AAPC CPC Exam Questions

Correct answer: The arteries

Atherosclerosis is a disease that is extremely harmful to the heart and the circulatory system. The medical prefix ather/o stands for plaque or a fatty substance. This brings us to the conclusion that atherosclerosis is the hardening of plaque and mainly occurs in the arteries.

The blood vessels, heart, and veins, while affected by atherosclerosis, are not directly affected like the arteries.

Correct answer: 30420

Searching the CPT Index for face, reconstruction, nose, leads to a series of codes 30400–30420, 30430–30450, 30620. Reviewing this list of codes leads to reporting 30420, described by rhinoplasty with elevation of the nasal tip and major septal repair. No other code or modifier is needed to describe the documented case. 

CPT code 30160 represents a total rhinectomy. A rhinectomy is a surgical removal of a nose. Understanding the suffix could help to identify this is the incorrect answer, as the suffix -ectomy means "to remove". The scenario does not mention a removal. Therefore, 30160 can be eliminated.

CPT code 30630 represents repair of nasal septal perforations, which was not documented in the scenario, and is incorrect.

CPT code 30400 represents primary rhinoplasty and/or elevation of the nasal tip.

Correct answer: 25628-RT

The patient had an open reduction, meaning an incision was made to get to the fracture. Searching the CPT index for carpal bone, scaphoid fracture leads to 25622, 25624, and 25628. Closer examination of these three codes leads to reporting 25628, described as open treatment of a carpal scaphoid fracture including internal fixation when performed. Modifier -RT is appended to describe the procedure performed on the right side.

CPT code 25622 describes a closed procedure; this case does not document a closed procedure.

CPT code 25624 describes a closed treatment of the carpal scaphoid with manipulation; this case does not document a closed treatment.

The fracture site was the scaphoid of the wrist (carpal), eliminating CPT code 25645, describing another carpal bone fracture other than the scaphoid.

CPT code 25651 is a percutaneous fixation (through the skin) of the ulnar styloid fracture; this case documented an internal fixation.

Correct answer: 99309

The best and quickest way to answer this question would be to turn to the Evaluation and Management section and look for the Nursing Facility Services subsection. Looking for the information you are given in the question, you will see that code 99309 is the best fit. It is for a subsequent nursing facility visit, medically appropriate history and exam, and an MDM of moderate complexity. Thirty minutes is usually how long these visits take. Everything mentioned above is in the question, so 99309 would be the correct answer.

Code 99304 is for an initial nursing facility care visit. Since the question is asking for a subsequent visit code, this would not be the correct answer. Code 99315 is for nursing facility discharge management, 30 minutes or less. The question is not asking for discharge management, so this would not be the correct answer.  Code 99307 is for a subsequent nursing facility care visit, medically appropriate history and exam, and straightforward MDM. This is not what the question is asking for, so this is also incorrect.

Correct answer: 93619

CPT code 93619 does not have a symbol indicating that it may not be reported with the -51 modifier.

CPT code 93616 has a symbol indicating that it is not billable with a -51 modifier.

CPT code 93613 is an add-on code and add-on codes are not reported with the -51 modifier.

CPT code 93600 has a symbol indicating that it is not billable with a -51 modifier.

Correct answer: Same

The medical prefix ipsi- is a directional suffix used in medical terms such as ipsilateral. In this case, this term means "on the same side." This means that the ipsi- prefix means "same." Wordpart meta- means after/beyond/transformation, meso- means middle, and retro- means behind/back.

Correct answer: 99490 and 99439x2

Codes 99490 and 99439 describe chronic care management by clinical staff under the supervision of a physician in a calendar month. 99490 describes the first 20 minutes, and 99439 describes each additional 20 minutes and may be reported up to twice within the month.

These services are reportable according to CPT.

Codes 99491 and 99437 describe chronic care management performed personally by the physician.

Code 99487 is reportable by clinical staff supervised by physicians in complex cases with patients of high medical decision-making complexity. This question does not indicate high complexity.

Correct answer: O47.02, Z3A.19

In the alphabetic index of the ICD-10 book, you will look up false, labor, before 37 completed weeks of gestation. This gives you the code O47.0-, which can be found in Chapter 15: Pregnancy, Childbirth, and the Puerperium. This code directly correlates to false labor before 37 completed weeks of gestation, second trimester. Because the patient is in her second trimester, you have to specify this, so if you look down the listing, you will see code O47.02, which is for false labor in the second trimester. Now, this does not fully answer the question, as you also have to specify how many weeks the patient is pregnant. According to the question, she is 19 weeks, so you will turn back to the index and look up pregnancy, weeks of gestation, 19 weeks, which gives you the code Z3A.19. Turning to Chapter 21: Factors Influencing Health Status and Contact with Health Services, you will see that this code directly correlates with 19 weeks of gestation of pregnancy. These two codes answer the question completely, so they will be the correct answer.

Code O47.1 is for false labor at or after 37 completed weeks of gestation. This is past the gestational age of the patient in the question, so this would not be the correct answer. Code O48.1 is for prolonged pregnancy. This is not what the question is asking for, so this is incorrect.

Correct answer: L1920

In the index of the HCPCS book, you would look up ankle-foot orthosis. This gives you the code range L1900-L1990, which is located in the Orthotic procedures and services section. Here you will see that these codes are all for an AFO, but the only one that is for an AFO with adjustable stop, custom-fabricated, is code L1920. This will be the correct answer to the question.

Code L1945 is for an AFO as well, but plastic, rigid anterior tibial section, custom-fabricated. This is not what the question is asking for, so this is an incorrect answer. Code L1971 is for an AFO also, but plastic/other material with ankle joint, prefabricated, includes fitting and adjustment. This is also not what the question is asking for, so this would be incorrect. Code L2000 is for a knee ankle foot orthosis. This is not what the question is asking for either, so this would be an incorrect answer.

Correct answer: L8600

In the index of the HCPCS book, you would look up prosthesis, breast, which gives you the code range of L8000-L8035 and also gives you the code L8600. First, check the code that is by itself to either eliminate it or use as the answer. Code L8600 is for implantable breast prosthesis, silicone or equal. Since we are looking for breast implants, this is the correct answer.

Code L8603 is for injectable bulking agent, collagen implant, urinary tract. The question did not ask for an implant of the urinary tract, so this is an incorrect answer. Code L8619 is for a cochlear implant, which is part of the ear. This is not what the question asks for, so this is also incorrect. Code L8641 is for a metatarsal joint implant. This is not what the question asks for, so this is an incorrect answer.

Correct answer: Luteinizing hormone (LH)

Under the Endocrine System Anatomy part of the chapter for endocrine diseases, the different glands of the system are broken down into what they are and what they secrete. The pituitary gland, anterior and posterior, secrete many of the body's important hormones for growth. The LH hormone, or Luteinizing hormone, controls the Progesterone/Testosterone levels in the body. For females, in particular, the rise of LH means that ovulation is at its peak.

Prolactin is a hormone triggered after childbirth; it helps to stimulate milk production. Growth hormones help to trigger the growth of muscles and bones. Oxytocin is a hormone secreted during childbirth and triggers uterine contractions.

Correct answer: 33641, Q21.11

The CPT Index search for Atrial Septal Defect leads to Repair, 33641, 33660. The code 33641 describes the repair of the atrial septal defect, secundum, with a patch. ICD-10-CM code Q21.11 describes the secundum atrial septal defect as defined in the question. Atrial fibrillation is a common symptom associated with secundum atrial septal defects and is not separately reported.

CPT code 33660 describes a repair of the atrioventricular canal which was not performed in this question.

ICD-10-CM code Q21.2 describes an atrioventricular septal defect, and R06.02 describes shortness of breath. This question describes a diagnosis of secundum atrial septal defect and the diagnostic statement does not indicate shortness of breath, although it is a common symptom of the diagnosis and would not be separately reported.

CPT code 33645 describes a patch closure but for sinus venosus, not an atrial septal defect.

CPT code 33647 describes an atrial defect and a ventricular defect, not an atrial septal defect.

CPT code 33675 describes the closure of multiple ventricular septal defects.

ICD-10-CM code Q21.0 describes a ventral septal defect.

Correct answer: 90620

This question can be answered by looking at any chapter in the CPT book. At the bottom of every page is a legend that goes along with the symbols next to certain codes. For codes that are pending FDA approval, a lightning symbol will appear next to it. You will look at the following codes and decipher which code is not pending FDA approval. All the codes are from the Medicine section, so you will start there. Code 90620 is for meningococcal recombinant protein and outer membrane vesicle vaccine, serogroup B (MenB), 2 dose schedule, for intramuscular use. This code does not have the lightning symbol next to it, so it is indeed approved by the FDA and is the answer to the question.

Code 90668 is for Influenza virus vaccine (IIV), pandemic formulation, split virus, for IM use. This code, according to the lightning symbol, is pending FDA approval, so this is not the correct answer. Code 90667 is for Influenza virus vaccine (IIV), pandemic formulation, split virus, adjuvanted, for IM use. Like the code above, it is also pending FDA approval, so it is not the correct answer. Code 90666 is for influenza virus vaccine, pandemic formulation, split virus, preservative free, for IM use. This code, like the others, is pending FDA approval. This is also not the correct answer.

Correct answer: 49591

Abdominal hernias are coded based on the size and the status of reducible, recurrent (repeated), incarcerated, or strangulated. This ventral hernia was not documented as recurrent, strangulated, or incarcerated and, therefore, can be categorized as reducible. This is supported by the statement that the omentum was "delivered" back into the peritoneal cavity. The size was documented at two centimeters. The approach was described as a laparoscopy. Reviewing the family of laparoscopic hernia codes, 49591-49622, 49591 describes the initial laparoscopic ventral hernia repair with mesh.

CPT code 49613 is described as a similar procedure but for a recurrent hernia.

CPT code 49623 is described as the removal of the mesh. In this case, the mesh was placed to repair the hernia, not removed.

CPT code 49621 is described as the repair of a parastomal hernia. This was a ventral hernia.

Correct answer: 23120

In the CPT index, you will look up clavicle, excision, partial, which gives you two codes: 23120 and 23180. Turning to the Musculoskeletal system section, where these codes are located, you will see that code 23180 is for the partial excision of the bone, for physiological reasons, clavicle. The patient was involved in an accident that broke his collarbone and does not have a disease that would force him to undergo this procedure, so this is incorrect. The last code, 23120, is for a claviculectomy, partial. Since this is the exact procedure that the question is asking for, 23120 will be the correct answer to the question.

Code 23125 is for a total claviculectomy. The patient only had a part of the collarbone removed, so this also is not the correct answer. Code 23150 is for the excision/curettage of a bone cyst or benign tumor of the proximal humerus. The patient does not have a bone cyst or a benign tumor, so this is incorrect.

Correct answer: 31622, 31627

The main procedure can be located in the index of the CPT® Professional Edition under bronchoscopy/exploration directing to 31622, 31634, 3147, and 31651. Reviewing this listing of codes leads to reporting 31622, described as bronchoscopy rigid or flexible with or without fluoroscopy. This case is documented without fluoroscopy. Instead, the add-on procedure 31627, bronchoscopy/computer-assisted navigation should be reported.

Modifier -51 is not used with add-on codes as per Appendix A in the CPT® Professional Edition. Moderate sedation is included with the procedure codes in this question.

CPT codes 31622 and 31627-51 are incorrect because the nodule is amenable to biopsy.

CPT code sequence 31622, 31627-51, 76376 is incorrect because the 76376 procedure is CT scan 3D rendering, which was not performed. Coding 31622 by itself is not correct, because that would be leaving out the stereotactic guidance portion of the service.

Correct answer: 96921

In the index of the CPT book, you would look up dermatology, psoriasis laser treatment. This gives you the code range 96920-96922, which you will look up in the Medicine section. When you look up this code range, you will see that all codes are for a psoriasis laser treatment but differ by the size of the area treated. The question states that 400 sq cm were treated, and code 96921 matches this. This code would be the correct answer.

Code 96920 is for a psoriasis laser treatment also, but is for less than 250 sq cm. Since the question is asking for a larger total area treated, this is not the correct answer. Code 96922 is for a psoriasis laser treatment as well. The question asks for less of a total area treated, so this is an incorrect answer. Code 96900 is for actinotherapy. This is not what the question is asking for, so this is incorrect.

Correct answer: 30124

In the index of the CPT book, you will look up cyst, dermoid, nose, excision, which gives you the codes 30124-30125. Turning to the Respiratory System section, you will see that the excision of a subcutaneous (or simple) cyst is code 30124 and will be the correct answer to this question.

Code 30125 is for the excision of a complex dermoid cyst. The question states that the cyst is a simple cyst, so this would not be the correct answer. Code 30110 is for the excision of a nasal polyp, simple. The question does not mention a nasal polyp, so this would be incorrect. Code 30117 is for the excision/destruction of an intranasal lesion, internal approach. The question does not mention anything about an intranasal lesion. In fact, it states that the dermoid cyst is on the tip of the nose, so this would not be the correct answer.

Correct answer: End-stage renal disease treatment facility

POS, or place of service, codes are extremely important to billing. They tell insurance companies exactly where the procedure or service took place. There are so many medical centers, facilities, and offices around the country and the world that it is vital that this code is not skipped. Code 65 is for an ESRD, or end-stage renal disease, treatment facility. This is a facility that only performs dialysis treatment, maintenance, and/or training to patients and their caregivers and, usually, these facilities are separately standing from hospitals or other facilities. This then would be the correct answer to the question. 

POS 51 stands for an inpatient psychiatric facility; POS 31 stands for a skilled nursing facility, and POS 34 stands for a hospice. None of these match what the question is asking for and are not correct answers.

Correct answer: Extracorporeal membrane oxygenation

The ECMO/ECLS chart can easily be found by turning to the Cardiovascular system section and then turning to the Extracorporeal Membrane Oxygenation or Extracorporeal Life Support Services subsection. As you will see, this chart is broken down into four separate procedures, which all are related by this subsection. They are: Initiation, Subsequent, Decannulation, and Additional Procedures. Immediately, you will see that one of the choices is the actual name of the subsection: Extracorporeal Membrane Oxygenation. While this is related to the chart, it is not one of the four procedures in the chart and, therefore, is the correct answer to this question.

As mentioned in the explanation above, Initiation, Decannulation, and Additional Procedures are all part of the chart. But, because the question asked which one was not one of the four procedures, these three choices are incorrect answers to the question.