Free and Premium AAPC CPC Dumps Questions Answers

11200 = removal of up to 15 skin tags

11201 = each additional 10 lesions or part thereof

26 lesions = 15 + 11 → 11201 ×2

1. CPT® Code 11604: This code is used for the excision of a malignant lesion on the back, with a size of 3.5 cm including margins. The 11600 series covers excision of malignant skin lesions, with 11604 being the correct code for a lesion size over 3.0 cm but not exceeding 4.0 cm.

2. CPT® Code 17110: This code is appropriate for the destruction of a benign lesion on the face (right cheek) via cryosurgery. 17110 covers the destruction of benign lesions (up to 14 lesions).

3. ICD-10-CM Code C44.509: This code represents unspecified malignant neoplasm of skin of trunk (back).

4. ICD-10-CM Code D23.39: This code is used for a benign neoplasm of skin of other parts of the face (right cheek).

Explanation of other options:

A. 11604, 11442, C76.8, C76.0: Incorrect because 11442 is for excision of a benign lesion, not a malignant lesion.

B. 11404, 11442, C44.509, D23.39: Incorrect because 11404 is used for a benign lesion excision, not malignant.

D. 11604, 11642, C76.8, C76.0: Incorrect as 11642 would indicate a second malignant excision rather than the benign lesion destruction.

Thus, the correct answer is C. 11604, 17110, C44.509, D23.39.

In this scenario, the procedure involved the excision of a large sacral pressure ulcer with deep tissue damage that required muscle and bone removal and was followed by a layered flap closure. The coding reflects both the extent of the ulcer and the procedure performed:

1. CPT® Code 15937: This code describes excision of a pressure ulcer with muscle and bone removal followed by flap closure, which matches the detailed procedure performed on the sacral ulcer.

2. ICD-10-CM Code L89.156: This code is used for a stage 4 sacral pressure ulcer, indicating the presence of deep tissue damage down to muscle and possibly bone, which aligns with the clinical findings.

Explanation of other options:

A. 15933, L89.153 and B. 15931, L89.153: These codes do not adequately describe the excision with muscle and bone removal nor the stage 4 severity of the ulcer.

C. 15935, L89.156: Although L89.156 is correct for a stage 4 ulcer, 15935 does not account for both muscle and bone excision with flap closure.

Therefore, the correct answer is D. 15937, L89.156, accurately capturing the procedure performed and the severity of the ulcer.

Cervical spondylosis with myelopathy: Condition requiring decompressive surgery.

Bilateral posterior laminectomy, facetectomies, foraminotomies: Procedures performed to decompress nerve roots.

Interspaces C5-C6 and C6-C7: Specific levels where the procedures were performed.

CPT code 63045 is used for the initial cervical laminectomy, and 63048 is for each additional segment. The combination covers the decompression across two interspaces.

When hypertension and chronic kidney disease (CKD) are documented together, ICD-10-CM assumes a cause-and-effect relationship.

I12.9 = Hypertensive chronic kidney disease with stage 1–4 CKD

N18.2 = CKD stage 2

I12.0 is only for CKD stage 5 or ESRD, which does not apply here.

Therefore, the correct code combination is I12.9, N18.2.

A sphincter is a muscular ring that encircles a lumen (or passage) and contracts to control the flow of substances through it. Sphincters are found throughout the body in areas such as the gastrointestinal tract (e.g., the lower esophageal sphincter, pyloric sphincter, anal sphincter) and the urinary system (e.g., urethral sphincter), where they regulate the passage of food, waste, and other materials.

A. Stricture refers to an abnormal narrowing of a passage or duct in the body, often due to scarring or disease, not a muscular ring.

B. Snare is a surgical instrument, not a structure within the body.

D. Sinus refers to a cavity or channel within bone or tissue, unrelated to muscle control of flow.

Therefore, the correct answer is C. Sphincter.

Shave removal → CPT 11300–11313, not excision (11400–11646).

Face (nose) → 11310–11313

0.6–1.0 cm → 11311

Inflamed seborrheic keratosis → L82.0

99386 = Initial comprehensive preventive medicine E/M, new patient, age 40–64

Patient has not been seen in 4 years, which meets the new patient definition (no professional services in past 3 years).

Age = 63

No problem-oriented complaints → preventive service only

Why others are incorrect:

99396 / 99397 – Established patient codes

99387 – Age 65+

1. Procedure and CPT® Code Selection:

The patient underwent an open partial colectomy involving the removal of the proximal colon and terminal ileum with reconnection of the distal ileum to the remaining colon.

CPT® Code 44160 is specific for an open partial colectomy with removal of a portion of the colon and the terminal ileum with an ileocolostomy (reconnection of the ileum to the colon). This accurately describes the procedure performed.

Code 44140 is for a partial colectomy without removal of the terminal ileum, making it inappropriate in this case.

Codes 44205 and 44204 involve laparoscopic approaches for colectomy procedures, but since this procedure was open, these codes are not suitable.

2. Diagnosis and ICD-10-CM Code Selection:

ICD-10-CM Code C18.2 is for a malignant neoplasm of the ascending colon, which is specified in this case as colon adenocarcinoma.

Code C18.9 represents an unspecified malignant neoplasm of the colon, which is less specific than C18.2. Therefore, C18.2 is the most accurate choice based on the location of the adenocarcinoma.

3. AAPC and CPT® Coding Guidelines:

Per AAPC guidelines, selecting the correct colectomy code involves identifying the specific approach (open vs. laparoscopic) and anatomical structures resected, both of which align with 44160 for this open ileocolic resection.

Thus, the correct answer, based on CPT® and ICD-10-CM guidelines, is D. 44160, C18.2.

Procedure: Abdominal aorta catheterization and selective placement in the celiac trunk for angiography.

CPT® Codes:

36246: This code is for the catheter placement in the abdominal aorta.

75726-26: This code represents the abdominal angiography with supervision and interpretation, with the -26 modifier indicating the professional component.

Code Selection Justification: The procedure involves the catheterization of the abdominal aorta and the specific imaging performed with supervision and interpretation.

AMA CPT® Professional Edition (current year)

ICD-10-CM (current year)

HCPCS Level II (current year)

For a complete bilateral mastectomy with insertion of breast prosthesis performed during the same surgical session, the correct CPT® codes are:

1. 19303-50: This code represents a complete mastectomy (removal of breast tissue) performed bilaterally (indicated by the -50 modifier).

2. 19340-50: This code is for the immediate insertion of a breast prosthesis following mastectomy, also performed bilaterally.

Explanation of other options:

A. 19303-50, 19342-50: Incorrect because 19342 is for the insertion of a breast implant, which differs from a prosthesis.

B. 19305-50, 19340-50: 19305 describes a modified radical mastectomy, which is more extensive than what is documented here.

C. 19325-50: This code represents a breast augmentation procedure, not a mastectomy with prosthesis insertion.

Thus, the correct answer is D. 19303-50, 19340-50, which accurately describes a bilateral mastectomy with prosthesis insertion.

The Office of Inspector General (OIG) provides compliance program guidance to form the basis of a voluntary compliance program for provider practices. This guidance is intended to help healthcare providers develop effective internal controls to monitor adherence to applicable statutes, regulations, and program requirements of Federal healthcare programs. The OIG issues various compliance guidelines and resources to assist organizations in establishing comprehensive compliance programs to prevent fraud, waste, and abuse.

OIG Compliance Program Guidance, AMA's CPT® Professional Edition, and healthcare compliance resources.

For a follow-up examination after the removal of polyps with no new polyps found, the appropriate diagnosis codes are:

Z09: Encounter for follow-up examination after completed treatment for conditions other than malignant neoplasm.

Z86.010: Personal history of colonic polyps.

Using Z09 indicates that the follow-up exam is to check the patient after treatment, and Z86.010 indicates a history of colonic polyps, which is relevant to the patient's medical history.

ICD-10-CM guidelines

AMA's CPT® Professional Edition (current year)

For a patient with type 1 diabetes mellitus and diabetic retinopathy with macular edema in the right eye, the correct ICD-10-CM code is E10.3511. This code specifically captures:

E10: Type 1 diabetes mellitus.

35: Diabetic retinopathy with macular edema.

1: Right eye.

Each choice addresses different severities or eye specifications:

A. E10.3211: Indicates mild nonproliferative diabetic retinopathy with macular edema in the right eye, not the general diabetic retinopathy category.

B. E10.3519: Refers to diabetic retinopathy with macular edema without specification to the right eye.

D. E10.311: Refers to nonproliferative diabetic retinopathy without macular edema in the right eye.

Thus, the correct answer is C. E10.3511, as it fully captures type 1 diabetes with diabetic retinopathy with macular edema in the right eye.

ICD-10-CM guidelines state that healing pressure ulcers are coded as the stage documented.

L89.624 = Pressure ulcer of left heel, stage 4

Stage 4 ulcers involve full-thickness tissue loss and are commonly referenced in exam scenarios involving treatment of healing ulcers

Unspecified stage or laterality codes are not appropriate when documentation supports specificity.

44970 = Laparoscopic appendectomy

K36 = Chronic appendicitis

Symptoms are not coded once definitive diagnosis is made

36223 = Selective catheterization of common carotid with imaging

36227 ×2 = Bilateral external carotid angiography

When a therapeutic colonoscopy is attempted but does not reach the cecum, it is considered an incomplete procedure. According to the CPT® Colonoscopy Decision Tree, if the colonoscopy extends beyond the splenic flexure but does not reach the cecum, the appropriate way to code this incomplete colonoscopy is by appending modifier 53 to indicate a discontinued procedure due to extenuating circumstances or risk to the patient.

A. 45378-53 is the correct answer as it designates a diagnostic colonoscopy with modifier 53, signifying that the procedure was started but not completed.

B. 45330 is incorrect as it represents a sigmoidoscopy, which only goes up to the splenic flexure.

C. 45331-45347 refers to therapeutic colonoscopies that were completed to the cecum.

D. 45379-45398 with modifier 52 is incorrect because modifier 52 is used for reduced services, which does not accurately describe an incomplete colonoscopy.

Thus, the correct answer is A. 45378-53.

35875 = Thrombectomy, femoral-popliteal artery

RT = Right side

75710-26 = Angiography, extremity, unilateral, professional component

P1–P6 = ASA Physical Status modifiers

AA, QS are anesthesia service modifiers

The CABG procedure involved multiple bypasses, with the use of autologous saphenous vein grafts and the left internal mammary artery, along with an extensive modified MAZE procedure. CPT® code 33535 describes a coronary artery bypass using arterial grafts, including at least three coronary artery bypasses. CPT® code 33259-51 is for the MAZE procedure for supraventricular tachycardia, with the -51 modifier indicating multiple procedures. CPT® code 33519-51 is for an additional vein graft, and CPT® code 33508-51 describes the endoscopic harvesting of the vein.

Repair of wound dehiscence → CPT 13160 (complex repair, secondary closure)

Occurs during global period and is unplanned → Modifier -78

Modifier -58 is for staged or planned procedures.

The procedure involved the placement of an intra-aortic balloon pump (IABP) through the right common femoral artery for a patient with acute MI and severe left main arteriosclerotic coronary artery disease.

Procedure Description:

Placement of an intra-aortic balloon pump (IABP).

Right common femoral artery approach.

Confirmation of good waveform and securement of the catheter.

CPT® Coding:

33975: Insertion of intra-aortic balloon assist device, percutaneous.

AMA's CPT® Professional Edition (current year).

CPT® Assistant for detailed coding guidelines on cardiac procedures.

Frozen section pathology coding rules:

88331 – Frozen section, first tissue block, each specimen

88332 – Frozen section, each additional tissue block, same specimen

Breakdown:

Specimen 1

Block 1 → 88331 × 1

Block 2 → 88332 × 1

Specimen 2

Block 1 → 88331 × 1

Block 2 → 88332 × 1

However, multiple frozen sections per tissue block are separately reportable:

Total first blocks = 4 frozen sections → 88331 × 4

Total additional blocks = 3 frozen sections → 88332 × 3

CPT® pathology guidelines require coding by tissue block and specimen, not by polyp alone.

For drug testing for cocaine and methamphetamines with a single analysis using direct optical observation and a subsequent confirmation for cocaine, the appropriate codes are:

80305 for the initial drug test (presumptive).

80353 for the confirmation test of cocaine.

1. Procedure and CPT® Code Selection:

The patient requires a surgical nasal sinus endoscopy to repair a cerebrospinal fluid (CSF) leak caused by a skull fracture that resulted in CSF draining into the nasal passage.

Code 31291 is the correct CPT® code for an endoscopic repair of a cerebrospinal fluid leak in the sphenoid sinus. This procedure code is appropriate because it specifically addresses surgical endoscopy for CSF leak repair in the sinus region.

Other codes provided, such as 31287 (nasal/sinus endoscopy with balloon dilation) and 31235 (nasal endoscopy with biopsy), do not match the description for surgical repair of a CSF leak and are therefore inappropriate for this case.

2. Diagnosis and ICD-10-CM Code Selection:

ICD-10-CM Code S02.19XA is used to describe a fracture of the anterior cranial base, which fits the described injury of the skull with cerebrospinal fluid leakage.

External cause code V47.5XXA is used for motor vehicle accidents involving a car hitting a stationary object.

Y92.411 is the appropriate code to describe the location of the accident as a highway.

3. Exclusion of Additional Procedure Codes:

There is no need for a second endoscopy code or a modifier, as 31291 fully describes the endoscopic repair procedure for the CSF leak.

4. AAPC and CPT® Coding Guidelines:

Per AAPC guidelines, procedure codes for sinus endoscopy are chosen based on the specific type of intervention (e.g., CSF leak repair). The guidelines for ICD-10-CM stress including external cause codes and location codes for trauma cases related to motor vehicle accidents.

Thus, the correct answer based on CPT® and ICD-10-CM coding standards is B. 31291, S02.19XA, V47.5XXA, Y92.411.

11765 = Excision of nail fold (wedge excision), ingrown toenail

TA = Left great toe

Other codes are incorrect:

11730 = Partial nail avulsion

11750 = Nail excision

11755 = Biopsy

Correct answer: 11765-TA

1. Procedure and CPT® Code Selection:

The patient underwent a repair of a ruptured aneurysm in the popliteal artery, involving incision, dissection, clamping, removal of the aneurysmal section, and patch grafting.

Code 35151 is the correct CPT® code for the repair of an aneurysm in the popliteal artery, as it specifically describes aneurysm repair in this location.

Code 35081 applies to aneurysm repair in the abdominal aorta, which does not pertain to the popliteal artery location.

Code 35152 is for an aneurysm repair involving the popliteal artery with vein graft, but there is no mention of a vein graft in this scenario, only a patch graft.

Code 35045 is used for repair of an aneurysm in the brachial artery and does not apply to the popliteal artery.

2. AAPC and CPT® Coding Guidelines:

According to AAPC guidelines, CPT® codes for aneurysm repair should be chosen based on the specific artery involved. Code 35151 is precisely for popliteal artery aneurysm repair without a vein graft, making it the most accurate choice.

Thus, based on CPT® guidelines and procedural details, the verified answer is B. 35151.

49083 – Abdominal paracentesis, diagnostic or therapeutic; with imaging guidance

This code includes imaging guidance (ultrasound or fluoroscopy).

Per CPT® guidelines, do not separately report fluoroscopy or ultrasound guidance with 49083.

The procedure was performed in the hospital, but CPT coding does not change based on site of service.

Why Other Options Are Incorrect:

A (49082) – Used without imaging guidance

B / D – Imaging guidance codes (77001, 77002) are bundled into 49083 per CPT® and NCCI edits

Official CPT® Guidance:

When a paracentesis is performed with imaging guidance, report 49083 only.

Lesion excision codes in the CPT® codebook include the removal of the lesion along with the necessary margins and a simple (nonlayered) closure when performed. These codes do not cover intermediate or complex closures, which are reported separately if performed. The measurement for selecting the appropriate lesion excision code includes the lesion and the margins required for complete excision.

AMA's CPT® Professional Edition, lesion excision guidelines.

99222: This code is used for initial hospital care, per day, for the evaluation and management of a patient, which requires a detailed or comprehensive history, a detailed or comprehensive examination, and medical decision making of moderate complexity.

The documentation shows a detailed history (including HPI, ROS, PMH, SH, and FH) and a detailed examination (covering multiple organ systems). The medical decision making involves the management of an acute asthma exacerbation, which includes admitting the patient to observation status, administering oral steroids, and planning for further diagnostic testing.

CPT® Professional Edition, AMA

Removal of a foreign body from the nose using forceps or other instrumentation is coded with CPT 30300. This code includes the use of local anesthesia, which aligns with the scenario where a nasal decongestant was used.

Procedure Coding:

44970 – Laparoscopic appendectomy

Appendix removed via scope through umbilical incision, confirming laparoscopic approach

Diagnosis Coding:

K35.32 – Acute appendicitis with perforation and localized peritonitis, without abscess

Documentation supports ruptured (perforated) appendicitis

No abscess documented

Why Other Options Are Incorrect:

B – Signs/symptoms (R11.2, R10.31) not coded once definitive diagnosis is established

C – 44960 = open appendectomy (not performed)

D – 44950 = open appendectomy, diagnosis code incorrect

ICD-10-CM Guideline Reference:

Do not code symptoms when a definitive diagnosis is confirmed.

The patient presented for a follow-up visit for chronic conditions, including hypokalemia, hypertension, and esophageal reflux. During this visit, the physician reviewed and discussed lab results, managed prescriptions, and noted that there were no new symptoms or complaints.

The level of service provided included an appropriate history and exam, as well as the management of multiple chronic conditions, which aligns with the criteria for CPT® code 99214. This code is used for an established patient office or other outpatient visit that requires at least 2 of the following 3 key components: a detailed history, a detailed examination, and medical decision-making of moderate complexity.

CPT® Professional Edition, AMA

Evaluation and Management Coding Guidelines

The Roux-en-Y anastomosis of the extrahepatic biliary duct to the gastrointestinal tract is a specific surgical procedure that involves connecting the biliary duct to the gastrointestinal tract.

Procedure Description: Roux-en-Y anastomosis of the extrahepatic biliary duct involves creating a direct connection between the biliary duct and the gastrointestinal tract.

Procedure Specificity: The procedure is complex and involves extensive surgical technique and anastomosis.

Coding Decision:

CPT® 47780 specifically describes the Roux-en-Y anastomosis of the extrahepatic biliary duct to the gastrointestinal tract.

AMA's CPT® Professional Edition (current year).

CPT® Assistant for detailed coding guidelines on biliary and gastrointestinal procedures.

The Office of Inspector General (OIG) operates under the Department of Health and Human Services (HHS) and is specifically responsible for detecting, investigating, and preventing fraud, waste, and abuse in federal healthcare programs such as Medicare and Medicaid.

This is a key compliance and regulatory topic on the CPC exam.

74021 = Abdomen, complete, including decubitus and erect views

-26 = Professional component

For a patient in observation care, selecting the correct E/M codes requires evaluating each day's service level and the provider's documentation.

Day 1: The patient was admitted for observation, and the physician prescribed IV and SQ insulin, noting diabetes with hyperglycemia requiring complex management. The CPT® code 99235 is appropriate here because it represents an initial observation or inpatient care for patients with high-complexity medical decision-making (MDM), which aligns with the patient's unstable glucose and the management requirements.

Day 2: The patient's glucose levels improved, and the provider documented spending 25 minutes with the patient in continued observation care. Since this is an established patient with continued observation, 99231 applies here, indicating subsequent observation care with low MDM complexity.

Day 3: The provider documented spending 15 minutes with the patient, whose glucose levels normalized, and then discharged the patient from observation care. Code 99238 is used for a discharge from observation care and is selected based on discharge times under 30 minutes.

These codes were selected based on CPT® guidelines for observation care and the provider’s time-based documentation. This matches the medical decision complexity documented per the case and code descriptions available for observation care management.

99213-25 = E/M with separate procedure

87880 = Rapid strep test

J02.0 = Streptococcal pharyngitis

Symptoms are not reported with definitive diagnosis

The patient had a post-operative complication (cardiac tamponade) following a previous CABG surgery, requiring a return to the operating room for exploration and evacuation of a blood clot. This is coded using CPT code 32658 (Exploration, mediastinum, with or without drainage; for postoperative hemorrhage, drainage of abscess, or to locate foreign body). Modifier 78 is appended to indicate an unplanned return to the operating room by the same physician following the initial procedure for a related procedure during the postoperative period.

The correct J codes are selected based on the specific medications administered and their quantities:

J2405 represents "ondansetron, 1 mg," and since the patient received a 2 mg dose, J2405 is reported once with a quantity of 2 mg.

J1885 represents "ketorolac tromethamine, 15 mg," which matches the single 15 mg dose administered to the patient, so J1885 is reported once.

Each J code is billed according to the precise dosage given, as no multipliers are required beyond the single-unit codes provided in choice A, making it the correct answer.

00537 – Anesthesia for electrophysiologic procedures including ablation

Patient is otherwise healthy → P1

Why others are incorrect:

00532 – Pacemaker insertion

01922 – MRI

01026 – Lower extremity procedures

90471/90472 = Administration without counseling

90707 = MMR

90746 = Hepatitis B, adult

1. Procedure and CPT® Code Selection:

The patient underwent a percutaneous needle biopsy of the liver with ultrasound guidance to assess primary biliary cirrhosis.

Code 47000 is the CPT® code for a percutaneous liver biopsy. This code encompasses the biopsy procedure itself.

Ultrasound guidance is commonly inherent to biopsy procedures, and guidance is not separately reported if the main code (47000) includes the technique used.

2. Diagnosis and ICD-10-CM Code Selection:

ICD-10-CM Code K74.5 is the correct code for primary biliary cirrhosis, which is specifically indicated in this case.

K74.3 is the code for other specified cirrhosis of the liver but is less specific than K74.5, making K74.5 the appropriate choice here.

3. Exclusion of Other Codes:

Code 47100 (option A) is for an open liver biopsy, which does not apply to this percutaneous procedure.

Codes 10005 (biopsy with imaging guidance) and 76942 (ultrasound guidance) would be redundant or incorrect since the main procedure code, 47000, sufficiently describes a percutaneous liver biopsy.

4. AAPC and CPT® Coding Guidelines:

AAPC guidelines state that guidance is included in certain biopsy codes when performed for the targeted organ, such as in 47000 for a liver biopsy.

Therefore, based on CPT® and ICD-10-CM coding rules, the correct answer is C. 47000, K74.5.

The procedure performed is a bilateral screening mammogram with computer-aided detection (CAD). CPT code 77067 is for bilateral screening mammography with CAD. ICD-10-CM code Z12.31 is for an encounter for screening mammogram for malignant neoplasm of the breast. Z80.3 is for a family history of malignant neoplasm of the breast. Therefore, the correct coding is 77067, Z12.31, Z80.3. References: CPT® Professional Edition (current year), ICD-10-CM (current year).

S06.0X1A = Concussion with brief LOC

V40.5XXA = Driver injured in collision with fixed object

V47.5XXA = Car accident, driverExternal cause codes correctly describe mechanism and role.

The patient is undergoing a cardiac catheterization with a CRNA providing monitored anesthesia care (MAC). Code 00520 is for anesthesia for heart catheterization procedures. Modifier QX indicates CRNA service with medical direction by a physician, QS indicates MAC, and P5 indicates a patient with a severe systemic disease that is a constant threat to life. Thus, the correct code and modifier combination is 00520-QX-QS-P5.

Emergency department visit with high severity

99285 = High complexity ED E/M

45540 = Repair of rectal prolapse, abdominal approach

52332 = Cystourethroscopy with ureteral stent

K62.3 = Rectal prolapse

30901 = Control of anterior epistaxis, limited, any method

30903/30905/30906 are for extensive packing or posterior epistaxis

1. Procedure and CPT® Code Selection:

The provider performed both a bronchoscopy and a microlaryngoscopy to evaluate the patient’s airway due to respiratory distress and stridor.

Code 31622 is used for a diagnostic bronchoscopy, which includes the inspection of the trachea, carina, and bronchial structures. Since the bronchoscopy was diagnostic and no additional therapeutic procedures were performed, this is the appropriate code.

Code 31526 is for direct laryngoscopy with the use of an operating microscope or telescope (microlaryngoscopy). This code is appropriate given the use of a Parson’s laryngoscope and magnifying telescope to inspect the larynx.

2. Modifier 51:

Modifier 51 is added to 31526 to indicate that it was performed in conjunction with another procedure (31622, bronchoscopy). Modifier 51 denotes multiple procedures without the necessity of a separate incision.

3. Exclusion of Code 69990:

Code 69990 is used for the use of an operating microscope in microsurgery but is not coded separately when the procedure (such as microlaryngoscopy) already includes visualization with a microscope or telescope as part of the CPT® descriptor. Thus, 69990 is not separately reported in this scenario, per CPT® guidelines.

4. AAPC and CPT® Coding Guidelines:

The guidelines specify that when visualization or microlaryngoscopy is inherently part of the procedure (as in 31526), 69990 should not be billed separately. Also, the use of Modifier 51 for multiple procedures in the same session is appropriate.

Therefore, the verified answer, following the CPT® and AAPC coding rules, is A. 31622, 31526-51.

Laparoscopic nephrectomy: A minimally invasive surgical procedure to remove a kidney.

Part of the ureter: Removal includes part of the ureter.

50220: Nephrectomy (open procedure), which doesn't apply since the procedure was laparoscopic.

50548: Nephrectomy, partial, laparoscopic, which doesn't match the full nephrectomy performed.

50543: Laparoscopy, surgical; nephrectomy with total ureterectomy.

50543 is the correct CPT code for the laparoscopic removal of the kidney along with part of the ureter, fitting the scenario described.

The emergent endovascular repair of an infrarenal abdominal aortic aneurysm with an aorto-aortic tube endograft is coded with CPT 34702. This code includes the deployment of the endograft and the necessary balloon angioplasty for sealing the proximal and distal attachment zones.

22514 = Vertebroplasty, lumbar (L5)

22515 = Each additional vertebral body (sacrum)

Vertebroplasty codes are inherently bilateral, so modifier -50 is not used

For initial fracture care of a closed scaphoid fracture, code 25622 is used, which includes treatment and initial casting. The application of the cast is part of the fracture care and is not reported separately. CPT® guidelines specify that casting or strapping performed as part of the fracture care is included in the fracture care code.

AMA's CPT® Professional Edition (current year), Surgery section, Musculoskeletal System.

To determine the correct anesthesia code for a cesarean delivery with specific conditions, we review the following codes:

01961 is defined as "Anesthesia for cesarean delivery only," which aligns with this scenario, as the patient is admitted for a cesarean section.

01960 refers to anesthesia for a vaginal delivery, which does not apply here as the delivery is via cesarean.

01967 is for "Anesthesia for planned vaginal delivery," which also does not apply due to the cesarean route.

01958 is used for planned vaginal delivery that may involve a complicated scenario, but since the procedure is a cesarean section, this code is not appropriate.

Given that the patient is in labor for a cesarean section and has had a previous external cephalic version, 01961 is the correct answer.

The CPT® codes for skin biopsies depend on the method used and the location of each lesion. Here, the scenario includes:

1. Two punch biopsies on the trunk: CPT® code 11104 is used for a full-thickness punch biopsy of the skin, and 11104 x 2 is appropriate since two lesions on the trunk were sampled.

2. One partial-thickness shave biopsy on the forehead: CPT® code 11102 is used for a tangential (shave) biopsy, which captures a partial-thickness sample, appropriate for the forehead lesion.

Explanation of other options:

B. 11104, 11105, 11103: Incorrect, as 11105 is an add-on for additional punch biopsies at separate sites but not used here.

C. 11104, 11103 x 2: 11103 is an add-on code for additional shave biopsies, which does not apply to the punch biopsies on the trunk.

D. 11104, 11102 x 2: Incorrect, as 11102 is only used for the shave biopsy, not for the punch biopsies.

The code 99471 is used for initial inpatient neonatal critical care, per day, for the evaluation and management of a critically ill infant or young child. Given the scenario where a 4-year-old critically ill child is admitted to the PICU and requires intensive care management, this code is appropriate as it reflects the critical care provided beyond the emergency department services. References: CPT® Professional Edition (current year), AMA.

69209 = Cerumen removal using irrigation

69210 = Cerumen removal using instrumentation

Different techniques on different ears require separate codes with laterality modifiers

72158 = MRI lumbar spine without and with contrast

M54.42 = Low back pain with sciatica, left side

Separate pain codes are not reported redundantly

The patient is an established patient presenting with bilateral thyroid nodules and has a detailed history and examination performed.

Procedure Description:

Detailed history and examination of bilateral thyroid nodules.

Review of systems and physical examination.

Assessment and plan for a percutaneous biopsy.

CPT® Coding:

99214: Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and moderate medical decision making.

AMA's CPT® Professional Edition (current year).

CPT® Assistant for detailed coding guidelines on evaluation and management services.

99222 = Initial hospital inpatient care, moderate MDM

Extensive diagnostic workup → moderate complexity

Final diagnosis established during admission

Diagnosis Coding:

G00.9 – Bacterial meningitis, unspecified

Do not code symptoms (fever, neck pain) once definitive diagnosis is confirmed

Why others are incorrect:

99284 – ED visit

99264 – Inpatient consultation (deleted code)

Symptom-only diagnosis codes inappropriate

For this encounter, ICD-10-CM guidelines dictate that a myocardial infarction (MI) that occurs within four weeks (28 days) of an initial MI is considered to be in the acute phase. Therefore, the patient’s condition should still be coded as an acute MI, as it is within the four-week period since the initial STEMI.

B. I21.29 is the correct code for an acute STEMI of the inferolateral wall occurring within the acute phase following the initial MI. The code I21.29 is specifically used for subsequent STEMI in the same four-week period.

Explanation of incorrect options:

A. I22.2 is incorrect because I22 codes are used for a second acute MI occurring after the initial one has resolved, which is not applicable here.

C. I21.19 and D. I21.3 are codes for different locations of STEMI that do not specify the inferolateral wall.

Therefore, the correct answer is B. I21.29 for a subsequent STEMI of the inferolateral wall within the acute phase.

00537 = Anesthesia for EP procedures

P1 = Normal healthy patient

94060 = Spirometry pre- and post-bronchodilator

94010 = Baseline spirometry

J45.21 = Mild intermittent asthma with exacerbation

The suffix in medical terminology provides information about a condition, procedure, disorder, or disease. The term "neuralgia" contains the suffix "-algia," which refers to pain, indicating a painful condition of the nerves. In contrast:

A. malaise has no identifiable suffix related to a specific medical condition or disease.

B. ambidextrous has no suffix indicating a disease, condition, or procedure.

D. hypotension includes the prefix "hypo-" (indicating low), but the core term "tension" refers to pressure without an additional suffix specific to condition.

Thus, "neuralgia" is the correct answer as it directly includes a suffix ("-algia") that denotes a pain-related condition in medical terms.

Place of Service (POS) codes are two-digit numeric codes used on professional claims to identify where a service was performed (e.g., office, inpatient hospital, outpatient hospital).

Reporting an incorrect POS can affect reimbursement and may result in claim denial ✔

POS codes are not alphanumeric

They describe many locations, not just ICU

POS codes are maintained by CMS, not found in the ICD-10-CM code book

CPT® code 15786 is used for abrasion treatment of a single lesion (e.g., for keratosis) through techniques like dermabrasion (lightly sanding the skin's surface). When treating multiple lesions in this manner, each lesion treated should be coded individually.

Since the patient has 5 keratosis lesions treated through sanding, 15786 x 5 accurately represents the procedure for each lesion.

Explanation of other options:

A. 15787 x 5: Incorrect because 15787 is designated for dermabrasion of "additional lesions" and would be used in conjunction with 15786, not alone.

B. 15786, 15787: Incorrect, as it does not account for all five lesions treated.

C. 15786, 15787 x 4: Incorrect, as 15787 is used only when performed in addition to 15786, not as a replacement for each additional lesion.

Therefore, the correct answer is D. 15786 x 5, which accurately reports the treatment of all five lesions.

C2617 = Implant, sinus, drug-eluting, absorbable

1. E/M Code Category Selection:

The patient was placed in observation care on 12/2/20XX for an acute asthma exacerbation and stayed in observation for a total of 16 hours, with discharge occurring on 12/3/20XX.

The appropriate E/M category for patients in observation care for a period that includes both admission and discharge on separate calendar dates is "Hospital Inpatient or Observation Care Services", with specific codes for admission and discharge on different dates.

2. Code Range and Specific Codes:

Code Range 99234-99236 applies to cases where observation care includes both admission and discharge, particularly when they occur on different calendar days and the total duration of care is under 24 hours.

For discharge on the subsequent day, 99238-99239 (Hospital Inpatient or Observation Discharge Services) applies, depending on the time spent on discharge.

3. Rationale for Excluding Other Options:

Option B and Option D include Initial Hospital Inpatient or Observation Care codes (99221-99223), which are typically used for admissions to inpatient care rather than for observation care scenarios as presented here.

Option C incorrectly combines Subsequent Inpatient or Observation Care codes (99231-99233), which are used for follow-up days rather than discharge services.

4. AAPC and CPT® Coding Guidelines:

According to CPT® guidelines, the 99234-99236 code range is used when observation care requires both admission and discharge on different dates, and 99238-99239 is appropriate for discharge services.

Therefore, the correct answer is A. Hospital Inpatient or Observation Care Services (Including Admission and Discharge Services) (99234-99236) and Hospital Inpatient or Observation Discharge services (99238-99239).

55250 = Vasectomy, bilateral procedure inherent (no modifier -50)

Z30.2 = Encounter for sterilization

Z30.012 is for contraceptive management counseling, not the procedure

The CPT code 11960 is used for the insertion of tissue expanders for other than breast, which includes the scalp in this case. The procedure involves inserting the tissue expanders, closing the skin, and gradually increasing the volume of the expanders until a satisfactory outcome is achieved for repairing the scalp defect. The other options do not accurately describe the procedure performed on the scalp.

AMA's CPT® Professional Edition (current year)

Per ICD-10-CM guidelines, when dependence is documented with either use or abuse, only the dependence code is assigned, as it takes precedence.

1. Procedure and CPT® Code Selection:

The patient initially underwent a laparoscopic total abdominal hysterectomy for endometriosis of the uterus. However, due to extensive adhesions, the surgeon converted the procedure to an open total abdominal hysterectomy to complete the surgery.

CPT® Code 58150 is appropriate for a total abdominal hysterectomy, including removal of the uterus and cervix, via an open approach. Since the procedure was converted to an open approach, 58150 is the correct code.

The -22 modifier is added to indicate increased procedural services due to the extensive adhesiolysis (removal of adhesions), which extended the surgery duration.

2. Diagnosis and ICD-10-CM Code Selection:

ICD-10-CM Code N80.00 is used for endometriosis of the uterus, which is the primary condition that prompted the hysterectomy.

ICD-10-CM Code N73.6 is appropriate for female pelvic peritoneal adhesions, reflecting the extensive adhesions that necessitated the conversion to open surgery.

3. Rationale for Excluding Other Options:

Code 58571 (in options B and C) is for a laparoscopic approach, which is incorrect because the procedure was converted to an open approach.

The -78 modifier is incorrect in this context because the conversion to open surgery was part of the same operative session and not an unplanned return to the OR.

Diagnosis code N99.4 (in options B and D) pertains to postprocedural pelvic adhesions, which does not apply here as the adhesions were not due to a prior procedure.

4. AAPC and CPT® Coding Guidelines:

AAPC guidelines specify using 58150 for an open total abdominal hysterectomy and adding the -22 modifier for increased complexity or time due to factors like extensive adhesiolysis.

Therefore, the correct answer based on CPT® and ICD-10-CM guidelines is A. 58150-22, N80.00, N73.6.

Cholecyst- = gallbladder

Entero- = intestine

-ostomy = creation of an opening

Cholecystenterostomy is the correct term for surgically creating a connection between the gallbladder and the intestine.

This aligns with surgical terminology commonly tested in the CPT® digestive system section (40000–49999).

60220 = Total lobectomy, unilateral thyroid

60500 = Parathyroidectomy (single gland)

Modifier -59 is appropriate to indicate a distinct procedure

89258 = Thawing of cryopreserved embryos

89250 = Culture of embryos, per day (reported once per encounter)

55970 = Female-to-male sex transformation

55980 is for male-to-female transformation

Unlisted codes (58999, 55899) are not used when a specific CPT® code exists

90960 = ESRD services, 4 or more visits/month

N18.6 = End-stage renal disease

Z99.2 = Dependence on renal dialysis

In coding burns, ICD-10-CM guidelines indicate that each burn site is coded separately, specifying the degree, location, and extent of the burn. Additionally, a code for total body surface area (TBSA) burned is included when burns cover more than 10% of the body. Here’s the breakdown:

1. T24.311A: Represents a third-degree burn on the left thigh, initial encounter.

2. T24.312A: Represents a third-degree burn on the right thigh, initial encounter.

3. T21.21XA: Represents a second-degree burn on the anterior chest wall, initial encounter.

4. T21.23XA: Represents a second-degree burn on the upper back, initial encounter.

5. T31.21: Represents burns with 20–29% TBSA involvement, with third-degree burns covering 10–19% of the TBSA.

Explanation of incorrect answers:

A includes an incorrect TBSA code (T31.21).

B has the correct codes but lists an incorrect TBSA code for third-degree burns.

C uses incorrect burn site codes for the areas involved and incorrect TBSA percentages.

Therefore, the correct answer is D. T24.311A, T24.312A, T21.21XA, T21.23XA, T31.21, which accurately captures the burns' degrees, locations, and TBSA.

73562 = Knee X-ray, 3 views

-26 = Professional component only

1. Procedure and CPT® Code Selection:

The test performed is a therapeutic drug assay to measure the concentration of vancomycin in the patient’s blood.

CPT® Code 80184 is specific for a therapeutic drug assay of vancomycin, making it the correct code to report for this test.

2. Rationale for Excluding Other Options:

Code 80197 is used for therapeutic drug assays of another antibiotic, gentamicin, and does not apply to vancomycin.

Code 80202 is for measuring the levels of cyclosporine, another drug, and is not relevant to vancomycin.

Code 80299 is for an unlisted therapeutic drug assay, which is unnecessary since a specific code (80184) exists for vancomycin.

3. AAPC and CPT® Coding Guidelines:

According to AAPC guidelines, specific therapeutic drug assay codes, like 80184 for vancomycin, should be used when available.

Therefore, the correct answer is C. 80184.

1. Procedure Type: This scenario describes a secondary repair of two extensor tendons in the wrist with a free graft. According to CPT® coding guidelines, the secondary repair with a free graft suggests a more complex repair than primary closure.

2. CPT® Code Selection:

Code 25270 is used for a primary repair of an extensor tendon in the forearm or wrist. Since this is a secondary repair, 25270 does not apply, ruling out options A and C.

Code 25272 represents the repair of a single extensor tendon in the forearm or wrist, which includes both primary and secondary repairs. However, it does not involve free grafts, ruling out option D.

Code 25274 specifically addresses the secondary repair of an extensor tendon with free graft in the forearm or wrist, which is the correct scenario described in the question.

3. Applying the Code for Multiple Tendons:

Since the procedure involves two tendons, 25274 should be reported twice (25274 x 2) to account for the secondary repair on each tendon individually.

4. Reference from AAPC CPC Guidelines:

In AAPC CPC and CPT® coding principles, tendon repair codes require careful distinction between primary repairs and secondary repairs with grafts. The guidelines specify that multiple tendons should be coded with individual codes when performed on separate anatomical structures, hence the use of 25274 twice for both tendons.

Therefore, the verified and precise answer based on CPT® guidelines and AAPC coding standards is B. 25274 x 2.

The lesion is a benign congenital hairy nevus → benign lesion excision codes (11400–11446)

Location: thigh (trunk/arms/legs)

Excision size with margins = 4.5 cm → 11406 (4.1–5.0 cm)

Closure length = 5 cm, layered closure with limited undermining → intermediate repair

12032 = Intermediate repair, trunk/extremities, 2.6–7.5 cm

Modifier -51 applies to the secondary procedure

1. Procedure and CPT® Code Selection:

The patient had a cochlear implant placed in the left ear and is now seeing the audiologist for initialization and programming of the implant.

CPT® Code 92603 is specific for initial programming of a cochlear implant for patients younger than 12 years old. This includes the setup and initial adjustments required for the cochlear implant, making it the correct code.

2. Rationale for Excluding Other Options:

Code 92626 is used for evaluating auditory function with the cochlear implant, focusing on assessment rather than programming, and is therefore incorrect for this programming session.

Code 92630 is for aural rehabilitation following cochlear implant, which does not apply to the programming/initiation stage.

Code 92604 is for subsequent programming sessions after the initial programming and is therefore not applicable for the first-time programming.

3. AAPC and CPT® Coding Guidelines:

According to AAPC guidelines, 92603 is the appropriate code for initial programming of a cochlear implant in children under 12 years of age.

Therefore, the correct answer is D. 92603.

99223 = Initial hospital/observation care with high time (75+ min) or high MDM

Prolonged service 99418 is bundled into observation services

49190 = Excision of peritoneal tumor greater than 10 cm

C48.2 = Malignant neoplasm of peritoneum

Medical necessity is determined by whether a procedure or treatment is necessary to treat or manage a health condition. Removing excess skin after significant weight loss from a gastric bypass often meets medical necessity criteria because excess skin can lead to physical complications, such as infections, rashes, and mobility issues. Insurance companies are more likely to cover this procedure when it's needed to alleviate health issues rather than for cosmetic purposes.

A. Speech therapy for a lisp: Typically, therapy for minor speech impediments like a lisp may not be deemed medically necessary unless it severely affects communication or daily functioning.

B. Tummy tuck after a pregnancy: This procedure is generally classified as cosmetic and not medically necessary, as it is often done to improve appearance rather than address a health condition.

C. Second rhinoplasty for a smaller nose: This would likely be considered elective and cosmetic, especially if it is solely for aesthetic preference without any health-related issues.

Thus, the correct answer is D. Removing excess skin in losing weight from a gastric bypass, as it can be essential for physical health and quality of life.

This scenario describes an anterior discectomy and arthroplasty at two levels (L3-L4 and L5-S1) using artificial discs. CPT® code 22857 describes total disc arthroplasty (artificial disc), anterior approach, including discectomy to prepare interspace (other than for decompression), single interspace, lumbar. Since the procedure was performed at two levels, the code should be reported twice.

Pregnancy guidelines require O codes first.

O98.513 = COVID-19 infection complicating pregnancy, third trimester

U07.1 = COVID-19

Z3A.32 = 32 weeks gestation

Symptoms (SOB, fever) are not coded separately when integral to COVID-19.

Correct sequencing makes A correct.

The scenario describes an emergency basic life support (BLS) ambulance service. The appropriate HCPCS Level II code for BLS emergency transport is A0429.

Modifier QN indicates that the service was provided by an ambulance supplier, and SH indicates the services were provided in an emergency situation.

HCPCS Level II, current year

81025 – Urine pregnancy test, by visual color comparison methods

Correct for office-based urine pregnancy testing

Why Other Options Are Incorrect:

81000–81005 – Urinalysis codes, not pregnancy testing

1. Procedure and CPT® Code Selection:

The patient underwent a suppression study involving five glucose tests and five human growth hormone tests.

CPT® Code 80430 represents a suppression panel specifically for growth hormone studies, which includes various assessments for diagnosing abnormal growth.

CPT® Code 82947 is used for each glucose test performed, and since five glucose tests were conducted, it should be coded as 82947 x 5.

CPT® Code 83003 is used for each human growth hormone test performed, and since five tests were conducted, it should be coded as 83003 x 5.

2. Rationale for Excluding Other Options:

Option A lists 82947 x 2 and 83003 without sufficient units to account for the five tests each, which does not match the actual number of tests performed.

Option B omits the suppression panel code 80430, which is necessary for documenting the overall suppression study.

Option D does not provide the correct quantity of glucose and growth hormone tests, which were each performed five times.

3. AAPC and CPT® Coding Guidelines:

According to AAPC guidelines, when a suppression panel includes multiple components that are performed more than once, the specific panel code 80430 should be used along with the correct number of individual component codes.

Therefore, the correct answer is C. 80430, 82947 x 5, 83003 x 5.

Procedure: Impedance testing via tympanometry is performed to assess hearing loss in the left ear.

CPT® Code:

92567: This code is for tympanometry (impedance testing) without reflex threshold measurements.

Code Selection Justification: The procedure involved tympanometry without reflex threshold, which is specifically coded as 92567.

AMA CPT® Professional Edition (current year)

1. Procedure and CPT® Code Selection:

The procedure involves an incision and drainage (I&D) of a deep abscess (felon) on the palmar surface of the right thumb. A felon is an abscess in the pulp of the fingertip, often involving deep tissue.

Code 26010 is specific for incision and drainage of a finger abscess, which includes the thumb. This code applies to cases where the abscess is drained from a deep tissue level.

Code 26011 is similar but involves the use of extensive drainage or debridement, which is not indicated in this case. Therefore, 26011 is not appropriate here.

Code 10061 refers to incision and drainage of abscesses at different locations on the body but not for specific areas such as the thumb, making it inappropriate in this context.

Code 10140 pertains to the evacuation of hematoma, seroma, or fluid but does not apply to abscesses, so it is not suitable for this scenario.

2. Modifier:

Modifier F5 is added to specify that the procedure was performed on the right thumb.

3. Diagnosis and ICD-10-CM Code Selection:

ICD-10-CM Code L02.511 is appropriate for cutaneous abscess of the right finger, as it accurately describes the diagnosis of a felon on the thumb.

L03.011 would represent cellulitis but does not specify an abscess, making it less precise for this case.

4. AAPC and CPT® Coding Guidelines:

The AAPC guidelines for coding finger abscess drainage emphasize the selection of specific codes for deep tissue drainage procedures in extremities. Additionally, correct laterality should be included with the use of modifiers and specific ICD-10-CM codes for an accurate representation of the site and nature of the condition.

Thus, based on the coding standards and guidelines, the verified answer is B. 26010-F5, L02.511.

The human shoulder is composed of three main bones: the clavicle (collarbone), scapula (shoulder blade), and humerus (upper arm bone). These bones form the shoulder joint, which is one of the most flexible and mobile joints in the human body, allowing for a wide range of motion.

AMA's CPT® Professional Edition (current year), Musculoskeletal System section.

Modifier 50 (Bilateral Procedure) is appended when a procedure is performed on both sides during the same session and the CPT® code is not inherently bilateral.

77066 is already defined as bilateral mammography

77065 is unilateral

75572 (CT heart) is not a bilateral procedure

73115 (MRI upper extremity joint) may be performed bilaterally and allows modifier 50

99464 = Attendance at delivery with initial stabilization

99465 is used when resuscitation is required

99460 is for normal newborn care after birth

The documentation describes making a skin incision off the tip of the twelfth rib and extending medially along the banger’s lines of the skin. The use of electrocautery to gain access through multiple layers of musculature and fascia indicates an open surgical approach. Open surgery involves making a large incision to expose and directly view the surgical site. This is distinct from percutaneous (which involves needles or catheters), laparoscopic (which uses small incisions and a camera), and other minimally invasive techniques.

AMA's CPT® Professional Edition, ICD-10-CM, and HCPCS Level II (current year)

1. Procedure and CPT® Code Selection:

The test ordered is a bile acid quantitation using an enzymatic method. This test measures the total bile acids in a patient with chronic hepatitis.

CPT® Code 82248 is specific for quantitation of bile acids, total, which is the correct code for a bile acid test using any method, including enzymatic.

2. Rationale for Excluding Other Options:

Code 82247 is used for the measurement of bilirubin, not bile acids, making it inappropriate for this test.

Code 82239 is for measuring an amino acid (gamma-glutamyl transferase), which is unrelated to bile acid quantitation.

Code 82252 is for a fecal bile acid screening, which is different from a quantitation of bile acids in serum or plasma.

3. AAPC and CPT® Coding Guidelines:

According to AAPC guidelines, 82248 should be selected for total bile acid quantitation regardless of the specific analytical method used.

Therefore, the correct answer is A. 82248.

Procedure Coding:

72158 – MRI, lumbar spine; without contrast, followed by with contrast

Single comprehensive code

Diagnosis Coding:

M54.42 – Low back pain with sciatica, left side

Why Other Options Are Incorrect:

B / C – Incorrectly unbundling MRI codes

D – Coding additional unspecified low back pain is inappropriate

20552 = Injection(s); single or multiple trigger points, 1–2 muscles

Total muscles injected = 2 (trapezius + pectoralis)

Number of injections does not determine code selection—number of muscles does