codes at required digit counts.

Question 91: A physician provides care and coordination for a patient with two or more chronic conditions via chronic care management. The physician spends 25 minutes in a calendar month. Which code is reported?

99491
99489
99487
99490 (Correct answer)

Correct answer: 99490

99490 is reported for the first 20 minutes of clinical staff time for CCM services in a calendar month for patients with 2+ chronic conditions.

Question 92: What does the abbreviation 'NOS' mean in ICD-10-CM?

Not Otherwise Specified (Correct answer)
No Other Source Available
No Operative Symptoms
Not On Schedule

Correct answer: Not Otherwise Specified

NOS means 'Not Otherwise Specified,' equivalent to 'unspecified,' used when documentation does not provide enough detail for a more precise code.

Question 93: A surgeon excises a malignant melanoma measuring 1.8 cm from the scalp with 1 cm margins. What is the total diameter used for code selection?

3.8 cm (Correct answer)
1.8 cm
1.0 cm
2.8 cm

Correct answer: 3.8 cm

The excised diameter includes the lesion (1.8 cm) plus the margins on each side (1 cm + 1 cm), totaling 3.8 cm.

Question 94: Which CPT code range is used for anesthesia services?

10004–19499
30000–39999
00100–01999 (Correct answer)
20100–29999

Correct answer: 00100–01999

CPT anesthesia codes are found in the 00100–01999 range and are reported by anesthesiologists and CRNAs.

Question 95: A physician and a non-physician practitioner (NPP) in the same group practice both have face-to-face encounters with a patient on the same day for a shared/split E/M visit. If coding is based on time, who reports the service?

The physician, regardless of the time spent.
The professional who spent the majority of the total time for the service. (Correct answer)
The NPP, as they are designated as the secondary provider.
Both professionals report a portion of the service.

Correct answer: The professional who spent the majority of the total time for the service.

For split/shared E/M services, when the code selection is based on total time, the service is reported by the professional (physician or NPP) who spent more than half of the total face-to-face or non-face-to-face time performing the service.

Question 96: When coding an outpatient encounter, what should be coded as the first-listed diagnosis?

The most chronic condition
The patient's primary insurance-covered diagnosis
The condition that required the most treatment
The condition established after study to be chiefly responsible for the visit (Correct answer)

Correct answer: The condition established after study to be chiefly responsible for the visit

For outpatient encounters, the first-listed diagnosis is the condition established after study to be chiefly responsible for the visit.

Question 97: A coder assigns code 99213 for an office visit. This code belongs to which code set?

CPT (Correct answer)
HCPCS Level II
ICD-10-CM
ICD-10-PCS

Correct answer: CPT

99213 is a CPT (Current Procedural Terminology) Evaluation and Management code.

Question 98: In ICD-10-CM, what type of character always occupies the first position of every code?

A numeric digit representing severity
A numeric digit representing the body system
An alpha character representing the chapter category (Correct answer)
A special character representing code type

Correct answer: An alpha character representing the chapter category

The first character of every ICD-10-CM code is always an alpha (letter) character, which identifies the chapter grouping.

Question 99: A patient is seen for a new patient office visit. The physician spends 45 minutes total time on date of encounter. Which E/M code applies under the 2021 guidelines?

99204 (Correct answer)
99203
99205
99202

Correct answer: 99204

Under 2021 AMA guidelines, 99204 corresponds to 45–59 minutes of total time on the date of service for a new patient.

Question 100: What is the purpose of a placeholder 'X' in ICD-10-CM?

To indicate an unspecified or unknown diagnosis
To flag a manifestation code
To represent an external cause secondary code
To allow a code to extend to a required 7th character position (Correct answer)

Correct answer: To allow a code to extend to a required 7th character position

The placeholder X fills an empty character position so that a code requiring a 7th character can be properly structured.

AAPC Certified Professional Coder (CPC) Exam

The CPC exam is a comprehensive assessment of a medical coder's ability to accurately assign medical codes for diagnoses, procedures, and services performed in a physician's office or outpatient setting.

100

Questions

240 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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aapc.com — Renewal, score validity, fees, score release, test delivery, exam format, passing score, time limit, exam information · verified Oct 2026
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