AAPC CPC Exam Questions

Correct answer: 76885

In the index of the CPT book, you will look up ultrasound, hips, infant. This gives you the codes 76885 and 76886, which can be found in the Radiology section. Turning to this section, you will see that the two codes are broken up into dynamic and limited. The question states a dynamic ultrasound was performed, so code 76885 would be the correct answer.

Code 76882 is for a limited extremity ultrasound. Since this is not what the question is asking for, this is incorrect. Code 76857 is for a limited pelvic ultrasound. This is also not what the question is asking for, so this would be incorrect. Code 76820 is for a fetal Doppler velocimetry, umbilical artery. This is not what the question is asking for either, so this is incorrect.

Correct answer: 99367

In the CPT index, you will look up medical team conference, which gives you the code range 99366-99368. Turning to the Evaluation and Management section where these codes are located, you will see that the codes are for services done with or without direct contact with the patient. In the question, the patient was not present in any way, so that eliminates 99366. All present are physicians, not a non-physician qualified health care professional, so code 99367 would be the correct answer to the question.

Code 99368 is for a medical team conference as well; however, it is with participation by a non-physician qualified health care professional. Since only physicians were present, this would not be the correct answer. Code 99446 is for an Interprofessional telephone/Internet/electronic health record assessment and management service provided by a consultive physician, including verbal and written report to patient's treating/requesting physician or other qualified health care professional; 5-10 minutes of medical consultative discussion and review. This code does not request a medical team conference, therefore it would not be the correct answer.

Correct answer: 22614

22614 represents arthrodesis, posterior or posterolateral technique, single interspace; each additional interspace (list separately in addition to code for primary procedure).

22612 represents arthrodesis, posterior or posterolateral technique, single interspace; lumbar (with lateral transverse technique, when performed).

Modifier 50 represents a bilateral procedure and is appended to indicate the procedures performed on both sides (right and left). Arthrodesis is either posterior or posterolateral, therefore modifier 50 does not apply to this scenario.

Correct answer: 19307-50, 19340-50

In the index of the CPT book, you will look up mastectomy, modified radical, which gives you the code 19307. Turning to the Integumentary System section, you will see that this code is indeed for a modified radical mastectomy. Because it is a bilateral procedure, you will also add on the 50 modifier to this code, showing that it is a bilateral procedure. The next code can be looked up in the index as insertion, breast, implants. This gives you the code range 19340-19342, which can again be found in the Integumentary System section. Code 19340 is for the immediate insertion of breast implant following mastectomy. This is exactly what the question states, so this would be the correct answer. Also, you will need to add a 50 modifier to this code as well to show that this is a bilateral procedure.

Code 19342 is for the insertion or replacement of breast implant on separate day from mastectomy. The question states that the implants were placed immediately after the procedure, while the patient was still in the OR, so this is not the correct answer. Code 19306 is for a radical mastectomy. The question asks for a modified radical mastectomy, so this is not the correct answer. Code 19303 is for a simple mastectomy, complete. The question asks for a modified radical mastectomy, so this is not the correct answer.

Correct answer: J9307

In Appendix A of the HCPCS book is the Table of Drugs and Biologicals. This is what you would use if you are looking up a drug in the HCPCS book. For this question, you would look up Folotyn, which then guides you to see Pralatrexate. One mg of Pralatrexate gives you the code J9307, which can be found in the Chemotherapy Drugs section of the book. Code J9307 is for a 1-mg injection of Pralatrexate, which has an alternate name of Folotyn. This is the correct answer for the question.

Code J9228 is for an injection of ipilimumab, which is not what the question asks for. This is not the correct answer. Code J9270 is for an injection of plicamycin, which is not what the question asks for. So, this is also not the correct answer. Code J9328 is for an injection of temozolomide, which is also not what the question asks for.

Correct answer: Face/palm up

The Directions and Positions section of the CPT manual offers definitions of common terms related to orientation and location of features of the body. This section lists supine as face up or palm up.

The same listing describes prone as face down or palm down. The left and right sides of the body are just that — the right and left sides of the patient's body from the patient's perspective, not the observer's visual of what is on the right or left.

Correct answer: T1

HCPCS codes and CPT codes both use modifiers to accurately describe what a doctor did in the medical office, emergency room, or operating room. Many of these modifiers are interchangeable between the two types of codes and typically describe which digit on the hand or foot was the focus of the procedure or service. Modifiers T1-TA describe toes on feet, from left to right. Since T1 is listed in both books as a usable modifier, it is the correct answer.

Modifier SB is for a nurse midwife and cannot be used with CPT codes, so this is incorrect. Modifier TP is for medical transport, unloaded vehicle. This would be used in transportation services (HCPCS code only), so this code is not interchangeable between the two coding systems. Modifier SL is for a state-supplied vaccine and would go with the drug for a specific vaccine. Since drugs are HCPCS codes, this would not be the correct answer to this question.

Correct answer: For detecting diabetes mellitus in pregnancy

The ICD-10 has many different guidelines that must be understood and followed when coding. For pregnancy, there are many guidelines that have to do with the characters in the codes. This question brings up the seventh character “0.” In the official guidelines at the beginning of the book, in the fifteenth section (for chapter 15: Pregnancy, Childbirth, and the Puerperium), there is a paragraph on what the “0” will be assigned for. In this case, diabetes mellitus in pregnancy is not one of those options. Diabetes has its own section of codes within this chapter.

The seventh character, however, would be assigned for the following instances: For single gestation in pregnancy, when documentation in the record is insufficient to determine the fetus and it is not possible to obtain clarification, and when it is not possible to figure out which fetus is affected by the disease. In turn, this makes these answers incorrect for this question.

Correct answer: T1013 x2

In the index of the HCPCS book, you would look up sign language, oral interpretive services. This gives you the code T1013. Of course, you cannot bill straight from the index, so you will have to turn to where the code is located, in the National Codes Established for State Medicaid Agencies. Code T1013 is for sign language/oral interpretive services, per 15 minutes. The question states that every session is a half hour, so if you are billing for each session, you would bill the code twice. Billing four times for a session is too much.

Code T1014 is for telehealth transmission. This is not mentioned in the question, so this is incorrect. Code T1018 is for school-based individualized education. This is also not what the question is asking for, so this is incorrect.

Correct answer: J9355

In the table of drugs and biologicals in the back of the HCPCS book, you will look up Herceptin. This gives you the code J9355, which is located in the Chemotherapy drugs section. Here, you will see that this code is for an injection of trastuzumab, 1 mg. Underneath the code, you will see the brand name for this drug is Herceptin. Since this is what the question is asking for, this will be the correct answer.

Code J9400 is for an injection of ziv-aflibercept, 1 mg. This is not the drug the question is asking for, so this is an incorrect answer. Code J9311 is for an injection of rituximab, 10 mg and hyaluronidase. This is also not the drug the question is asking for, so this would be incorrect. Code J9371 is for an injection of vincristine sulfate liposome, 1 mg. This is not the drug the question is asking for either, so this would be incorrect.

Correct answer: 26123-RT, 26125

The patient is having a fasciectomy of the palm and one finger. Searching the CPT index for fasciectomy of the palm directs to 26121-26125. Reviewing this family of codes leads to 26123, which includes the partial palmar release (documented as subpalmar) and single digit (ring finger). In the course of performing this procedure, the surgeon noted a problem with the middle finger and also excised disease tissue there. The add-on code, 26125, describing each additional digit, is part of the same fasciectomy family of codes and describes this part of the procedure. Note the RT modifier on the primary procedure but not on the add-on code.

CPT code 26121-RT describes the fasciectomy but only on the palm. The two fingers are not included.

CPT code 26035 describes decompression, not fasciectomy.

CPT code 26040 describes a fasciotomy for Duputryen's contracture, for the palm only, percutaneously. This question describes a surgical fasciectomy.

Correct answer: ICD-10 codes cannot be unspecified, so the coder must find out the actual trimester from the physician

In OB/GYN billing for pregnant women, trimesters must always be specified by the doctor. This is part of ICD-10 codes for pregnancy; using unspecified codes in ICD-10 while billing must always be avoided. If the physician does not specify the trimester, the biller must find out what the trimester is by using the LMP (last menstrual period) and a pregnancy wheel. 

Guessing a trimester is unacceptable, just as using an unspecified code is unacceptable. Accuracy is key in general coding, so finding a code that does not need trimester specification is unacceptable since the code will probably be wrong.

Correct answer: Bladder

The medical prefix Cyst/o can be used to describe any procedure or disease relating to the bladder. Technically speaking, the word cyst means a fluid-filled sac and can stand for a lump on the skin anywhere on the body. However, when a coder sees this prefix in either a procedure or disease name, it will be for the bladder. 

The gallbladder's medical prefix is Cholecyst/o since its name is somewhat related to the bladder. However, these two organs have nothing to do with each other, and a coder should never use Cyst/o on its own to describe the gallbladder. The stomach, while it can be filled with fluid at times, has a medical prefix of Gastr/o and is also not a logical choice for this question.

Correct answer: 10061

CPT code 10061 describes the incision and drainage of a complicated subcutaneous abscess.

CPT code 10060 describes an incision and drainage of a simple subcutaneous abscess.

CPT code 10121 describes a complicated incision and removal of a foreign body from the subcutaneous tissue. There is no indication that a foreign body was removed.

CPT code 10140 is incorrect as it represents a different procedure — the incision and drainage of a hematoma, seroma, or fluid collection.

Correct answer: 33501

Searching the CPT index for coronary chamber fistula directs to 33500, 33501. Reviewing these codes leads to 33501, repair of coronary arteriovenous chamber fistula without cardiopulmonary bypass.

CPT code 33500 describes the procedure in the case of a cardiopulmonary bypass.

CPT code 33572 describes an add-on code for a coronary endarterectomy. This case documented an arteriovenous chamber fistula. Additionally, modifier -59, distinct procedure, does not apply to this case.

CPT code 33507 describes the repair of an aortic anomaly by unroofing or translocation. This is not documented in the case.

Correct answer: 64612-50, J0585 x2

Searching the CPT index for blepharospasm, chemodenervation leads to code 64612; reviewing the code advises that this is specifically described as a unilateral code, and to correctly code both sides of the face. Therefore, the -50, bilateral, modifier should be appended. Per the guidelines in this section, the supply of chemodenervation (drug) agent is reported separately. The HCPC code for Onabotulinumtoxin A is J0585. Because the patient's procedure was done bilaterally, two units are reported.

CPT code 67345 describes the chemodenervation of extraocular muscle. This case documents that injections were for blepharospasm. The modifier -50, bilateral, is also not reported with this code.

Correct answer: 83013, 83014

Searching the CPT index under Pathology and Laboratory and H. pylori, a series of breath urease activity codes are discovered. Researching the series, 83013 describes the test itself, and 84014 describes the drug administration.

CPT code 87338 describes testing for H. pylori in the stool — this exam was a breath test.

CPT code 87339 describes a blood test for H. pylori — this exam was a breath test.

CPT code 83009 describes a blood test for H. pylori urease activity using a non-radioactive isotope.

Correct answer: 43235

In the index of the CPT book, you will look up esophagogastroduodenoscopy, collection of specimen, which gives you the code 43235. Turning to the Digestive System section, you will see this code is for a flexible EGD, transoral, diagnostic. This is what the question states the procedure is, so this would be the correct answer.

Code 43236 is for an EGD with directed submucosal injections. These injections are not mentioned in the question at all, so this would be incorrect. Code 43240 is for an EGD with transmural drainage of pseudocyst. Again, the drainage procedure is not mentioned in the question, so this is also an incorrect answer. Code 43244 is for an EGD with band ligation of esophageal/gastric varices. This procedure is also not mentioned in the question, so this is incorrect.

Correct answer: 00640

In the index of the CPT book, you will look up anesthesia, spinal manipulation, which gives you the code 00640. Turning to the Anesthesia section, where this code is located, you will see that this code is for anesthesia for manipulation of the spine or closed procedures of the cervical, thoracic, or lumbar spine. Since this is what the question is asking for, this code would be the correct answer.

Code 00625 is for anesthesia for procedures on the thoracic spine and cord via an anterior transthoracic approach, not utilizing 1 lung ventilation. This is not what the question is asking for, so this would be an incorrect answer. Code 00670 is for anesthesia for extensive spine and spinal cord procedures. Nothing extensive was done, so this would also not be the correct answer. Code 00604 is for anesthesia for procedures on the cervical spine and cord, procedures with patient in the sitting position. Again, this is not what the question is asking for, so this is incorrect.

Correct answer: -58

Modifier -58 represents a staged (planned) or related procedure or service by the same physician during the postoperative procedure.

Modifier -22 represents increased procedural service. Modifier -52 represents reduced service. Modifier -77 represents a repeat procedure by another physician.