AAPC CPC Exam Questions

Correct answer: Disease must last at least 12 months or until the death of the patient

Chronic Care Management Services is an E&M service that lasts about 20 minutes in duration. It is dedicated to clinical staff time for patients with the following criteria: multiple chronic conditions expected to last at least a year, or until the patient’s death, chronic conditions that put the patient at some sort of serious risk, and a comprehensive care plan has been established, implemented, revised, or monitored. Since a disease lasting at least 12 months, or until the death of the patient, is one of the criteria for this code, this would be the correct answer for this question.

If a patient has gone to a specified doctor's office for at least five years and treated for the same condition, the clinical staff would not use a chronic care management services code. They would only be considered an established patient. Therefore, this would not be the correct answer. If a patient has a confirmed case of mental illness, no matter the diagnosis, it is not enough to correctly use code 99490 or the chronic care management services code. Therefore, this would not be the correct answer either. Finally, if a patient was recently released from an extended inpatient stay, depending on the diagnosis, this would also not be the correct criteria for code 99490.

Correct answer: K51.018, L52

This case requires understanding the guidelines regarding both the convention NEC and manifestation coding. Searching the ICD-10-CM alphabetic index for pancolitis leads to ulcerative (chronic) and subterm complications or specified complications. Because this patient is diagnosed with a specific complication that is not listed in the subterms, it is correct to choose the specified complication NEC K15.018. The tabular index confirms this code. The complication is also coded as a manifestation. Searching the ICD-10-CM alphabetic index for erythema nodosum leads to L52. Manifestation guidelines in the OGCR I.A.13 advise that the reporting should be K51.018, L52. 

Coding of L53.8, K51.018 is coding an incorrect manifestation, other erythematous condition, unspecified, before the etiology, which is against the guidelines I.A.13. Coding L53.8, K51.019 reports an incorrect manifestation, other erythematous condition, before the etiology, which is against the guidelines I.A.13. The K51.019 choice is also incorrect, described as having an unspecified complication when the complication is specified in the documentation and will also be coded in the case. Coding K51.218, L52 is coding ulcerative proctitis with other complications; this case is ulcerative chronic pancolitis. The manifestation code is correct.

Correct answer: X-ray, CT, MRI

For many of the subsections in the Radiology section, there is a certain order that the testing takes. With the exception of any special testing sprinkled in between, the order is: X-ray, CT, and MRI scans. There are certain sections for PET scans and all other special radiologic testing.

Correct answer: 93880

In the index of the CPT book, you would look up duplex scan, arterial studies, extracranial. This gives you the code range 93880-93882, which you will look up in the Medicine section. When you look up these codes, you will see that both codes are for an extracranial artery duplex scan. However, code 93880 is for a bilateral study, and 93882 is for a unilateral study. Since the question is asking for a bilateral study, 93880 will be the correct answer.

Code 93895 is for a quantitative carotid intima-media thickness and carotid atheroma evaluation, bilateral. This is not what the question is asking for, so this is an incorrect answer. Code 93925 is for a duplex scan of lower extremity arteries/arterial bypass grafts, complete bilateral study. This is not what the question is asking for either, so this is an incorrect answer.

Correct answer: 58661, 58563-59

Searching the CPT index for Laparoscopy, ovary/oviduct, oophorectomy, salpingectomy directs to 58661. Searching the CPT index for hysteroscopy, ablation, endometrial, directs to 58563. Because these two procedures are performed by different approaches for different reasons, they are distinct procedural services, and the -59 modifier is appended to 58563. Searching CMS-issued RVUs for the two codes, in this case, will show that 58563 is a lower RVU and should be the code with the modifier appended.

CPT code 58660 describes a laparoscopic lysis of adhesions. This patient had a salpingo-oophorectomy.

CPT code 58353 describes an endometrial ablation but without a hysteroscopy. This patient had a hysteroscopy.

CPT code 58558 describes an endometrial polypectomy with or without D&C. This was not the procedure documented in the case.

CPT code 58662 describes a laparoscopic excision or fulguration of lesions in the area. This was not the procedure documented in the case.

Modifier -51 is not the best modifier for this case because there are not multiple procedures of the same reason, same type, or in the same surgical incision being performed.

Correct answer: 45172

The procedure can be located in the index of the CPT® Professional Edition under excision, rectum, tumor, which directs to 45160, 45171, and 45172. Reviewing these codes leads to code 45172, which describes an excision of a rectal tumor by transanal approach including full thickness. It is important to note the approach (transanal) and the procedure (excision).

CPT code 45190 describes the destruction of a rectal tumor. This case was excising a transrectal tumor.

CPT code 45160 describes an excision of a rectal tumor by proctotomy, using a transsacral or transcoccygeal approach. This case used a transanal approach.

CPT code 0184T-59 describes a transanal endoscopic excision of a rectal tumor, but using a microsurgical approach. This case does not document a microsurgical approach. Since this is not a code to report for this case, the distinct service modifier is also not appropriate.

Correct answer: Closed

There are many rules when it comes to medical billing and coding. One of the most important rules is remembering that if it was not documented, you cannot bill for it. When it comes to billing for treatments of fractures and other various musculoskeletal system diseases, if the doctor does not document what happened in his notes, then you will bill for the lesser service. In this case, that would be closed treatment.

Open treatment is surgically opening the area where a fractured bone is located. For obvious reasons, this treatment is considered to be a “higher” service than a closed treatment, so this would not be the correct answer. Percutaneous skeletal fixation is a treatment that is neither open nor closed. Pins, or any other kind of fixation device, are put across the fracture to treat it. Because this is more involved than closed treatment, this is not the correct answer. Manipulation is not considered a fracture treatment. Therefore, this is not the correct answer.

Correct answer: 00172-P2-AA, 99100 

Searching the CPT for Anesthesia and cleft palate repair leads to code 00172. Reviewing the code selection confirms the correct code. This patient has mild sickle-cell disease, a systemic condition; therefore, the P2 modifier is appended. Since the anesthesia procedure was performed by an anesthesiologist, the -AA modifier is appended. The anesthesia guidelines advise that a qualifier code, 99100, should be appended for anesthesia procedures on patients under 1 year of age.  

Code 00170 is for anesthesia for intraoral procedures. While this is, technically, an intraoral procedure, there is a specific code for cleft palate repair. Modifier -P1 describes a healthy patient; this patient has mild systemic disease. Code 00190 is for anesthesia for procedures on the facial bones/skull. Cleft palate can be considered in this category; however, there is a specific code for cleft palate repair.

Correct answer: R30.0

For this question, you will turn to the index in the front of the book. Painful urination will be listed under its other name, dysuria. Under this entry in the index, the code given is R30.0, which is located in Chapter 18. R30.0 directly translates to dysuria, so this would be the correct ICD-10 code for this question.

Code R42 is for dizziness and giddiness. This does not match the patient's given symptom, so this would be an incorrect answer. Code R10.9 is for unspecified abdominal pain. While the patient is complaining of pain, he is not complaining of abdominal pain, so this would also be incorrect. Code R06.4 is for hyperventilation. Again, this symptom does not match what the patient came in for, so this also would be an incorrect answer.

Correct answer: 20102, 13121-59, 13122

Searching the CPT for wound, exploration, and penetrating leads to a series of codes based on body part; the option for the abdomen is 20102. Reviewing the code confirms the choice for this case. Turning to the repairs to the legs, consulting CPT index for wound, repair, legs, and complex leads to a series 13120-13122 based on the size of the wound. Reviewing the case, there were two wounds in the leg, with a total of 11 cm of wound repaired. Analyzing the code choice leads to 13121 for the first 7.5 cm of the wounds and 13122 add-on code to fulfill the reporting for the additional wound repair. Because the wound repair is a different procedure and separate from the wound exploration in the abdomen, modifier -59 is appended to the 13121. According to Appendix A on Modifiers, the -59 modifier is used for "a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury..." 

Code 32100 describes a thoracotomy with exploration; this procedure is typically performed to access the internal organs of the chest, such as the lungs and pleura. The penetrating wound exploration 20102 more specifically describes this case. Codes 12002 and 12004 are simple surgical repair codes for areas such as the extremities. This case documented complex repair. The repair code subheading describes the criteria for coding simple, intermediate, and complex repairs and advises that complex repairs are appropriate for "debridement of wound edges, e.g., traumatic lacerations..." Modifier -51 is used to describe multiple procedures. The documentation of this case, after researching in Appendix A, leads to a choice of a -59 modifier.

Correct answer: 71048

In the index of the CPT book, you will look up X-ray, chest. This gives you the code range 71045-71048, which can be found in the Radiology section. The difference between the codes in this range is how many views are done on the chest area. In the case of this question, the patient has a 4-view chest X-ray done. Code 71048 is for radiologic examination, chest, 4 or more views, so this would be the correct answer.

Code 71045 is also for a chest X-ray with a single view. Code 71046 is for a 2-view chest X-ray; the case documents 4 views. Code 71047 is for a 3-view chest X-ray; the case documents 4 views.

Correct answer: 49593

Searching the CPT index for hernia repair, ventral directs to 49591-49618. Reviewing these codes leads to 49593, describing a reducible ventral hernia repair of three to ten centimeters in size. The code includes the use of mesh and describes a procedure done in any approach. A reducible hernia is documented in the statement, "able to be reduced easily " in the medical documentation.

CPT code 49591 describes the correct hernia repair, for a hernia of less than three centimeters. This case documented a hernia of 4.6 centimeters.

CPT code 45954 describes the same location and size of hernia, but for a hernia that was incarcerated or strangulated. This case documented a reducible hernia.

CPT code 49650 describes a laparoscopic initial inguinal hernia repair. This case documents a ventral hernia.

Correct answer: 86485

Searching the CPT index for candida, skin test, leads to 86485. Reviewing the code confirms the correct reporting. 

Code 86486 describes a skin test, unlisted antigen, each; this is a less specific code. Code 86510 describes a skin test, histoplasmosis; this case documented candida. Code 86228 describes an immunological assay for candida. The parenthetical statement under this code would direct to the correct code, skintest for candida.

Correct answer: 38120

In the index of the CPT book, you would look up splenectomy, laparoscopic, which gives you the code 38120. Turning to the Hemic and Lymphatic Systems section, within the Cardiovascular System section, you will see that 38120 is for a laparoscopic surgical splenectomy. This is exactly what the question is asking for, so this is the correct answer.

Code 38129 is for an unlisted laparoscopy procedure involving the spleen. The procedure listed in the question is in the CPT book, so this would not be the correct answer. Code 38100 is for a total splenectomy. The procedure done in the question is a laparoscopic procedure, which has its own code, so this would not be the correct answer. Code 38101 is for a partial splenectomy. Again, the procedure performed in the question is a laparoscopic procedure, so this would not be the correct answer.

Correct answer: J32.0, J34.2

In the alphabetic index of the ICD-10 book, you will look up first sinusitis, maxillary. This gives you the code J32.0, which can be found in Chapter 10: Diseases of the Respiratory System. This code directly correlates to chronic maxillary sinusitis, which is exactly what the question asks for. For the second diagnosis, you will turn back to the index and look up deviation, nasal septum. This gives you the code J34.2, which is located in the same chapter. This code directly correlates to deviated nasal septum, which is exactly what the question asks for. These two codes do not need any more characters to complete them, so this would be the correct answer to this question.

Code J34.89 is for other specified disorders of the nose and nasal sinuses. Since there is an actual code for the type of sinusitis/deviated septum the question asks for, this would not be the correct answer. Code J33.1 is for polypoid sinus degeneration. This is not what the question is asking for, so this is incorrect. Code J31.0 is for chronic nasopharyngitis. This is not what the question is asking for either, so this would be incorrect.

Correct answer: The ear

Meniere’s disease is a condition that causes, among other things, severe dizziness, feeling pressure or pain in the ear; it can affect the patient’s hearing. It mainly affects the inner ear.

Correct answer: 54230, 74445-26

The procedure can be found in the index of the CPT® Professional Edition under cavernosography/corpora, 54230. The parenthetical note below the procedure code directs the coder to the radiology code 74445. The radiology code is reported with a modifier -26 for professional services.

CPT code 54231 can be eliminated, as the case did not involve a dynamic cavernosometry.

CPT code 99283-25 should not be reported, as there is no discussion of appropriate history, exam, or medical decision-making by the ER physician.

Correct answer: Z21

The code Z21's full title is: "Asymptomatic HIV infection status." This means an HIV-positive patient with no current symptoms of infection would be the correct use of this code, along with other codes that describe what the patient came in for that day.

Code B20 is for an HIV-infected patient who comes into the office complaining of related symptoms. Since this patient is not complaining of anything related to the disease in this question, it would not be the correct answer. Code Z20.6 is for exposure to HIV, meaning a patient says he has come in contact with the virus. Code R75 is for inconclusive serological evidence of HIV, meaning that there is not enough blood work/workup done on a patient to officially say he is HIV positive. These codes can be found under the actual HIV code, in the Excludes1 section.

Correct answer: 72081

In the index of the CPT book, you will look up X-ray, spine, total. This gives you the code range 72081-72084, which can be found in the Radiology section. Turning to this section, you will see that these codes, all for scoliosis evaluations of sorts, differ by the number of views. The question states that only one view was ordered, so code 72081 would be the correct answer to the question. 

Code 72020 is also for a spinal X-ray; however, it is only for one level (i.e., cervical, lumbar, thoracic). The study for scoliosis checks different levels at the same time, so this would not be the correct answer. Code 72100 is for a 2-3 view lumbar X-ray. This is also not what the question is asking for, so this would be incorrect. Code 72125 is a CT scan of the cervical spine, without contrast. This is not what the question is asking for either, so this is incorrect.

Correct answer: 99284

In the index, you would look up new patient, emergency department services, which gives you a code range of 99281-99288. Turning to the Evaluation and Management section, you will see that this range of codes is for emergency department services, for a new or established patient. (This means that, even if a patient has been seen in the same ER before, or if the patient has never been seen there, it will be the same code.) The question states that an expanded problem-focused history and exam and moderate MDM were performed, so you would look within the code range given. Code 99283 will be the correct answer, given that the code states that an expanded problem-focused history and exam have to be performed, as well as a moderate MDM.

Code 99282 is also for an ER visit; however, it asks for MDM of a low complexity, so this would not be the correct answer. Code 99252 is for an inpatient consultation. Regardless of the history, exam, and MDM levels, the question states it was an ER, not inpatient consultation, so this would be incorrect. Code 99243 is for an in-office consultation. Again, because the code is not for an ER consultation, this would be incorrect.