AAPC CPC Exam Questions

Correct answer: 77067

In the index of the CPT book, you will first look up mammography, screening mammography, which has the code 77067. Turning to the Radiology section, you will see that this code is for a screening mammography, bilateral, including computer-aided detection (CAD) when performed. Since this matches what the question is asking for exactly, this would be the correct answer.

Code 77066 is for a bilateral diagnostic mammography including CAD when performed. The question states that a screening mammography is performed, not a diagnostic mammography, so this would be an incorrect answer. Code 77047 is for a bilateral MRI of the breast, without contrast material. An MRI was not performed per the question, so this would be an incorrect answer. Code 77063 is an add-on code, for screening digital breast tomosynthesis, bilateral. Since this is an add-on code, this is also not the correct answer.

Correct answer: A9180

In the index of the HCPCS book, you would look up Administrative, miscellaneous and investigational. This is an entire section of codes not listed anywhere else in the HCPCS book. Here, you will see that topical lice treatment to be administered by patient/caregiver is best described using code A9180, which would be the correct answer to this question.

Code A9270 is for a non-covered item/service. While this may be true for patients with Medicare, you would still code for the service using the code listed above. Code A9150 is for non-prescription drugs. Lice treatment is not considered to be part of non-prescription drugs, so this would be incorrect. Code A9282 is for a wig, any type. A wig would not be properly utilized in this situation. The physician gave the patient an actual topical treatment, so this would not be the correct answer.

Correct answer: 92540, 92546, 92547

One way to find this answer in the index of the CPT® Professional Edition is under vestibular function, tests, nystagmus, directing to a list of codes. Reviewing the list of codes leads to reporting 92540, 92546, and add-on code 92547. Code 92540 describes the majority of the procedures, with 92546 describing the sinusoidal vertical axis rotational testing and the add-on code describing the use of electrodes.

Modifier -51, multiple procedures, is not used with add-on codes.

CPT code 92545 describes an oscillating tracking test with recording. This case does not document this procedure.

CPT code 92542 describes a positional nystagmus test. This case does not document this procedure.

CPT code 92541 describes a spontaneous nystagmus test. This case does not document this procedure. Because this is not an appropriate code, the modifier is also not appropriate.

Correct answer: 23412

Searching the CPT index under Repair, musculotendinous cuff (also rotator cuff), leads to code range 23410-23412. Reviewing the series leads to the choice of 23412 for the chronic, as opposed to acute, condition documented in the case. 

CPT code 23410 represents the open treatment of a shoulder dislocation with surgical fixation. It is used when an orthopedic surgeon performs an open repair of a ruptured musculotendinous cuff. CPT code 23405 represents a tenotomy of the shoulder area addressing only the tendons. CPT code 23406 represents tenotomy of multiple tendons, but the repair of the musculotendinous cuff more specifically addresses this case.

Correct answer: R55, Z87.820 

In the alphabetic index of the ICD-10 book, you will look up syncope. This gives you the code R55, which can be found in Chapter 18: Symptoms, Signs, and Abnormal Clinical and Laboratory Findings, NEC. This code directly correlates to syncope and collapse. Because the patient has a history of traumatic brain injury, the testing and diagnosing of the patient included special consideration. Therefore, the history of traumatic brain injury is also coded. The ICD-10-CM Alphabetic index main term history, personal, does lead to essential modifier traumatic brain injury, and code Z87.820, which is confirmed in the tabular index.  

Code R55 is not reported by itself because of the patient's history. Code R56.1 is for post-traumatic seizures, which is not documented in this case. Code R40.20 describes a coma, which is not documented in this case; the patient did lose consciousness but recovered.

Correct answer: T1031

In the index of the HCPCS book, you would look up nursing care, in home. This gives you the codes T1030 and T1031, which are located in the national codes established for state Medicaid agencies section. Here, you will see that these two codes differ by which type of nurse performs the nursing visit. The question states an LPN performed this visit, which is code T1031. This will be the correct answer to the question.

Code T1030 is for nursing care as well, but performed by an RN. Since the question asks for an LPN, this is not the correct answer. Code T2022 is for case management, per month. This is not what the question is asking for, so this would be incorrect. Code T2031 is for assisted living, waiver, PRN. This is also not what the question is asking for, so this would be incorrect.

Correct answer: The cavity is punctured, and fluid is removed

An amniocentesis is a diagnostic procedure that, according to the medical suffix –centesis, occurs when the physician punctures the cavity of the sac that surrounds the unborn fetus and removes fluid.

The other answer choices do not correctly describe amniocentesis.

Correct answer: 76705

In the index of the CPT book, you will look up ultrasound, abdomen, which gives you the code range of 76700-76705. Turning to the Radiology section, you will see that the difference between the two codes in the range is whether the ultrasound was complete or limited. In the question, only the liver and gallbladder are seen (basically, only the RUQ), so this would be considered a limited ultrasound, which is code 76705. Code 76705 would then correctly answer the question.

Code 76700 is for a complete abdominal ultrasound. The ultrasound done was not complete, so this is an incorrect answer. Code 78201 is for liver imaging, static only. The liver and gallbladder are seen in the study performed in the question, and the study done was an ultrasound, which is not what this code is for. Thus, this is not the correct answer. Code 78215 is for liver and spleen imaging, static only. The spleen is not mentioned in the question, and an ultrasound, the actual test performed, is not mentioned in the code. So, this is not the correct answer.

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 code 00640 is indeed for anesthesia for manipulation of the spine or for closed procedures on the cervical, thoracic, or lumbar spine. Since this matches exactly what the question asks for (anesthesia for spine manipulation), this would be the correct answer to this question.

Code 00670 is for anesthesia for extensive spine and spinal cord procedures. This is not considered an extensive procedure and, also, there is an anesthesia code for spinal manipulation. Therefore, this would not be the correct answer. Code 00604 is for anesthesia for procedures on the cervical spine and cord, with patient in the sitting position. This is not a spinal manipulation, so this would be incorrect. Code 00620 is for anesthesia for procedures on the thoracic spine and cord. Again, this is not a spinal manipulation, so this would also be incorrect.

Correct answer: 99214, J02.0, H65.00

The patient is seeing their regular pediatrician, which indicates this is an established patient and indicates this is an office visit. The visit is described as being moderate medical decision-making because there are two diagnoses, data includes unique testing, and there was prescription management, indicating this is moderate decision-making leading to code 99214. Addressing the diagnoses, searching for sore throat, and streptococcal leads to J02.0, and searching otitis media leads to category H66, but more specifically, with effusion directs to otitis, media, non-suppurative, serous leading to H65.0 subcategory, leading to H65.00 acute serous otitis media, unspecified ear, because the case does not indicate which ear or if both ears were infected.

CPT code 99212 indicates straightforward medical decision making and in this case, moderate medical decision-making was established.

ICD-10-CM code J02.9 describes acute pharyngitis but does not address the strep infection.

CPT code 99213 describes an EM of low medical complexity and does not reflect all the skills used in this encounter.

ICD-10-CM code H65.90 does not indicate an acute infection as H65.00 does.

Correct answer: 61697

In the index of the CPT book, look up aneurysm repair, carotid artery, which gives you the code range of 35001-35002 and the codes 61613, 61697, 61700, and 61703. The code range given in the 30000 section is not correct because this question asks for an intracranial approach, and neither of these codes describes an intracranial approach surgery. This leaves us with the last series of codes, which is located in the Nervous System section. Looking closer at these codes, 61697 is for the surgery of a complex intracranial aneurysm, intracranial approach, carotid circulation. This correctly describes the procedure used, so this would be the correct answer.

Code 61698 is for the same type of surgery but with vertebrobasilar circulation. This is not what the patient suffered from, so this would be incorrect. Code 61700 is also for the same type of surgery and for the same type of circulation, but it is for a simple intracranial aneurysm. Code 61703 is for the same type of surgery but using a cervical approach (around the neck). Since it is not the correct approach, this is not the correct answer.

Correct answer: 32552-58

CPT code 32552 describes the removal of an indwelling pleural catheter with a cuff. Appendix A in the CPT manual lists the numeric modifiers. The key phrase to choose the correct modifier is “Staged (planned) return...during the postoperative period,” which is found in the description for modifier -58.

CPT modifier -79 describes an unrelated procedure during the postoperative period. The procedure in this case was related.

CPT modifier -78 describes an unplanned return to the operating room during the postoperative period.

CPT code 32036 describes a thoracostomy with biopsies of the lung, on one side. This case documented the removal of a catheter.

CPT code 32035 describes a thoracostomy. This case documented the removal of a catheter.

CPT code 32440 describes the removal of a lung or pneumonectomy. This case documented the removal of a catheter.

Correct answer: 66770

In the CPT index, you will look up destruction, cyst, iris, which gives you the code 66770. Turning to the Eye and Ocular Adnexa section, you will see that this code is for the destruction of a cyst or lesion of the iris or ciliary body. Also mentioned in the question, the doctor used a nonexcisional method (laser) to perform the procedure, which is also mentioned in the code's description. Because of this, code 66770 is the correct answer.

Code 66600 is for an iridectomy, with corneoscleral or corneal section, for removal of a lesion. The surgeon used a laser to destroy the cyst on the patient's iris; nothing was excised. Therefore, this is not the correct answer. Code 66700 is for ciliary body destruction; diathermy. The cyst was located on the iris, not the ciliary body, so this is also an incorrect answer. Code 66761 is for an iridotomy/iridectomy by laser surgery. Technically, only lesion/cyst destruction was done, so this is not the correct answer either.

Correct answer: 29883

CPT code 27447 describes an open, rather than arthroscopic, procedure, so this option can be eliminated. CPT code 29868 is arthroscopic, but the procedure is a transplant, rather than a repair, so this is also incorrect.

The distinction between CPT codes 29882 and 29883 is the words “and” vs. “or”. In this scenario, the patient had both the medial and lateral meniscus repaired, so CPT code 29883 is correct.

Correct answer: A patient has borderline kidney failure and develops acute kidney failure every time he gets sick

Coding guidelines and rules change, for the most part, every calendar year. A good way to follow compliance rules is to keep up with all the changes that come with the many insurances (including, and especially, Medicare) and codes that come and go. Renal dialysis can be very tricky to bill, especially in an inpatient setting, since dialysis is usually only done on an outpatient basis. However, there are a few exceptions to this. If a patient suffers from an acute illness and the kidneys happen to fail, short-term, or acute, dialysis will be used. Another instance is if a patient's kidneys are on the borderline of failure. Every time they develop an illness, their kidneys can fail and require a dialysis treatment. This is called episodic dialysis and also answers the question. 

If a patient has ESRD or chronic kidney failure, then dialysis cannot be used in the inpatient setting.

Correct answer: G47.33

In the alphabetic index of the ICD-10 book, you will look up apnea, sleep, obstructive. This gives you the code G47.33, which can be found in Chapter 6: Diseases of the Nervous System. This code directly correlates to obstructive sleep apnea, which is exactly what the question asks for. Code G47.33 does not need any more characters to complete it, so this would be the correct answer to this question.

Code G47.30 is for sleep apnea, unspecified. Since there is an actual code for the type of sleep apnea the question asks for, this would not be the correct answer. Code G47.39 is for other sleep apnea. There is a code for the type of sleep apnea in the question, so this is incorrect. Code G47.23 is for circadian rhythm sleep disorder, irregular sleep-wake type. This is not what the question is asking for, so this would be incorrect.

Correct answer: 43761

When you turn to the index in the back of the CPT book, you will look up repositioning, Gastrostomy tube. This gives you the code 43761, which is located in the Digestive System section. Code 43761 is for the repositioning of a naso- or oro-gastric feeding tube, through the duodenum for enteric nutrition. This is exactly what the patient had done, so this is the correct answer.

Code 43762 is for the replacement of a gastrostomy tube, percutaneous, includes removal, when performed, without imaging or endoscopic guidance; not requiring revision of gastrostomy tube. The patient did not have his tube replaced; he only had it repositioned. So, this would not be the correct answer. Code 43756 is for a duodenal intubation and aspiration, diagnostic, including imaging guidance; single specimen. The question does not mention anything about intubation and aspiration, so this would not be the correct answer. Code 43752 is for a naso- or oro-gastric tube placement, requiring physician's skill and fluoroscopic guidance. The patient already has a tube placed, he just had it repositioned. Therefore, this also is not the correct answer.

Correct answer: 90989

In the index of the CPT book, you would look up dialysis, patient training, completed course. This gives you the code 90989, which you will look up in the Medicine section. When you look up this code, it is for dialysis training, patient, including helper where applicable, any mode, completed course. Since this is what the question is asking for, this is the correct answer to the question.

Code 90993 is for dialysis training as well; however, it is for an incomplete course. The patient in the question completed the course, so this is not the correct answer. Code 90967 is for ESRD-related services for dialysis less than a full month of service, per day, for patients younger than 2 years of age. This is not what the question is asking for, so this is an incorrect answer. Code 90999 is for unlisted dialysis procedure, inpatient or outpatient. Again, this is not what the question is asking for, so this is incorrect as well.

Correct answer: I82.0

In the alphabetic index of the ICD-10 book, you will look up Budd-Chiari syndrome (hepatic vein thrombosis). This gives you the code I82.0, which can be found in Chapter 9: Diseases of the Circulatory System. This code directly correlates to Budd-Chiari syndrome, which is exactly what the question asks for. Code I82.0 does not need any more characters to complete it, so this would be the correct answer to this question.

Code I82.1 is for thrombophlebitis migrans. This is not what the question is asking for, so this would be incorrect. Code I81 is for portal vein thrombosis. This is not what the question is asking for either, so this is incorrect. Code I82.3 is for embolism and thrombosis of renal vein. Again, this is not what the question is asking for, so this would be incorrect.

Correct answer: K37

K37—unspecified appendicitis—is correct because there is no indication of the appendicitis being acute, chronic, or recurrent. There is no indication of hyperplasia, peritonitis, or other conditions associated with appendicitis.

K35.890—other acute appendicitis without perforation or gangrene—is incorrect because there is no indication that there is some other specific appendicitis not otherwise listed in the ICD-10-CM.

K35.80—unspecified acute appendicitis—is incorrect because there is no indication that the patient's appendicitis was acute.

K38.9—disease of the appendix, unspecified—is incorrect because there is a more specific code describing the condition as appendicitis, as noted in the diagnostic statement.