AAPC CPC Exam Questions

Correct answer: 51

When exploration is reported in conjunction with other definitive procedures, including arthrodesis and decompression, append modifier 51 to 22830.

Modifier 59 is described as a distinctly separate procedure. This modifier is used when different procedures are performed for different reasons during the same encounter.

Modifier 55 is described as postoperative management only. This modifier is used when a surgical procedure has been performed. In the three major portions of surgery, the pre-surgery EM, the surgical encounter itself, and the post-surgical care, the provider reporting the 55 modifier has only performed the post-surgical part of the surgery.

Modifier 62 is described as two surgeons. This modifier is used when two surgeons are both performing significant portions of the surgery, not just one surgeon assisting the other.

Correct answer: 38505, 76942-26

CPT Index for biopsy, lymph node, needle directs to 38505. CPT code 38505 describes a biopsy of lymph nodes by needle and notes the axillary node. This code has a following parenthetical statement indicating that imaging guidance should be reported with a series of optional codes. Reviewing that series, 76942 is the correct code to describe ultrasound guidance as is described in this case. Modifier -26 is reported to describe that the surgeon interpreted the ultrasound, not actually performed it.

CPT code 38525 describes an open excision of the deep axillary nodes. This case was a core needle biopsy, not an excisional biopsy. The radiological code is correct, but not when reported with this primary procedure.

CPT codes 38500 and 77002 represent an open excision of lymph nodes. This case was a core needle biopsy.

The radiological code 77002 represents fluoroscopy guidance which is also incorrect for this case.

CPT code 10022 was deleted as a code in 2018.

A needle was used to obtain the biopsies, eliminating 38500, 77002-26, 38525, and 76942-26.

An aspiration (drawing fluid out) was not performed, eliminating 10022.

Correct answer: E11.9 and I10

E11.9 describes Type 2 diabetes mellitus without complications. The medical documentation does not indicate that hypertension is a manifestation of diabetes. I10 describes essential (primary) hypertension, high blood pressure, and hypertension.

E11.2 is a truncated code; it requires more characters and refers to Type 2 diabetes mellitus with kidney complications.

E11.0 is a truncated code; it requires more characters and refers to type 2 diabetes mellitus with hyperosmolarity.

E11.3 is a truncated code; it requires more characters and refers to Type 2 diabetes mellitus with ophthalmic complications.

Correct answer: 70490

In the index of the CPT book, you will look up CT scan, without contrast, neck. This gives you the code 70490, which can be found in the Radiology section. Turning to this section, you will see that this code 70490 is for computed tomography, soft tissue neck, without contrast material. Since this is what the question is looking for, this would be the correct answer.

Code 70491 is also for a CT of the soft tissue neck but is a study performed with contrast. Since this is not what the question is asking for, this is incorrect. Code 70540 is for magnetic resonance imaging (or MRI) of the orbit, face, and/or neck, without contrast. This is also not what the question is asking for, so this would be incorrect. Code 70547 is for magnetic resonance angiography (or MRA) of the neck, without contrast material. This is not what the question is asking for either, so this is incorrect.

Correct answer: 57022

Searching the CPT index for vagina, hematoma, leads to codes 57022 and 57023. Because the case documents that the patient is postpartum, the appropriate code for this is 57022, describing a hematoma drainage postpartum.  

Code 57023 describes an incision and drainage of a vaginal hematoma, non-obstetrical; this case was postpartum. Code 57010 describes an incision and drainage of a vaginal abscess. An abscess and a hematoma are not the same; in this case, the patient had a hematoma. Code 57020 describes an incision and drainage of the vagina, a colpocentesis procedure. This is not the drainage of a hematoma.

Correct answer: Adrenal gland; 60540

For this question, you will need to know on what part of the body an adrenalectomy is performed. The prefix adrenal- stands for the adrenal gland, so that answers the first part of this question. For the code, go to the index and look up adrenal gland, excision. This gives you the code 60540, which you will look up in the Endocrine System section at the back of the Female Genital system. Code 60540 is for an adrenalectomy, transabdominal approach, so this would be the correct answer.

Adrenaline cannot be removed from the body (at least not in the way the question asks), so this would not be the correct answer. Code 60650 is for an adrenalectomy but with a laparoscopic approach. Because of that approach, this is not the correct answer. The thyroid and parathyroid would not be correctly described by using the suffix adrenal/o but would use the suffixes thyroid- or parathyroid-. Code 60500 is for a parathyroidectomy, which would not be correct for this question. Code 60545 is for an adrenalectomy with excision of the adjacent retroperitoneal tumor. The question asks for an adrenalectomy, so this would not be the correct answer.

Correct answer: Z32.02

In the index of the ICD-10 book, you would look up encounter, pregnancy, test, result negative. This would give you the code Z32.02. Of course, you do not want to code directly from the index, so you would go to the chapter where this code is located, which is chapter 21, Factors Influencing Health Status and Contact with Health Services. This code is for an encounter for a pregnancy test, result negative, which is what you would need to answer the question correctly.

Code Z32.01 is for a positive pregnancy test result, which is the opposite of what you need, so this would not be the correct answer. Code Z32.00 is for an unknown result to a pregnancy test. Since the question says what the result is, you would not use this for the answer. Code Z31.82 is for an encounter for supervision of other normal pregnancy in the second trimester. The patient in the question is not pregnant, so this would be incorrect.

Correct answer: 2 or more self-limited or minor problems

In 2023, the E/M services guidelines were completely revamped. Elements like Review of Systems have been completely taken away, along with the old MDM, or Medical Decision Making, charts and guidelines. In the beginning of the Evaluation and Management section of the CPT book, as before, there is a section dedicated to guidelines for E/M codes. Flipping through, you can see that almost every guideline has been replaced or, at the very least, changed. Table 1, called the Levels of Medical Decision Making, shows how each level of MDM has changed and how E/M codes should be coded from now on.

As far as this question goes, 1 acute, complicated injury; 2 or more stable, chronic illnesses; and 1 acute or chronic illness or injury that poses a threat to life or bodily function are elements of other MDM levels as shown in the grid. The only choice that is under low MDM is 2 or more self-limited or minor problems, which would be the answer to this question.

Correct answer: 65205

In the CPT index, you will look up removal, foreign body, eye, external eye. This gives you a code range of 65205-65222, which can be found in the Eye and Ocular Adnexa section. You will see that the given range, which consists of four codes, is either for the conjunctiva or the cornea. The question states that the contact lens is stuck in his eye. The conjunctiva is the outermost part of the eye, and the lens is considered stuck superficially since the doctor did not have to do anything surgically. With this information, we can safely say that code 65205, which is for foreign body removal, external eye, conjunctival superficial, is the correct answer. 

Code 65235 is for the removal of a foreign body, intraocular, from the anterior chamber of the eye/lens. The foreign body was only stuck superficially, so this is not the correct answer. Code 65210 is for the removal of a foreign body, external eye, conjunctival embedded. The lens was not embedded in the patient's eye, so this is an incorrect answer. Code 65175 is for the removal of an ocular implant. Ocular implants are not mentioned at all in the question and therefore, this is incorrect.

Correct answer: Colorectal cancer

The Cologuard screening system is a fairly new technique. This testing kit screens the patient's stool or fecal DNA to check for any hints of colorectal cancer. This, then, would be the correct answer.

Melanoma, colon polyps, and prostate cancer are screened for using other means and testing. Because of this, these would not be the correct answer.

Correct answer: 90471, 90472, 90632, 90666

Coding for vaccines requires, at minimum, two codes. One is for the administration of the vaccine, and the other is for the vaccine serum. The CPT Medicine section identifies that codes for vaccine administration are different for people under 18 and over 18. This case identified a patient who is an adult, so 90471 is reported for the first vaccine. The serum code for hepatitis A is 90632 because this patient is an adult. An additional vaccine administration, 90742, is reported for the second vaccine. The influenza pandemic vaccine is coded with 90666.

CPT code 90460 is not reported because it is used for pediatric cases with physician counseling.

The subcategory guidelines in the CPT® Professional Edition under the heading “Vaccines, Toxoids” indicate that modifier -51 should not be appended to these codes.

CPT code 99213 is not reported because an office visit was not performed.

CPT code 99211 is not reported because the vaccine was administered by a medical assistant and their services are not billed separately.

CPT code 90667 is not reported because is not preservative-free, it is an adjuvanted vaccine.

CPT codes 90473 and 90474 are not reported because they describe intranasal or oral administration. These vaccines were intramuscular.

Correct answer: 87495

Searching the CPT for cytomegalovirus results in several code choices. Reviewing all of them leads to 87495, which specifically describes direct probe technique. 

CPT code 87271 describes the microbiological study of cytomegalovirus by direct fluorescent antibody. CPT code 87496 describes the amplified probe technique for testing for cytomegalovirus. The question states that a direct probe technique is used, so this would not be the correct answer. CPT code 87490 describes the direct probe technique for chlamydia trachomatis, not for cytomegalovirus.

Correct answer: 10021

In the index of the CPT book, you will look up fine needle aspiration, diagnostic, which gives you the code 10021. Turning to the Integumentary System section, you will see that this code is for a fine needle aspiration, without any imaging guidance, first lesion. This would be the correct answer to the question.

Code 10005 is for a fine needle aspiration, with ultrasound guidance, first lesion. The question is only asking for a fine needle aspiration, no imaging guidance, so this would not be the correct answer. Code 19081 is for a breast biopsy. This is not at all what the question is asking for, so this would be an incorrect answer. Code 19086 is an add-on code for a breast biopsy. This is also an incorrect answer because the question is not asking for this at all.

Correct answer: LM

When certain parts of the body are operated on, they may need a specific modifier added to the procedure. In this case, if the left main coronary artery were operated on or part of the procedure, it would need a specific modifier. Going to Appendix B, for HCPCS Level II modifiers, you will look for the left main coronary artery in the description. LM matches that description exactly, so this will be the correct answer.

KX modifier's description is "requirements specified in the medical policy have been met." This is not what the question is asking for, so this would be an incorrect answer. QW modifier's description is "CLIA waived test." This also is not what the question is asking for, so this is incorrect. QS modifier's description is "monitored anesthesia care service." Again, this is not what the question is asking for, so this would be incorrect.

Correct answer: 29914-RT

CPT code 29914 has the # symbol listed to indicate this code is out of sequence. Additionally, the parenthetical note listed with this code provides information related to the correct reporting of codes used in conjunction. 22914 is the correct code describing arthroscopy of the hip with femoroplasty. Modifier -RT, describing the right side, is appended. This case would not report 29914 as a secondary code nor would a -59 modifier for distinct procedural service, be appended.

CPT code 29860 describes an arthroscopy of the hip with or without synovial biopsy. This case involved a femoroplasty, a more extensive procedure.

CPT code 29861 describes an arthroscopy of the hip with the removal of a foreign or loose body; there was no loose or foreign body documented.

CPT code 29862 describes an arthroscopy of the hip with debridement of articular cartilage; debridement is included in the process of a femoroplasty.

Correct answer: 80053, 80074

In this question, the organ or disease-oriented panels do not contain overlapping codes; therefore, each panel, 80053, and 80074, are both reported.

CPT code 80074 would not be reported alone as it would not address the Comprehensive Metabolic Panel.

CPT code 80053 would not be reported with a -52 modifier as the entire panel was performed. Modifier -52 is never reported with panel codes; if all the panel items were not performed, each individual test is reported instead.

CPT codes 86709, 86705, 87340, and 86803 are not reported individually since they are all members of the acute hepatitis panel. The provider ordered the panel, including all four items.

Correct answer: 99288

In the CPT index, you would look up emergency department services, physician direction of advanced life support. This gives you the code 99288, which is an Evaluation and Management service code. Turning to the E/M section, you will see that this code is for a physician or other qualified healthcare professional direction of EMS emergency care, advanced life support. Since this is what the question is asking for, this would be the correct answer.

Code 99285 is for an ED visit where the presenting problem/s are of high severity and pose an immediate significant threat to life or physiological function. The patient is not in the ED just yet in the question, so this would be incorrect. Code 99291 is for critical care, evaluation and management of the critically ill/injured patient, first 30-74 minutes. The question does not mention that the service performed is critical care, so this also would be an incorrect answer. Code 99251 is for an inpatient consultation where the presenting problem/s is/are self-limited or minor. The question does not mention anything about a consultation, so this would be incorrect.

Correct answer: The blood vessels

The medical term angioplasty can be broken into two parts: angi/o and –oplasty. The medical suffix –oplasty stands for surgical repair, while angi/o is the medical prefix for the blood vessels. A procedure consisting of an angioplasty will include the blood vessels.

While the arteries, capillaries, and heart are related to the blood vessels and are more than likely involved in an angioplasty, they are not directly included.

Correct answer: 99211

In the index of the CPT book, you will look up evaluation and management, office and other outpatient, which gives you the code range 99201-99215. Turning to the Evaluation and Management section, you will see that this code range is for new and established patients. The patient in this question is established, so that would eliminate half. The patient did not see the doctor. So, code 99211 would be the best answer to this question.

Code 99202 is for office/other outpatient visit for evaluation and management of a new patient, which requires a medically appropriate history and/or examination and straightforward medical decision making. The patient is an established patient, so immediately you would see that this is not the correct answer. Code 99213 is for an established patient and a 15-minute evaluation requiring 2 of 3 components: an expanded problem focused history and examination and low MDM. Even though the patient is established, the patient only spent a total of 5 minutes, so this is not the correct answer. Code 99212 is for an established patient and a 10-minute evaluation requiring 2 of 3 components: an expanded problem-focused history and examination and straightforward MDM. Even though the patient is established, a history exam and MDM were not performed in the question, and her visit only lasted 5 minutes. So, this is not the correct answer.

Correct answer: 16035, 16036 x2

CPT codes 97597 and 97602 can be found in the Medicine chapter and describe active open wound care (e.g., decubitus ulcers). Beneath the Active Wound Care Management coding guidelines, there is the following notation: “For debridement of burn wounds, see 16020-16030.” CPT code 16030 is used to describe the removal of dead tissue on second-degree (partial thickness) burns. In this scenario, the patient sustained third-degree burns. There is no mention of tissue removal, only cleansing and incisions, so eliminate this option.

CPT code 16035 describes an escharotomy (note the suffix -otomy, which means "to cut into”). An escharotomy is a procedure used to repair third-degree burns, in which incisions are made into the thick dead tissue in order to keep underlying nerves and vessels from being injured or constricted. CPT code 16036 is an add-on code used in conjunction with 16035 to describe each additional incision. CPT code 16035 describes the first incision, and code 16036 x2 describes the second and third incisions.