Certified Professional Coder CPC Updated Exam

1. Procedure and CPT® Code Selection:

The patient underwent an appendectomy performed via laparoscopic approach. The procedure involved removal of the appendix using a scope inserted through an umbilical incision.

CPT® Code 44970 is specific for a laparoscopic appendectomy, which is the correct code for this procedure.

Code 44950 would be used for an open appendectomy, but since this case was performed laparoscopically, 44970 is appropriate.

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

The diagnosis given by the physician is chronic appendicitis.

ICD-10-CM Code K36 is used to report chronic appendicitis, which is the definitive diagnosis in this case.

Additional codes for symptoms such as nausea (R11.2) and right lower quadrant pain (R10.31) are not necessary because the primary diagnosis of chronic appendicitis (K36) fully explains the symptoms, according to ICD-10-CM guidelines on coding symptoms when a definitive diagnosis is available.

3. AAPC and CPT® Coding Guidelines:

AAPC guidelines indicate that when a definitive diagnosis is established, symptom codes should not be reported separately. The use of 44970 for laparoscopic appendectomy and K36 for chronic appendicitis is fully supported by these coding standards.

Therefore, the correct answer is C. 44970, K36.

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

Face (nose) → 11310–11313

0.6–1.0 cm → 11311

Inflamed seborrheic keratosis → L82.0

Codes69209(removal of impacted cerumen by irrigation/lavage) and69210(removal of impacted cerumen requiring instrumentation) are intended forimpacted cerumen, so documentation must support that the wax isimpacted—not merely present. That makes optionBthe most accurate statement. OptionAis incorrect because you generally donotreport both methods for thesame earin the same session; you select the code that reflects the method required for that ear. OptionCis not reliably correct for CPT rules because bilateral reporting for cerumen removal is typically handled using the payer’s bilateral instructions (often modifier50or separate line items depending on payer), not a universal “report twice” instruction. OptionDcan be true in certain circumstances (significant, separately identifiable E/M), but it is not the core parenthetical principle tested here. CPC exam focus: impacted requirement + select the correct method code.

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.