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1|Page AAPC CPB FINAL EXAM|| AAPC CPB FINAL EXAM PREPARATION ALL QUESTIONS AND CORRECT ANSWERS|| LATEST UPDATE GRADED A+4| BRAMND NEW!!! Patient is in the observation room with an impending CVA. The test results come back with the patient having a CVA and is admitted to the hospital. What ICD-10- CM code is reported? A, 163.8 B. 167.9 C. Z03.89 D. 163.9 - ANSWER: D. 163.9 ICD-10-CM coding guideline I.B.11 indicates because the CVA did occur and is no longer impending, code the confirmed diagnosis. You will only report one code, the confirmed diagnosis CVA. CVA stands for Cerebrovascular accident. From the ICD-10-CM Alphabetic Index look for Accident/cerebrovascular (embolic) (ischemic) (thrombotic). This index refers you to 163.9 in the Tabular List. 2|Page A patient presents with symptoms of chest pain, nausea, and pain in the neck and arm. He is diagnosed with a STEMI (or ST Elevation) myocardial infarction of the anterior wall. What ICD-10-CM code(s) is/are reported? A. 121.29, RO7.89 B. 121.29 C. 121.09, RO7.9, R11.0, M54.2, M79.629 D. 121.09 - ANSWER: D. 121.09 A STEMI is an ST Elevated Myocardial Infarction. In the ICD10-CM Alphabetic Index look for Infarct, infarction/myocardium myocardial/ST Elevation (STEMI)/anterior (anteroapical) (anteroseptal) (Q wave) (wall), which leads to 121.09. Chest pain, nausea, and pain in the neck and arm are symptoms of the MI and not separately reported. Verify code in the Tabular List. Patient is admitted with SOB (shortness of breath) and cough with production of sputum. He has a history of COPD (chronic obstructive pulmonary disease) and is taking Symbicort. Diagnosis: Exacerbation of COPD. What ICD-10-CM code is reported? A, J44.1 B. J44.0 C. J44.9 D. J42 - ANSWER: A. J44.1 Rationale: In the ICD-10-CM Alphabetic Index look for Disease, diseased/pulmonary/chronic obstructive/with/exacerbation (acute) which leads to J44.1. Verify in the Tabular List. An exacerbation is different from an infection 4|Page A 16-year-old presents to the emergency room with a possible head injury from falling off his skateboard. The patient was wearing his helmet. Examination reveals no outward head injury. What ICD-10-CM codes are reported? A. S09.90XA, Z04.1, VO0.131A, Y93.51 B. V00.131A, Y93.51, S09.90XA C. $09.90XA, V00.131A, Y93.51 D. Z04.1, V00.131A, Y93.51 - ANSWER: D. Z04.1, V00.131A, Y93.51 The patient had a possible head injury. ICD-10-CM coding guideline, section [V.H indicates not to code diagnoses that indicate uncertainty. The head injury code, $09.90XA, is not reported. ICD-10-CM guideline, 1.21.c.6, Observation Codes are reported when a person is being observed for a suspected condition that is ruled out. In the ICD-10-CM Alphabetic Index look for Observation/accident/transport referring you to Z04.1. Verify code in the Tabular List. The observation codes are to be used as a principal diagnosis only. ICD-10-CM guideline, I.C.20.a.6, An External Cause code can never be a principal diagnosis. Look in the Alphabetical Index to External Causes of Injures for Accident/transport/pedestrian/conveyance/skateboard/fall. This index refers you V00.131, which needs a 7th character A. Then look for Activity/skateboarding. This refers you to Y93.51. Verify all codes in the Tabular List. [Page After testing a newborn in the NICU, the newborn is found to have hypothyroidism due to congenital absence of a thyroid gland. How is this reported for the newborn? A. E03.4 B. E03.1 C. P72.2 D. E03.8 - ANSWER: B. E03.1 Congenital means present at birth. Although it seems like a code from the congenital anomaly chapter would apply to a congenital condition, not all congenital codes appear there. From the ICD-10-CM Alphabetic Index look for Hypothyroidism/congenital (without goiter). You are referred to E03.1. In the Tabular List under code E03.4 there is an excludes note that indicates Congenital atrophy of thyroid is excluded from E03.4, meaning you do not code E03.4 for congenital hypothyroidism. Because congenital hypothyroidism is classified to a specific code, a nonspecific alternative E03.8 is not appropriate. This thyroid disorder is not transitory, since it is permanent, therefore code P72.2 is incorrect What is the [CD-10-CM code for DM? A. E09.9 B. E11.9 C.E10.9 D. 271.3 - ANSWER: B. E11.9 DM is the medical abbreviation for diabetes mellitus. In the ICD-10-CM Alphabetic Index, look for Diabetes, diabetic (mellitus) (sugar). You are referred to E11.9. In the Tabular List locate code E11.9. ICD-10-CM Official Guideline Section I.C.4.a.2. states if the type of diabetes mellitus is not documented in the medical record the default is subcategory E11, type 2 diabetes mellitus [Page What codes are reported for a patient that is being treated for ESRD and hypertension? A. 112.0, N18.5 B. 111.9, N18.9 C. 112.9, N18.6 iD) 112.0, N18.6 - ANSWER: D. 112.0, N18.6 The ICD-10-CM guideline (1.C.9.a.2) indicates to assign codes for category 112 with code from category N18 as the relationship between hypertension and chronic kidney disease is presumed A patient complains of a severe sore throat, a fever and headache. Based on the results of a rapid strep test the provider determines the patient has strep throat. What ICD-10-CM coding is reported? A. J02.0, R50.9, R51.9 B. J02.9, R50.9, RS1.9 C. 102.0 D. RO7.0, R50.9, R51.9 - ANSWER: C. J02.0 The ICD-10-CM guideline (I.B.18) states when a definitive diagnosis is documented by the provider, the signs and symptoms of the condition would not be reported separately. If the provider was waiting for the results of the lab work, the signs and symptoms would be reported. [Page What should a biller do if the ICD-10-CM instructions indicate " See" or " See Also?" A. Add all the ICD-10-CM codes indicated to the claim B. Ignore this statement it only used by coders C. Only research the other codes if you do not know what this diagnosis is D. Go to the main term referenced with the "see" note to locate the correct code - ANSWER: D. Go to the main term referenced with the "see" note to locate the correct code The "see" or "see also" indicates that another term should be referenced for correct code selection Which ICD-10-CM must be listed first on a claim? A Z98.870 B. Z87.892 C. Z65.0 D. Z51.0 - ANSWER: D. Z51.0 The ICD-10-CM guideline (I.C.21.c.16) indicates that Z51.0 must be reported as the principal/first-listed diagnosis, except when there are multiple encounters on the same day and the medical records for the encounters are combined. [Page A patient has a burn that the provider notat s as non-healing. How should this be coded? A, Code as a corrosion burn B. Code as a late effect burn C. Code as an acute burn D. Code as an infected burn - ANSWER: C. Code as an acute burn The ICD-10-CM guideline (I.C.19.d.3) indicates to code, "non-healing burns as acute burns." A patient is seen in the emergency room for treatment of injuries that occurred from a fall during rock climbing. The patient has a large laceration of the forehead that requires stitches. The patient also suffered some small abrasions and bruises in the area. What code(s) should be selected? A. SOL81XA B. SO1.82XA C. S01.81XA, S00.81XA, S00.83XA D. S01.90XA - ANSWER: A. S01.81XA Per the ICD-10-CM guideline (1.C.19.b.1), superficial injuries such as abrasion or contusions are not coded when associated with more severe injuries of the same site 9|Page What is the CPT® coding for removal of a pancreatic calculus? A. 48020 B. 43264 C. 43264, 48020 D. 43265 - ANSWER: A. 48020 Look in the CPT® Index for Calculus/Removal/Pancreatic Duct and you are directed to 43264, 48020. 43264 is for calculi removed through an endoscopic retrograde cholangiopancreatography (ERCP). There is no mention of ERCP in the procedure statement. 48020 is for removal of pancreatic calculus. Which reporting option below is correct use of a modifier with an E/M code? A, 99213-22 B. 99213-25 C. 99213-59 D. 99213-54, 55, 56 - ANSWER: B. 99213-25 Modifiers 22, 54, 55, 56 and 59 are not appended to office visit codes. Modifier 25 indicates the office visit is separately identifiable from another procedure and is correct to append to an office visit code What CPT® code is reported for a diagnostic proctosigmoidoscopy? A. 45300 B. 45305 C. 45317 D, 45320 - ANSWER: A. 45300 [Page A patient is seen by his family provider at the provider's office. The patient last saw the provider four years prior. Which range of codes would a code be selected from? A. 99202-99215 B. 99202-99205 C. 99211-99215 D. 99221-99233 - ANSWER: B. 99202-99205 The patient has not seen the provider in over three years. Look in the CPT® Index for Evaluation and Management/Office and Other Outpatient which directs you to 99202-99215. In the Evaluation and Management section of the CPT® codebook, the Office and Other Outpatient codes are further broken down into new and established patient. New patient codes are reported from the range 99202-99205 1 |Page What does the icon indicate for procedure code 20974? A. Modifier 51 must be used with procedure code 20974. B. Use modifier 59 instead of 51 with procedure code 20974. C. Modifier 51 cannot be used with procedure code 20974. D. Use modifier 58 with procedure code 20974 since it was a planned procedure following the surgical procedure. - ANSWER: C. Modifier 51 cannot be used with procedure code 20974. CPT® code 20974 has an icon next to it which designates codes that are exempt from the use of modifier 51, but are not add-on codes What is the CPT® code for anesthesia performed for surgical arthroscopy on the ankle? A. 29891 B. 01464 C. 00400 D. 01522 - ANSWER: B. 01464 Look in the CPT® Index for Anesthesia/Arthroscopic Procedures/Ankle and you are directed to 01464, Verify code selection in numeric section of the CPT® codebook. 1 |Page A patient comes into the office for follow up of neck pain. The provider documents a medically appropriate history and exam. The medical decision making was of low complexity. What E/M code is reported for this visit? A, 99213 B. 99212 C. 99202 D. 99203 - ANSWER: A. 99213 A patient is seen in your clinic. Her husband calls later in the day to ask for information about the visit. The practice pulls the patient's privacy authorization to see if they can speak to the husband. What act does this action fall under? A. Health Information Act B. Social Security Act C. HIPAA BD ADA - ANSWER: C. HIPAA The Privacy Act is under HIPAA and protects the health info mation of the patient. According to HIPAA, for the practice to release information to the husband, the patient would have to have signed an authorization. Which of the following situations allows the release of PHI without authorization from the patient? A. Request for life insurance B. Request from family member C. Physician's office to release to a family member D. Workers' compensation - ANSWER: D. Workers! compensation 1 |Page Workers' compensation is listed as one of the exceptions permitted by the Privacy rule for use and disclosure of information. Billing for a lower level of care than is supported in documentation, making false statements to obtain undeserved benefits or payment from a federal healthcare program, or billing for services that were not performed is defined as what by CMS? A. an Anti-kickback B. abuse C. a Stark violation D. fraud - ANSWER: D. fraud All of these actions are considered Fraud by CMS. CMS defines fraud as making false statements or misrepresenting facts to obtain an undeserved benefit or payment from a federal healthcare program. CMS defines abuse as an action that results in unnecessary costs to a federal healthcare program, either directly or indirectly 15|Page What standard transactions is NOT included in EDI and adopted under HIPAA? A. Healthcare claim status B. Waiver of liability C. Referrals and Authorizations D. Eligibility in the health plan - ANSWER: B. Waiver of liability There are 8 standard transactions for EDI - waiver of liability is not included. The eight standard transactions for Electronic Data Interchange (EDI) adopted under HIPAA are: - Claims and encounter information; - Healthcare payment and remittance advice; - Healthcare claims status; - Eligibility for a health plan; - Enrollment and disenrollment in a health plan; - Referrals and authorizations; - Coordination of benefits; and - Health plan premium payments Ifa provider is excluded from federal health plans, what does that mean? I. They may not participate in Medicare, but may participate in Medicaid to help the needy. Il. They may not participate in Medicare, Medicaid, VA programs or TRICARE. Til. They cannot bill for services, provide services, order services, or prescribe medication to any beneficiary of a federal plan. IV. They cannot bill for services or provide services, but may give Medicare patients referrals to receive services somewhere else A.II, Il B. 1, Il C. I, IV D. I, Il, IV- ANSWER: A. II, III 1 |Page One of the most severe penalties associated with the Social Security Act is the ability of the Office of Inspector General (OIG) to exclude an entity or an individual from participation in any and all federal healthcare programs. This includes Medicare, Medicaid, VA programs, and TRICARE. An excluded individual cannot bill for services, provide referrals, prescribe medications or order services for any beneficiary of a federally administered health plan. What types of entities do conditions of participation (CoP) apply to for health plans? 6 I. Hospitals II. Clinics III. Transplant centers IV. Psychiatric hospitals A. I, IL, I B. 1, IL, Ill, IV C. IL Il, IV D. I, IL, [V - ANSWER: B. I, I, HI, IV CMS and other health plans have conditions that healthcare organizations must meet to participate with the plan or program. CoPs are designed to protect patient health and safety, and to ensure quality of care. These apply to entities such as: ambulatory surgical centers, hospitals, hospices, clinics, psychiatric hospitals, long term care facilities, and transplant centers. 
