AAPC CPC Exam Questions

Correct answer: 00145

In the index of the CPT book, you will look up anesthesia, eye, which gives you the code range 00140-00148. Turning to the Anesthesia section, where this range is located, you will see that the range is broken up by what type of procedure was done. In this case, the procedure done was a retinal surgery, so code 00145, which is anesthesia for a vitreoretinal surgery, would be the correct answer to this question.

Code 00140 is for an anesthetic procedure on an unknown eye procedure. Since the question states which surgical eye procedure is done, and there is a code for this, this would not be the correct answer. Code 00148 is for anesthesia for an ophthalmoscopy. The procedure done was to repair a retinal detachment; an ophthalmoscopy was not mentioned. Therefore, this is not the correct answer. Code 00190 is for anesthesia on procedures on the facial bones/skull. The eye is not considered to be part of the bones of the face or the skull. This would not be the correct answer.

Correct answer: 90792, 90785

This is an initial psychiatric evaluation with medical services, 90792. Because the physician documented the patient's distress and that it complicated the encounter, the add-on code for interactive complexity appropriate to report is 90785.

EM code 99205 requires a high level of medical complexity, or time documentation which is not documented in the question. The parenthetical statements outline that 90791 should not be reported with EM codes 99202-99316 and others. CPT code 90791 is a similar procedure to the correct code, but does not require a physician's services; this code can be performed by a therapist.

CPT code 90847 describes family psychotherapy. In this question, the parent was present to offer information about the patient's condition, not for counseling.

CPT code 90863 is an add-on code for pharmacological management when performed during psychotherapy services; it cannot be reported alone, and psychotherapy services were not performed in this encounter.

Correct answer: N13.2

In the alphabetic index of the ICD-10 book, you will look up hydronephrosis, with obstruction, renal calculus. This gives you the code N13.2, which can be found in Chapter 14: Disease of the Genitourinary System. This code directly correlates to hydronephrosis with renal and ureteral calculus obstruction, which is exactly what the question asks for. Code N13.2 does not need any more characters to complete it, so this would be the correct answer to this question.

Code N13.30 is for unspecified hydronephrosis, and N20.2 is for calculus of kidney with calculus of ureter. There is a code that combines the two if a patient is diagnosed with both, so this would not be the correct answer. Code N13.70 is for vesicoureteral-reflux, unspecified. This is not what the question is asking for, so this is incorrect. Code N13.1 is for hydronephrosis with ureteral stricture, not elsewhere classified. This is not what the question is asking for either, so this would be incorrect.

Correct answer: 00794

In the index of the CPT book, you will look up anesthesia, pancreatectomy, which gives you the code 00794. Turning to the Anesthesia section, where this code is located, you will see that this code is for anesthesia for intraperitoneal procedures in the upper abdomen including laparoscopy, pancreatectomy, partial or total (including the Whipple procedure). Since this is what the question is asking for, this code would be the correct answer.

Code 00790 is for anesthesia for intraperitoneal procedures in the upper abdomen including laparoscopy, not otherwise specified. This procedure does have a specific anesthesia code, so this would not be the correct answer. Code 00700 is for anesthesia for procedures on the upper anterior abdominal wall, not otherwise specified. This is not what the question is asking for, so this would also be incorrect. Code 00732 is for anesthesia for an endoscopic retrograde cholangiopancreatography (ERCP). Again, this is not what the question is asking for, so this would be incorrect.

Correct answer: 32800

For this question, you will go to the CPT index and look up hernia repair, lung. This gives you the code 32800; reviewing the code information confirms the coding for this case. 

Code 32810 is for the closure of chest wall following open flap drainage for empyema. The question states that a hernia repair was done, not a chest wall closure. Code 32900 is for the resection of ribs, extrapleural, all stages, not a lung hernia repair. Code 32820 is for major reconstruction of the chest wall, not a repair of lung hernia.

Correct answer: 99283

CPT code 99283 represents an ED visit for evaluating and managing a patient with a minor problem with a medically appropriate history and examination and low-level decision-making. The documentation provided in this scenario meets the requirements for CPT code 99283.

99284 describes an ED visit with moderate MDM.

99281 describes an ED visit that does not necessarily require the presence of a physician.

99282 describes an ED visit that requires straightforward medical decision-making.

Correct answer: Duodenum

The digestive system, while seemingly simple, is very complex. It stretches from the mouth all the way to the rectum and anus. Most of the digestive system is concentrated in the stomach and intestinal area, which has about 12 organs squeezed into one area. All four answer options are located in this area, and they are all located within inches of each other.

The ileum and cecum are located closer to the rectum and appendix than the stomach, so that eliminates these two answers. The jejunum, while located close to the stomach, is not directly at the bottom of the stomach and the beginning of the small intestine. So, this answer would not be correct either. The duodenum, the last option, is located right where the stomach ends and the small intestine begins. It leads to the jejunum, which can be confusing when it comes to their location. But because of its location, the duodenum is the correct answer to this question.

Correct answer: Fracture

For this question, you would turn to the Debridement subsection within the Integumentary System section. Debridement is the cleaning out of a wound and is typically done on either the skin, muscles, or bones. There is a description of how to code debridement in this subsection, and this description explains that a debridement may be reported for “injuries, infections, wounds, and chronic ulcers.” All these are prone to getting foreign debris caught inside. The one “answer” not mentioned here is fractures, as they typically do not need a debridement.

As mentioned above, infections, chronic ulcers, and injuries are all acceptable to be reported with a debridement.

Correct answer: 01990-P6

In the index of the CPT book, you will look up anesthesia, life support for an organ donor, which gives you the code 01990. Turning to the Anesthesia section, this code is for physiological support for the harvesting of organ(s) from a brain-dead patient. In this case, you would also attach modifier P6, which is for a declared brain-dead patient whose organs are being removed for donor purposes. This describes exactly what the question states, so this would be the correct answer.

Code 00862 is for anesthesia for renal procedure including upper one-third of ureter or donor nephrectomy. Even though the P6 modifier (for a declared brain-dead patient) is attached to the code, there is a code for harvesting organs from a brain-dead patient, so this would not be the correct answer. Using code 01990, while partially correct, should not be billed without modifier P6. So, this would not be the correct answer. Code 01999 is for an unlisted anesthesia procedure. The situation in the question is listed as an anesthesia procedure, so this would not be the correct answer.

Correct answer: 00320

In the index of the CPT book, you will look up anesthesia, thyroid, which gives you the code range 00320-00322. Turning to the Anesthesia section, where this range is located, you will see that the range is broken up by what type of procedure was done on the thyroid and also states that the patient must be older than one year in order to use the anesthesia code. In this case, the procedure was done on a 20-year old, and it was a thyroidectomy, so code 00320, which is anesthesia for all procedures on the esophagus, thyroid, larynx, trachea, and lymphatic system of the neck, would be the correct answer for this question.

Code 00322 is also for anesthesia but is for a needle biopsy of the thyroid. The question does not mention this, so this would be an incorrect answer. Code 00326 is for anesthesia for all procedures on the larynx and trachea in children younger than one year. The patient in the question is 20 years old, and the procedure is on the thyroid, so this is also not the correct answer. Code 00300 is for anesthesia on all procedures on the integumentary system of the head, neck, and posterior trunk. The question does not mention the integumentary system as part of the procedure done, so this is incorrect.

Correct answer: The coder would use the code with the lesser amount

Specifics are everything when it comes to medical coding. For certain codes, the doctors must specify the weight of certain body organs in order for the coder to correctly bill the claim. In this case, if a physician performs a vaginal hysterectomy, the uterus weight must be given to bill correctly. However, if there is no weight given, no matter what the reason, the coder must pick the code with the lesser weight. For example, the code 58260 would be used for a vaginal hysterectomy when the physician does not specify the uterine weight.

Picking a different code, while it may slightly resemble the procedure done, is not the correct way to code. Therefore, this would not be the correct answer. Guessing the weight of the uterus is also not the correct way to code. Guessing anything in medical billing is unacceptable and should never be done. This is also not the correct answer to the question. Just like using a code that “slightly” resembles the procedure, picking a code that describes more than what actually was done is unacceptable as well. You must never code higher than what has been done. This answer is also not correct for this question.

Correct answer: NCDs are measured on a national level, and LCDs are measured on a more local level

NCDs and LCDs vary by coverage determination. NCD, or National Coverage Determination, explains Medicare’s rules on when they will pay for certain items or services. LCD, on the other hand, stands for Local Coverage Determination and is more specific. They explain when a service is necessary, determine CPT and ICD-10 necessity, and give guidance on coverage limitations. They work hand-in-hand.

They do not measure ICD-10, HCPCS, or CPT code values, at least not separated by NCD and LCD. They are not separated by whether or not they are a part of Medicare A or B and, while they could measure what is medically necessary or liable, like ICD-10, CPT, and HCPCS, they do not separate these duties between LCD and NCD.

Correct answer: A patient, under the age of 18, requires a legal guardian in the room with them

Interactive complexity, or code 90785, is an add-on code for psychiatric services found within the Medicine section. In a nutshell, this type of add-on service is used when any kind of barrier in communication hinders the proper delivery of a specific psychiatric service. Examples of these kinds of barriers are: using an interpreter for a patient who does not speak the same language as the psychiatrist, and severe bouts of emotion or disruptive behavior from the caregiver of the patient. When a patient is under the age of 18, and he has a parent or legal guardian with him during the session, this does not constitute proper use of the interactive complexity code and, therefore, is the correct answer for this question.

In the Medicine section, underneath the Interactive Complexity subsection, the caregiver's emotions interfere with the ability to provide care, maladaptive communication needs to be managed among participants who complicate quality and delivery of care, and when a translator is involved in order to help overcome the language barrier between the psychiatrist and the patient are all listed as factors that make using this code appropriate.

Correct answer: H18.823

In the alphabetic index of the ICD-10 book, you will look up disorder, cornea, due to contact lens. This gives you the code H18.82-, which can be found in Chapter 7: Diseases of the Eye and Adnexa. This code directly correlates to corneal disorder due to contact lens. Since the question states that the patient had a complaint in both eyes, you will look down the listing a little bit and see that code H18.823 is the bilateral code for corneal disorder due to contact lens. This would be the correct answer to this question. 

Code H18.821 is for corneal disorder due to contact lens, right eye. Since the question states that the condition is bilateral, this would not be the correct answer. Code H18.813 is for anesthesia and hypoesthesia of cornea, bilateral. This is not what the question is asking for, so this is incorrect. Code H18.9 is for unspecified disorder of cornea. There is a code for the disease listed in the question, so this would be incorrect.

Correct answer: 53442

CPT code 53442 represents the removal or revision of a sling for male urinary incontinence, which clearly describes the procedure.

CPT code 53431 represents a treatment for incontinence, but this is urethroplasty with tubularization of the posterior urethra and/or lower bladder.

Reviewing modifiers in CPT Appendix A, modifier -51 represents multiple procedures in the same session by the same physician. The patient had the sling placed several months ago, the removal is the only procedure that is now performed and reported. Therefore, modifier -59, a procedure that is distinctly reported with another service on the same day, is also not appropriate for this question.

Correct answer: 33208, I49.5

To assist with locating the correct answer efficiently, attempt to identify the proper ICD-10 code first. The correct diagnosis is in the "Postoperative Diagnosis" section. The diagnosis in this case is sick sinus syndrome. ICD-10 code I49.5 represents sick sinus syndrome. CPT code 33208 describes the "Initial pulse generator insertion or replacement plus insertion of transvenous dual leads."

ICD-10 code I20.9 represents angina pectoris, unspecified.

ICD-10 code I49.5 represents sick sinus syndrome.

ICD-10 code I49.9 represents cardiac arrhythmia, unspecified.

CPT code 93280 describes the evaluation of the programming of the implanted dual channel dual lead pacemaker system.

Correct answer: L7364 x2

In the HCPCS index, you would look up battery, twelve volt, which gives you the code L7364. Turning to the Prosthetic Procedures section, you will see that code L7364 is for one 12-volt battery. Since this code is only for one battery, you would code L7364 twice. Therefore, L7364 x2 is the correct answer to the question.

Code L7366 is for a 12-volt battery charger. The question asks for a battery, not a charger, so this is an incorrect answer. Code L7259 is for an electronic wrist rotator, any type. The patient currently has an electronic wrist rotator and is only receiving the battery for it, so this also is not the correct answer.

Correct answer: The type of treatment and stabilization

According to the general guidelines of the Surgery: Musculoskeletal System, codes for the treatment of fractures and joint injuries are categorized by the type of treatment and stabilization.

According to the general guidelines of Surgery: Musculoskeletal System, the type of fracture does not define the type of treatment. For example, a fracture where the bone breaks through the skin is an open fracture. However, it may not require a surgeon to perform open treatment. Another example is that a patient with a closed fracture, one that is not open through the skin, may require open treatment, where a surgeon makes an incision to put plates or screws in to stabilize the fracture.

The type of the fracture (open, sticking outside of skin, or closed, not sticking outside of skin) or the type of joint (hinge, ball and socket, suture) are not criteria for selecting a correct code. The size of the fracture or the degree of dislocation of the joint do not impact the choice of code. The posterior or anterior approach to the joint does not impact the choice of code.

Correct answer: Behind the lens of the eye

Cataracts are an aging condition that causes blurry vision due to the clouding of the lens. They should be caught and treated early on because they could cause blindness if left untreated. Typically, they are located behind the lens of the eye.

They are not located within the vitreous humor of the eye, inside the choroid layer of the eye, or within the optic nerves behind the eye.

Correct answer: 50547, 50328-51, 50325-51

Searching the CPT index for donor procedures, kidney excision leads to 50300 and 50320. Reviewing these codes leads to the subheading of codes with guidelines related to kidney donorship. The guidelines in this subheading include a parenthetical statement directing to 50547 for a laparoscopic donor nephrectomy (for a living donor; there is no laparoscopic code for a cadaver donor). The backbenching, or reconstructing the arterial anastomosis, is coded with 50328 as listed in this family of codes. The backbenching preparation of the living donor allograft is coded with 50325. Modifier -51 is appended to the second and third codes because there are multiple procedures on the same area in the same incisions being performed. 

CPT code 50320 describes an open nephrectomy from a living donor; this case documented a laparoscopic donor nephrectomy. CPT code 50327 describes venous anastomosis backbenching; this case documented arterial anastomosis backbenching. CPT code 50300 describes a donor nephrectomy from a cadaver donor, not a living donor. CPT code 50323 describes backbenching preparation for a cadaver donor allograft. CPT code 50329 describes a ureteral anastomosis; not an arterial anastomosis.