AAPC CPC Exam Questions

Correct answer: 99468

The patient was first admitted to the hospital, making this inpatient care. Because the patient is a neonate and was provided critical care, we refer to the Inpatient Neonatal and Pediatric Critical Care codes. Because the patient was admitted and critical care was administered on the same day, this is an initial inpatient neonatal critical care service; code 99468 is correct.

99477 — initial hospital care for a neonate who requires intensive observation, frequent intervention, and other intensive care services — is incorrect because it does not address the provision of critical care services.

99479 — subsequent intensive care, per day, for the evaluation and management of the recovering low birth weight infant — is not correct because it does not show that this patient was admitted the same day, making this an initial visit, nor that critical care services were rendered.

99466 — critical care face-to-face services during interfacility transport for a 24-month or younger patient for 30-74 minutes of hands-on care during transport — does not clearly describe the patient's admission.

Correct answer: 76536, 60300-51, 76942-51,-XU

In this case, the endocrinologist did an ultrasound of the neck including the thyroid and aspirated the cyst using ultrasound guidance. Searching the CPT index for ultrasound of neck leads to 76536, then searching the CPT index for thyroid gland, cyst aspiration leads to 60300. Because this is another procedure on the thyroid area, a modifier -51 is appended. The aspiration was performed with ultrasound guidance; the parenthetical statement under 60300 leads to 76942 for the ultrasound guidance coding. Modifier -51 is again used for multiple procedures in this area, and the -XU modifier for the fact that this is a distinct procedure not overlapping other components of the service. 

CPT code 10004 describes an add-on code for additional fine needle aspiration lesions; this case aspirated a cyst. Modifier -59 does not apply for this case, a more specific modifier applies. CPT code 77012 describes CT scan imaging guidance; this case used ultrasound guidance. CPT code 60200 describes an excision of a thyroid cyst; this case aspirated a cyst. CPT code 60252 describes a thyroidectomy; this case aspirated a cyst.

Correct answer: P2, GC

Anesthesia has its own set of modifiers and should be used correctly in order to bill the claim completely. While you may also use regular modifiers to correctly bill an anesthesia claim, you must use anesthesia modifiers only on anesthesia CPT codes. Regular modifiers would go on the actual procedure claims. There are two different kinds of modifiers specific to anesthesia codes: physical status modifiers and documentation modifiers.

Physical status modifiers explain what condition the patient was in when he was put under anesthesia. There are six different types:

• P1-Normal, healthy patient
• P2-Patient with mild systemic disease
• P3-Patient with severe systemic disease
• P4-Patient with severe systemic disease that is a constant threat to life
• P5-Moribund patient who is not expected to survive without operation
• P6-Declared brain-dead patient whose organs are being removed for donor purposes

Documentation modifiers, ranging from AD-G9, tell who is performing the surgery (they would be considered the “supervisor” of the anesthesiologist or the doctor/CRNA who is giving medical direction). These modifiers are considered optional, but some insurances may deem them appropriate.

Correct answer: 99214

CPT code 99214 represents an office or other outpatient visit to evaluate and manage an established patient, requiring a medically appropriate history, examination, and moderate-level medical decision-making. In this case, the patient is an established patient presenting with a chronic illness that has exacerbation, which is moderate in number and complexity of diagnoses. In terms of data, the physician uses an independent historian, the mother, and orders a test, the x-ray; this meets the limited data criteria of 2 category 1 elements. In terms of risk, the physician does consider prescription but advises over-the-counter medication now, which is prescription management. Two of these, the number and complexity of diagnoses and the risk, are all of moderate complexity; therefore, the encounter is an established visit of moderate complexity, 99214. 

99204 is not appropriate because the patient is established, not new. 99203 is not appropriate because the patient is established, not new. 99213 is incorrect because the medical condition is a chronic illness that is worsening, and the physician does consider medication management, which is a moderate-risk activity.

Correct answer: Stimulates saliva flow

The parasympathetic nervous system is an essential part of the autonomic nervous system. It sends signals via five different cranial nerve/nerve clusters (III, VII, IX, X, and the pelvic splanchnic). Each nerve/nerve cluster has different responsibilities, from constricting the pupils to contracting the bladder. Cranial nerve IX is responsible for stimulating saliva flow.

Contracting the bladder is done by the pelvic splanchnic nerves; constricting the pupils is done by cranial nerves III and IV, and slowing the heartbeat is done by cranial nerve X.

Correct answer: Medial rectus

There are six long muscles that help the eyes move around in the way our brain wants them to. Two of the muscles, the inferior and superior obliques, are located at the bottom and top of the eye, respectively. The other four muscles (the lateral, inferior, superior, and medial rectus) are located on all sides of the eyes and help the oblique muscles move the eye in every which way. The muscle in charge of inward movement is the medial rectus, and this would be the correct answer to the question.

The lateral rectus is in charge of outward movement; the inferior oblique is in charge of the upward and outward movements, and the superior oblique muscle is in charge of the downward and outward movements.

Correct answer: 49411, 77002-26

Searching the CPT index for radiation therapy, guidance, and interstitial devices direct to 49411 and 49412. Reviewing both codes leads to the reporting of 49411. The case documents that fluoroscopic guidance was utilized for this procedure. There is a parenthetical statement under 49411 stating a series of imaging codes appropriate to be reported with this procedure. CPT code 77002, fluoroscopic guidance, is to be reported, and the modifier -26, professional services, should be appended.

CPT code 32553 describes the placement of interstitial devices for radiation therapy guidance like fiducial markers. However, there is a parenthetical statement under this code that states for intra-abdominal, intrapelvic, and retroperitoneal radiation therapy guidance, use 49411. A -59 modifier would not be appropriate to add to this incorrect code for this case.

CPT code 49412 describes an add-on code for placement of interstitial devices for radiation therapy guidance, with an open approach. This case documents a percutaneous approach, not an open approach. Because this case does not document this procedure, the associated -51 multiple service modifier is also not reported, and the imaging code is not appropriate to report with this CPT code in this case.

Correct answer: 88304, 88305

Surgical pathology codes are organized in levels based on the intensity of physician skill required to make assessments. Each surgical pathology code description includes a listing of specimens that are coded with each particular code. Reviewing these listings for the atherosclerotic lesion in the coronary artery results in 88304. Reviewing the listings for the cutaneous ulceration (skin, other than cyst, tag, debridement, or plastic repair) results in 88305. There is no requirement, according to guidelines, to assess modifiers for multiple procedures.

CPT codes 88302, 88307, and 88309 are not appropriate for this case because they do not list the specimens that were reviewed for this patient.

Correct answer: C43.0, C43.31, C43.4

In the alphabetic index of the ICD-10 book, you will look up three different melanoma codes: one for the lip, one for the nose, and one for the neck. These can all be found in the melanoma section of the index. First, the code for melanoma of the lip is C43.0. Checking in Chapter 2: Neoplasms, where all these codes will be located, you will see that this code is for melanoma of the lip. There are no other characters needed, so this would be correct for this part of the question. Next, turning back to the alphabetic index, you will go back to the melanoma section and see that the code given for the nose is C43.31. Turning back to the chapter for Neoplasms, you will see that this code is complete and also does not require any other characters. Therefore, this would be the correct code for this part of the question. Finally, going back to melanoma in the alphabetic index, you will see that the neck melanoma code is C43.4. Again, going back to the Neoplasm chapter, you will see that this code is also correct and complete, so this would also be the correct answer for this final part of the question.

Code C43.3 is for malignant melanoma of other and unspecified parts of the face. First, this code is not complete and requires more characters. Second, this is too unspecified for this question, as there are actual codes for the diseases in the question. So, this would not be the correct answer. Code C4A.0 is for Merkel cell carcinoma of the lip. The question does not mention this type of carcinoma, so this would be incorrect.

Correct answer: 99450

In the CPT index, you would look up disability evaluation services, basic life and/or disability examination, which gives you the code 99450. Turning to the Evaluation and Management section, you will see that this code is for basic life and/or disability examination. This exam includes height, weight and blood pressure management, medical history completion and the collection of a blood or urine sample. This is exactly what the question is asking for, so this is the correct answer.

Code 99455 is for work-related or medical disability examination. The question is asking for a disability insurance evaluation, not a work-related/medical disability evaluation, so this would be an incorrect answer. Code 99421 is for an online digital evaluation and management service, for an established patient, for up to 7 days, cumulative time during the 7 days; 5-10 minutes. This is not what the question is asking for at all, so this would be an incorrect answer also. Code 99456 is for a more extensive work related evaluation. Again, this is not the type of evaluation the question is asking for, so this would also be incorrect.

Correct answer: Medicare; before any service or procedure is performed

Medicare has its own set of rules and regulations that must be met on the off-chance that they decide not to pay. An ABN, or Advanced Beneficiary Notice, is one such regulation. It is a form that explains to Medicare patients and medical staff that if Medicare decides not to pay, for any reason, then it is the patient's responsibility to either: A) pay the office fee or B) call Medicare and fight them to pay for the rendered services. Typically, the reasons for denied claims or no payment are the services are not covered by Medicare, or severe coordination of benefits issues exist and were never taken care of properly, so Medicare does not consider themselves to be a payer of the rendered services.

Getting the patient to sign the ABN form before any services/procedures are performed is imperative, as it could cause issues if any situations occur with non-payment. This form is for Medicare only, so patients with state Medicaid and any commercial/managed care plans do not need to sign this form.

Correct answer: D50.8

In the index of the ICD-10 book, you would look up anemia, deficiency, nutritional, with poor iron absorption. The code next to this subcategory is D50.8. Going into the tabular list, this code is in chapter 3, Diseases of the Blood and Blood-Forming Organs and Certain Disorders Involving the Immune Mechanism. Code D50.8 is for other iron deficiency anemia. Underneath the code, iron deficiency anemia due to inadequate dietary iron intake is listed, meaning that this also applies to D50.8.

Code D50.0 is for iron deficiency anemia secondary to blood loss. While the question asks for iron deficiency anemia, it does not say that it is secondary to blood loss. Code D51.1 is for vitamin B12 deficiency anemia due to intrinsic factor deficiency. The question does not ask for Vvtamin B12 deficiency anemia. Code D53.8 is for other specified nutritional anemias. This code is too vague, and we now know that there is an exact code by looking in the index.

Correct answer: 81025, 84702

CPT code 81025 is for a urine pregnancy test by visual color comparison methods to indicate that there is hCG in the urine. CPT code 84702 is gonadotropin, chorionic (hCG); qualitative to indicate the concentration of hCG which will indicate how pregnant the patient is.

CPT code 81005 is used for an analysis of the urine for protein, glucose, and bacteria. This test is often performed using a dipstick and may be accompanied by a microscopic examination, which accurately reflects the urinalysis conducted.

CPT code 84704 is used to test gonadotropin, chorionic (hCG); free beta chain. The scenario does not specify that the urinalysis tested for the free beta biochemical marker; therefore, we can eliminate this choice.

Correct answer: The STEMI code

If a patient presents with symptoms of a heart attack, typically, he will go through many tests to make sure he is actually having a heart attack, and the symptoms he is having are not pointing to another condition. One of those tests is an ECG or electrocardiogram. The "ST" in STEMI is for a part of the ECG which, if elevated away from the baseline, shows the patient is having a heart attack and is, therefore, diagnosed with STEMI. However, there are many other instances where the ECG will not show elevated ST. When this happens, the physician will diagnose the patient with NSTEMI. Since an NSTEMI is more common than a STEMI, a coder should watch out for those patients whose condition elevates from an NSTEMI to a STEMI. When this happens, the STEMI code will take precedence, and the NSTEMI code will not be coded.

NSTEMI and STEMI should never be coded together, as the patient will not have both at the same time. Code I25.2 will be coded for a patient who has had an MI in the recent past and does not usually apply in this situation.

Correct answer: Appropriate Evaluation and Management (E/M) codes

Searching the CPT index for antepartum care directs to codes for vaginal or cesarean delivery. The entire family of codes is in the 59XXX range. Reviewing this range of codes leads to a parenthetical statement reading: "For 1-3 antepartum care visits, see appropriate E/M code[s]." The specific E/M codes are not reportable with this documentation.

CPT code 59510 describes routine obstetrical care that does include antepartum, cesarean delivery, and postpartum care. This case documents the first three antepartum visits that were not part of an entire obstetrical package and were performed by the patient's primary care provider.

CPT code 59425 describes antepartum care, but for four to six visits. This case documents three visits.

CPT code 59426 describes antepartum care, for seven or more visits. This case documents three visits.

Correct answer: L23.6

In the alphabetic index of the ICD-10 book, you will look up dermatitis, contact, allergic, due to food in contact with skin. This gives you the code L23.6, which can be found in Chapter 12: Diseases of the Skin and Subcutaneous Tissue. This code directly correlates to allergic contact dermatitis due to food in contact with the skin, which is exactly what the question asks for. Code L23.6 does not need any more characters to complete it, so this would be the correct answer to this question.

Code L22 is for diaper dermatitis. This is not the type of dermatitis that the question is asking for, so this would be an incorrect answer. Code L23.9 is for allergic contact dermatitis, unspecified cause. There is a specified code for what the question is asking for, so this is incorrect. Code L23.81 is for allergic contact dermatitis due to animal dander. This is not what the question is asking for, so this would be incorrect.

Correct answer: 62365, 62355-51, T85.79XA, M48.5XXS, Z45.1

Searching the CPT index for spinal cord, removal, pump, the code 62365 is discovered, describing the removal of the pump. Above this code is 62355, describing the removal of the catheter. Modifier -51 is appended to describe the multiple procedures. Searching for ICD-10-CM alphabetic index for infection, device, catheter, infusion, intrathecal, leads to the family of T85.7. Reviewing this family of codes leads to T85.79XA describing the infection and inflammatory reaction due to an internal prosthetic device. Additionally, searching the terms "encounter for adjustment and management" of the implanted device leads to Z45.1, encounter for adjustment and management of infusion pump. Finally, searching for fracture, compression leads to M48.5XXS describing an unspecified compression fracture in an unspecified vertebrae sequelae.

CPT code 36590 describes the removal of a tunneled venous access device, not the removal of an intrathecal catheter or associated pump.

CPT code 62360 describes the implantation or replacement of the intrathecal catheter; this case was simply removing the devices.

CPT code 62350 describes another type of implantation or revision or repositioning; this case was a removal.

ICD-10-CM code T85.89XA describes a complication of an internal prosthetic device not classified elsewhere. There is a more specific code available.

ICD-10-CM code T88.8XXA describes other specified complications of surgical and medical care. There is a more specific code available.

ICD-10-CM code T81.4XXA describes an infection following a procedure. There is a more specific code available.

ICD-10-CM code Z45.49 describes an adjustment of an implanted nervous system device. This device was an infusion pump.

Correct answer: 50547

Searching the CPT index for Kidney donor nephrectomy directs to 50300, 50320, 50547. The procedure technique was laparoscopic, leading to the choice of 50547.

CPT code 50300 describes incisional kidney donation from a cadaver donor. This kidney was donated by the recipient's living father and was done laparoscopically.

CPT code 50320 describes incisional kidney donation from a living donor. This kidney was donated by a living donor but by laparoscopic technique. 

CPT code 50543 describes a laparoscopic procedure but a partial nephrectomy, not a nephrectomy of the donor's kidney.

Correct answer: The femoral artery

If a patient is receiving a typical aortography procedure, the main arteries leading up to the heart are viewed and examined. To do this, the radiologist must insert a catheter into the patient’s body. Usually, this catheter is inserted into the femoral artery, which is the main artery leading to the heart.

The common iliac arteries, renal artery, and celiac trunk, while examined during an aortography, are not the main throughway for the catheter.

Correct answer: 19081

CPT index search under Breast, biopsy, with localization device placement, stereotactic guidance, leads to 19081, 19082. Further examination of this series of codes leads to the 19081 code, describing the one lesion. 

CPT code 19101 describes an open incisional biopsy. This case was a stereotactic needle biopsy. CPT code 19083 describes a needle breast biopsy with location devices but using ultrasound guidance, not stereotactic guidance. CPT code 19084 describes an add-on code describing additional needle biopsies using ultrasound guidance. This case was of one lesion and with stereotactic guidance. CPT code 76942-26 describes the professional component of ultrasound guidance for needle placement. This is not part of this case.