AAPC CPC Exam Questions

Correct answer: 45330

Searching the CPT Index for colonoscopy, flexible, diagnostic leads to 45378. Reviewing this code would typically lead to coding 45378. However, this procedure was discontinued because the surgeon could not advance the flexible scope past the splenic flexure. To understand how to code this accurately, there is a colonoscopy decision tree diagram. This tool advises that a diagnostic colonoscopy that does not reach the splenic flexure, as happened in this case, should be coded with a sigmoidoscopy 45330. 

CPT code 44388-52 describes a colonoscopy done through a stoma, reported with a modifier -52, reduced service. Because this procedure was not done through a colostomy stoma, it is not reported, and therefore, the modifier is also not reported. CPT code 45378 describes a completed colonoscopy procedure; this case was not a completed colonoscopy. Modifier -53 does describe a discontinued procedure. However, the CPT guidelines do advise, and the Decision Tree does diagram that the documented procedure, the fact that the scope did not go beyond the splenic flexure, should be reported differently.

Correct answer: 33410

CPT code 33410 represents an open replacement of the aortic valve with a stentless valve using the cardiopulmonary bypass technique.

CPT code 33406 represents the same procedure, but with a different kind of valve, an allograft.

CPT code 33362 represents an aortic valve replacement, with an open approach, but the approach is through the femoral artery using the Transcatheter Aortic Valve Replacement (TAVR) technique, not the cardiopulmonary bypass technique.

CPT code 33510 represents a coronary artery bypass using a vein from another part of the body, not a replacement of a valve of the heart.

Correct answer: S40.012A

In the alphabetic index of the ICD-10 book, you will look up contusion, shoulder. This gives you the code S40.01-, which can be found in Chapter 19: Injury, Poisoning, and Certain Other Consequences of External Causes. This code directly correlates to contusion of shoulder, and since the question states that the left shoulder is affected, you will look down the listing and find code S40.012, which is for the left shoulder. Also, this code requires a 7th character, which in this case will be an A (initial encounter), D (subsequent encounter), or S (sequela). Since this is the first time the patient is presenting with this problem, you will correctly code this S40.012A.

Code S40.019 is for contusion of unspecified shoulder. Since the question did specify which shoulder was hurt, this would not be the correct answer.

Correct answer: 67924-E2

Searching the CPT index for eyelid, repair, entropion, extensive leads to 67924. Reviewing the code confirms the correct reporting. To indicate which eyelid was treated, appending the -E2 modifier is appropriate.

CPT code 67914 describes a repair of an ectropion.

CPT code 67921 describes a less intensive repair of an entropion.

CPT code 67917 describes an extensive repair of an ectropion.

CPT modifier -E4 describes the lower right eyelid. This case was lower left.

CPT modifier -E1 describes the upper left eyelid. This case was the lower left.

Correct answer: 43831

In the CPT index, you will look up gastrostomy, temporary, neonatal, which gives you the code 43831. When you turn to the Digestive system section, you will see that code 43831 is for an open gastrostomy, neonatal, for feeding (this is technically a temporary procedure). Since this is exactly the procedure described in the question, this code is the correct answer. 

Code 43830 is for an open gastrostomy, without construction of the gastric tube. The question states that a newborn had this procedure done, and since there is a more specific code for this situation, this code is not the correct answer. Code 43800 is for a pyloroplasty. This is a completely different procedure than what the question asked for, so this would not be the correct answer either. Code 43840 is for a gastrorrhaphy. This, also, is a completely different procedure than what the question describes. Therefore, this is not the correct answer.

Correct answer: B35.4

In the alphabetic index of the ICD-10 book, you will look up ringworm, body. This gives you the correct code B35.4, which can be found in Chapter 1: Certain Infectious and Parasitic Diseases. This code translates to tinea corporis, which is the technical term for ringworm of the body. 

Searching the ICD-10-CM alphabetic index for Ringworm leads to code B35.9, Dermatophytosis, unspecified, Ringworm, NOS. This is not correct; the case describes that the patient has ringworm over the whole body. Researching the essential modifiers under the main term, "Ringworm," leads to the correct subterm, "body," and B35.4, the correct code. Code B35.3 is for tinea pedis or foot ringworm. Again, this is not the correct type of ringworm for the documented case. Code B35.1 is for tinea unguium or ringworm of the nails. Again, this is not the correct type of ringworm, so this is also incorrect.

Correct answer: Loxapine

For this question, you will turn to the definitive drug classes listing subsection in the Pathology and laboratory section. There, you will see that there is a list of every class tested within the definitive drug class. Antipsychotics are listed here, and as you read the list, you will see that loxapine is a drug tested within this class. Since this is what the question is asking for, this drug name would be the correct answer.

Drug HWH-398 is tested under the cannabinoids, synthetic drug class. Since this is not what the question is asking for, this is incorrect. Drug acetone is tested under the alcohol(s) drug class. This is also not what the question is asking for, so this would be an incorrect answer. Drug ketamine is tested under the ketamine and norketamine drug class. Again, this is not what the question is asking for, so this code would be incorrect.

Correct answer: 15788

In the CPT index, you will look up chemical peel, which gives you the code range 15788-15793. Turning to the Integumentary system section, where these codes are located, you will see that these three codes are all for chemical peels but differ in whether the peel was dermal or epidermal, or whether it was facial or nonfacial. In the question, the patient had an epidermal facial peel. Given this information, code 15788 would be the best fit since it is for a chemical peel, facial, epidermal. Therefore, this code would be the correct answer.

Code 15793 is for a dermal facial chemical peel. The question states that an epidermal peel was done, so this would not be the correct answer. Code 15780 is for dermabrasion, total face. This does not match the procedure given in the question, so this also would be an incorrect answer. Code 15824 is for a rhytidectomy, forehead. This procedure is not mentioned in the question at all, so this would be an incorrect answer.

Correct answer: 80305

In the index of the CPT book, you will look up drug assay, presumptive drug class, which gives you the code range 80305-80307. Turning to the Pathology and Laboratory section, you will see that the difference between the codes is how the sample is read. In the question, the patient has a urine dipstick to test for these substances, which can be read by direct optical observation, and does not need assistance from anything else. So, this leaves us with code 80305, which is for a presumptive drug test, any number of drug classes, any number of devices or procedures, capable of being read by direct optical observation only. Since this matches what the question was asking for, this would be the correct answer.

Codes 80345, 80353, 80358, and 80361 are for testing barbiturates, cocaine, methadone, and opiates, respectively. Since you cannot bill for testing these substances separately, this would not be the correct answer. Code 80306 is for a presumptive drug test, read by instrument-assisted direct optical observation. Since you know that no other means were necessary when it came to getting results from the urine dipstick, this is incorrect. Code 80307 is for a presumptive drug screen as well, but by using instrument chemistry analyzers, chromatography, and mass spectrometry either with or without chromatography. This code is too detailed for what the question is asking for, so this would also not be the correct answer.

Correct answer: Digestive

The palatoglossal arch is a part of the mouth at the end of the hard palate and is attached to the uvula. Since the mouth is a part of the digestive system, this part of the mouth would automatically be a part of the digestive system as well. This cancels out the chances of it being a part of the circulatory, respiratory, or musculoskeletal systems.

Correct answer: Thin layer chromatography

The answer to this question can be found in the Definitions and Acronym Conversion Listing after the Organ or Disease-Oriented Panels subsection of the Pathology and Laboratory section. According to this listing, TLC is an acronym standing for thin layer chromatography. It does not stand for (in medical coding terms) tender loving care, tramadol, lithium, cocaine, or total light coming through.

Correct answer: 69740

Code 69990, which is at the end of the Auditory System section, is for an operating microscope. This is an add-on code that can be used with almost any procedure code in which the physician used an operating microscope for assistance. In the description of the microscope and its uses, there is a list of codes that should not be used with 69990. These codes already include the use of an operating microscope in the billing, so there is no need to code it twice. Code 69740, which is for suture of a facial nerve, is intratemporal. This code is not one of the codes listed in the description not to use, so it would be the correct answer to this question.

Codes 64727, 63075, and 65091 are all listed in the description of the operating microscope, and because of this, they would not be the correct answers to this question.

Correct answer: 99211, Z44.8

In this scenario, the returning (established) patient did not have any complaints that required the presence of a physician. There was no examination or medical decision-making performed for the patient, guiding to the established patient office visit code 99211. For the diagnosis code, the pessary was removed for cleaning with no documentation of a complication of the device nor is this device a contraceptive device; therefore, reporting Z44.8 (fitting, device, prosthetic, other specified) is correct.

CPT code 99212 requires an appropriate history, exam, and straightforward medical decision-making. That is not documented in this case, eliminating 99212 and its associated diagnosis option.

Also eliminated are new patient codes 99201 and 99202 and therefore the diagnoses associated with those answer options.

ICD-10-CM code Z97.5 describes the presence of an IUD; this case does not document this diagnosis.

Correct answer: 23

Place-of-service codes are extremely important in medical billing because they help to dictate where exactly the services were rendered, whether it be in a hospital, medical office, or even an urgent care or assisted living facility. At the beginning of the CPT book, there is the entire list of place-of-service codes. It includes descriptions and what the numbers stand for. 

When a patient comes to an emergency room, for any reason, and is seen by the doctor, the place-of-service number would be 23, according to the place-of-service codes table. If the patient is admitted to the hospital, for any reason, that place-of-service code would change to 21 (which would then eliminate this answer). Place-of-service code 24 is for an ambulatory surgical center, and place-of-service code 11 is for a medical office, so neither of these would be correct.

Correct answer: Debridement

Such traumatic events as a shooting or a stabbing require much more than your usual wound repair. Typically, codes 20100-20103 include the surgical exploration of the wound, extension of dissection, debridement, removal of any foreign body if applicable, and the ligation/coagulation of any surrounding blood vessel(s), without the requirement of a thoracotomy/laparotomy. They are usually very extensive, since the physician needs to see the extent of the damage and repair any injuries. Since debridement is listed as part of the wound exploration explanation, this would be the correct answer to the question.

Simple wound repair (not requiring wound enlargement), muscle biopsy, and fine needle aspiration all have their own codes and do not usually go with a traumatic wound exploration. So, none of these choices would be the correct answer.

Correct answer: 99291-25, 36555, 31500

According to the CPT subsection guidelines for Inpatient Neonatal and Pediatric Critical Care: To report critical care services provided in the outpatient setting (for example, emergency department or office) for neonates and pediatric patients of any age, see the Critical Care codes 99291, 99292. A list of services included in reporting critical care is found in the CPT subsection guidelines under Critical Care Services, including the blood gas procedure. Modifier -25 needs to be appended to 99291 since it is an evaluation and management service in which billable procedures were performed on the same date of service. Code 36555 describes the central venous catheter placement which is reportable with the critical care service. Code 31500 describes the emergency endotracheal intubation, which is also reportable with the critical care service.

CPT code 36556 describes a central venous catheter for a person over five years. This patient is two years old.

CPT code 82503 describes blood gases and is included in the critical care service; it is not separately reportable in this case.

CPT code 99285 is an emergency room visit. This is where the service took place, but the case indicates that this is critical care.

CPT code 99475 describes critical care services for a pediatric patient who has already been admitted.

CPT code 82803 describes testing for blood gases, which is included in critical care service and is not reported separately.

Correct answer: 33214, 33222-51

There are extensive guidelines for Pacemakers and Implantable Defibrillators in the CPT manual. Reviewing the chart in the guidelines, describing an upgrade of a single-chamber system to a dual-chamber system directs to 33214 and notes that this code includes the removal of the existing pulse generator. In this case, the skin pocket was also relocated, which is described by CPT 33222, under the same CPT subheading. Multiple procedure modifier -51 is appended.

CPT code 33208 describes an initial insertion or replacement plus the insertion of transvenous dual leads. This was an upgrade from single to dual.

CPT code 33234 describes the removal of a transvenous electrode from a single lead system. This case was more complex than this description.

CPT code 33233 describes only the removal of a pulse generator. This case was more complex than this description.

CPT code 33223 describes the relocation of the skin pocket for the implantable defibrillator. This case was a pacemaker, not a defibrillator.

Correct answer: 55700, 76942-26

Searching the CPT index for needle biopsy, prostate, directs to 55700. Reviewing the code 55700 described as biopsy, prostate; needle or punch, single or multiple, any approach describes the documented case. The code 55700 describes single or multiple procedures, therefore, coding multiples of 55700 is not appropriate. Imaging guidance is not part of the code description and, according to the parenthetical statement, it is appropriate to code the imaging guidance. In this case, ultrasound imaging guidance was used and, of the imaging guidance code options in the parenthetical statement, 76942 is accurate. A modifier of -26, professional component, is appended.

CPT code 10022 was deleted in 2019. It is no longer a valid code.

Correct answer: Chromosome 7

There are 23 different pairs of chromosomes that make up human DNA, and all may possibly carry genetic flaws. Chromosome 7 is one example. The gene CFTR carries cystic fibrosis, a disorder which causes a sticky substance to adhere to the airways, making breathing difficult. Chromosome 7 is the chromosome which carries the CFTR gene.

Chromosome 1 (the largest human chromosome) has the capability to cause glaucoma, breast cancer, and Parkinson's disease. It does not have the capability to carry the CFTR gene, so this is an incorrect answer. Chromosome 4 has the capability to cause bladder cancer and Huntington’s disease. It does not have the capability to carry the CFTR gene, so this is an incorrect answer. Chromosome 8 has the capability to cause cleft lip and schizophrenia. It does not have the capability to carry the CFTR gene, so this is an incorrect answer.

Correct answer: J1559

Looking up this code is not as easy as going to the index in front of the HCPCS book. To look up the drug, you will have to turn to Appendix A, which is the table of drugs and biologicals. When you look up Hizentra, you are relocated to immune globulin, which is on the same page. Under immune globulin, you will see Hizentra listed. For the 100-mg code, the table lists J1559. Going to this code in the Drugs Administered Other than Oral Method section, you will see that code J1559 is for an injection of immune globulin, Hizentra being the drug name, for 100 mg. This is the correct code for the question.

Code J1562 is for an immune globulin injection as well, but the drug name is Vivaglobin, so this is incorrect. Code J1443 is the code for a ferric pyrophosphate citrate solution, so that eliminates this answer. Code J1330 is the code for an ergonovine maleate injection so, again, this is an incorrect answer.