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Download link for Answer Keys of CPC Practice Papers

Hello guys, here I am sharing download link for CPC Practice Papers and answer keys. These practice papers are very useful for CPC exam purpose. I have collected these papers from various sources on internet. Click on below links to get Practice papers in pdf format….

150-CPC-Exam-2008-questions

CPC 2008 ANSWERS

150-CPC-Exam-2010-questions

CPC 2010 ANSWERS

150-CPC-Exam-2011-questions

CPC 2011 ANSWERS

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DOWNLOADABLE CPC®PRACTICE EXAM QUESTIONS

 

CPC Practice paper 2

DOWNLOADABLE CPC®PRACTICE EXAM QUESTIONS

  1. Dr. Jess removed a 4.5 cm (excised diameter) cystic lesion from Amy’s forehead. The ulcerated lesion was anesthetized with 20 mg of 1% Lidocaine and then elliptically excised. The wound was closed with a layered suture technique and a sterile dressing applied. The wound closure, according to Dr. Jess’s documentation, was 5.3 cm. How would you report this procedure?
  1. a. 11446, 12053-51 b. 11646, 12013-51
  2. c. 11446, J2001 x 2, 12013-59 d. 11313, 12053-59
  1. How should you code an excision of a lesion when completed with an adjacent tissue transfer or rearrangement?
  1. a. The excision is always reported in addition to the adjacent tissue transfer or rearrangeme
  2. The excision is not separately reported with adjacent tissue transfer or rearrangement codes.
  3. c. Code only malignant lesions in addition to the adjacent tissue transfer or rearrangement code
  4. Code the lesion with a modifier -51 and code in addition to the adjacent tissue transfer or rearrangement codes.
  1. Sally suffered a burst fracture to her lumbar spine during a skiing accident. Dr.

Phyllis performed a partial corpectomy to L2 by a transperitoneal approach followed by anterior arthrodesis of L1-L3. She also positioned anterior instrumentation and placed a structural allograft to L1-L3. How would Dr. Phyllis report this procedure?

  1. a. 63090, 22558-51, 22585, 22845, 20931 b. 63085, 22533, 22585-51, 22808-59
  2. c. 22612 x 2, 22808, 22840-51, 20931
  3. 22558, 22585-51, 22845-51, 20931-59
  1. What modifier should you report when the same physician provided a re-reduction of a fracture?
  1. a. -76 b. -59 c. -77 d. -54
  1. While playing in his front yard at home, Riley fell from a tree and dislocated his patella. The surgeon documented an open dislocation. Riley underwent a closed treatment under anesthesia. How would you report the treatment and diagnoses?
  1. a. 27420, 836.3
  2. 27562, 836.4, E884.9, E849.0
  3. c. 27840, 27562-51, 836.3, E884.9 d. 27562, 836.4
  1. What code would you report for a cervical approach of a mediastinotomy with exploration, drainage, removal of foreign body, or biopsy?
  1. a. 39010 b. 39000 c. 39200 d. 39400
  1. Dr. Sacra performed a CABG surgery on Fred five months ago. Today, Dr. Sacra completed another coronary artery bypass using three venous grafts with harvesting of a femoropopliteal vein segment. How would Dr. Sacra report her work for the current surgery?
  1. a. 33512, 33530-51, 35572-51 b. 33535, 35500-51, 33519
  2. c. 33512, 33530, 35572
  3. 33535, 33519, 33530-51, 35500
  1. Mrs. Reyes had a temporary ventricular pacemaker placed at the start of a procedure.

This temporary system was used as support during the procedure only. How would you report the temporary system?

  1. a. 33210 b. 33211 c. 33207
  2. 33210, 33207-51, 33235-51
  1. An 88-year-old male patient suffering from dementia accidentally pulled out his gastrostomy tube during the night. Dr. Reid, an interventional radiologist, takes him

into an angiography suite, administers moderate sedation (an independent observer was present during the procedure), probes the site with a catheter and injects contrast medium for assessment and tube placement. Dr. Reid finds that the entry site remains open and replaced the tube into the proper position. The intra-service time for the procedure took 45 minutes. How would Dr. Reid report his services?

  1. a. 49440, 99149, 99150 b. 49440, 49450-59
  2. c. 49450, 99144, 99145 d. 49450
  1. Tom was placed under general anesthesia (by an anesthesiologist) for an excision of a

local lesion of the epididymis. How would you report the surgeon’s services?

  1. a. 54861-50 b. 54860-47
  2. c. 54830, 00920-51 d. 54830
  1. An infant born at 33-weeks underwent five photocoagulation treatments to both eyes due to retinopathy of prematurity at six months of age.The physician used an operating microscope during these procedures.These treatments occurred once per day for a defined treatment period of five days. How would you report all of these services?
  1. a. 67229 -50 b. 67229 x 5
  2. c. 67229, 69990 d. 67229 -52
  1. Andrea, a 52-year-old patient, had a hysterectomy on Monday morning. That afternoon, after returning to her hospital room, she suffered a cardiac arrest. A cardiologist responded to the call and delivered one hour and 35 minutes of critical care. During this time the cardiologist ordered a single view chest x-ray and provided ventilation management. How should you report the cardiologist’s services?
  1. a. 99291, 99292
  2. 99291, 99292, 71010, 94002 c. 71010, 94002, 99231
  3. 99291, 99292, 99292-52
  1. How does the CPT Professional Edition® define an emergency department?
  1. a. An organized hospital-based facility for the provision of unscheduled episodic services to patients who present for immediate medical attenti The facility must be available 24 hours a day.
  1. An organized hospital-based facility for the provision of scheduled episodic services to patients who present for immediate medical attention. The facility must be available 24 hours a day.
  2. c. An organized hospital-based facility for the care and treatment of chronically ill patients who present for service The facility must be available on weekends and holidays.
  3. An organized outpatient-based facility for the care and treatment of unscheduled patient who present for immediate medical attention. The facility must be available 24 hours a day.
  1. An anesthesiologist provides general anesthesia for a 72-year-old patient with mild systemic disease who is undergoing a ventral hernia repair. How would you report the anesthesia service?
  1. a. 00834-AA-P2, 99100 b. 00832-AA-P2, 99100
  2. c. 49560, 00834-QX-P3, 99100-51 d. 00832-QX-P3
  1. Which service is not included with anesthesia services?
  1. a. Swan-Ganz monitoring b. Administration of blood c. Blood pressure
  2. Mass spectrometry
  1. Sally had a DXA bone density study for her hips, pelvis, and spine. The procedure was performed in a hospital. How would you report for the professional services of this study?
  1. a. 77078-26, 77080-26 b. 77080-26
  2. c. 77082-26
  3. 77081-26, 77080-26
  1. Which modifier would you use to report with code 88239 if the test was looking for hereditary breast cancer?
  1. a. -OB -59 c. -91 d. -OA
  1. Blepharoplasty describes what type of a procedure?
  1. a. Surgical reduction of the upper/lower eyelids to remove excess fat, skin,

and muscle.

  1. Treatment for spider veins with injections of sclerosing solution.
  2. c. Replacement of damaged skin with healthy tissue taken from a donor. d. Destruction of tissue by burning or freez
  1. Which term does not refer to a level of consciousness?
  1. a. Syncope b. Stupor
  2. c. Coma
  3. Sciatica
  1. Cynthia is 28 years old and pregnant. She presents to the emergency room complaining of diarrhea with watery bowel movements with incontinence, cramps, nausea, and vomiting for the past 12 hours. She is unable to keep anything down, including liquids. She has been eating a healthy diet and does not feel this problem is based on something she ate. After testing, she was found to have enteritis due to Clostridium difficile. She was admitted for hydration and further treatment. In what order should you report the diagnoses codes for Cynthia’s condition?
  1. a. There are no sequencing rules that would apply to code this case.
  2. Symptoms, Signs, and Ill-Defined Conditions codes only (Chapter 16). c. Complications of Pregnancy, Childbirth and Puerperium (Chapter 11) codes first, followed by Infectious and Parasitic codes (Chapter 1).
  3. Infectious and Parasitic codes (Chapter 1), followed by Complications of

Pregnancy, Childbirth and Puerperium (Chapter 11) codes.

Answers to 20 sample test questions for the CPC exam

  1. A. You would report this excision to a benign lesion.In the CPT Professional Edition® under the heading Excision – Benign Lesions, cystic lesion is given as an example, (layered) intermediate closure should be reported in addition to the excision. The local anesthesia is included per the CPT Surgery section guidelines.
  1. B. The CPT Professional Edition® subcategory guidelines for Adjacent Tissue Transfer or Rearrangement procedures under the Surgery/Integumentary System guidelines indicate that excision (including lesion) is not separately reportable with adjacent tissue transfer or rearrangement codes
  1. A. The primary procedure is a partial corpectomy. You can find this in the CPT Professional Edition® index under Corpectomy. An arthrodesis procedure was done in addition to the definitive procedure; therefore modifier -51 is necessary (you can find this in the subcategory guidelines under Arthrodesis). Do not attach modifier -51 to add-on codes (see Appendix A for this definition). Additionally, you would report the code for a structural allograft without a modifier -51.
  1. A. You can find this answer in the CPT Professional Edition® in the main section guidelines for the Musculoskeletal System.
  1. B. Refer to the index of the CPT Professional Edition® under Dislocation/Patella/closed treatment for a code range. It is necessary to look up the code range and read the descriptions to select the correct code. You can find the ICD-9-CM codes under Dislocation/Patella/Open. The E code Alphabetic listing is in Volume 2, Section 3 – in this index look up Fall, (from off), tree; the second code, look up Accident, (occurring at in), house.
  1. B. Code 39000 is a cervical approach; code 39010 reports a transthoracic approach.
  1. C. The codes 33530 and 35572 are add-on codes and should not have modifier 51 appended. Review modifier -51 in Appendix A of the CPT Professional Edition® for this note.
  1. A. The code 33210 reports a temporary transvenous single chamber pacemaker. There is not enough information in this question to code for the placement of the permanent system.
  1. C. This is a replacement procedure via the same access site. The same provider completed the procedure and the moderate sedation. The procedure code does not include moderate sedation; therefore, codes for the sedation would be reported. You can find the guidelines for moderate sedation in Appendix G of the CPT Professional Edition®.
  1. D. You can find this answer in the CPT Professional Edition® index under

Excision/Lesion/Epididymis. Be careful with the index in this section and follow down to lesion or you may report an incorrect code adjacent tissue transfer or rearrangement codes.

  1. A. In the CPT Professional Edition® the note under Prophylaxis indicate that these services are repetitive, performed in multiple sessions, and are intended to include all services in a defined treatment period. The parenthetical note under code 67229 states to use modifier -50 for a bilateral procedure. The operating microscope is bundled into this procedure. Refer to code 69990 for a list of bundled codes.
  1. A. See the critical care guidelines in the CPT Professional Edition® or a list of included services. These services are not separately reported in addition to critical care codes when services are performed by the physician providing the critical care.
  1. A. You can find this definition in the CPT Professional Edition® under the subcategory guidelines for Emergency Department Services.
  1. B. You should report the anesthesia service with modifiers -AA (indicates anesthesiologist preformed the anesthesia) and -P2 (for mild systemic disease). The add- on code for qualifying circumstances is reported due to the patient’s age.
  1. A. According to the Anesthesia Guidelines in the CPT Professional Edition®, Swan- Ganz monitoring is not included.
  1. B. You can find this study in the index of the CPT Professional Edition® under DXA (with a cross reference). This study was completed on the axial skeleton.
  1. A. Genetic Testing Modifiers are listed in Appendix I of the CPT Professional Edition®.

The note in the CPT Professional Edition® under the subcategory Cytogenetic Studies refers coders to Appendix I.

  1. A. You can find this answer in the index of the CPT Professional Edition® under Blepharoplasty. Once you locate the term, cross reference the code(s) to determine the type of procedure.
  1. D. Sciatica is an inflammation of the sciatic nerve that results in pain, burning, and tingling along the course of the nerve through the thigh and leg. You could find the answer to this question by looking up each term in the ICD-9-CM index.
  1. C. You can find this answer in the ICD-9-CM coding guidelines under Chapter 11, a, 1.

Codes from Chapter 11states, “. . . Chapter 11 codes have sequencing priority over codes from other chapters. Additional codes from other chapters may be used in conjunction with Chapter 11 codes to further specify conditions.”

CPC Practice Questions

DOWNLOADABLE CPC®PRACTICE EXAM QUESTIONS

  1. Jill is a 29-year-old patient of Dr. Marks. She is seen by Dr. Marks for a cough with wheezing and yellow-colored mucus of three days’ duration, as well as four days of external bleeding hemorrhoids and diarrhea. Dr. Marks gives Jill Amoxicillin for acute viral bronchitis, instructions for care of external hemorrhoids, and a diet plan to assist with the diarrhea. What diagnoses should Dr. Marks use for this encounter?
  1. a. 0, 455.5, 787.91 b. 787.91, 466.11, 455.5 c. 466.11, 787.91, 455.2 d. 466.0, 455.8, 787.91
  1. What HCPCS Level II code describes Ensure HN therapy with an enteral infusion pump with alarm?
  1. a. B4150, B9002 b.  B4152, B9000 c.   B4150
  2. None of the above
  1. Which types of joints are considered synovial?
  1. a. Suture joint, medial joint, and articulation joint
  2. Ball-and-socket joint, hinge joint, and saddle joint c. Pivot joint, talus joint, and cranial joint
  3. Ball-and socket joint, nasal joint, and elevation joint
  1. A physician applied a cast and also provided all of the subsequent fracture care. The same physician may report the application of the cast separately from the fracture care.
  1. a. True b. False
  1. Immediately prior to inserting a permanent pacemaker and placing an electrode in the ventricle, the same physician surgically created a pocket to hold the pulse generator. How should the physician report the creation of the pocket?
  1. a. Skin pocket is included b.  33222
  2. c. 33222, 33215-51 d.  33233
  1. What modifier should be used for an incomplete colonoscopy when the patient was prepared for a full colonoscopy?
  1. a. 78 b. 52 c. 24
  2. None of the above
  1. A physician inserts a single temporary transvenous pacing catheter into the right atrium and connects the electrode to an external pulse generator. How should the physician report these services?
a. 33214
b. 33206
c. 33210
d. 33211-52
  1. A surgeon performs a diagnostic laparoscopy followed by a laparoscopic

nephrectomy (including partial ureterectomy). How should the physician report these services?

  1. a. 50546
  2. 49320, 50546-51 c. 49320
  3. 50549
  1. It is appropriate to separately report a visceral repair when a closure of an ureterovisceral fistula is performed during the same surgical session.
  1. a. True b. False
  1. A dermatologist excises a 3.5 cm benign lesion from a patient’s back. After the lesion is successfully removed, the dermatologist performs an intermediate 3.5 cm layered closure. How should you report these services?
a. 11404, 12031
b. 11404, 12032-51
c. 11404
d. 11404, 12032-57
  1. How would a physician report a bilateral diagnostic nasal endoscopy followed by endoscopic debridement of the nasal cavity during the same operative session?
a. 31240, 31237
b. 31254
c. 31237-50
d. 31237
  1. What is the name of a procedure that involves the passage of an endoscope down through the esophagus?
  1. a. Septoplasty b.  Sinusotomy
  2. c. Laryngoscopy d.  Esophagoscopy
  1. A physician excises a lesion from the iris of the right eye. How should the physician report these services?
  1. a. 66761-50 b. 66770-RT c. 66635-52 d.  66600-RT
  1. A patient presents to have corns removed from his foot. The physician performs paring to successfully remove four lesions. How should the physician report these services?
  1. a. 11056
  2. 11056, 12000 c.  11056 x 4
  3. 11704
  1. The subsection microbiology in the Pathology and Laboratory section of the CPT Manual includes codes for bacteriology, mycology, parasitology, and virology.
  1. a. True b.  False
  1. A 13-year-old patient suffering from end-stage renal disease received a full month of services, including growth and development assessment, parent counseling, and

monitoring of adequate nutrition. These services were completed in an outpatient facility. How would the physician report these services?

a. 90999
b. 97803, 90924
c. 90920
d. 90924
  1. A patient is admitted to the hospital for insertion of 15 interstitial radiation ribbons.

How would the facility report the radiology services?

  1. a. 77778
  2. 99222, 77763 c.  77777-TC
  3. 77762 x 15
  1. Mrs. Smith was seen by her family physician, Dr. Marks. Mrs. Smith complains she has had a sore throat, breathing problems, and a fever for five days. She is a diabetic patient and has been taking over-the-counter medications that have interfered with her insulin medication. Dr. Marks documented a detailed history, detailed examination, and moderately complex decision-making. Dr. Marks spent 35 minutes with the patient during the examination. How should the physician report this service?
a. 99215
b. 99204
c. 99205
d. 99214
  1. Pediatric critical care patient transport codes include vascular access procedures, blood gases, and review of information data stored in computer.
  1. a. True b.  False
  1. An anesthesiologist administers anesthesia for a male patient prior to the surgeon performing a total hip replacement. The patient is 75 years old and suffers from mild hypertension. How should you code the anesthesia services?
  1. a. 01214, 99100-59 b.  01214-47
  2. c. 01214-P2, 99100 d.  01214-P3

Answers to sample test questions for the CPC exam

  1. “a” Hemorrhoids are external with bleeding and the bronchitis is not specific to the type of virus.
  1. “a” Report both the supplement and the pump.
  1. “b” There are six types of freely moving or synovial joints: ball-and- socket, hinge, pivot, condyloid, saddle, and gilding joints.
  1. “b” When a physician applies the initial cast and assumes all of the subsequent fracture care, the physician cannot report the application of the cast separately because it is included in the treatment of the fracture.
  1. “a” This procedure is included with insertion of the pacemaker.
  1. “b” A colonoscopy is the examination of the entire colon from the rectum to the cecum, and may include the examination of the terminal ileum. You can find this description in the surgery section of the CPT Professional Edition under digestive endoscopy procedures.
  1. “c” Reports a temporary pacemaker.
  1. “a” The diagnostic laparoscopy is bundled into the surgical laparoscopy.
  1. “b” A visceral repair is included in a closure of a ureterovisceral fistula.

The code for this procedure is 50930.

  1. “b” The guidelines with excision–benign lesion provide directions to code additionally for intermediate and complex closures.
  1. “c” The guidelines for codes 31231–31294 report unilateral procedures unless otherwise stated.
  1. “d” Esophagoscopy
  1. “d” The surgical term for this procedure is iridectomy.
  1. “a” Code 11056 includes “two to four lesions.”
  1. “a” True. Review the subcategory guidelines of CPT Professional Edition

under microbiology.

  1. “c” The guidelines of CPT Professional Edition listed with Dialysis services clearly define inpatient and outpatient services.
  1. “a” The guidelines for clinical brachytherapy indicate that admission to the hospital is included with these services. There are definitions of simple, intermediate, and complex, with numbers of ribbons or sources.
  1. “d” This is an established visit. The documentation lists all three of the key components for a 99214 visit. Only two of the three key components must be met to qualify for this level of visit.
  1. “a” A list of codes and services included are listed in this subcategory guideline of the CPT Professional Edition.
  1. “c” Anesthesia codes must have a physical status modifier. This question has qualifying circumstances based on the patient age.

Radiology Questions – Answers

DOWNLOADABLE CPC®PRACTICE EXAM QUESTIONS

ANSWERS

  1. “a” Report a screening mammography with 77057 and the computer-aided detection with 77052. The code 77052 is an add-on code and should not have a modifier -51 attached (see Appendix A in the CPT Professional Edition for a definition of modifier -51).
  1. “c” The code 76942 is the correct code to report this procedure According to the CPT Assistant, Apr 05:15-16, “From a CPT coding perspective, code 76942 should be reported per distinct lesion that requires separate needle placement. Therefore, if passes are made into two separate lesions in the same organ (i.e., two lesions in same breast), then code 76942 would be reported twice.”
  1. “b” You can find this study in the index of the CPT Professional Edition under DXA (with a cross reference).This study was completed on the axial skeleton.
  1. “b” You can find this answer in the index of the CPT Professional Edition under Proton Treatment Delivery.
  1. “d”
  2. “a” The fastest way to find these codes is to refer to the list in Radiology Guidelines of the CPT Professional Edition. Or, refer to the index under Unlisted Services and Procedures for a complete listing.
  1. “a” You can find this answer by referring to the index of the CPT Professional Edition under Magnetic Resonance Imaging (MRI), Heart. When you cross reference the code set, the subcategory guidelines preceding these codes define the difference in testing.
  1. “c” You can find his answer in the index of the CPT Professional Edition under Brachytherapy, High Code Electronic. There is also a parenthetical note preceding CPT Code 77750.
  1. “c” The common part of the code 78130 (the part before the semicolon) is considered part of the code 78135.
  2. C The radiological service is a screening mammogram of both breasts, eliminating multiple choices A, B and D. There is a parenthetical note under code 77057 which states “Use 77057 in conjunction with 77052 for computer-aided detection applied to a screening mammogram”.
  3. B This procedure was performed bilaterally (stents placed in the right and left ureter), eliminating multiple choice answer A and C. The pyelogram was retrograde, eliminating multiple choice answer D. Retrograde pyelogram is included in cystoscopy, 52005. The stent placement 52332-50 correctly reports the bilateral procedure. Modifier 26 is correctly appended to 74420 since the procedure was performed in an outpatient facility with the physician interpreting the radiological service.
  4. A The x-ray was taken in two views (oblique and lateral) without arthrography, eliminating multiple choice answers B and C. The fracture is an open fracture which is indexed in the ICD-9-CM manual under Fracture/radius/lower end or extremity/open referring you to code 813.52.
  5. C This radiological service is a bone density study using computed tomography (CT) to asses bone mass or density of the spine.

14.B This is a follow-up ultrasound since the previous ultrasound showed abnormalities of the fetuses. The note under 76816 states to report 76816 with modifier -59 for each additional fetus.

  1. B Patient is having a broken tip of a catheter removed from the right ventricle, eliminating multiple choices A and D. There is a parenthetical note under code 37203 that states “For radiological supervision and interpretation use 75961“, eliminating multiple choice C. The fracture of the port-a-cath is a mechanical complication of a vascular device.
  2. A Patient is having a peritoneocentesis performed, eliminating multiple choice answers B and D. The needle placement to withdraw the fluid was done under ultrasonic (imaging) guidance, eliminating multiple choice answer C. There is a parenthetical note under procedure code 49080 that states “If imaging guidance is performed, see 76942, 77012”.
  3. B. The key words for this encounter are “dual energy”, which eliminates C and D. 77081 is the correct code since an example is given in parentheses what an “appendicular skeleton” is. The foot is in the same category as the wrist or heel which is considered peripheral bones.
  1. D. When a selective catheter placement is performed, it includes the procedure to gain access. In this case the femoral access is to the aorta. From the aorta the physician selectively catheterizes the right renal artery which is considered a first order branch from the aorta reported with 36245. 36200 is included with 36245 and cannot be coded separately. Refer to Appendix L in the CPT® manual. The renal artery is considered a first order branch. Two imaging services are performed. The aortography (75625) is bundled with the renal angiography (75722). Only the renal angiography is reported. Modifier 26 is appended to report the professional component was performed by the physician for the radiology services.
  2. A. The patient receives seven radiation treatments, which is reported with 77427. In the coding guidelines for this section it states, “ Code 77427 is also reported if there are three or four fractions beyond a multiple of five at the end of a course of treatment; one or two fractions beyond a multiple of five at the end of a course of treatment are not reported separately.”
  3. C. Codes for MRI are determined by anatomical site and whether contrast is used. In this case, the MRI is of the lumbar spine. From the index, look up magnetic resonance imaging/spine/lumbar. You are referred to 72148-72158. Option A is an X-ray so it is not the correct answer. 72148 is without contrast, which is the correct code. According to ICD-9-CM Official Coding Guidelines, do not report signs and symptoms of a definitive diagnosis. In this case the patient complains of lower back pain and leg pain. He is diagnosed with lumbar spinal stenosis. The symptoms he presents with are symptoms associated with his diagnosis and should not be reported. From the index, look up stenosis/spinal/lumbar. You are referred to 724.02. Verify the code accuracy in the tabular section.
  1. D. The patient presents for a ureteral catheter exchange via the ileal conduit. 50398 is not correct because it is for a nephrostomy tube which is in the kidney. 50393 is performed using a percutaneous approach, which is not used in this case. 50385 is performed using a transurethral approach, which is not correct. The exchange is performed via the ileal conduit, which is reported with 50688. Imaging is performed. There is a parenthetical note under 50688 that states that imaging is reported with 75984.
  1. D. In the beginning of the obstetric ultrasound subsection in CPT®, there are descriptions of what is required for the OB ultrasound codes. In this case the ultrasound is limited because only two elements are examined the fetal heart rate and fetal position. This type of ultrasound is reported with 76815. In the code description it states “1 or more” which means the code is only reported once whether it is a single fetus or multiple fetuses.
  2. C. Ultrasound codes are selected by anatomic site. The liver is an organ in the abdomen. Because the ultrasound is performed on one organ, it is reported as limited. Please note in the parentheses following code 76705 it states “one organ.” 76970 is not appropriate because this is an initial ultrasound and not a follow-up.
  1. A. From the CPT® index, look CT scan/heart/evaluation/for coronary calcium. You are referred to 75571. Verify the code description. Codes 75572 and 75574 are performed with contrast so answer options B and C are not correct. 75557 is an MRI which is also incorrect.
  2. B. The physician inserts the needle through the skin which indicates this is a percutaneous approach and not an open procedure. Answer options A and C can be eliminated. Fluoroscopic guidance was used, which is reported with 77002 for this type of procedure.

Practice Questions – Anaesthesia – Answers

ANESTHESIA

  1. “b” You should report the anesthesia services with modifier -P2 for mild systemic disease and qualifying circumstances due to the patient’s age.
  1. “c” Refer to Appendix G in the CPT Professional Edition. This appendix lists the codes that include moderate conscious sedation along with guidelines to assist with reporting these services. Additionally, code 93315 has a “bulls-eye” symbol that indicates moderate conscious sedation is included with the service.
  1. “d” According to the Anesthesia Guidelines in the CPT Professional Edition, the preoperative visit is “bundled” or included in the anesthesia services.
  1. “b” According to the Anesthesia Guidelines in the CPT Professional Edition, “To report regional or general anesthesia provided by a physician also performing the services for which the anesthesia is being provided, see modifier -47 in Appendix A.” Appendix A describes the use of modifier -47 for a basic service when the anesthesia is provided by the surgeon.
  1. “a” According to the Anesthesia Guidelines in the CPT Professional Edition, Swan-Ganz monitoring is not included.
  1. “c” You can find the definition for Modifier -23 – Unusual Anesthesia in Appendix A of the CPT Professional Edition.
  2. C The patient receives anesthesia for a laparoscopic radical nephrectomy. From the CPT® index, look up anesthesia/nephrectomy. You are referred to 00862. Review the code description to verify accuracy. The patient has controlled type II diabetes which supports the use of P2. The patient has renal pelvis cancer. The distinction of secondary cancer is not made so the cancer is coded as a primary neoplasm. In the neoplasm table go to the kidney/pelvis row and the primary column. You are referred to 189.1. The patient also has controlled type II diabetes. To locate, look up diabetes which refers you to 250.0x. A fifth digit is required. The scenario stated the patient is controlled with type II which is reported with a fifth digit of “0.”
  1. C The patient receives monitored anesthesia care also known as MAC which is reported with HCPCS Level II modifier QS. There is no indication the patient has a history of cardiopulmonary condition so G9 would not be appropriate. From the CPT® index, look up anesthesia/forearm. You are referred to multiple codes (00400, 01810-01820, 01830-01860). Refer to these codes to determine the correct code using the code descriptions. The procedure was open and performed on the distal radius. The appropriate code is 01830.
  1. B The patient receives general anesthesia for the removal of a laryngeal mass. From the CPT® index, look up anesthesia/larynx. You are referred to 00320 and 00326. Review the code descriptions. 00326 is the correct code to indicate the procedure is performed on a patient younger than one year. 99100 is not reported because the patient’s age range is included in the description of the anesthesia code. There is a parenthetical note following 00326 that states the code should not be reported with 99100.
  2. C The patient receives general anesthesia for the repair of a cleft palate. From the CPT® index, look up anesthesia/cleft palate repair. You are referred to 00172. Verify the code description for accuracy. The patient is 6 months old, 99100 is appropriate for this scenario.
  1. B The patient had a previous mastectomy. For this encounter the mastopexy and reconstruction is performed. From the CPT® index, look up anesthesia/breast. You are referred to 00402-00406. Refer to the code description for the correct code. 00402 is the correct code for anesthesia administered for breast reconstruction.
  1. C A code is selected for the general anesthesia performed for the total knee replacement. From the CPT® index, look up anesthesia/replacement/knee. You are referred to 01402 which is the correct code. The lumbar epidural is also reported because the purpose is for postoperative pain. The procedure is reported with 62319. There is a parenthetical note following 62319 that indicates to use 01996 in conjunction with 62318-62319. 01996 is a per day code. In this scenario, the physician performs two days of daily management. Modifier AA indicates the anesthesia was performed by an anesthesiologist.
  2. A MAC is performed for a procedure performed on the anterior trunk of the integumentary system. From the CPT® index, look up anesthesia/integumentary system/anterior trunk. You are referred to 00400 which is the correct code. The QS modifier is appended to identify that the type of anesthesia is MAC. The QX modifier is appended to report the service was provided by a medically directed CRNA.
  1. A .The procedure performed is a coronary artery bypass. From the CPT® index, look up anesthesia/heart/coronary artery bypass grafting. You are referred to 00566 and 00567. The note indicates that the heart and lung bypass was used. Select 00567 because the code description includes “with pump oxygenator.” The anesthesia start time is 6:00 PM and the anesthesia ends at 12:00 AM which is six hours.
  2. B. There is no indication that one lung ventilation is used. The correct anesthesia code for this procedure is 00540. The anesthesiologist reports the anesthesia with modifier QK to identify medical direction. The CRNA uses modifier QX to indicate it is a medically directed service.
  1. C. The block is reported because it is done for postoperative pain management and not the mode of anesthesia. The block is reported with 64417. The procedure is reported with 64721, which crosswalks to 01810. In the CPT® manual look up anesthesia/wrist. The anesthesia is reported with 01810. Modifier 59 is appended because these services are bundled.
  1. D. From the CPT® index, look up anesthesia/thyroid. You are referred to 00320-00322. The procedure performed is a thyroid needle biopsy, which is reported with 00322. Anesthesia time starts when the anesthesiology provider begins to prepare the patient and ends when they are no longer in personal attendance. In this case the anesthesia time starts at 0900 and ends at 1000 which is one hour.
  2. D. The patient received a neuraxial epidural for labor for a planned vaginal delivery, which is reported with 01967. During the course of labor the patient requires a caesarean section. The patient begins to hemorrhage requiring a hysterectomy. The add-on code 01969 is used to report the anesthesia for the caesarean and hysterectomy.
  1. C. From the index, look up anesthesia/ heart/ coronary artery bypass/grafting. You are referred to 00566 and 00567. In the scenario it states that cardiopulmonary bypass is used, which indicates that the code that includes pump oxygenator is the correct answer. The patient has COPD, which is a severe systemic disease, but there is no indication that is a threat to the patient’s life. Append physical status indicator P3.
  1. C. Anesthesia is performed for cleft lip repair. From the index, look up anesthesia/cleft lip repair. You are referred to 00102. Refer to the code description to verify accuracy. The patient is healthy, which means P1 is the correct physical status modifier. 99100 is reported because the patient is under one year of age and the patient’s age is not included in the CPT® code for the anesthesia service
  2. B. In this case MAC is performed, which requires modifier QS. This eliminates answer options A and C. The patient had a diagnostic arthroscopy. There is no indication that a surgical procedure was performed. Because the service was provided by an anesthesiologist, modifier AA is appended to the anesthesia code.
  3. C. The patient receives anesthesia for a tracheostomy. From the CPT® index, look up anesthesia/trachea. You are referred to 00320, 00326, 00542. The patient is a 9-month-old which eliminates answer options A and B. There is a parenthetical note under code 00326 which states “Do not report 00326 in conjunction with 99100”.
  4. a. One way to find this answer in the index of the CPT® Professional Edition is under the main term “Anesthesia,” “Pelvis,” then “Repair.” The guidelines for anesthesia indicate the use of physician status modifiers when reporting anesthesia codes. Additionally, the add-on code 99100 identifies the age of the patient in this question.
  5. b. Review of modifier -47 in Appendix A of the CPT® Professional Edition provides instructions for placement of this modifier on the procedure code when the surgeon provides either general or regional anesthesia.
  6. d. The anesthesia guidelines in the CPT® Professional Edition provide add-on codes for qualifying circumstances. The code 99100 is used to report the age of a patient as younger than 1 or older than 70 years. The parenthetical note following this add-on code provides the codes where age is a factor and already defined; therefore, the add-on code is unnecessary for correct reporting.
  7. c. Anesthesia code 00604 describes the patient in a sitting position. Careful review of codes will help determine the correct reporting if there is an anatomical location and/or position included in the description.
  8. c. Code 58823 includes moderate sedation. The add-on codes for qualifying circumstances and physical status modifiers are listed with anesthesia codes and should not be appended to a surgical procedure code.
  9. d. The anesthesia guidelines in the CPT® Professional Edition provide a list of services that are included or bundled when provided. Additionally, the monitoring services that are not bundled are listed in the same guidelines.
  10. a. This question specifies reporting for three days of hospital management. Code 01996 would be reported x 3 units.
  11. a. The total body surface area (TBSA) burned is 54%. The first code, 01952, includes 9% of the burn; the add- on code 01953 would be reported for each additional 9% (five units equal 45% plus the initial 9% reaches the total 54%).

ANESTHESIA

  1. “b” You should report the anesthesia services with modifier -P2 for mild systemic disease and qualifying circumstances due to the patient’s age.
  1. “c” Refer to Appendix G in the CPT Professional Edition. This appendix lists the codes that include moderate conscious sedation along with guidelines to assist with reporting these services. Additionally, code 93315 has a “bulls-eye” symbol that indicates moderate conscious sedation is included with the service.
  1. “d” According to the Anesthesia Guidelines in the CPT Professional Edition, the preoperative visit is “bundled” or included in the anesthesia services.
  1. “b” According to the Anesthesia Guidelines in the CPT Professional Edition, “To report regional or general anesthesia provided by a physician also performing the services for which the anesthesia is being provided, see modifier -47 in Appendix A.” Appendix A describes the use of modifier -47 for a basic service when the anesthesia is provided by the surgeon.
  1. “a” According to the Anesthesia Guidelines in the CPT Professional Edition, Swan-Ganz monitoring is not included.
  1. “c” You can find the definition for Modifier -23 – Unusual Anesthesia in Appendix A of the CPT Professional Edition.
  2. C The patient receives anesthesia for a laparoscopic radical nephrectomy. From the CPT® index, look up anesthesia/nephrectomy. You are referred to 00862. Review the code description to verify accuracy. The patient has controlled type II diabetes which supports the use of P2. The patient has renal pelvis cancer. The distinction of secondary cancer is not made so the cancer is coded as a primary neoplasm. In the neoplasm table go to the kidney/pelvis row and the primary column. You are referred to 189.1. The patient also has controlled type II diabetes. To locate, look up diabetes which refers you to 250.0x. A fifth digit is required. The scenario stated the patient is controlled with type II which is reported with a fifth digit of “0.”
  1. C The patient receives monitored anesthesia care also known as MAC which is reported with HCPCS Level II modifier QS. There is no indication the patient has a history of cardiopulmonary condition so G9 would not be appropriate. From the CPT® index, look up anesthesia/forearm. You are referred to multiple codes (00400, 01810-01820, 01830-01860). Refer to these codes to determine the correct code using the code descriptions. The procedure was open and performed on the distal radius. The appropriate code is 01830.
  1. B The patient receives general anesthesia for the removal of a laryngeal mass. From the CPT® index, look up anesthesia/larynx. You are referred to 00320 and 00326. Review the code descriptions. 00326 is the correct code to indicate the procedure is performed on a patient younger than one year. 99100 is not reported because the patient’s age range is included in the description of the anesthesia code. There is a parenthetical note following 00326 that states the code should not be reported with 99100.
  2. C The patient receives general anesthesia for the repair of a cleft palate. From the CPT® index, look up anesthesia/cleft palate repair. You are referred to 00172. Verify the code description for accuracy. The patient is 6 months old, 99100 is appropriate for this scenario.
  1. B The patient had a previous mastectomy. For this encounter the mastopexy and reconstruction is performed. From the CPT® index, look up anesthesia/breast. You are referred to 00402-00406. Refer to the code description for the correct code. 00402 is the correct code for anesthesia administered for breast reconstruction.
  1. C A code is selected for the general anesthesia performed for the total knee replacement. From the CPT® index, look up anesthesia/replacement/knee. You are referred to 01402 which is the correct code. The lumbar epidural is also reported because the purpose is for postoperative pain. The procedure is reported with 62319. There is a parenthetical note following 62319 that indicates to use 01996 in conjunction with 62318-62319. 01996 is a per day code. In this scenario, the physician performs two days of daily management. Modifier AA indicates the anesthesia was performed by an anesthesiologist.
  2. A MAC is performed for a procedure performed on the anterior trunk of the integumentary system. From the CPT® index, look up anesthesia/integumentary system/anterior trunk. You are referred to 00400 which is the correct code. The QS modifier is appended to identify that the type of anesthesia is MAC. The QX modifier is appended to report the service was provided by a medically directed CRNA.
  1. A .The procedure performed is a coronary artery bypass. From the CPT® index, look up anesthesia/heart/coronary artery bypass grafting. You are referred to 00566 and 00567. The note indicates that the heart and lung bypass was used. Select 00567 because the code description includes “with pump oxygenator.” The anesthesia start time is 6:00 PM and the anesthesia ends at 12:00 AM which is six hours.
  2. B. There is no indication that one lung ventilation is used. The correct anesthesia code for this procedure is 00540. The anesthesiologist reports the anesthesia with modifier QK to identify medical direction. The CRNA uses modifier QX to indicate it is a medically directed service.
  1. C. The block is reported because it is done for postoperative pain management and not the mode of anesthesia. The block is reported with 64417. The procedure is reported with 64721, which crosswalks to 01810. In the CPT® manual look up anesthesia/wrist. The anesthesia is reported with 01810. Modifier 59 is appended because these services are bundled.
  1. D. From the CPT® index, look up anesthesia/thyroid. You are referred to 00320-00322. The procedure performed is a thyroid needle biopsy, which is reported with 00322. Anesthesia time starts when the anesthesiology provider begins to prepare the patient and ends when they are no longer in personal attendance. In this case the anesthesia time starts at 0900 and ends at 1000 which is one hour.
  2. D. The patient received a neuraxial epidural for labor for a planned vaginal delivery, which is reported with 01967. During the course of labor the patient requires a caesarean section. The patient begins to hemorrhage requiring a hysterectomy. The add-on code 01969 is used to report the anesthesia for the caesarean and hysterectomy.
  1. C. From the index, look up anesthesia/ heart/ coronary artery bypass/grafting. You are referred to 00566 and 00567. In the scenario it states that cardiopulmonary bypass is used, which indicates that the code that includes pump oxygenator is the correct answer. The patient has COPD, which is a severe systemic disease, but there is no indication that is a threat to the patient’s life. Append physical status indicator P3.
  1. C. Anesthesia is performed for cleft lip repair. From the index, look up anesthesia/cleft lip repair. You are referred to 00102. Refer to the code description to verify accuracy. The patient is healthy, which means P1 is the correct physical status modifier. 99100 is reported because the patient is under one year of age and the patient’s age is not included in the CPT® code for the anesthesia service
  2. B. In this case MAC is performed, which requires modifier QS. This eliminates answer options A and C. The patient had a diagnostic arthroscopy. There is no indication that a surgical procedure was performed. Because the service was provided by an anesthesiologist, modifier AA is appended to the anesthesia code.
  3. C. The patient receives anesthesia for a tracheostomy. From the CPT® index, look up anesthesia/trachea. You are referred to 00320, 00326, 00542. The patient is a 9-month-old which eliminates answer options A and B. There is a parenthetical note under code 00326 which states “Do not report 00326 in conjunction with 99100”.
  4. a. One way to find this answer in the index of the CPT® Professional Edition is under the main term “Anesthesia,” “Pelvis,” then “Repair.” The guidelines for anesthesia indicate the use of physician status modifiers when reporting anesthesia codes. Additionally, the add-on code 99100 identifies the age of the patient in this question.
  5. b. Review of modifier -47 in Appendix A of the CPT® Professional Edition provides instructions for placement of this modifier on the procedure code when the surgeon provides either general or regional anesthesia.
  6. d. The anesthesia guidelines in the CPT® Professional Edition provide add-on codes for qualifying circumstances. The code 99100 is used to report the age of a patient as younger than 1 or older than 70 years. The parenthetical note following this add-on code provides the codes where age is a factor and already defined; therefore, the add-on code is unnecessary for correct reporting.
  7. c. Anesthesia code 00604 describes the patient in a sitting position. Careful review of codes will help determine the correct reporting if there is an anatomical location and/or position included in the description.
  8. c. Code 58823 includes moderate sedation. The add-on codes for qualifying circumstances and physical status modifiers are listed with anesthesia codes and should not be appended to a surgical procedure code.
  9. d. The anesthesia guidelines in the CPT® Professional Edition provide a list of services that are included or bundled when provided. Additionally, the monitoring services that are not bundled are listed in the same guidelines.
  10. a. This question specifies reporting for three days of hospital management. Code 01996 would be reported x 3 units.
  11. a. The total body surface area (TBSA) burned is 54%. The first code, 01952, includes 9% of the burn; the add- on code 01953 would be reported for each additional 9% (five units equal 45% plus the initial 9% reaches the total 54%)

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DOWNLOADABLE CPC®PRACTICE EXAM QUESTIONS

CPC Exam 2010 Answers Part 5 – 8

DOWNLOADABLE CPC®PRACTICE EXAM QUESTIONS

Q: 76 C

Anesthesia is performed for cleft lip repair. From the index, look up anesthesia/cleft lip repair. You are referred to 00102. Refer to the code description to verify accuracy. The patient is healthy, which means P1 is the correct physical status modifier. 99100 is reported because the patient is under one year of age and the patient’s age is not included in the CPT® code for the anesthesia service.

Q: 77 C

Codes for MRI are determined by anatomical site and whether contrast is used. In this case, the MRI is of the lumbar spine. From the index, look up magnetic resonance imaging/spine/lumbar. You are referred to 72148-72158. Option A is an X-ray so it is not the correct answer. 72148 is without contrast, which is the correct code. According to ICD-9-CM Official Coding Guidelines, do not report signs and symptoms of a definitive diagnosis. In this case the patient complains of lower back pain and leg pain. He is diagnosed with lumbar spinal stenosis. The symptoms he presents with are symptoms associated with his diagnosis and should not be reported. From the index, look up stenosis/spinal/lumbar. You are referred to 724.02. Verify the code accuracy in the tabular section.

Q: 78 D

The patient presents for a ureteral catheter exchange via the ileal conduit. 50398 is not correct because it is for a nephrostomy tube which is in the kidney. 50393 is performed using a percutaneous approach, which is not used in this case. 50385 is performed using a transurethral approach, which is not correct. The exchange is performed via the ileal conduit, which is reported with 50688. Imaging is performed. There is a parenthetical note under 50688 that states that imaging is reported with 75984.

Q: 79 D

In the beginning of the obstetric ultrasound subsection in CPT®, there are descriptions of what is required for the OB ultrasound codes. In this case the ultrasound is limited because only two elements are examined the fetal heart rate and fetal position. This type of ultrasound is reported with 76815. In the code description it states “1 or more” which means the code is only reported once whether it is a single fetus or multiple fetuses.

Q: 80 C

In this scenario, three CPK enzyme levels are performed. Modifier 91 is appended to the second, and third CPK CPT® to indicate the services were repeat clinical diagnostic tests. Since each of the CPK enzymes were elevated, the isoenzymes were also tested, which is reported with 82552. Modifier 91 is appended to the second and third test to indicate the tests are repeat clinical diagnostic tests.

Q: 81 A

In the panel section of the laboratory tests, look up each of the codes to determine the tests are included in the panel. 80061 is the only test that does not include chloride. 80050 includes a comprehensive metabolic panel (80053) which includes chloride.

Q: 82 B

First the physician performs a UA dipstick with no indication of a microscopic test. This test is reported with 81002. The urine culture is performed with identification for each isolate, which is reported with 87088. 87086 is a quantitative test for a colony which is incorrect.

Q: 83 C

Unbundling is reporting components of a code separately that can be reported with one code. In this case 80061 includes 83718 and 84478. It is unbundling to report components of a panel separately.

Q: 84 C

The site of service indicates the code to select. The physician is overseeing the home ventilator management care plan. There is one code for home ventilator care which is 94005. This code requires a minimum of 30 minutes. This physician has performed 45 minutes of care.

Q: 85 D

We know this patient is established because she is seeing “her pediatrician.” The well check up is coded as a preventive service. The patient is two-months-old. The proper code is 99391. According to NCCI, modifier 25 is appended when a significant and separately identifiable E/M service is performed with other services at the same encounter. In this case vaccinations are performed. A vaccine administration for each is coded as well as the vaccine itself. In this case three vaccines are performed; rotavirus (90680), combination vaccine DTap-Hib (90721) and Pneumococcal (90669). The physician counsels the patient’s mother regarding the vaccinations. 90465is reported for the initial vaccine and 90466 is reported for the second and third vaccine.

Q: 86 A

In this case the patient presents for allergen immune therapy for food allergies. The injections are prepared and provided by the physician, which is reported with 95125 for two injections. The therapy is not for an insect which makes 95131 and 95146 incorrect answers. 95117 does not include the provision of the extract so it is also incorrect.

Q: 87 A

Angi- is a Greek combine form for “a vessel” and the suffix graphy refers to writing or a graph. In angiography, an imaging technique is used to allow the visualization of the inside of blood vessels. An opaque contrast agent is usually injected and X-ray performed so the veins and arteries can be reviewed.

Q: 88 C

Meatus is a Latin word meaning passage, and describes any of numerous passages within the body that have external openings: acoustic meatus (ear canal); urinary meatus (urethra); and middle, inferior, or superior nasal meatus (nasal openings into the sinus).

Q: 89 D

The first three bones listed are all long bones. The calcaneus is a triangular shaped bone in the foot – not a long bone. A long bone has a shaft and two heads, and they provide structure, mobility and strength to the body. Long bones contain yellow bone marrow and red bone marrow, whereas the calcaneus has a hard outer shell and a spongy bone center.

Q: 90 D

The esophagus lies between the trachea and the spine. The trachea carries air into the lungs and the esophagus carries nutrients into the stomach. The esophagus of an adult is about 25 cm long, and is lined with muscles that contract to push food into the stomach. Glands along the lining of the esophagus produce mucus to facilitate the movement of food along its pathway.

Q: 91 C

This is a straightforward lookup from the index, under Tritanopia, and reports a form of color blindness involving blue and yellow. What’s important to remember here is that congenital conditions are not limited to the congenital chapter of ICD-9-CM, but appear throughout the code set.

Q: 92 A

The reason for this encounter is pain management, pain in neoplastic disease (338.3) should be the first listed diagnosis. The patient has metastatic cancer of the lung, which is reported with 197.0 as a secondary diagnosis.

Q: 93 B

The patient is being counseled regarding his obesity, which would be reported with 278.01 and V85.41. The comorbidities of the patient, his bad knees, and diabetes contribute to the decision for surgery and should be included. There are no complications of diabetes noted, so 250.00 is the correct code for his condition. The arthritis is a complication of his obesity, not his diabetes.

Q: 94 C

Keep in mind that codes describing symptoms and signs, as opposed to diagnoses, are acceptable for reporting purposes when a diagnosis has not been confirmed by the physician. Coders should select an ICD-9-CM code to describe the diagnosis, symptom, complaint, condition, or problem, indicating why the service was performed if a final diagnosis is not available. In this case, the angina was ruled out by the physician, so 413.9 is incorrect. The costochondritis, 733.6, has not been confirmed. The guidelines tell us we cannot report “rule out” or “probable” diagnoses in an outpatient setting. Therefore, all we can code is the precordial pain, 786.51. Code 786.50 is unspecified, and since we know the pain is behind the sternum, 786.51 is a better choice. See Pain/substernal, which takes us to 786.51.

Q: 95 B

Look up the description for each code. G0168 reports a wound closure using tissue adhesives.

Q: 96 C

In this scenario we are selecting a code to report the refill of insulin pump. J1815 reports insulin but not for a pump. J1817 is insulin through a pump which is the correct code. J1817 reports 50 units. Two units are reported to account for 100 units of the insulin.

Q: 97 A

According to ICD-9-CM Official Coding Guidelines, when the patient has completed treatment for cancer and there is not an existing malignancy, select a personal history of malignancy by site. From the index, look up history/malignant neoplasm (of)/thyroid.

Q: 98 A

Critical care services can be provided at any site. If the patient is critically ill, the services provided can be coded with critical care regardless of where the services take place. A minimum of 30 minutes of critical care must be performed in order to report 99291. If less than 30 minutes, select the appropriate E/M code based on the three key components. Time spent reviewing results and discussing the critically ill patient with medical staff is included in the critical care time.

Q: 99 C

An ABN must include the service that may be denied, an estimated cost of the patient’s responsibility if Medicare denies the service and the response for the potential denial. Generic ABNs are not allowed. Signing of the ABN cannot be obtained during a medical emergency. The patient must be stable. The ABN must be signed prior to providing the service.

Q: 100 B

Services performed by physicians are covered by Medicare Part B. Inpatient services are covered by Part A. Medicare does not cover routine dental care.

Q: 101 D

To narrow down to the correct reconstruction code, your hint is “TRAM flap,” which is found in the code description in 19367.

Q: 102 B

This patient is coming in to have an in-grown toe nail removed, eliminating multiple choice answer D (Evacuation of Subungual Hematoma), which is evacuating blood from under the nail. You are now left with choices A, B, and C that involves the removal of an ingrown toenail. Code 11752 is not correct. The scenario does not mention an amputation. The clue to help you narrow down between the codes 11765 and 11750 is that the lateral border of the nail was incised and “excised in total”. Those words lead you to the code description in 11750.

Q: 103 A

You need to first find out if this lesion is benign or malignant. For this scenario the patient has a basal cell carcinoma. This falls under malignant lesion, which eliminates multiple choice codes C and D as they deal with benign lesions. Now you need to find out where the lesion is located and the size of the removal. The malignant lesion is on the chin (face) and the size is 3.0 cm + .3 cm = .3 cm = 3.6 cm, leading you to code 11644. CPT® guidelines state: For excision of malignant lesion(s) requiring intermediate or complex closures should be reported separately. For this scenario the wound was closed in two layers qualifying the closure to be coded with an intermediate repair of the chin (4 cm), 12052. The diagnosis, basal cell carcinoma of the chin, is indexed in the ICD-9-CM manual in the Neoplasm Table, under Skin/chin/malignant (column), referring you to code 173.3

Q: 104 D

For narrowing down to the correct procedure code for the Mohs micrographic surgery, you should find out where on the body the tumor was removed. For this scenario, it is the neck; eliminating multiple choice codes B and C, which involve the trunk, arms or legs. The tissue block removals were performed in two stages, coding 17311 and 17312. Code 17315 is not coded for this scenario, since the physician would have to remove more than five tissue blocks in any stage. There were only four tissue blocks removed in the first stage and two tissue blocks removed in the second stage, both falling short of six or more tissue blocks removed in either stage.

Q: 105 A

This patient is having a mass removed from the shoulder area, eliminating multiple choices B, which is biopsy and D, which is incision and drainage of an abscess. The size of the mass that was excised was 4.5 cm, which leads you to code 23076.

Q: 106 A

This surgery is being performed by arthroscopy, eliminating multiple choice answer C, which is an open procedure code without using any type of scope. Our next clue is that a “subacromial decompression” was performed, which leads you to code 29826. The scenario does not mention that the physician lyses and resects adhesions, eliminating multiple choice answers B and D. 29824 is performed when the physician opens the AC (acromioclavicular) joint to the anterosuperior portal grounding of 10 mm of “distal clavicle” then totally grounding it out due to a cyst.

Q: 107 B

One way to narrow down the choices is to code for the diagnosis first, which is a medial meniscus tear of the left knee. In the ICD-9-CM index, look up Tear/meniscus/medial; you are referred to code 836.0. You eliminated choices C and D. 29881 (medial OR lateral) is the correct procedure code, since the menisectomy (removing torn fragments) was performed on the medial meniscus only.

Q: 108 A

The physician is repairing a nonunion tibia fracture (failure of two ends of a fracture to completely heal). Next you need to find out what type of graft was used. Your hints are “bone grafting” and “iliac crest,” which leads you to the code 27724, eliminating multiple choice codes B and C. The bone graft was harvested from the iliac crest, and then the graft is placed at the fracture site of the tibia compressing it for desired position and alignment and the screws were used to stabilize the fracture. In the ICD-9-CM index, look up Fracture/nonunion referring you to code 733.82. The late effect code is also appropriate in this case.

Q: 109 C

This three year old had a “tracheostomy” done due to acute respiratory distress. This eliminates choices B and D where a bronchoscopy is performed. Then a laryngoscope was used to remove the coin, coded 31530. To assign the ICD-9-CM code for the swallowed coin, in the index, look up Foreign Body/trachea. Code 934.0 falls under the injury codes, which indicates that E codes would need to be coded to provide the cause of injury and be used as an additional code for more detailed analysis. In Section 3 of the alphabetic index (right after the Drug Table); look up Foreign body/air passage/with asphyxia, obstruction, suffocation. You are referred to code E912. The next E code is to show the place of occurrence of the injury. In Section 3, look up, Accident/occurring (at) (in)/home (private) (residential), you are referred to E849.0. Verify all codes in the tabular section for accuracy.

Q: 110 C

The key term to narrow down your choices is “diagnostic” maxillary sinusoscopy, which is found in the code description of 31233.

Q: 111 B

To narrow down your choices, you can start with coding the diagnosis first. The patient is having the procedure done due to a lung mass. A specimen was sent to pathology and came back indicating that the lung mass is cancerous. In the ICD-9-CM index, look up in the Neoplasm Table lung/malignant/primary column. You are referred to code 162.9, eliminating multiple choice answers A and D. You would not code 31622 since this is a separate procedure. A diagnostic procedure is not coded if performed at the same session as a surgical procedure in the same area. A surgical procedure (biopsy) was performed with the bronchoscopy.

Q: 112 A

To start narrowing down your choices, you need to identify the type of hernia. The operative note indicates that it is an inguinal hernia. Next does the op not mention if the hernia is incarcerated or strangulated? No, so this eliminates multiple choice answers C and D. Code 49568 (Mesh) would not be coded. According to CPT® guidelines the mesh is only coded for incisional hernia repairs. This statement is found in the subsection above the hernia repair codes. In the ICD-9-CM index, look up, Hernia/inguinal referring you to 550.9X. Your fifth digit is “0” since there is no indication in the op note that the hernia is recurrent or bilateral.

Q: 113 D

One way to narrow down your choices is by looking up the diagnosis first. In the ICD-9-CM index, look up Adenoiditis/with chronic tonsillitis, referring you to code 474.02. This eliminates multiple choice answers A and C. The patient is having a tonsillectomy and an adenoidectomy, which leads to code 42821.

Q: 114 B

Patient is having an Upper GI endoscopy, eliminating multiple choice answers C and D, which report esophagoscopy. Your key terms to look for are “balloon dilation” which is in code description 43249.

Q: 115 D

The hint to narrow down your choices is a D&C (dilation and curettage) for a blighted ovum. This eliminates multiple choice answers A (there is no indication this was a hydatidiform molar pregnancy) and B (there is no indication that this is a missed abortion). 58120 is not the correct D&C, since this is an obstetrical (pregnancy) reason for the procedure. Blight ovum is indexed in the ICD-9-CM under Mole/pregnancy.

Q: 116 A

This patient is having a stent removed, eliminating multiple choice answers B and D, which should be used for insertion of a stent. You would not code 52000 since this is a separate procedure, which means that this code is only billed for diagnostic or examination purposes only, with no other procedures being performed at that time. A surgical procedure (removal of the stent) was done at the same time of the cystoscopy. Code 74420 is coded for the use of a retrograde ureterogram (urography). Modifier 26 is appended to report the professional component was performed.

Q: 117 D

You can narrow down your choices by first coding the diagnosis. The patient had testicular cancer; in the ICD-9-CM index go to the Neoplasm Table testis,testes/malignant/primary column where you are referred to code 186.9. This eliminates codes A, B, and C. 54690 is the correct procedure code since a laparoscopy was performed to remove the left testicle (orchiectomy).

Q: 118 C

The key terms for this scenario are “Corneal foreign body” removal with a “slit lamp”. This procedure is reported with 65222. RT is appended to indicate the procedure is performed on the right eye.

Q: 119 C

The patient is having a “thyroid lobectomy,” eliminating multiple choice answers A and D, which is a thyroidectomy (removal of the thyroid). 60220 is the correct code since the scenario indicates that a small thyroid lobe (total lobe) is dissected free; it does not indicate that part of the lobe was removed.

Q: 120 D

When coding for facet joint or facet joint nerve injections, you report each level that is injected. In this case, the joints for L4-L5 and L5-S1 were injected. The codes for facet joint and facet joint nerve injections are unilateral. The procedure was performed bilaterally at each level, therefore modifier 50 should be reported. In the coding guidelines for facet joint injections, it states that fluoroscopic guidance is included. This service should not be reported separately.

Q: 121 B

In the CPT® book, look up Evaluation and Management/Office or Outpatient. You are referred to 99201-99215. Review the codes to choose the appropriate level of service. 99204 is the correct code. Patient is a “new patient” since this is an initial visit. Comprehensive HPI (Extended HPI, Complete ROS, and Complete PFSH) + Comprehensive Exam (eight system exam) + Moderate MDM (New problem to examiner with additional work up planned, 1 data point (radiology), moderate level of risk (prescription) = 99204.

Q: 122 B

In this case, the ED physician performed an E/M service and moderate conscious sedation so the orthopedic surgeon could provide fracture care. The services are performed in the ED setting, which is reported with codes 99281-99285. This category requires three of three key components for the E/M code. The physician performs a detailed history (extended HPI, extended ROS and complete PFSH), detailed exam (extended six system exam), and moderate MDM (New problem to the examiner, no additional workup planned, 1 data point, moderate risk). The documentation supports a 99284. Modifier 25 is appended to the E/M service because a significant and separately identifiable E/M service is performed during the same encounter as a procedure which is the moderate conscious sedation. When coding for MCS, you need to know the age of the patient, the amount of time and whether the physician providing MCS is the same physician performing the diagnostic or therapeutic procedure for which the patient requires MCS. In this case, the ED physician is providing the MCS. He is not performing the fracture care service. The proper code is within range 99148-99150. This eliminates answer options C and D. The patient is four-years-old and the MCS is provided for 30 minutes. The correct code is 99148.

Q: 123 C

Dr. X is performing a follow-up consultation in a nursing facility. According to CPT® guidelines, “Follow-up consultations that are performed in order to complete the initial consultation (eg, certain tests results previously not available are now ready) provided in the nursing facility setting, the subsequent nursing facility care codes (99307-99310) should be reported”. In the CPT® book, look up Nursing Facility Services/Subsequent Care. You are referred to 99307-99310. Review the codes to choose appropriate level of service. In this case the physician performed a problem focused history, expanded problem focused exam (limited exam of two systems) and low MDM (Established problem stable, 3 data points (labs, EKG, consult) and low risk). In this category two of the three key components are required, 99308 is the correct code.

Q: 124 C

According to CPT® guidelines, “Critical care is the care of the unstable critically ill or unstable critically injured patient who requires constant physician attendance (the physician need not be constantly at bedside per se but is engaged in physician work directly related to the individual patient’s care). The critical care codes may be reported wherever critical care services are provided. It is important to recognize that the critical care codes are reported based upon the type of care rendered not the location of where the care is rendered. The critical care codes are used to report the total duration of time spent by a physician providing constant attention to an unstable critically ill or unstable critically injured patient even if the time spent by the physician providing critical care services on that date is not continuous.” For this encounter the physician was called to the floor to evaluate a critically ill patient. The keywords to look for are the statement “total critical care time,” to indicate a critical care service. In the CPT® book, look up Evaluation Management/Critical Care. You are referred to codes 99291-99292. Review codes to choose appropriate level of service. The physician documents 48 minutes of critical care time which is reported with 99291.

Q: 125 B

In this case MAC is performed, which requires modifier QS. This eliminates answer options A and C. The patient had a diagnostic arthroscopy. There is no indication that a surgical procedure was performed. Because the service was provided by an anesthesiologist, modifier AA is appended to the anesthesia code.

Q: 126 C

The patient receives anesthesia for a tracheostomy. From the CPT® index, look up anesthesia/trachea. You are referred to 00320, 00326, 00542. The patient is a 9-month-old which eliminates answer options A and B. There is a parenthetical note under code 00326 which states “Do not report 00326 in conjunction with 99100”.

Q: 127 C

The type of biopsy performed is a percutaneous needle core biopsy, which is reported with 19102. 10022 is not correct because an aspiration of a cyst is not performed. 19101 is an incisional biopsy, which is also not correct for this scenario. Modifier RT is appended to indicate the procedure is performed on the right breast. There is a parenthetical note following 19102, which states to report the imaging guidance performed. In this case, ultrasound guidance is used, which is reported with 76942. Because the service is performed in the physician’s office, modifier 26 is not appropriate.

Q: 128 C

Ultrasound codes are selected by anatomic site. The liver is an organ in the abdomen. Because the ultrasound is performed on one organ, it is reported as limited. Please note in the parentheses following code 76705 it states “one organ.” 76970 is not appropriate because this is an initial ultrasound and not a follow-up.

Q: 129 A
From the CPT® index, look CT scan/heart/evaluation/for coronary calcium. You are referred to 75571. Verify the code description. Codes 75572 and 75574 are performed with contrast so answer options B and C are not correct. 75557 is an MRI which is also incorrect.

Q: 130 B

The physician inserts the needle through the skin which indicates this is a percutaneous approach and not an open procedure. Answer options A and C can be eliminated. Fluoroscopic guidance was used, which is reported with 77002 for this type of procedure.

Q: 131 B

The identification of ooctyes in the follicular fluid is performed. The stage in this scenario does not include the culture or preparation of the oocyte, only the identification of them. This service is reported with 89254.

Q: 132 B

The appropriate code is determined by the type of specimen. In this case the specimen is a bone marrow biopsy. Under each code in this section of CPT® is a list of specimens for each code. For this scenario, the correct answer is 88305 because it is specific for bone marrow. 88304 is reported for bone fragments which is not correct. 88307 is reported for a bone biopsy. 88309 is reported for bone resection.

Q: 133 A

The pathologist services are not reported with E/M codes, which eliminates answer option B. 80502 is clinical consultation requested by an attending physician for the pathologist medical interpretive judgment, which is not described in this scenario. The service is not performed during surgery, which eliminates D as a correct answer. The code description for 88325 matches the scenario in the question making it the correct answer.

Q: 134 C

The photodynamic therapy is performed externally in this case which eliminates option A. Photochemotherapy is not used, which eliminates option D. The code description for 96567 reports the services provided for this patient.

Q: 135 C

A nurse visit (99211) is not supported in this case. The patient presents for a scheduled injection, which is the only service performed. Injections are coded by route. In this case, the injection is given intramuscularly which is reported with 96372. The 1000 mcg of vitamin B12 is reported with J3420. The substance injected is not a chemotherapy medication; 96401 is an incorrect answer.

Q: 136 B

The services are provided in an inpatient setting which eliminates 90804. The physician performs 30 minutes of psychotherapy, which is reported with 90816. A diagnostic interview is not performed nor is psychoanalysis.

Q: 137 B

Percutaneous transluminal coronary angioplasty mechanically widens narrowed blood vessels in the heart. The approach is transluminal, meaning a catheter is threaded through the skin and into a blood vessel, then carried into the heart artery where it will make the repair. Narrowed vessels in the heart can deprive cardiac tissue of the blood supply it needs to do its work effectively.

Q: 138 D

Contra is derived from a Latin root meaning against, and lateral, from a Latin form meaning side. Contralateral means occurring on the opposite side. The opposite of contralateral is ipsilateral, meaning occurring on the same side.

Q: 139 A

In ascites, fluid collects in the peritoneal cavity of the abdomen. Ascites is typically caused by cirrhosis, malignancy, or heart failure. It is usually managed medically but may be treated with paracentesis. Ascites is indexed in ICD-9-CM, and this answer could have been found by reviewing the tabular entry, which notes, “Fluid in peritoneal cavity.”

Q: 140 D

Exotropia is an outward deviation of the eye. The muscles of the eye are controlled by the fourth cranial nerve. The facial nerve is the seventh cranial nerve. This distinction can be found in illustrations and written information within your ICD-9 and CPT® code books. Tarsal tunnel syndrome is nerve impingement in the foot, and brachial plexis lesions refer to a complex of nerves found between the neck and armpit. Bell’s palsy, is a common disorder of the facial nerve, and causes an inability to control facial muscles of expression. It may be caused by a brain tumor, stroke, or Lyme disease, but can be idiopathic and transient.

Q: 141 A

The lymphatic system has three main functions: To collect interstitial fluid to help maintain the fluid balance in the body; to produce lymphocytes for fighting disease; and to absorb fats from the intestine and transport them to the blood. The lymphatic system is composed of the lymph nodes, spleen, thymus, bone marrow, lymph nodes, and ducts.

Q: 142 C

The islets of Langerhans produce hormones, most notably insulin, within the pancreas. Insulin causes cells to take up glucose from the blood. If the production of insulin stops or becomes inefficient, the patient will develop diabetes.

Q: 143 A

Hyperlipidemia occurs when too many fats are circulating in the blood and can lead to the buildup of fatty plaque in the blood vessels. This fatty plaque is also known as atherosclerosis.

Q: 144 D

The reason for this encounter is for radiation therapy. The ICD-9-CM Coding Guidelines instruct us that V58.0 is to be “first listed, followed by the diagnosis code when a patient’s encounter is solely to receive radiation therapy or chemotherapy for the treatment of a neoplasm.” In this case, 174.1 would be sequenced secondarily. Because the cancer is still being treated, a history code would be inappropriate.

Q: 145 D

Barrett’s esophagus describes changes at the cellular level in the epithelium of the esophagus, a precursor to cancer. It is usually caused by gastrointestinal reflux disease (GERD, 530.81). This patient has a narrowing of the esophagus (530.3) that caused food to be lodged in her throat. A biopsy during that encounter found Barrett’s changes (530.85). For the current encounter, the FB (935.1) has been resolved, and so would not be reported. Because we know her condition more precisely, V41.6 would be inappropriate. Proper coding would be for the Barrett’s, the stenosis, and the GERD, or D.

Q: 146 B

The only code provided as an option that describes an event recorder is C1764. The other code options are for generators, pacemakers, or cardioverter-defibrillators.

Q: 147 C

To select the correct code for casting supplies, you need to know the type, material and age of the patient. In this case the patient is a 12-year-old, which eliminates Q4011 and Q4012. The cast is made of fiberglass, which makes Q4010 the correct answer.

Q: 148 D

According to the ICD-9-CM Official Coding Guidelines, do not report signs and symptoms that are integral to a definitive diagnosis. When the same condition is diagnosed as acute and chronic and there is a separate code for both, report both codes. An ICD-9-CM code is not valid unless it is coded to the highest level of specificity. Combination code instructions are also in the tabular section. Do not rely solely on the alphabetic index to select the correct code.

Q: 149 B

An ABN is a waiver of liability. When a patient has been informed a service that is otherwise covered by Medicare but might not be covered in a particular instance an ABN is signed by the patient prior to receiving the service. To inform Medicare the ABN has been signed, append modifier GA. If an ABN is signed, the claim is the patient’s responsibility if the claim is denied.

Q: 150 B

Under HIPAA regulations, patients have the right to receive a copy of their medical record and request that errors are corrected.

CPC Exam 2010 Answers Part 1 – 5

DOWNLOADABLE CPC®PRACTICE EXAM QUESTIONS

Question:1 C

The physician is taking a split-thickness skin autograft from the thigh and grafting it to the patient’s left leg, which needs repair. In the CPT® manual look up Split/Grafts, you are referred to 15100-15101, 15120-15121. Code 15100 is the correct code since there was less than 100 sq cm taken from the leg (thigh). The second procedure 15002 is coded since the patient had a hypertrophic scar on the leg and the physician is preparing the recipient’s site by excising the scar, which left a 90 sq cm defect, to provide healthy blood vessels onto which the skin graft will be placed.

Question:2 C

First list all lacerations by anatomical sites and/or type of wound closure. The only site that has a layered closure is the chin of 4 cm, which is coded 12052. (Forehead) 8.6 cm + (RT and LT cheek) 9.5 cm= 18.1 cm, which is coded 13132, 13133 x 3 (13132 for the first 7.5 cm and 13133 x 3 for the additional 10.6 cm) . The last site is the chest at 12.5 cm, which is coded 13101, 13102.

Question: 3 B

Keywords in this scenario is “actinic keratoses,” of which there are five. Code 17000 is the correct code since the code description gives an example of what a “premalignant lesion” is in parentheses and for the first lesion being destroyed. Code 17003 is reported for each of the four remaining actinic keratoses lesions. Code 17110 is the correct code for the last procedure, since it covers the destruction of the three benign lesions.

Question: 4  A

27096 is the correct code since a steroid injection (Celestone and Marcaine) is placed into the sacroiliac (SI) joint. Code 77003 is coded since there is a parenthetical note under the code descriptive that states: (For fluoroscopic guidance without formal arthrography, use 77003). Modifier 26 is appended to the radiology code for the professional component, physician not owning the equipment.

Question: 5 C

There is a diagnosis of a closed fracture of the lateral condyle. The fracture is closed since the scenario does not mention a piece of bone has broken through the skin and is exposed. In the ICD-9-CM manual, look up Fracture/humerus/condyle(s)/lateral (external). You are referred to code 812.42. You have eliminated multiple choice answers A and D. The next step is to figure out if the fracture care is opened or closed treatment. A hint is that the surgeon made “an incision” to get to fracture site. Code 24579 is the correct code since this was an open treatment due to the surgeon making an incision to get to fracture site along with performing an internal fixation (two pins). Also ORIF means Open Reduction and Internal Fixation which is also an indication an open approach is used to perform the surgery.

Q:6 C

The keyword in this op note is “disectomy,” which in this scenario is a removal of the herniated disk in the cervical spine (neck). Eliminating multiple choice B. There is no documentation of the vertebrae being fused together (arthrodesis), eliminating Multiple choice D. The scenario documents end plates were decorticated to insert an artificial disk (Kineflex-C device) to replace the cervical disk that was removed, guiding you to code 22856.

Q: 7 D

Defibrillator is the first hint in finding this procedure code. The only codes that have “defibrillator” in their code description are 33240 and 33249. Code 33249 is the correct code since electrical leads were inserted for a dual chamber pacemaker defibrillator in connecting it to a generator. Code 71090 is coded to report the fluoroscopic guidance to place the leads. Since this procedure was performed in an outpatient hospital lab, modifier 26 is appended to report the professional component.

Q: 8 D

For this procedure the thoracic surgeon is performing a thoracostomy, which is the puncturing of the chest between the ribs to remove fluid and/or air from the chest cavity. This eliminates the codes that have thoracentesis, which a needle is used to puncture the chest. The final clue is “tube” thoracostomy which leads to the code 32551.

Q: 9  B

A surgical endoscopy is being performed since there is a removal of tissue from the sphenoid sinus. No biopsies were performed or just a look-see (diagnostic endoscopy) for that area of the sinus.

Q: 10  A

A sigmoidoscopy is performed for a diagnostic colorectal cancer screening since the patient has a history of colon cancer. During the procedure the removal of three polyps are done by hot biopsy forceps. The correct procedure is 45333. Since the patient has a history of colon cancer, the V10.05 is coded. This is indexed in you ICD-9-CM manual, History/malignant neoplasm (of)/colon. Code 211.3 is coded since polyps were found. According to ICD-9-CM guidelines, when the patient is coming in for a screening exam only and a condition is discovered during the screening then the code for the condition is assigned as an additional diagnosis. So for this procedure, the polyps were discovered during the screening, not before, and can only be assigned as an additional diagnosis.

Q: 11 B

The removal of the gallbladder (cholecystecomy) was begun as a laparoscopic procedure. During the procedure, the surgeon decides that additional exposure is needed to complete the procedure. The procedure is converted to an open approach. When a laparoscopic approach is converted to an open approach, you code for the approach used to complete the surgery. You cannot code for both. Modifier 22 is appropriate for the additional work involved in the case. 47001 is coded to report the needle liver biopsy that was performed during this open procedure.

Q: 12  B

Hemorrhoids were removed by rubber band ligation, eliminating C and D. There were two different scopes used to indentify the internal hemorrhoids. Only code 45300 (Proctosigmoidoscopy) will be billed. 46600 (Anoscopy) is a “separate procedure,” meaning this is only coded when it is not an integral part of the another procedure performed at the same time. For this procedure, the doctor is removing the hemorrhoids while performing the anoscopy, making the anoscopy an integral component (included) in the procedure code for removal of the hemorrhoids. The 51 modifier is appended to the second procedure code since there was an additional procedure performed in the surgery.

Q: 13 B

According to CPT® guidelines, when twins are delivered, the global code (prenatal, delivery and post partum) is only reported once. When one twin is delivered via c-section select 59510 for the global procedure and the vaginal delivery only (54909) for the second twin. Modifier 51 is appended to indicate multiple procedures are performed. To code for the twin delivery in the ICD-9-CM manual, look up Delivery/twins, you are referred to 651.0X, the fifth digit being 1 indicating a delivery. The second diagnosis is coded due to the second twin being in a transverse lie, the reason for the cesarean. This is indexed under Delivery/ complicated / transverse/presentation or lie, referring to 652.3X, the fifth digit being a 1.

Q: 14  B

The removal of cyst from the ovary is coded 58925. The RT modifier is appended to indicate to the payer the ovarian cystectomy was performed on the right side. The removal of the salpingo-oophorectomy is coded 58720. Modifiers 51 and LT are appended to this procedure code since the removal of the ovary and fallopian tube was done on the left side and it was an additional procedure performed during the surgery.

Q: 15 A

Since this a 35-year-old patient getting a circumcision, that eliminates code 54160, which is for a neonate (28 days of age or less). The patient is having the circumcision performed using a clamp with regional block. Modifier 52 is not appended to 54150 since there is no indication in the encounter of the physician reducing the services provided. The procedure is performed as it is described by the CPT® code.

Q: 16 C

55700 is the correct code since only needle biopsies were performed, without mapping the prostate under a template guide through a transperineal route. There are parenthetical notes under code 55700, which one states: (If imaging guidance is performed, use 76942). Since ultrasonic guidance (imaging guidance) was used, you would need to code 76942. Appending modifier 26 indicates the professional component; the procedure was done in an outpatient surgical center where the physician does not own equipment.

Q: 17 B

This procedure is being performed in the lumbar which eliminates “C” for the cervical or thoracic. 62311 is the correct procedure code since the patient is getting the meds injected by a syringe not a continuous infusion by a catheter. 77003 is coded since fluoroscopic guidance was used to place the needle for the therapeutic injection. Modifier 26 is appended for the professional component, physician not owning the equipment.

Q: 18 B

The key word in this scenario is “ectropion”, which eliminates D for one who has entropion. One of the eyelids had an excision of the tarsal wedge coded with 67916 and modifier E4 is appended to indicate the procedure was performed on the right lower lid. The other eyelid had a suture repair coded with 67914 and modifier E2 is appended to indicate the repair was done on the left lower lid. A different procedure was performed on each eyelid. Modifier 50 would not be appended to the codes since both lids did not have the same procedure performed.

 

Q: 19 B

The key word in this encounter is “injection” which eliminates the spinal puncture procedure codes. 62273 is the correct code for the patient’s blood is injected to plug the wound that is causing the CSF leak (blood patch). This is the only code to bill for this visit, since the lumbar puncture was performed three days ago.

Question:20. B

Code 67145 is the correct procedure code since the patient had a retinal tear (retinal break) and the physician uses a laser light (photocoagulation) to seal the retina back into place. Code 92004 is coded to report the evaluation of the complete visual field. The patient is new patient. An evaluation of the eye was performed in addition to performing the procedure. Modifier 25 is appended to the evaluation code.

Q: 21 D

According to CPT® guidelines: Final hospital care for discharge of a patient includes final examination of the patient, discussion of the hospital stay, instructions for continuing care, and preparation of discharge records.(Final day of a multiple day stay) This code includes all the E/M services provided on the day of discharge. No other E/M code is reported with discharge codes. The patient for this encounter was admitted on one date of service and got discharged a few days after.

Q: 22 B

The patient was not referred by another physician for a second opinion for his sleep apnea, so this is not a consultation visit. The patient decided to go on his own to get the opinion from another doctor. According to CPT® guidelines: If a “consultation” is requested by a patient and/or family and not requested by a physician (self-referral), an office visit code may be used to report this service The doctor is seeing the patient for the first time, making him a new patient. In the CPT® index, look up Evaluation and Management/Office or Outpatient. You are referred to 99201-99215. Review the codes to choose the appropriate level of service. 99204 is the correct code. Comprehensive History (Extended HPI, Complete ROS, and Complete PFSH) + Comprehensive Exam + Moderate MDM (New patient to examiner; 1 data point; moderate risk) = 99204.

Q: 23 D

For this encounter the established patient is coming into a doctor’s office to get an evaluation before he goes in for surgery. In the CPT® book, look up Evaluation and Management/Office and Other Outpatient. You are referred to 99201-99215. Review codes to choose the appropriate level of service. Two out of three key components are required. The provider performs a detailed exam and moderate MDM. 99214 is the correct code. After the evaluation the patient needs the physician to address questions and concerns he has regarding the liver transplant surgery. According to CPT® guidelines: 99354-99355 are used to report the total duration of face-to-face time spent by a physician beyond the usual service in either the inpatient or outpatient setting. The prolonged service includes the time he spent in face-to-face contact with the patient when he was not performing the history, physical examination, and medical decision making related to the level of E/M service he reported. In the CPT® index, look up Prolonged Services. You are referred 99354-99357, 99360. 99354 is the correct code since 30 minutes was spent face-to-face.

Q: 24 B

There is no indication that one lung ventilation is used. The correct anesthesia code for this procedure is 00540. The anesthesiologist reports the anesthesia with modifier QK to identify medical direction. The CRNA uses modifier QX to indicate it is a medically directed service.

Q: 25 C

The block is reported because it is done for postoperative pain management and not the mode of anesthesia. The block is reported with 64417. The procedure is reported with 64721, which crosswalks to 01810. In the CPT® manual look up anesthesia/wrist. The anesthesia is reported with 01810. Modifier 59 is appended because these services are bundled.

Q: 26 D

From the CPT® index, look up anesthesia/thyroid. You are referred to 00320-00322. The procedure performed is a thyroid needle biopsy, which is reported with 00322. Anesthesia time starts when the anesthesiology provider begins to prepare the patient and ends when they are no longer in personal attendance. In this case the anesthesia time starts at 0900 and ends at 1000 which is one hour.

Q: 27 B

The key words for this encounter are “dual energy”, which eliminates C and D. 77081 is the correct code since an example is given in parentheses what an “appendicular skeleton” is. The foot is in the same category as the wrist or heel which is considered peripheral bones.

Q: 28 D

When a selective catheter placement is performed, it includes the procedure to gain access. In this case the femoral access is to the aorta. From the aorta the physician selectively catheterizes the right renal artery which is considered a first order branch from the aorta reported with 36245. 36200 is included with 36245 and cannot be coded separately. Refer to Appendix L in the CPT® manual. The renal artery is considered a first order branch. Two imaging services are performed. The aortography (75625) is bundled with the renal angiography (75722). Only the renal angiography is reported. Modifier 26 is appended to report the professional component was performed by the physician for the radiology services.

Question: 29  A

The patient receives seven radiation treatments, which is reported with 77427. In the coding guidelines for this section it states, “ Code 77427 is also reported if there are three or four fractions beyond a multiple of five at the end of a course of treatment; one or two fractions beyond a multiple of five at the end of a course of treatment are not reported separately.”

Q: 30 B

The encounter mentions that a specimen was removed from the proximal jejunum, which is part of the small intestines, during a resection for cancer. Code 88309 is the only lab code that covers the small intestine resection of a tumor.

Q: 31 C

The first three labs (HDL -87318, total serum, cholesterol-82465 and triglycerides-84478) are part of the lipid panel for code 80061. That leaves the lab, quantitative glucose, to be added with code 82947.

Q: 32 A

This is a therapeutic drug test, since the patient is taking gold for rheumatoid arthritis, and this type of drug test is found between codes 80150 – 80299. 80172 is the correct code since the physician wants to measure the level of gold found in the blood stream.

Q: 33 B

Although the patient is scheduled for chemotherapy, only hydration therapy is performed. Hydration therapy codes are selected based on time. The total time for this procedure is one hour and 10 minutes. There is a parenthetical note following code 96361 which states “Report 96361 for infusion intervals greater than 30 minutes beyond one hour increments. Because there are only 10 additional minutes beyond the first hour, only 96360 is reported.

Q: 34 A

Injection, catheterization, angiography and supervision and interpretation are included in 93458 itself. It is not necessary to code separately.

Q: 35 C

OMT stands for “osteopathic manipulative treatment”. This was performed on three body regions (cervical, thoracic and sacral) which leads you to code 98926.

Q: 36 D

The key to this encounter is time and monitoring of the cerebral seizures. 95950 is the correct code since it covers an eight channel EEG (electroencephalogrpahy) to measure and record the brain’s electrical activity, monitoring a 24-hour period evaluating her cerebral seizure.

Q: 37 C

Orchitis is marked by painful swelling of the testis. It may occur without cause, or be the result of infection. The Greek root orchis means testicle, and –itis is a suffix indicating inflammation or infection.

Q: 38 C

Debridement is the removal of foreign materials and dead tissue from a wound so that clean, vital tissue is all that remains. Debridement can be surgical, with dissection of nonvital tissue, or it can be a manual process.

Q: 39 C

Meconium is fetal stool, composed of materials ingested in utero. It is odorless and tarlike. Meconium is usually expelled in a neonate’s first bowel movements, but during stress before or during birth, may be expelled into the amniotic fluid. It can be inhaled into the fetal lung and cause pneumonia at birth. Meconium staining refers to discoloration of the amniotic fluid, or of the neonate (for example, meconium staining of fingernails).

Q: 40 A

Both the heart and the nose have a septum, defined as a wall dividing two chambers. The nasal septum separates the two nostrils. A septum also divides the right and left atriums and right and left ventricles of the heart.

Q: 41 A

Lordosis is a spinal deformity in which the anterior curvature of the lumbar spine is excessive. It is also called a “sway back.” Lordosis may be caused by tight lower back muscles, obesity, or pregnancy. It can lead to lower back pain. The answer to this question is easily found by looking in the ICD-9-CM Index.

Q: 42 B

Congenital herpes is a bit tricky in the index. It isn’t listed under Herpes/herpetic. Instead, look under Infection/herpes/congenital to be directed to 771.2. By the process of elimination, the other codes are inappropriate: 054.9 and 054.0 are unacceptable based on an exclusion note at the beginning of category 054. Code 646.92 is incorrect because it is a maternal code, not a code for an infant, and because a fifth-digit 2 is not acceptable with 646.9x, based on the bracketed information presented under the code in the tabular section.

Q: 43 C

Congestive heart failure has many codes, but without more information, we must choose 428.0 (Failure/heart/congestive). The heart failure is an adverse effect of the drug trastuzumab, an antineoplastic antibiotic agent. The adverse affect in therapeutic use is reported with E930.7 (in therapeutic use), according to the table of drugs and chemicals. Finally, report the breast cancer, as suspension of therapy for the breast cancer will need to be addressed at some point in this patient’s plan of care. We don’t have enough information on the breast cancer to report anything but 174.9. Because the patient is still being treated with trastumumab and the physician notes that treatment is being discontinued for contraindications, she is still considered to have active cancer, and a history code would be inappropriate. Note that separate codes exist for antineoplastic drugs vs antineoplastic antibiotics. Answers B and D mix up the two types of drugs and are therefore in error. Only answer C captures the clinical situation correctly.

Q: 44 B

Always pause to consider the meaning of “history” when you see it in a note. Physician documentation does not always dovetail with the language of ICD-9-CM. History is a good example of this. A physician may document that the patient has a history of a disease, and this usually will mean that the disease has been eradicated. But it may mean that the disease is not a diagnosis new at this encounter, but something ongoing in the patient’s care. It may also mean that this is a problem that the patient has had and resolved in the past, and that it has recurred. In the case of “history of symptomatic HIV,” we all know this is not a disease that resolves. Once a patient has symptomatic HIV, the patient whether they have symptoms at the time of the service or not, the diagnosis is coded as 042. According to the Official Guidelines, once a patient with HIV develops symptoms or an opportunistic disease, report code 042.

Q: 45 C

Codes from V27 are reserved for the mother’s chart, so we can automatically eliminate A and D as options. Guidelines tell us that a code from 765.2 should be assigned in addition to a code from 764, and this code was omitted from B. Further, B listed as a diagnosis 763.4, indicating the patient was adversely affected by the C-section, and no adverse affects were documented.

Q: 46 B

When a patient is covered by Medicare, HCPCS Level II codes are reported over CPT® codes with the same description. Since two different procedures were performed in two different compartments of the knee, 29881 is reported for the meniscectomy and G0289 is reported for the removal of loose bodies.

Q: 47 D

In the Official ICD-9-CM Coding Guidelines, there is a listed of V codes that can be reported as a first listed diagnosis code. The current version of the guidelines is available at http://djk9qtinkh46n.cloudfront.net/ppdf/icdguide091.pdf

Q: 48 B

The description for code 61535 is indented which means the description from 61533 up to the semicolon is the beginning of the full description for 61535.

Q: 49 D

Place of service codes are reported on the claim form to identify the site of the service provided. In this case, the services are rendered in the emergency department which is reported with POS 23. The place of service codes can be found on in the CPT® manual.

Q: 50 B

Answer b is the only example of unbundling of CPT® which would result is a fraudulent claim. According to NCCI (National Correct Coding Initiative) and CPT® coding guidelines, a biopsy performed on the same lesion as an excision during the same encounter is an incidental service and is not reported separately. If ultrasound guidance is performed for a liver biopsy, it is billable. X-rays performed in a physician’s office does not require modifier 26. Since the physician owns the equipment and performs the interpretation, he bills the global service. Modifier 57 is appended to the EM service the day prior or day of a major surgery, not a minor surgery.

Q: 51 C

To first tackle this scenario, you need to find out what type of graft was used on this patient. It was a porcine graft, which is a type of xenograft, so multiple choice A is eliminated. There are two ways to start eliminating choices to get to the correct answer. One way is to look at the remaining choices, B, C, and D. The only one out of those three choices that has an extra code is C, code 15040 (Harvest of skin for tissue skin autograft, 100 sq cm or less). This was performed when a split thickness skin graft was harvested using dermatome (skin harvesting) from a separate donor site (autograft). The other way is to add the group body areas together with their total sq cm. The first group to add is: Face, scalp, neck 500 cm + hands & feet 300 cm = 800 cm coded, 15420, 15421 x7. Your next group is the trunk 950 cm + arms & legs 725 = 1675 cm coded, 15400, 15401 x 16. Those took care of the xenograft codes. The next set of codes deal with the excision of the burn eschar to provide healthy skin onto which the skin graft will be placed. You would use the same sq cm totals that are grouped in the same body areas that you used for the xenograft codes. Face, scalp, neck, hand, and feet are coded 15004, 15005 x 7. Trunk, legs and arms are coded 15002, 15003 x 16.

Q: 52 A

One way to get to the correct answer is by the diagnosis. This patient is having the procedure performed due to a breast mass. The only two choices that have the ICD-9-CM code for breast mass are A and B. The diagnosis is indexed in the ICD-9-CM manual under Mass/breast. Now to find the procedure code, your key term is “excision” of the mass, which leads you to codes 19120 and 19125. 19120 is the correct answer since radiological markers were not used to identify the breast tissue that needed to be excised. Neither a biopsy of the breast was performed (19101) nor was a malignant tumor with part of the breast removed (19301).

Q: 53 B

This procedure is being performed on a sacral decubitus ulcer or pressure ulcer, which eliminates multiple choice answer A. Code 15937 was performed due to the ulcer being removed by debridement along with the removal of part of the coccyx (ostectomy) to prepare for the split-thickness skin graft closure. Code 15100 is coded since the split-thickness graft is being used to repair the defect left from removing the ulcer and coccyx (25 sq cm).

Q: 54 B

The key term is “long leg walking cast,” which is found in the code description of procedure code 29355. Code 29345 does have long leg cast in its description, but it does not include a walker type of a long leg cast. This patient did not have a fracture, eliminating choice C; neither did the patient have a long leg cast brace, eliminating choice A. The diagnosis is indexed in the ICD-9-CM manual under Sprain/knee.

Q: 55 D

Trigger point is your key term in this scenario, eliminating choice B. Trigger points are coded by the number of muscles that the injections are performed on, not by the number of trigger point injections. The scenario tells you that six trigger points were injected into four muscle groups which lead you to the procedure code 20553.

Q: 56 B

One way to start finding the correct answer is to look up the diagnosis in the ICD-9-CM manual. It is indexed under Fracture/femur/shaft/open which refers you to code 821.11, eliminating codes C and D. The only difference between choices A and B are the second procedure codes. Code 11012 is the correct code since extensive debridement was performed all the way to the bone on an open fracture.

Q: 57 A

The multiple choice answers are between a rhinoplasty and septoplasty for which you will need to know the difference. Rhinoplasties are performed on patients that are having cosmetic surgery, restorative, or reconstruction on the nose. This patient is coming in to correct a deviated septum, which falls under a septoplasty which is removing a portion of the deviated septum and straightening the septum to correct airway obstruction. You eliminate multiple choice answers B and D. C is incorrect since the patient is not coming in for a dermatoplasty, which is surgical replacement of destroyed skin.

Q: 58 D

With these codes you need to know what type of catheter was inserted in this patient, which was a PICC line. This eliminates multiple choice answers A, B, and C. The ultrasound guidance is reported with 76942. Modifier 26 is appended to indicate the professional component was performed.

Q: 59 A

This is a direct laryngoscopy with “injection into vocal cords,” which eliminates multiple choice codes B and D. You would not code 69990, Operating Microscope, since 31571 has operating microscope already in its code descriptive.

Q: 60 C

This scenario is on a patient having a coronary artery bypass graft (CABG) involving three venous grafts, which eliminates multiple choice answer A. Code 33508 is an add-on code, which does not need a modifier 51 appended to the procedure, eliminating multiple choice answer D. 33254 is the correct code since a modified maze was performed on the patient.

Q: 61 D

43257 is the correct procedure for the Upper GI Endoscopy delivering thermal energy, eliminating multiple choice answer B. Modifier 73 and 74 are reported for the facility codes which eliminates answers A and C. The correct modifier for the physician’s service is 53. For the diagnosis codes GERD is indexed in the ICD-9-CM manual under Reflux/Gastroesophageal, you are referred to code 530.81. 458.29 is indexed under Hypotension/postoperative. V64.1 is reported to indicate the surgery was not carried out.

Q: 62 A

This colonoscopy involved polyps being removed by hot biopsy forceps which leads to code 45384. This is only coded once regardless of the number of polyps that was removed with this one technique.

Q: 63 D

You first need to look at the approach of the surgery, which is the physician incising the chest (thoracotomy) to expose the esophagus, eliminating multiple choice answer C. The physician is not removing a lesion from the esophagus; the physician is removing the esophagus (esophagectomy) and replacing it with the stomach, eliminating multiple choice answer A. The next key term to help you choose between procedure code 43112 and 43117 is “cervical”. 43112 is the correct code since the stomach is pulled through the middle of the chest into the neck and the stomach is connected to the stump of the esophagus in the neck (cervical).

Q: 64 B

Radiological guidance was used for this procedure; there are parenthetical notes that inform you for each of these ECRP procedure codes to use 74328 or 74329 for radiological supervision and interpretation, eliminating multiple choice answer C. Since the surgery is being performed in an outpatient hospital, the physician does not own the equipment so modifier 26 needs to be appended to radiology code eliminating multiple choice answer D. 43264 is the correct code since there was a removal of a calculus (stone) from the common bile duct.

Q: 65 B

One way to get to the correct answer is to code for the diagnosis first. The procedure is being performed due to the patient having vaginal lesions. In the ICD-9-CM index, look up Lesion(s)/vagina. You eliminate multiple choice answers C and D. 57065 is the correct code since the scenario states that the laser surgery was used to destroy “extensive” number of vaginal lesions.

Q: 66 B

The physician performs a cervical cerclage. We know the patient is pregnant so 57700 is an incorrect code. We know the approach for this procedure is vaginally because the scenario states that a speculum is used to access the vagina to view the cervix. From the index look up cerclage/vaginal. You are referred to 59320. The patient is diagnosed with an incompetent cervix. In the ICD-9-CM index, look up incompetent/cervix/in pregnancy. The patient is pregnant so the fifth digit is “3”.

Q: 67 C

52000 is a separate procedure, which indicates that only a cystourethroscopy is performed for diagnostic (examination) purposes only with no other procedure being performed at this time. For this scenario a surgical procedure was performed with the cystourethroscopy, eliminating multiple choice answers A and B. 52204 is not coded because biopsies were not taken from the bladder, leaving multiple choice answer C as the correct choice since a 7 cm bladder tumor was removed with fulguration.

Q: 68 A

The keywords for narrowing your search to the correct code is “carpal tunnel” and “median nerve,” which is found in the code descriptive of 64721. RT is appended to indicate the surgery is performed on the right side.

Q: 69 C

There was an anesthetic agent injected in the “cervical plexus,” eliminating codes A and B. Although three injections are performed, only one nerve is involved. It is inappropriate to report multiple units unless the procedure is performed bilaterally, which in this case it is not.

Q: 70 D

A tympanostomy was performed eliminating multiple choice answers A and B. The patient was under general anesthesia which leads you to procedure code 69436.

Q: 71 A

The patient is in the hospital for 3 days being seen by the physician for subsequent hospital care. In the CPT® index, look up Hospital Services/Inpatient Services/Subsequent Hospital Care. You are referred to 99231-99233. Review codes to choose appropriate level of service. 99231 is the correct code. Two out of three key components are needed for subsequent hospital care codes. The physician documented a problem focused exam (1 system) + Low MDM (Established problem to examiner; stable, 2 data points, low level of risk) =99231.

Q: 72 C

The E/M service is at the request of the ED physician to render an opinion on whether the patient needs surgery. A written report of the findings is documented in the ED chart. According to CPT® coding guidelines, the requirements for a consultation have been met. The service is provided in the ED, which is an outpatient setting. The plastic surgery performs a detailed history (extended HPI, extended ROS and pertinent PFSH), a detailed exam (extended 4 body area/organ system exam) and moderate MDM (New problem to examiner no additional workup planned and need for major surgery). For an outpatient consultation three of the three key components are required. 99243 is the appropriate code. During this encounter, the physician made the decision to perform a major surgery, which is scheduled for the next day. Modifier 57 is appended to the E/M service.

Q: 73 D

During this encounter, the physician performs resuscitation, endotracheal intubation, and inserts an umbilical line. According to CPT® coding guidelines, “procedures that are performed as a necessary part of the resuscitation are reported separately in addition to 99465”. Code 99464 cannot be reported with 99465. The critically ill neonate is admitted to critical care. According to CPT® coding guidelines, 99468 can be reported with 99465. The guidelines also state “other procedures performed as a necessary part of the resuscitation are also reported separately when performed as part of the pre-admission delivery room care”. In this scenario the intubation (31500) and the umbilical line (36510) were performed pre-admission for resuscitation so they are both reported. Modifier 59 is required because both services are bundled with 99468 when performed during after admission. Modifier 25 is reported to indicate a separate and significant E/M service.

Q: 74 D

The patient received a neuraxial epidural for labor for a planned vaginal delivery, which is reported with 01967. During the course of labor the patient requires a caesarean section. The patient begins to hemorrhage requiring a hysterectomy. The add-on code 01969 is used to report the anesthesia for the caesarean and hysterectomy.

Q: 75 C

From the index, look up anesthesia/ heart/ coronary artery bypass/grafting. You are referred to 00566 and 00567. In the scenario it states that cardiopulmonary bypass is used, which indicates that the code that includes pump oxygenator is the correct answer. The patient has COPD, which is a severe systemic disease, but there is no indication that is a threat to the patient’s life. Append physical status indicator P3.