CPC Questions Bank

Under HIPAA (Health Insurance Portability and Accountability Act), PHI stands for Protected Health Information. It includes any individually identifiable health information related to a patient’s health status, provision of healthcare, or payment for healthcare. Protection of PHI is a key compliance topic on the CPC exam.

The operative report documents amalignant lesion excision(basal cell carcinoma) on theright forearmfollowed by reconstruction with anadjacent tissue transfer (rotation flap)afterfrozen sectionconfirmed clear margins. In CPT, when a defect is repaired withadjacent tissue transfer/rearrangement, the flap code includes the work ofexcision (including necessary undermining and preparation of the recipient site)performed as part of creating and closing the defect; therefore the malignant excision code (e.g.,11606) isnot separately reportedin this same session when the excision is integral to the flap repair. Code selection for adjacent tissue transfer is based on theanatomic siteand thetotal defect area (primary + secondary defects). The documentedtotal area is 8 sq cm, and the site is theforearm (arm/leg grouping). For arms/legs,10 sq cm or lessis reported with14020. Codes14040apply to a different anatomic region grouping and do not match the forearm. Frozen section pathology/margin control does not change the primary surgical coding here. Therefore, report14020 only.

CPT code 19081 is used for percutaneous biopsy of breast(s) using stereotactic guidance, which includes the placement of a localization device and imaging of the biopsy specimen when performed. This accurately describes the procedure performed on the right breast with the placement of a Gelmark clip using stereotactic imaging. The other codes either describe open biopsies or separate procedures that are not applicable here.

AMA's CPT® Professional Edition (current year)

CPT code 99450 is used for the examination of a patient for the purpose of establishing medical baseline information or for insurance purposes. Since Eric's primary care provider completed the required physical exam documentation for his life insurance policy, this is appropriately reported with code 99450. References: CPT® Professional Edition (current year), AMA.