AAPC CPC Exam Questions

Correct answer: K codes are established for use by the Durable Medical Equipment Medicare Administrative Contractors, DME MACs

The HCPC Level II Coding Procedure guidelines describe in section D, Other Notable Codes, that K codes are established for DME MACs where current codes do not include information necessary to implement the DME MAC medical review policy. Therefore, E codes are not established specifically for the DME MACs, they do contain some similarities in equipment, and there are differences in the need for the different code selections.  

Correct answer: 80 percent

CORF services, or Comprehensive Outpatient Rehabilitation Facility services, deal with patients in some sort of rehab facility and have physical, occupational, or respiratory services rendered. CORF services are 80 percent of the physician fee services since they act in place of Medicare Part B for patients in a CORF.

CORF services, just like Medicare, do not alter their fee schedule percentage due to differences in services. So, CORF services will never pay at 20, 90, or 100 percent.

Correct answer: 36568-36573

A PICC line is a peripherally inserted central venous catheter. The definition of the abbreviation is found in Appendix C: List of Abbreviations in the HCPC Level II manual. Searching the CPT index for catheterization and then peripherally inserted, leads to this family of codes. Researching this family of codes clearly describes the PICC procedure.

The code set family 36555-36558 refers to a centrally inserted central venous catheter, not peripherally inserted. Researching code family 36901-36909 leads to creating a dialysis circuit by needle or catheter with associated procedures. The code family 64553-64598 refers to a percutaneous implantation of neurostimulator electrodes. 

Correct answer: 99238

In the index of the CPT book, you would look up discharge services, hospital. This gives you two codes: 99238 and 99239. Turning to the Evaluation and Management section, where these codes are located, you will see that code 99238 is for hospital discharge day management, thirty minutes or less. The question states that the physician, who has seen the patient before, was with the patient twenty minutes before he decided that she had healed well enough to be discharged. Since 99238 correctly describes the service, it is the correct answer.

Code 99239 is the same but for more than thirty minutes. The physician did not spend more than thirty minutes with the patient, so this is an incorrect answer. Code 99234 is for observation/inpatient hospital care with detailed history, examination, and low/straightforward MDM. This does not have anything to do with discharging a patient and, because of that, this is not the correct answer. Code 99233 is for subsequent hospital care, with detailed history, examination, and high MDM. This is a typical hospital visit and also has nothing to do with discharging a patient. So, this is also not the correct answer.

Correct answer: 67312-50, 67340-RT, 67334-50

Searching the CPT index for Strabismus leads to a family of 63XXX codes, and two horizontal muscles to 67312. The CPT® Professional Edition provides multiple illustrations of strabismus surgery. These illustrations are helpful for the review of the anatomic locations of muscles. 67312 describes the procedure, and a -50 modifier for the bilateral procedure is appropriate. The CPT index search for extraocular muscles directs and then redirects to Strabismus repair, extraocular muscles, 67340; this code is an add-on code to be reported with 67312. 67340 was only performed on the right eye; therefore, the -RT modifier is appropriate. Finally, within the family of add-on codes, there is 67334, describing the placement of the posterior fixation sutures. This was performed on both eyes; therefore, a -50 modifier is appropriate.

CPT 67335 describes an add-on code for the placement of adjustable sutures. There is no documentation that the sutures placed were adjustable.

CPT code 67316 describes two verticle muscles treated in strabismus surgery. The muscles described in the case are horizontal muscles.

CPT code 67332 describes a patient with scarring of extraocular muscles and other conditions that were not documented in this case.

Correct answer: G0420 

One of the keywords here to determine the correct code is Medicare; this hints at an HCPC code. Searching the HCPC Level II index for educational services, face-to-face leads to G0420 and G0421. Code G0420 is for individuals, with G0421 for groups. These codes specifically describe services for chronic kidney disease patients. 

Code M1189 describes a kidney health evaluation documentation, not a patient education service. CPT Code 98960 is an education service provided by a nonphysician healthcare clinician using a standardized curriculum but does not describe chronic kidney disease patients.  

Correct answer: 54163

Searching the CPT index for circumcision repair directs to 54612 and 54613. Reviewing the family of codes, there is the description of 54163: repair incomplete circumcision. Redundant foreskin means that not enough foreskin was removed in the original circumcision, and excess foreskin remained, as described in the operative report.

CPT code 54610 describes a circumcision, not a repeat circumcision.

CPT code 54150 describes a specific type of circumcision technique. This patient needed a repeat circumcision.

CPT code 54164 describes a frenulotomy of the penis. This patient had a repeat circumcision performed.

Correct answer: For cases of advanced metastatic disease with no known primary/secondary sites specified

Codes unspecified were correct to use with ICD-9, but since the implementation of much more specific ICD-10, they should almost never be used. If the doctor's documentation supports an unspecified code, then they may be used. For cancer codes C80.0 and C80.1, this code applies even more so. For code C80.0, for example, if a patient has advanced metastatic disease of any part of the body and there is no known primary or secondary site specified, then you will code with this. However, this should almost never happen, as the patient typically has a primary malignancy listed in her medical history. This will be the correct answer to the question.

The physician should not tell the coder to use an unspecified diagnosis code. Typically, if something points to an unspecified code, you should contact the physician for more specific information. If a patient has any kind of specified malignancy listed, then code C80.0 will not be used. If a patient is showing signs and symptoms of cancer but has not been formally diagnosed, then the signs and symptoms will be coded, not a cancer code.

Correct answer: 59120, 59151-53

In this case, the procedure began as a laparoscopic removal of ectopic pregnancy, and was discontinued and turned into an open removal of ectopic pregnancy with removal of a fallopian tube. Searching the CPT index for ectopic pregnancy, tubal, with salpingectomy or oophorectomy, leads to CPT code 59120 for the open procedure and 59151 for the laparoscopic procedure. The open procedure was ultimately completed and is coded first. The laparoscopic procedure, which was started and discontinued, is reported with a -53, discontinued procedure, modifier.

CPT code 59151, the laparoscopic procedure, was not completed. It was discontinued and therefore reported with -53 modifier. The procedure that was finally performed was an open approach reported with 59120. Because the open procedure was actually completed, it is reported primarily.

No biopsies were taken or polyps removed, eliminating 59121.

The code 59120 was performed after the laparoscopic 59151 was discontinued.

Correct answer: 56805

Searching the CPT Index for Intersex leads to codes for intersex state and intersex surgery. The case does indicate intersex state. There is one code for clitoroplasty, 56805. 

CPT code 55970 describes full intersex surgery from male to female. In this case, the surgery involved clitoromegaly, enlarged clitoris, and is more specifically described with code 56805. CPT code 55980 describes full intersex surgery from female to male. In this case, the surgery involved clitoromegaly, enlarged clitoris, and is more specifically described with code 56805. CPT code 58999 is an unlisted code for procedures of the female genital system that are not related to obstetrics. There is a more specific code for this case. 

Correct answer: 0

MUEs, or Medically Unlikely Edits, have their own reference point in Appendix G of the HCPCS book- also referred to as General Correct Coding Policies. While there are no longer tabular lists of what each code's MUE is, the policies are important to reference when necessary. In this case, under sub-section D of Appendix G, number 3 states that "the MUE values of HCPCS Level II codes for discontinued drugs are generally '0'". This means that 0 would be the correct answer.

Values 99, 700, and 1,000, while entirely possible that they could be listed within the same sub-section as being MUEs for different codes, they are not the correct answers to this question. 

Correct answer: 59612

First, you will need to understand what VBAC means before you begin to look in the index for the code. VBAC stands for Vaginal Birth After Cesarean, which describes a patient who has a successful vaginal birth after having a cesarean section in the past. Now, you will look in the index of the CPT book for vaginal delivery, after previous cesarean delivery. This gives us the code range 59610-59612. Turning to the Female Genital section, you will see that the difference between the codes within the range is whether or not the patient had previous antepartum care with the same physician/group who delivered the baby and whether they received postpartum care as well. In this case, the question did not mention antepartum or postpartum care, so you would not bill the codes that mention those services. This leaves you with code 59612, which is for vaginal delivery only, after previous cesarean delivery. This would be the correct answer to this question.

Code 59614 is for a successful VBAC and postpartum care. Postpartum care is not mentioned in the question, so this would not be the correct answer. Code 59610 is for a successful VBAC with antepartum care and postpartum care. This also would not be the correct answer since antepartum and postpartum care are not mentioned in the question. 59618 is for a cesarean delivery following an attempted vaginal delivery, after a previous cesarean delivery. The recent birth in the question was vaginal, so this would not be the correct answer.

Correct answer: 50541

In the CPT index, you will look up laparoscopy, kidney, ablation, cysts. This gives you the code 50541, which is located in the Urinary system section. This code is for a surgical laparoscopy, ablation of renal cysts. Since this is exactly the procedure the patient went through, this would be the correct answer.

Code 50542 is also for a surgical laparoscopy; however, it is for the ablation of renal mass lesion(s) including intraoperative ultrasound guidance and monitoring when performed. Renal mass lesions were not removed, renal cysts were. Because of this detail, this is not the correct answer. Code 50200 is for a renal biopsy, percutaneous, by trocar or needle. A biopsy was not performed, so this is also incorrect. Code 50250 is for an open ablation, 1 or more renal mass lesion(s), cryosurgical, including intraoperative ultrasound guidance and monitoring if performed. The procedure in the question is done via laparoscopy and is not an open procedure. Because of this, this code is also not the correct answer.

Correct answer: 99244

In the CPT index, you would look up consultation, office and/or other outpatient, which gives you the code range 99241-99245. Turning to the Evaluation and Management section, you will see that each code has its own components that set it apart from the other codes. The question gives you three criteria: comprehensive history taken, performed in a specialty office, lasting one hour. Checking each code, the one that closely resembles these criteria is 99244, which would be the correct answer.

Code 99245 is also an office consultation code; however, this service is a higher level, lasting about 55 minutes. Because of this, it is not the correct answer. Code 99254 is an inpatient consultation code. The question asks for an office consultation code, so this would not be the correct answer. Code 99214 is an established patient office visit code. The question asks for a consultation code, not an office visit code, so this would also be incorrect.

Correct answer: 43238

Searching esophagogastroduodenoscopy (EGD), needle aspiration leads to a choice of 43238 or 43242. Reviewing those choices, 43238 is the clearer code choice; it does not refer to reaching a surgically altered stomach, as code 43242 describes.

CPT code 43235 describes an EGD but does not include the transendoscopic ultrasound-guided transmural fine needle aspiration.

CPT code 43238-59 is the correct procedure code, but should not be reported with another code nor with modifier -59 for a separate procedure.

CPT code 43242-51 describes a similar EGD, but refers to reaching a surgically altered stomach. TI is not part of a multi-procedural surgery, therefore, the -51 modifier is not appropriate.

CPT code 76942-26 describes imaging, and ultrasound imaging is included in the description of the correct procedure code.

Correct answer: 99344

In the index of the CPT book, you will look up home services and new patients. This would be the correct category since this is the first time the physician has seen the patient. This gives you a code range of 99341-99345. Turning to the Evaluation and Management section, you will look closer at the levels for history, exam, and MDM (medical decision-making). For this question, you will need a medically appropriate history and exam and an MDM of moderate complexity. With this information at hand, you will see that 99344 closely resembles what you need to bill correctly. Alternatively, the Evaluation and Management Table describes Home or Residence Services for both new and established patients. The new patient visit with an MDM of moderate complexity in the table is Level 4, 99344. Remember that time is also a criterion for coding this service. In this question, the physician spends about 45 minutes with the patient and 20 minutes getting to know the patient's family. The total time on the date of the encounter is 65 minutes. Code 99344 states that 60 minutes of total time must be met or exceeded.

Code 99342 is also for new home visits; however, the history and exam are only on an expanded problem-focused level, and the MDM is low. Considering these factors, you will see that it is not the correct answer. Code 99349 is for home visits for an established patient. Without even looking at the levels, you will see that it is not the correct answer because it is for an established patient. Code 99341 is for new home visits, but the exam and history are only at a problem-focused level. The MDM is straightforward, so this does not correctly answer the question.

Correct answer: V5050

In the index of the HCPCS book, you would look up hearing devices. The code range for this is V5000-V5299. These codes are located in the Hearing Services section of the book. Looking closer at this code range, the monaural hearing aids are located in codes V5030-V5060. Code V5050 is the only hearing aid that goes in the ear, so this would be the best answer for the question.

Code V5060 is for a monaural hearing aid, but it is for behind the ear. This would not be the correct answer. Code V5030 is for a monaural hearing aid as well, but it is for a body-worn aid. Code V5130 is for a binaural aid, so this is not the correct answer to the question either.

Correct answer: 12034, 12042

In the index of the CPT book, you would look up repair, skin, wound, intermediate. This gives you the code range 12031-12057. Turning to the Integumentary System section, you will see that the codes are separated by body part and wound size. In the question, the arm and the hand have wounds on them, and the wounds are 8 cm and 3 cm respectively (meaning the wound on the arm is 8 cm, and the wound on the hand is 3 cm). The code for the arm would be 12034, and the code for the hand would be 12042.

Code 12031 is for intermediate repair of the scalp, axillae, trunk, and/or extremities, 2.5 cm or less. The question states that the wounds on the arm are 8 cm, so this would not be the correct answer. Code 12041 is for intermediate repair of wounds of the neck, hands, feet and/or external genitalia, 2.5 cm or less. The question states that the wounds on the hand are 3 cm, so this is also not correct. Code 12034 is for intermediate repair of the scalp, axillae, trunk, and/or extremities, 7.6 cm-12.5 cm. This is incorrect because you would not combine the two wound surfaces since they are not on the same parts of the body. Code 12004 is for simple repair of the scalp, axillae, trunk and/or extremities, 7.6 cm-12.5 cm, and code 12001 is for simple repair of the scalp, axillae, trunk, and/or extremities. The question states that intermediate repair was done, so these codes are not the correct answer.

Correct answer: Digestive system 

Malignant jaundice is found in the ICD-10-CM alphabetic index as jaundice, malignant, and referenced with code K72.90 in the ICD-10-CM, which is Chapter 11, Diseases of the Digestive System. This is referenced in the tabular index and leads to the definition of hepatic failure. 

While the term malignant is often in reference to cancer, in this case, the jaundice itself is not a malignancy. While many jaundice diagnoses are categorized in the congenital defect chapter, malignant jaundice is not a congenital defect. While many jaundice-related diagnoses are categorized in the infectious disease chapter, malignant jaundice is not listed as an infectious disease.

Correct answer: 17000, 17003 x3

In the CPT index, you will look up destruction, lesion, skin, premalignant, which gives you the code range 17000-17004. (This index listing also gives you the code 96567, but since this is not located in the Integumentary system section, for the sake of this exercise, you can skip it.) Turning to the Integumentary system section, where these codes are located, you will see that these codes are all for the destruction of premalignant lesions but differ on how many lesions are destroyed. In the question, four lesions are destroyed via laser surgery. Given this information, codes 17000 and 17003 would be the best fit. Since 17003 is an add-on code for each extra lesion, you would code it three times (or x3). Therefore, this code set would be the correct answer.

Codes 17000 and 17003 are correct for this question; however, attaching a 51 modifier (multiple procedures) would not be correct. To answer the question correctly, you would code 17003 multiple times. Code 17004 is for the destruction of premalignant lesions as well, but for 15 or more lesions. Since only four were destroyed in the question, this would not be the correct answer.