AAPC CPC Certified Professional Coder (CPC) Exam Exam Practice Test

Procedure: The physician performed a liver biopsy using ultrasonic guidance.

CPT® Codes:

47000: This code is for the liver biopsy.

76942-26: This code is for ultrasonic guidance for needle placement, with modifier -26 indicating the professional component.

Code Selection Justification: The CPT® code 47000 specifically captures the liver biopsy, and 76942-26 accurately represents the ultrasonic guidance utilized during the procedure.

References:

AMA CPT® Professional Edition (current year)

ICD-10-CM (current year)

HCPCS Level II (current year)

The Schede thoracoplasty for empyema is accurately described by CPT code 32905, which covers the radical procedure involving the resection of multiple ribs and often the obliteration of the pleural cavity to treat chronic empyema.

References:

AMA's CPT® Professional Edition (current year)

For a follow-up examination after the removal of polyps with no new polyps found, the appropriate diagnosis codes are:

Z09: Encounter for follow-up examination after completed treatment for conditions other than malignant neoplasm.

Z86.010: Personal history of colonic polyps.

Using Z09 indicates that the follow-up exam is to check the patient after treatment, and Z86.010 indicates a history of colonic polyps, which is relevant to the patient's medical history.

References:

ICD-10-CM guidelines

AMA's CPT® Professional Edition (current year)

For this scenario, two surgeons are working together, each as a primary surgeon. Therefore, the correct coding requires the use of the modifier -62, which indicates co-surgeons.

The transthoracic approach to excise the damaged portion of the vertebral body is coded with 63087.

The insertion of the bone graft and metal plate is coded with 63088.

Both codes are appended with modifier -62 to indicate that two surgeons worked together as primary surgeons on this case.

References:

AMA's CPT® Professional Edition (current year)

ICD-10-CM (current year)

HCPCS Level II (current year)

The Roux-en-Y anastomosis of the extrahepatic biliary duct to the gastrointestinal tract is a specific surgical procedure that involves connecting the biliary duct to the gastrointestinal tract.

Procedure Description: Roux-en-Y anastomosis of the extrahepatic biliary duct involves creating a direct connection between the biliary duct and the gastrointestinal tract.

Procedure Specificity: The procedure is complex and involves extensive surgical technique and anastomosis.

Coding Decision:

CPT® 47780 specifically describes the Roux-en-Y anastomosis of the extrahepatic biliary duct to the gastrointestinal tract.

References:

AMA's CPT® Professional Edition (current year).

CPT® Assistant for detailed coding guidelines on biliary and gastrointestinal procedures.

Cystourethroscopy: This is a procedure that involves the use of a cystoscope to look inside the urethra and bladder.

Pyeloscopy: Involves the examination of the upper urinary tract, typically done through the cystoscope.

Lithotripsy: A procedure that uses shock waves or a laser to break up stones in the kidney, bladder, or ureter.

Indwelling stent insertion: A procedure to place a stent in the ureter to help urine flow from the kidney to the bladder.

52356: Cystourethroscopy with ureteroscopy and/or pyeloscopy; with lithotripsy (ureteral catheterization and/or ureteral stent placement).

The code 52356 includes all components mentioned: cystourethroscopy, pyeloscopy, lithotripsy, and stent insertion performed in the same operative session.

References:

AMA's CPT® Professional Edition (current year)

ICD-10-CM (current year), HCPCS Level II (current year)

For initial fracture care of a closed scaphoid fracture, code 25622 is used, which includes treatment and initial casting. The application of the cast is part of the fracture care and is not reported separately. CPT® guidelines specify that casting or strapping performed as part of the fracture care is included in the fracture care code.References: AMA's CPT® Professional Edition (current year), Surgery section, Musculoskeletal System.

Dr. Burns is providing initial hospital or birthing center care for the evaluation and management of a normal newborn infant. CPT code 99460 is used to report initial hospital or birthing center care, per day, for evaluation and management of a normal newborn infant. This includes a comprehensive history, examination, and medical decision-making. The description of the service provided fits this CPT code accurately. References: CPT® Professional Edition (current year), AMA.

CPT code 19081 is used for percutaneous biopsy of breast(s) using stereotactic guidance, which includes the placement of a localization device and imaging of the biopsy specimen when performed. This accurately describes the procedure performed on the right breast with the placement of a Gelmark clip using stereotactic imaging. The other codes either describe open biopsies or separate procedures that are not applicable here.References: AMA's CPT® Professional Edition (current year)

The patient is seeing a new doctor in the same specialty group for an enlarged goiter and is undergoing a medically appropriate history and exam, along with a fine needle aspiration biopsy.

Procedure Description:

Medically appropriate history and exam.

Review of TSH results and ultrasound.

Ordering of fine needle aspiration biopsy.

CPT® Coding:

99202: Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and straightforward medical decision making.

Since it has been two years since the last visit and the patient is being seen by a new doctor in the same specialty group, the encounter is considered a new patient visit.

References:

AMA's CPT® Professional Edition (current year).

CPT® Assistant for detailed coding guidelines on evaluation and management services.

For a mastectomy that involves removing the breast tissue, skin, pectoral muscles, and surrounding tissue, including the axillary and internal mammary lymph nodes, the appropriate CPT® code is:

19306: Mastectomy, radical, including pectoral muscles, axillary lymph nodes.

This code captures the extent of the surgery, including the removal of the breast tissue, skin, pectoral muscles, and lymph nodes.

References:

CPT® Professional Edition (current year)

Surgery guidelines for mastectomy procedures

The correct CPT® code for a therapeutic drug test to monitor the total level of carbamazepine is 80156. The ICD-10-CM code G40.909 is used for epileptic seizures, not otherwise specified, which aligns with the patient's condition being treated for seizures.

References:

AMA's CPT® Professional Edition (current year)

ICD-10-CM (current year)

The patient is undergoing a cardiac catheterization with a CRNA providing monitored anesthesia care (MAC). Code 00520 is for anesthesia for heart catheterization procedures. Modifier QX indicates CRNA service with medical direction by a physician, QS indicates MAC, and P5 indicates a patient with a severe systemic disease that is a constant threat to life. Thus, the correct code and modifier combination is 00520-QX-QS-P5.References: CPT® Professional Edition (current year), AMA.

Cesarean Delivery with Antepartum and Postpartum Care: The procedure involved the cesarean section delivery of twins, including antepartum and postpartum care.

CPT Code 59510: This code is used for routine obstetric care including antepartum care, cesarean delivery, and postpartum care. The code is not reported per fetus but per delivery, even when delivering multiples.

References:

AMA's CPT® Professional Edition (current year)

CPT® code 49083 describes an abdominal paracentesis with imaging guidance, such as ultrasound. This code includes the imaging guidance as part of the procedure, so it is not necessary to separately report the ultrasonic guidance.

References:

AMA's CPT® Professional Edition (current year), Code 49083

For a procedure involving the placement of a 6-French sheath and catheter into the coronary artery, advancing to the left ventricle, performing ventriculography with power injection of contrast agent, obtaining pressures in the left heart, and imaging the coronary arteries, the correct CPT® code is 93458. This code includes all the components of the described procedure.

References:

AMA's CPT® Professional Edition (current year)

CPT® code 69644 refers to a tympanoplasty with mastoidectomy, which includes canalplasty, middle ear surgery, and tympanic membrane repair. The specific procedure described by this code is performed with an intact or reconstructed canal wall and includes ossicular chain reconstruction. The use of a semicolon in the CPT® description helps distinguish between different variations of the procedure.References: AMA's CPT® Professional Edition, specific code descriptions and guidelines.

For a patient with a mass in the left lower lung suspected to be cancer that is currently documented as a tumor of uncertain behavior, with existing ovarian cancer with metastases to the liver, the ICD-10-CM codes are:

D38.1: Neoplasm of uncertain behavior of bronchus and lung.

C56.9: Malignant neoplasm of unspecified ovary.

C78.7: Secondary malignant neoplasm of liver and intrahepatic bile duct.

D38.1 is used because the behavior of the lung tumor is uncertain, and C56.9 and C78.7 are used to document the known primary and metastatic cancers.

References:

ICD-10-CM guidelines

AMA's CPT® Professional Edition (current year)

The human shoulder is composed of three main bones: the clavicle (collarbone), scapula (shoulder blade), and humerus (upper arm bone). These bones form the shoulder joint, which is one of the most flexible and mobile joints in the human body, allowing for a wide range of motion.References: AMA's CPT® Professional Edition (current year), Musculoskeletal System section.

29827: Arthroscopic rotator cuff repair is correctly coded as 29827.

29828: Arthroscopic biceps tenodesis is an additional procedure and should be coded as 29828 with modifier -51 (Multiple Procedures).

29824: Arthroscopic claviculectomy (partial resection of the distal clavicle) is coded as 29824 with modifier -51.

29826: Arthroscopic subacromial decompression, including coracoacromial ligament release, is coded as 29826.

All these procedures were performed arthroscopically and documented in the operative report, justifying the use of these codes and the use of modifier -51 for multiple procedures.

References:

CPT® Professional Edition, AMA

The patient with malignant lymphoma is administered Rituximab (800 mg) and Benadryl (100 mg) intravenously.

Procedure Description:

Administration of Rituximab (800 mg) intravenously.

Administration of Benadryl (100 mg) intravenously.

HCPCS Level II Coding:

J9312: Injection, Rituximab, 10 mg.

For 800 mg, report 80 units of J9312.

J1200: Injection, Diphenhydramine HCl, up to 50 mg.

For 100 mg, report 2 units of J1200.

References:

HCPCS Level II Code Book (current year).

HCPCS Level II coding guidelines for intravenous drug administration.

The procedure involves a tympanoplasty with a radical mastoidectomy and removal of a cholesteatoma from the middle ear, including grafting of the eardrum without ossicular chain reconstruction.

Procedure Description:

Tympanoplasty.

Radical mastoidectomy.

Removal of cholesteatoma from the middle ear.

Grafting technique used to repair the eardrum without ossicular chain reconstruction.

CPT® Coding:

69645: Tympanoplasty with mastoidectomy (including canalplasty, atticotomy and/or middle ear surgery), radical or complete, with removal of cholesteatoma; with mastoid obliteration.

References:

AMA's CPT® Professional Edition (current year).

CPT® Assistant for detailed coding guidelines on otolaryngology procedures.

The CPT code 10005 is for fine needle aspiration biopsy, including ultrasound guidance, for the first lesion. CPT code 10006 is for each additional lesion with ultrasound guidance. Since the provider aspirated tissue from three nodules, the coding should be 10005 for the first nodule and 10006 x 2 for the additional two nodules.References: AMA's CPT® Professional Edition (current year)

Procedure: Impedance testing via tympanometry is performed to assess hearing loss in the left ear.

CPT® Code:

92567: This code is for tympanometry (impedance testing) without reflex threshold measurements.

Code Selection Justification: The procedure involved tympanometry without reflex threshold, which is specifically coded as 92567.

References:

AMA CPT® Professional Edition (current year)

The mediastinum is an anatomical region located in the thoracic cavity. It is bounded by the sternum in front, the vertebral column at the back, and is situated between the lungs. It contains the heart, trachea, esophagus, thymus, and other structures, but it is not itself an organ. Therefore, the correct answer is that it is a location in the chest.References: ICD-10-CM, Medical Anatomy and Physiology textbooks

The scenario describes an emergency basic life support (BLS) ambulance service. The appropriate HCPCS Level II code for BLS emergency transport is A0429.

Modifier QN indicates that the service was provided by an ambulance supplier, and SH indicates the services were provided in an emergency situation.

References:

HCPCS Level II, current year

CPT® code 46255 describes the excision of both internal and external hemorrhoids, which matches the procedure described. The ICD-10-CM codes K64.0 (First degree hemorrhoids) and K64.4 (Residual hemorrhoids) describe the conditions treated.

References:

AMA's CPT® Professional Edition (current year), Code 46255

ICD-10-CM (current year), Codes K64.0, K64.4

The Office of Inspector General (OIG) provides compliance program guidance to form the basis of a voluntary compliance program for provider practices. This guidance is intended to help healthcare providers develop effective internal controls to monitor adherence to applicable statutes, regulations, and program requirements of Federal healthcare programs. The OIG issues various compliance guidelines and resources to assist organizations in establishing comprehensive compliance programs to prevent fraud, waste, and abuse.References: OIG Compliance Program Guidance, AMA's CPT® Professional Edition, and healthcare compliance resources.

Injection of atropine: Atropine is administered to reduce sialorrhea.

Bilateral submandibular salivary glands: The physician administers the injections into the salivary glands.

Total of four glands: Indicates that multiple glands are treated in the same session.

CPT code 64611 accurately represents chemodenervation of the salivary glands, bilateral. The use of -50, -52, or x4 modifiers is not appropriate since CPT guidelines include bilateral procedures in this code without needing additional modifiers or codes.

References: AMA's CPT® Professional Edition (current year)

Medicare provides specific codes for screening colonoscopy based on the patient's risk factors. For a Medicare patient scheduled for a screening colonoscopy who is at high risk (such as those with a history of intestinal polyps), the appropriate code is G0105.

G0105 is used for colorectal cancer screening; colonoscopy on individuals at high risk.

References:

HCPCS Level II, current year

Medicare Guidelines for Colorectal Cancer Screening