ICD-10-CM and CPT Coding for Various Medical Conditions and Procedures, Exams of Nursing

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AAPC CPC Final Practice Exam Questions and Answers 2024

A covered entity does NOT include a. Healthcare providers b. Health plans c. Patients d. Clearinghouses Correct Answer: c. Patients What does MAC stands for? a. Medicare Administrative Contractor b. Medicare Advisory Contractor c. Medicaid Administrative Contractor d. Medicaid Alert Contractor Correct Answer: a. Medicare Administrative Contractor When are providers responsible for obtaining an ABN for a service NOT considered medically necessary? a. After providing a service or item to a beneficiary. b. Prior to providing a service or item to a beneficiary. c. After a denial has been received from Medicare. d. During a procedure or service. Correct Answer: b. Prior to providing a service or item to a beneficiary AAPC credentialed coders have proven mastery of what information? a. Code sets b. Evaluation and management principles c. Documentation guidelines d. All of the above Correct Answer: d. All of the above Local Coverage Determinations are administered by whom? a. LMRPs b. NCDs c. State Law d. Each regional MAC Correct Answer: d. Each regional MAC Rationale: Each Medicare Administrative Contractor (MAC) is then responsible for interpreting national policies into regional policies Which of the following best describes constituent components of the human lymphatic system? a. Lymph nodes, lymphatic vessels, spleen, thoracic duct b. Lymph nodes, lymphatic vessels, thymus gland, pancreas c. Lymph nodes, lymphatic vessels, tonsils, liver d. Lymph nodes, lymphatic vessels, bone marrow, kidneys Correct Answer: a. Lymph nodes, lymphatic vessels, spleen, thoracic duct

The term hemic specifically refers to what bodily fluid? a. Bile interstitial fluid b. Interstitial fluid c. Blood d. Lymph Correct Answer: c. Blood Which part of the brain controls blood pressure, heart rate and respiration? a. Cerebellum b. Cerebrum c. Cortex d. Medulla Correct Answer: d. Medulla The radiology term fluoroscopy is described as: a. Use of high-frequency sound waves to image anatomic structures b. An X-ray procedure allowing the visualization of internal organs in motion c. Technique using magnetism, radio waves and a computer to produce images d. A scan using an X-ray beam rotating around the patient Correct Answer: b. An X-ray procedure allowing the visualization of internal organs in motion Which of the following characterizes the disorder dystonia? a. Difficulty swallowing b. Slowness of motion c. Abnormal muscle tone causing abnormal postures and muscle spasm d. Impairment of speech Correct Answer: c. Abnormal muscle tone causing abnormal postures and muscle spasm In the ICD- 10 - CM Alphabetic Index what is the code next to the main term called? a. Category Code b. Default Code c. Unspecified Code d. Subcategory Code Correct Answer: b. Default Code What is the ICD- 10 - CM code for eyestrain? a. H53. b. H53.10, H53. c. H57.811, H57. d. H57.813 Correct Answer: a. H53. What is the ICD- 10 - CM code for fatigue? a. R29. b. F45. c. F48. d. R53.83 Correct Answer: d. R53.

A patient sees his primary care provider for chest pain and regurgitation. The provider's diagnosis for the patient is gastroesophageal reflux. What diagnosis code(s) should be reported? a. K21. b. K21.9, R07.9, K21. c. R07.9, R11. d. R07.9, R11.10, K21.9 Correct Answer: a. K21. A 45 year-old female with malignant Mullerian duct cancer is receiving her first treatment of chemotherapy. What diagnosis codes are reported? a. C79.82, Z51. b. C57.7, Z51. c. Z51.11, D28. d. Z51.11, C57.7 Correct Answer: d. Z51.11, C57. According to ICD- 10 - CM guidelines, when a patient is seen for management of anemia due to malignancy, how is it reported? a. Anemia is the only condition reported. b. The malignancy is the only condition reported. c. Anemia is reported first, followed by the code for the malignancy. d. The malignancy is reported first, followed by the code for the anemia. Correct Answer: d. The malignancy is reported first, followed by the code for the anemia. What ICD- 10 - CM code is reported for a patient who is a habitual abuser of cannabis? a. F12. b. F12. c. F12. d. F12.10 Correct Answer: d. F12. A patient presents to the ED with weakness on the left side and aphasia. Tests are ordered and the patient is admitted with a cerebrovascular accident (CVA). What ICD- 10 - CM code(s) is/are reported? a. I67. b. R53.1, R47. c. I63. d. I63.9 Correct Answer: d. A patient is admitted after being found unresponsive at home. The patient had right-sided hemiplegia and aphasia from a previous CVA. The provider documents a current cerebral infarction due to occlusion of the right middle cerebral artery as the final diagnosis and the patient is transferred for rehabilitation. What ICD- 10 - CM code(s) is/are reported? a. I67.89, I69.959, I69. b. I65. c. I67.89, I69.954, R47. d. I63.511, I69.351, I69.320 Correct Answer: d. I63.511, I69.351, I69.

Response Feedback: Rationale: Refer to ICD- 10 - CM guideline I.C.9.d.2. Look in the ICD- 10 - CM Alphabetic Index for Infarct, infarction/cerebral/due to/occlusion NEC/cerebral arteries directing you to code I63.5-. Report I63.511 Cerebral infarct due to unspecified occlusion or stenosis of right middle cerebral artery. This patient has a history of CVA with right-sided hemiplegia and aphasia. Look in the Alphabetic Index for Sequelae (of)/infarction/cerebral/hemiplegia which directs the coder to I69.35-. Also look for Sequelae/infarction/cerebral/aphasia I69.320. Verify in the Tabular List I69.351 Hemiplegia and hemiparesis following cerebral infarction affecting right dominant side.Per ICD- 10 - CM guideline I.C.9.d.1 because the right side was affected and we do not know the dominant side, the default for dominance is right Four years post hepatic transplant, the patient is diagnosed with combined hepatocellular carcinoma and cholangiocarcinoma of the liver. What ICD- 10 - CM codes are reported? a. T86.49, C80.2, C22.0, C22.1, Z94. b. C80.2, C22. c. C80.2, C22.0, C22.1, Z94. d. T86.49, C80.2, C22.0 Correct Answer: d. T86.49, C80.2, C22. What is NOT an example of active treatment for pathological fractures? a. Surgical treatment b. Emergency department encounter c. Evaluation and treatment by a new provider d. Cast change Correct Answer: d. Cast change A patient was admitted three weeks following a normal vaginal delivery with a postpartum breast abscess. What ICD- 10 - CM code is reported? a. O91. b. O91. c. N61. d. O91.13 Correct Answer: a. O91. What is/are the external cause code(s) for a passenger involved in an MVA that lost control on the highway and hit a guardrail? a. Y92. b. V47.6XXA c. V47.5XXA d. V47.6XXA, Y92.411 Correct Answer: a. Y92. A 7 year-old female patient was seen in the emergency department after being bitten by a dog. The child received treatment for the puncture wounds to her left leg. She also received a rabies vaccine because the dog was known to have rabies. What ICD- 10 - CM codes are reported? a. S81.852A, Z20.3, Z23, W54.0XXA b. S81.812A, Z20.3, Z23, W54.0XXA c. S81.812A, A82.9, Z23, W54.0XXA d. S81.852A, Z23, W54.0XXA Correct Answer: a. S81.852A, Z20.3, Z23, W54.0XXA

A male patient is here for his chemotherapy for metastatic carcinoma of the liver secondary to cancer of the right areola. What ICD- 10 - CM codes are reported? a. C22.9, C50.019, Z51. b. Z51.11, C78.7, C50. c. Z51.11, C50.029, C78. d. C78.7, C50.021, Z51.11 Correct Answer: b. Z51.11, C78.7, C50. Rationale: ICD- 10 - CM guideline I.C.2.e.2 states that if a patient admission/encounter is solely for the administration of chemotherapy, immunotherapy, or radiation therapy, assign code Z51. Encounter for antineoplastic radiation therapy, or Z51.11 Encounter for antineoplastic chemotherapy, or Z51.12 Encounter for antineoplastic immunotherapy as the first listed or principal diagnosis. In the ICD- 10 - CM Alphabetic Index look for Encounter (with health service) (for)/chemotherapy for neoplasm guiding you to code Z51.11. Next, look in the Alphabetic Index for Metastasis, metastatic/cancer/from specified site and you are directed to see Neoplasm, malignant, by site. In the ICD- 10 - CM Table of Neoplasms look for Neoplasm, neoplastic/liver and select the code from the Malignant Secondary column, guiding you to code C78.7. Next look for Neoplasm, neoplastic/areola and select the code from the Malignant Primary column or Neoplasm, neoplastic/breast/areola and select the code from the Malignant Primary column, guiding you to subcategory code C50.0-. In the Tabular List, the 5th character is reported for the sex of the patient. In this case the patient is a male resulting in a 5th character of 2. The 6th character is for laterality; 1 is for right. The complete code is C50.021 for primary cancer of the right male areola. When assigning breast cancer codes make sure to select for the correct sex of the patient. The secondary cancer is listed first because the chemotherapy is directed to the secondary site per ICD- 10 - CM guideline I.C.2.b. Verify code selection in the Tabular List. What is the correct CPT® code for a complete, four-view, chest X-ray? a. 71048 b. 71046 x 2 c. 71047 d. 71045 x 4 Correct Answer: a. 71048 How many days does it take CMS to implement HCPCS Level II Temporary Codes that have been reported as added, changed or deleted? a. 90 b. 30 c. 60 d. 365 Correct Answer: a. 90 What codes are voluntarily reported to payers, provide evidence-based performance-measure data? a. HCPCS Level II codes b. CPT® Category I codes c. CPT® Category III codes d. CPT® Category II codes Correct Answer: d. CPT® Category II codes HCPCS Level II includes code ranges that consist of what type of codes?

a. Permanent national codes, miscellaneous codes and temporary national codes b. Permanent national codes, dental codes and category II codes c. Category II codes, temporary national codes and miscellaneous codes d. Dental codes, morphology codes, miscellaneous codes and permanent national codes Correct Answer: a. Permanent national codes, miscellaneous codes and temporary national codes When procedures are "mandated" by third party payers, what modifier would you use? a. 52 b. 26 c. 76 d. 32 Correct Answer: d. 32 A patient is taken to surgery for removal of a squamous cell carcinoma of the right thigh. What is the correct diagnosis code for today's procedure? a. C79. b. C79. c. C44. d. C44.722 Correct Answer: d. C44. A 14 year-old boy was thrown against the window of the car on impact. The resulting injury was a star-shaped pattern cut to the top of his head. In the ED, the MD on call for plastic surgery was asked to evaluate the injury and repair it. The total length of the intermediate repair was 5+4+4+5 cm (18 cm total). The star-like shape allowed the surgeon to pull the wound edges together nicely in a natural Y-plasty in two spots. What CPT® code is reported for the repair? a. 14041 b. 13121 c. 14040 d. 12035 Correct Answer: d. 12035 A patient presents with a recurrent seborrheic keratosis of the left cheek. The area was marked for a shave removal. The area was infiltrated with local anesthetic, prepped and draped in a sterile fashion. The lesion measuring 1.8 cm was shaved using an 11-blade. Meticulous hemostasis was achieved using light pressure. The specimen was sent for permanent pathology. The patient tolerated the procedure well. What CPT® code is reported? a. 11642 b. 11200 c. 11312 d. 11442 Correct Answer: c. 11312 INDICATIONS FOR SURGERY: The patient is an 82 year-old male with biopsy-proven basal cell carcinoma of his right lower eyelid extending to the upper part of the cheek. I marked the area for rhomboidal excision and I drew my planned rhomboid flap. The patient observed these markings in a mirror, he understood the surgery and agreed on the location and we proceeded. DESCRIPTION OF PROCEDURE: The area was infiltrated with local anesthetic. The face was prepped and draped in sterile fashion. I excised the lesion as drawn into the subcutaneous fat. Hemostasis was achieved using Bovie cautery. Modified Mohs analysis showed the margin to be

clear. I incised the rhomboid flap as drawn and elevated the flap with a full-thickness of subcutaneous fat. Hemostasis was achieved in the donor site, the Bovie cautery was not used, hand held cautery was used. The flap was rotated into the defect. The donor site was closed and flap inset in layers using 5 - 0 Monocryl and 6 - 0 Prolene. The patient tolerated the procedure well. The total site measured 1.3 cm x 2.7 cm. What CPT® code(s) should be reported? a. 14040, 14060 b. 14060, 11643 c. 14060 d. 11643 Correct Answer: c. 14060 Operative Report PREOPERATIVE DIAGNOSIS: Congenital left breast deformity. POSTOPERATIVE DIAGNOSIS: Congenital left breast deformity. PROCEDURE PERFORMED: Placement of left breast implant using mentor catalog #, lot #, serial #, 425 cc smooth round moderate profile implant filled with 475 cc of normal saline for breast reconstruction. INDICATIONS FOR SURGERY: The patient is a 34 year-old female who approximately 15 to 16 years ago had a left breast implant placed for breast reconstruction for her congenital deformity of the left breast. This implant ruptured and in late September 20XX, I performed a capsulectomy and exchanged her ruptured implant for a new implant. About a week after surgery the patient developed an infection. Due to the infection, her implant had to be removed. The patient's infection has completely resolved and she is now ready to have her implant replaced. In the preoperative holding area, I marked her for the ideal position of this implant and performed a breast exam not showing a mass in either breast and no mass in axillae and we proceeded. We discussed with the patient that even though her original implant was placed in subglandular position I felt it would be beneficial to place the implant behind her pectoralis major muscle in submuscular position today. The patient agreed and we proceeded. DESCRIPTION OF PROCEDURE: The patient was given 1 g of IV Vancomycin. The patient was taken to the operating room; general anesthesia was induced and bilateral pneumatic compression stockings were worn throughout the procedure. A lower body Bair Hugger was placed. Both arms were secured to padded arm boards using Kerlix rolls. The neck, chest, axillae, and upper abdomen were prepped and draped in sterile fashion. I began by incising the central portion of her previous scar. I dissected down to the pectoralis major muscle. A submuscular plane was developed through a lateral approach and the inferior and medial origin of the muscle was partially divided using the Bovie cautery. Meticulous hemostasis was achieved using Bovie cautery. There were no signs of infection nor were there any pockets of seroma fluid or hematoma. The wound was carefully inspected. Meticulous hemostasis was achieved. Gloves were changed. The implant was opened and air was evacuated. It was placed in the submuscular pocket and the wound was temporarily closed using a skin stapler. The implant was filled to its maximum volume of 475 cc of normal saline. The patient was sat up. I adjusted the volume and ultimately felt she needed a 475 cc implant for breast symmetry with her contralateral breast. Once I was satisfied with the position of the implant, the patient was placed supine. Gloves were

changed again. The fill tube was removed and I then secured the filled valves digitally and the deepest layer of breast tissue was closed using 3-0 Vicryl in running suture and the skin was closed in three layers using 4-0 Monocryl, 5-0 Monocryl, and 5-0 Prolene. The wound was dressed with Xeroform and gauze. The patient tolerated the procedure well. She was taken to recovery in good condition. What CPT® and ICD- 10 - CM codes are reported? a. 19325-LT, N64. b. 19342 - LT, Q83. c. 19316 - LT, N64. d. 19340 - LT, Q83.9 Correct Answer: b. 19342 - LT, Q83. In ICD- 10 - CM, what classification system is used to report open fracture classifications? a. Muller AO classification of fractures b. Danis-Weber classification c. Gustilo classification for open fractures d. PHF classification of fractures Correct Answer: c. Gustilo classification for open fractures A patient is given Xylocaine, a local anesthetic, by injection in the thigh above the site to be biopsied. A small bore needle is then introduced into the muscle, about 3 inches deep, and a muscle biopsy is taken. What CPT® code is reported for this service? a. 20206 b. 27324 c. 20225 d. 20205 Correct Answer: a. 20206 This 45 year-old male presents to the operating room with a painful mass of the right upper arm. Upon deep dissection a large mass in the soft tissue of the patient's shoulder was noted. The mass appeared to be benign in nature. With deep blunt dissection and electrocautery, the mass was removed and sent to pathology. What CPT® code is reported? a. 23030 - RT b. 23075 - RT c. 23076 - RT d. 23066-RT Correct Answer: d. 23066 - RT A 22 year-old female sustained a dislocation of the right elbow with a medial epicondyle fracture while on vacation. The patient was given general anesthesia and the elbow was reduced and was stable. The medial epicondyle was held in the appropriate position and was reduced in acceptable position and elevated. A long arm splint was applied. The patient is referred to an orthopedist when she returns to her home state in a few days. What CPT® code(s) are reported? a. 24576 - 54 - RT, 24620 - 54 - 51 - RT b. 24565 - 54 - RT, 24605 - 54 - 51 - RT c. 24577 - 54 - RT, 24600 - 54 - 51 - RT d. 24575 - 54 - RT, 24615 - 54 - 51 - RT Correct Answer: b. 24565 - 54 - RT, 24605 - 54 - 51 - RT

A patient is seen in the hospital's outpatient surgical area with a diagnosis of a displaced fracture of the lateral condyle, right elbow. An ORIF (open reduction) procedure was performed and included the following techniques: An incision was made in the area of the lateral epicondyle. This was carried through subcutaneous tissue, and the fracture site was easily exposed. Inspection revealed the fragment to be rotated in two places about 90 degrees. It was possible to manually reduce this quite easily, and the manipulation resulted in an almost anatomic reduction. This was fixed with two pins driven across the humerus. The pins were cut off below skin level. The wound was closed with plain catgut subcutaneously and 5-0 nylon for the skin. Dressings and a long arm cast were applied. What CPT® and ICD- 10 - CM codes are reported? a. 24577 - RT, S42.451A b. 24579 - RT, S42.451A c. 24579 - RT, 29065 - 51 - RT, S42.434B d. 24575 - RT, S42.434B Correct Answer: c. 24579 - RT, 29065 - 51 - RT, S42.434B What CPT® code is reported for open decortication and parietal pleurectomy? a. 32652 b. 32225 c. 32320 d. 32220 Correct Answer: c. 32320 A 65 year-old patient is complaining of difficulty breathing. Patient is scheduled for a diagnostic VATS (Video-assisted thoracoscopic surgery). Under general anesthesia he was placed in left lateral decubitus position and a thoracoscope was inserted through a port site. The VATS exploration immediately revealed a mass of the right upper lobe. A biopsy was performed and sent to pathology. Results from pathology revealed small cell carcinoma. The decision was made to perform VATS and remove the upper lobe of the right lung. What CPT® code(s) is (are) reported? Correct Answer: 32663 Rationale: The patient started out with a diagnostic VATS but it became a surgical VATS when the upper lobe of the right lung was removed. According to CPT® guidelines a surgical thoracoscopy always includes a diagnostic thoracoscopy. You will not report 32607 or 32609 which are diagnostic VATS codes. The removal of the upper lobe was performed by VATS. Code 32480 is not correct because that is if the patient had an open surgery to remove the upper lobe. A patient with AML (Acute Myelogenous Leukemia) has just learned his sister is an HLA (Human Leukocyte Antigen) match for him. Stem cells taken from the donor (the patient's sister) will be transplanted into the patient to help with his treatment. What CPT® code is used to report the harvesting of the stem cells from the donor (his sister)? a. 38204 b. 38205 c. 38206 d. 38207 Correct Answer: b. 38205 38205:Rationale: In the CPT® Index look for Stem Cell/Harvesting. This directs you to code range 38205, 38206. Code selection is based on whether it is allogenic (from a donor) or autologous (from the patient). This is allogenic making 38205 the correct code choice.

A returning 2 year-old child is seen in the pediatrician's office with stridor and a bark like cough. The pediatrician examines the child quickly and determines the child has stridulous croup. The child is given a nebulizer breathing treatment in the office to improve PO 2 levels. Medication used is breathable Epinephrine. What CPT® and ICD- 10 - CM codes are reported? a. 94644, J04. b. 94644, R06.1, R c. 94640, J38. d. 94642, J38.5, R05, R06.1 Correct Answer: c. 94640, J38. A patient with chronic pneumothoraces presents for chemopleurodesis. Under local anesthesia a small incision is made between the ribs. A catheter is inserted into the pleural space between the parietal and pleural viscera. Subsequently, 5g of sterile asbestos free talc was introduced into the pleural space via the catheter. What CPT® and ICD- 10 - CM codes are reported? a. 32650, 32560, J93.11 b. 32601, 32560, J95. c. 32650, J95.811 d. 32560, J93.81 Correct Answer: d. 32560, J93. Patient presents to her physician 10 weeks following a true posterior wall myocardial infarction. The patient is still symptomatic and is diagnosed with ischemic heart disease. What is (are) the correct ICD- 10 - CM code(s) for this condition? a. I22. b. I21. c. I25. d. Z51.89, I25.9 Correct Answer: d. Z51.89, I25. What information is needed in order to accurately code hypertension retinopathy in ICD- 10 - CM? a. The affected eye(s). b. Whether the hypertension is malignant or benign. c. Which side of the heart is affected? d. The stage of retinopathy Correct Answer: a. The affected eye(s). An arterial catheterization is performed by cutdown for transfusion. What CPT® code is reported? a. 36640 b. 36625 c. 36620 d. 36600 Correct Answer: b. 36625 INDICATIONS FOR CORONARY INTERVENTION: Acute inferior myocardial infarction. Documented mildly occlusive plaque with much clot in the right coronary artery. PROCEDURE: Insertion of temporary pacemaker in the right femoral vein. Primary stenting of the right coronary artery with a 4.5 x 16 mm Express stent. Angio-Seal to the vessels of the right common femoral artery post procedure, and also Angio-Seal of the right common femoral vein. TECHNIQUE: Judkins percutaneous approach from the right groin with Perclose at the arterial puncture site post procedure. CATHETERS: 4 French Angio-Jet catheter device, insertion of a 5 French temporary pacing wire, a 4.5 x 16 mm Express stent.

PRESSURES: Aortic Pressure: 107/ RESULTS: Coronary stenting procedure of the right coronary artery: The right coronary artery was primarily stented with a 4.5 x 16 mm Express stent. It was expanded to 12 atmospheres. There was no residual stenosis. IMPRESSION: Successful Angio-Jet and stenting of the distal right coronary artery with no residual stenosis. Angio-Seal to the right femoral vein post procedure. PROCEDURE: Through the femoral artery sheath, the EBU was advanced to the right coronary. Following this a PT graphic intermediate wire was used to cross the lesion. Following this angioplasty of the lesion was performed, utilizing a 2.5 x 20 millimeter CrossSail balloon at multiple sites to ten atmospheres. Following this there was a fair result; however, there was a significant stenosis and significant calcification at the area, and the decision was made to pursue trying to stent the lesion. Multiple stents were attempted, including a 2.5 x 9 millimeter zipper MX and a 2.5 x 13 millimeter Guidant stent. This was abandoned, and in switching out to a balloon for further ballooning, the patient became hypertensive and with difficulty in terms of her respiratory status. Angiography revealed an occlusion of the mid left anterior descending and thrombus throughout the proximal left anterior descending extending into the left main. Recheck of ACT showed the ACT to be at eight seconds. This likely represented subtherapeutic range for her anticoagulation. A check of her medications revealed that instead of Angiomax, the patient had been given ReoPro without antithrombotic agent. She was therefore given IV heparin up to 12,000 units, and her ReoPro was continued. The lesion was then rewired, and an AngioJet was used to try to suction out this area of thrombus. Unfortunately, the AngioJet was unable to cross the mid left anterior descending lesion and therefore was somewhat limited in its use for a more distal thrombus, although it did suction out the proximal left anterior descending thrombus. At this point, the patient was emergently intubated, and multiple pressors were started, including dopamine, Levophed, vasopressin, and epinephrine. Following this, a laser was attempted to cross the lesion an excimer laser X Spectranetics 0.9 Vitesse; however, this laser was unable to cross the lesion. Therefore, a long balloon, a 2.0 x 40 millimeter CrossSail balloon, was used to cross the lesion and inflate multiple segments of the mid left anterior descending up to a maximum inflation pressure of ten atmospheres. This improved flow though by no means restored it back to normal. Therefore, following this, longer balloon inflations were performed utilizing a 2.0 x 20 millimeter CrossSail balloon up to fourteen atmospheres for one and a half minutes. This did not improve significantly the flow distally, and therefore the decision was made to try to stent the mid segment with a 2.5 x 9 millimeter zipper MX stent to a maximum inflation pressure of fourteen atmospheres. This resolved the issue in terms of the mid left anterior descending lesion; however, beyond the stent there continued to be residual stenosis, and multiple balloons were used to balloon this up to a 2.5 x 20 millimeter balloon up to fourteen atmospheres. The final result in the left anterior descending revealed a lesion in the mid-left anterior descending that was approximately 40 percent, there was TIMI III flow throughout the proximal and mid left anterior descending. However, at the level of the apex, there was TIMI 0 flow. Throughout the angioplasty, the patient had episodes of bradycardia, and a temporary pacemaker was placed, and this was removed at the end of the procedure. IMPRESSION: Successful stent to the mid left anterior descending, complicated by thrombotic event in the left anterior descending system. Final result was a successful stent to the mid left anterior descending with residual TIMI 0 flow in the distal left anterior descending. We returned

to the right coronary artery and successfully employed a 4.5 x 16 mm Express sent. At the end of the case, an intra-aortic balloon pump was placed in the left femoral artery sheath, and the patient was sent to the Coronary Care Unit on multiple pressors including epinephrine, vasopressin, Levophed and dopamine. a. 92928-RC, 92929-LD, 92973 b. 92928 - RC, 92928-LD, 33967, 92973 c. 92928-RC, 92929 - LD d. 92928 - RC, 92929 - LD, 33967, 92973 - RC Correct Answer: d. 92928 - RC, 92929 - LD, 33967, 92973 - RC ??? CLINICAL SUMMARY: The patient is a 41 year-old female with known coronary disease and recent recurrent chest pain, cardiac catheterization demonstrated subtotal occlusion of the diagonal artery at its takeoff from the left anterior descending artery. PROCEDURE: With informed consent obtained, the patient was prepped and draped in the usual sterile fashion. With the right groin area infiltrated with 2% Xylocaine, the patient was given 2 mg of Versed and 50 mcg Fentanyl intravenously for conscious sedation and pain control. The right femoral artery was cannulated with a modified Seldinger technique and a 6 French catheter sheath placed. A 6 French JL3.5 catheter with no side holes was utilized as a guiding catheter. After the initial guiding picture had been obtained, the patient was given Angiomax per protocol, and a short Cross-it 100 wire was advanced to the LAD and then into the diagonal vessel. A 2.0. 15 - mm-long Maverick balloon was used for dilatation of the diagonal artery ostium with inflation pressure up to 8 atmospheres applied. Final angiographic documentation was carried out after the patient received 200 mcg of intracoronary nitroglycerine. The guiding catheter was then pulled, the sheath secured in place. The patient is now being transferred to telemetry for post coronary intervention observation and care. RESULTS: The initial guiding picture of the left coronary system demonstrates the high-grade ostial stenosis of the diagonal artery taking off within the LAD. Following the coronary intervention with balloon angioplasty there is complete resolution of the stenosis with less than 10 percent residual narrowing observed, no evidence for intimal disruption, no intraluminal filling defect, and good antegrade TIMI III flow preserved. CONCLUSION: Successful coronary intervention with balloon angioplasty to the ostial/proximal segment of the second diagonal vessel. a. 92937 - LD b. 92924 - LD c. 92920 - LD d. 92921 - LD Correct Answer: c. 92920 - LD ??? What ICD- 10 - CM code(s) is reported for ulcerative colitis with rectal bleeding? a. K51. b. K52.9, K62. c. K51. d. K51.511 Correct Answer: C

Bile empties into the duodenum through what structure? a. Common hepatic duct b. Common bile duct c. Biliary artery d. Pyloric sphincter Correct Answer: B A patient is seen in the gastroenterologist's clinic for a diagnostic colonoscopy. When performing the service, the physician notes suspicious looking polyps and removes three using a snare technique to send to pathology for further testing. What is/are the correct CPT® code(s) to report? a. 45378, 45385- 51 b. 45385 c. 45380 d. 45378, 45380 - 51 Correct Answer: c. 45380 A patient with hypertension is scheduled for same day surgery for removal of her gallbladder due to chronic gallstones. She is examined preoperatively by her cardiologist to be cleared for surgery. What ICD- 10 - CM codes are reported by the cardiologist? a. K80.21, Z01.89, I b. K80.20, I10, Z01. c. Z01.810, K80.20, I d. I10, Z01.818, K80.20 Correct Answer: c. Z01.810, K80.20, I A 56 year-old patient complains of occasional rectal bleeding. His physician decides to perform a rigid proctosigmoidoscopy. During the procedure, two polyps are found in the rectum. The polyps are removed by a snare. What CPT® and ICD- 10 - CM codes are reported? a. 45320, K62. b. 45309, 45309, K63. c. 45385, K63. d. 45315, K62.1 Correct Answer: d. 45315, K62. What ICD- 10 - CM code is reported for carcinoma of the bladder dome? a. C67. b. C67. c. C67. d. C67.1 Correct Answer: d. C67. Vasectomy reversal is performed, bilaterally, using the operating microscope. Choose the procedure code(s). a. 55400-50, 69990 b. 55250-50, 69990 c. 55400 d. 55250 Correct Answer: a. 55400 - 50, 69990

When a cystectomy is performed, there are various means of diverting the urine. One method is to create a neobladder which allows the patient to void through his or her urethra. Which code describes this procedure? a. 51590 b. 51595 c. 51596 d. 51580 Correct Answer: c. 51596 A 58 year-old man with an enlarging right hydrocele is here for surgical repair. He is taken to the operating room where the hydrocele was enucleated from the skin in dartos fashion and delivered into the wound. It was skeletonized at the equator and then was opened and drained. Excess hydrocele sac tissue was excised with electrocautery. It was then wrapped backward around the spermatic cord and sewn there so it would not reform. There were a few pockets also opened up and skeletonized. The testicle was replaced in the scrotum. What CPT® code is reported for this service? a. 55041 - RT b. 55000 - RT c. 55040 - RT d. 55100-RT Correct Answer: c. 55040-RT The patient presents to the office for cystometrogram (CMG). Complex CMG with voiding pressure studies is done. Intraabdominal voiding pressure studies and complex uroflowmetry are also performed. What CPT® code(s) is/are reported for this service? a. 51726 b. 51728-26, 51797-26, 51741- 51 - 26 c. 51728, 51797, 51741- 51 d. 51726, 51728 - 51, 51797 Correct Answer: c. 51728, 51797, 51741 - 51 What ICD- 10 - CM code is reported for VIN III? a. N90. b. D07. c. D07. d. N87.1 Correct Answer: b A diabetic woman delivered her child and now returns to obstetrician's office for follow up. She has had type 1 diabetes controlled with insulin for most of her life. Her obstetrician will monitor her closely for several weeks to be sure her pregnancy does not cause her permanent problems. What diagnosis code is used for her visit 2 weeks after her delivery? a. O24. b. O24.019, E10. c. O24. d. P70.1 Correct Answer: a. O24. What CPT® code is used to report 50% removal of the vulva and deep subcutaneous tissues? a. 56633 b. 56625

c. 56620 d. 56630 Correct Answer: d. 56630 A patient presents with cervical cancer; it has spread and metastasized throughout the pelvic area. She receives a total abdominal hysterectomy with bilateral salpingo-oophorectomy, cystectomy and creation of an ileal conduit and partial colectomy. What is/are the CPT® code(s) reported for this service? a. 58152, 44141 b. 58150, 51590, 44140, 58720 c. 58150, 51590, 44140 d. 58240 Correct Answer: b. 58150, 51590, 44140, 58720 A patient with severe adenomyosis has a vaginal hysterectomy with bilateral salpingo- oophorectomy. After the uterus is removed it is weighed at 300 grams. What is the CPT® code reported for this procedure? a. 58262 b. 58290 c. 58292 d. 58291 Correct Answer: b. 58290 What is a dime sized opening in the skull to access the brain called? a. Burr hole b. Cistern c. Craniectomy d. Trephine Correct Answer: a. Burr hole A patient is having a decompression of the nerve root involving two segments of the lumbar spine via transpedicular approach. What CPT® code(s) is/are reported? a. 63056, 63057 b. 63030, 63035 c. 63030 d. 63056 Correct Answer: a. 63056, 63057 A patient with MEN1 (Multiple Endocrine Neoplasia 1) has surgery to remove three of her parathyroid glands and part of the fourth parathyroid gland. What CPT® and ICD- 10 - CM codes are reported? a. 60502, E31. b. 60500, E31. c. 60505, E31. d. 60505, E31.21 Correct Answer: b. 60500, E31. A patient with a malignant neoplasm of the spinal meninges is receiving a programmable pump implantation for chemotherapy. The patient is placed in the prone position where the provider made a midline incision overlying the area of the spinal cord. The reservoir was placed in the subcutaneous tissues and attached to the previously placed catheter. Layered sutures were used to

close the incision. The patient tolerated the procedure well and was released in good condition. What CPT® and ICD- 10 - CM codes are reported for this procedure? a. 62360, C70. b. 62367, C70. c. 62350, C70. d. 62362, C70.1 Correct Answer: d. 62362, C70. A 47 year-old female presents to the OR for a partial corpectomy to three thoracic vertebrae. One surgeon performs the transthoracic approach while another surgeon performs the three vertebral nerve root decompressions necessary. How should each provider involved code their portion of the surgery? a. 63085, 63086-82 x 2 b. 63087-80, 63088-80 x 2 c. 63085-62, 63086-62 x 2 d. 63087 - 52, 63088 - 52 x 2 Correct Answer: c. 63085 - 62, 63086- 62 x 2 Which option best describes what is being done during strabismus surgery? a. Corrects the condition in which the refractive surfaces of the eye are unequal. b. Is a repair of the cornea. c. Removes the opaque covering on or in the lens. d. Corrects the muscle misalignment. Correct Answer: d. Corrects the muscle misalignment. A 65 year-old patient presents with an ectropion of the right lower eyelid. Repair with tarsal wedge excision is performed for correction. Attention was then directed to the left eye. The patient also has an ectropion of the left lower eyelid which is repaired by suture repair. What CPT® code(s) is/are reported? a. 67914- 50 b. 67916 - E4, 67914-E c. 67916- 50 d. 67923 - E4, 67921-E2 Correct Answer: b. 67916 - E4, 67914 - E A patient with right and left prominent ears presents for an otoplasty. What CPT® and ICD- 10 - CM codes are reported? a. 69320, H61. b. 69300-50, Q17. c. 69310, H61. d. 69300, Q17.5 Correct Answer: d. 69300, Q17. A 65 year-old male with a history of chronic glaucoma has progressive optic nerve damage and elevated intraocular pressure. A clear corneal incision is made and viscoelastic material is injected into the anterior chamber over the lens to increase and maintain anterior chamber depth. The endoscope is inserted through the temporal incision to view the nasal ciliary processes, which is coagulated with the endpoint of shrinkage and whitening. The endoscope is moved in an arc, allowing treatment of the processes over an arc of 180° and a second corneal incision is made 90° away and 180° of ciliary processes are destroyed with laser therapy. The surgeon has

completed coagulation of 270° of angle. The eye is reformed with balanced salt solution. Wounds are checked for leakage and sutures are placed to seal the wound. What CPT® code is reported? a. 66710 b. 66711 c. 66680 d. 66700 Correct Answer: b. 66711 A patient presents to the emergency room with a severely damaged eye. The injury was sustained when the patient was a passenger in a multi-car accident on the public highway. The patient sustained a large open lacerated wound to the left eye. The posterior chamber was ruptured and significant vitreous and some intraocular tissue was lost. The eyeball was not repairable and was removed, en masse. A permanent implant was inserted but not attached to the extraocular muscles. The patient was released with an occlusive eye patch. What CPT® and ICD- 10 - CM codes are reported? a. 65103 - LT, S05.22XA, V49.59XA, Y92. b. 65101 - LT, S05.22XD, V89.2XXD, Y92. c. 65093 - LT, S05.22XA, V43.92XA, Y92. d. 65091-LT, S05.22XS, V49.59XS, Y92.411 Correct Answer: a. 65103-LT, S05.22XA, V49.59XA, Y92. Report the appropriate anesthesia code for an obstetric patient who had a planned general anesthesia for cesarean hysterectomy. a. 01962 b. 01969 c. 01963 d. 01967 Correct Answer: c. 01963 What is the anesthesia code for an insertion of a penile prosthesis performed via a perineal approach? a. 00934 b. 00938 c. 00932 d. 00936 Correct Answer: b. 00938 What ICD- 10 - CM code is reported for left knee primary osteoarthrosis? a. M17. b. M17. c. M17. d. M17.2 Correct Answer: c. M17. Code 00940 Anesthesia for vaginal procedures (including biopsy of labia, vagina, cervix or endometrium); not otherwise specified has a base value of three (3) units. The patient was admitted under emergency circumstances, qualifying circumstance code 99140, which allows two (2) extra base units. A preanesthesia assessment was performed and signed at 2:00 a.m. Anesthesia start time is reported as 2:21 am, and the surgery began at 2:28 am. The surgery finished at 3:25 am and the patient was turned over to PACU at 3:36 am, which was reported as

the ending anesthesia time. Using fifteen-minute time increments and a conversion factor of $100, what is the correct anesthesia charge? a. $800. b. $1,200. c. $900. d. $1,000.00 Correct Answer: a. $800. A 40 year-old female in good physical health is having a laparoscopic tubal ligation. The anesthesiologist begins to prepare the patient for surgery at 08:30 am. Surgery begins at 09: am and ends at 10:00 am. The anesthesiologist releases the patient to recovery nurse at 1015. What is the total anesthesia time and anesthesia code? a. 1 hr. 15 minutes, 00851 b. 1hr. 45 minutes, 00851 c. 1hr. 30 minutes, 00840 d. 1 hr., 00840 Correct Answer: b. 1hr. 45 minutes, 00851 What ICD- 10 - CM code is reported for a routine chest X-ray? a. Z00. b. Z00. c. R07. d. R07.9 Correct Answer: Z00. A 32 year-old patient with cervical cancer is in an outpatient facility to have HDR brachytherapy. The cervix is dilated and under ultrasound guidance six applicators are inserted with iridium via the vagina to release its radiation dose. The placement is in the cervical cavity (intracavitary). What CPT® code is reported for the physician service? a. 77799- 26 b. 77789- 26 c. 77761- 26 d. 77762 - 26 Correct Answer: a A 56 year-old patient who has been admitted requires a tunneled CV catheter insertion. The physician uses ultrasound guidance to perform the insertion. The physician documented vessel patency and that permanent recordings are in the patient's record. What CPT® codes are reported for the physician's services? a. 36558, 76000- 26 b. 36558, 76937- 26 c. 36556, 76937- 26 d. 36558, 77001 - 26 Correct Answer: b. 36558, 76937- 26 A Computed tomography scan (CT) confirms improper ossification of cartilages in the upper jawbone and left side of the face of a patient with facial defects. A CT scan is performed with contrast material in the hospital. What CPT® code is reported by an independent radiologist contracted by the hospital? a. 70542- 26 b. 70460- 26

c. 70487- 26 d. 70481 - 26 Correct Answer: b. 70460 - 26 What ICD- 10 - CM code is reported for an adverse effect to diagnostic iodine, initial encounter? a. T50.995A b. T49.0X5A c. T50.8X5A d. T49.0X1A Correct Answer: c. T50.8X5A What is the code for gross and microscopic examination (surgical pathology) of breast tissue from a simple mastectomy? a. 88307 b. 88309 c. 88305 d. 88300 Correct Answer: c. 88305 A cardiac patient must take digoxin to treat his atrial fibrillation (Afib). This condition has been controlled for several years but the patient now presents to his physician with new complaints of irregular heartbeats. The physician orders a total digoxin study to determine the total level of digoxin in order to measure the drug's efficacy in treating his Afib. What CPT® code is reported? a. 80163 b. 82542 c. 80299 d. 80162 Correct Answer: d. 80162 A lab test reveals an excessive level of alcohol in the blood. What ICD- 10 - CM code is reported? a. R78. b. R78. c. R78. d. R78.4 Correct Answer: b. A patient has partial removal of his lung which is sent in for gross and microscopic examination. The pathologist also did gross and microscopic exam on biopsies for several lymph nodes in the patient's chest which are placed in one container. A consultation is performed on a tissue block of a single specimen intraoperatively by frozen section. The pathologist also performs a trichrome stain. What CPT® codes are reported for the lab tests performed? a. 88307, 88305 x 2, 88332 b. 88309 x 2, 88313, 88329 c. 88309 x 2, 88307 x 2, 88313, 88331, 88332 d. 88309, 88305, 88313, 88331 Correct Answer: d A couple with inability to conceive has fertility testing. The semen specimen is tested for volume, count, motility and a differential is calculated. The findings indicate infertility due to oligospermia. What CPT® and ICD- 10 - CM codes are reported? a. 89264, N46. b. 89320, N46.

c. 89257, Z31. d. 89310, 89320, Z31.41 Correct Answer: b A patient is seen by Dr. B who is covering on call services for Dr. A. The patient is an established patient with Dr. A. but she has not been seen by Dr. B. before. Which E/M subcategory is appropriate to report the services provided by Dr. B? a. Office consultation b. Preventive medicine visit c. New patient office visit d. Established patient office visit Correct Answer: d A patient is diagnosed as having both acute and chronic tonsillitis. How is this reported in ICD- 10 - CM? a. The chronic tonsillitis is reported first; the acute tonsillitis is reported second. b. The acute tonsillitis is reported first; the chronic tonsillitis is reported second. c. Only the chronic tonsillitis is reported. d. Only the acute tonsillitis is reported. Correct Answer: b A 3 year-old critically ill child is admitted to the PICU from the ER with respiratory failure due to an exacerbation of asthma not manageable in the ER. The provider starts continuous bronchodilator therapy and pharmacologic support along with cardiovascular monitoring and possible mechanical ventilation support. The provider documents a comprehensive history and exam and orders are written after treatment is initiated. What is the CPT ® code for this encounter? a. 99476 b. 99475 c. 99291 d. 99284 Correct Answer: b Subjective: 6 year-old girl twisted her arm on the playground. She is seen in the ED complaining of pain in her wrist. Objective: Vital Signs: stable. Wrist: Significant tenderness laterally. X-ray is normal Assessment: Wrist sprain Plan: Over the counter Anaprox. Give twice daily with hot packs. Recheck if no improvement. What is the E/M code for this visit? a. 99281 b. 99241 c. 99221 d. 99284 Correct Answer: a an established patient presents to the clinic today for a follow-up of his pneumonia. He was hospitalized for 6 days on IV antibiotics. He was placed back on Singulair and has been doing well with his breathing since then. An expanded problem focused exam was performed. Records were obtained from the hospital and the provider reviewed the labs and X-rays. The patient was told to continue antibiotics for another two weeks to 20 days, and the prescription Keteck was

replaced with Zithromax. Patient is to return to the clinic in two weeks for recheck of his breathing and follow up X-ray. What CPT® code is reported? a. 99213 b. 99242 c. 99335 d. 99214 Correct Answer: a A patient who has had two recent seizures underwent a 3-hour EEG study. What CPT® code is reported? a. 95953- 52 b. 95812 c. 95813 d. 95950 - 52 Correct Answer: c A provider has ordered de-ironing by therapeutic phlebotomy to be performed weekly. The patient is diagnosed with hemochromatosis and therapeutic phlebotomy is used to avoid irreversible tissue damage. One unit of blood is removed weekly. What CPT® and ICD- 10 - CM codes are reported for each weekly visit treatment? a. 99195, E80.0 b. 36415, E83.110 c. 99195, E83.119 d. 36430, 99195, E83.119 Correct Answer: c A patient with atrial fibrillation had a dual lead pacemaker implanted 1 year ago. Today she returns to the provider's office for evaluation of function of the device by analyzing and reviewing the parameters stored comparing it to current readings. It was determined minor adjustments and reprogramming were needed. What CPT® code is reported? a. 93288 b. 93280 c. 93289 d. 93283 Correct Answer: a A patient with carcinoma of the descending colon presents for chemotherapy administration at the infusion center. The infusion was started with 1000 cc of normal saline. Heparin, 1000 units was added and then Fluorouracil, 800 mg was added and infused over 2 hours. Dexamethasone, 20 mg was administered, IV push. At the end of the 2 hours, the IV was disconnected and the patient was discharged. What codes are reported? a. 96415, 96375, J9190, J1100, J1644, Z51.0, C18.9 b. 96413, J9190, J1100, J1642, Z51.11, C18.6 c. 96413, 96415, 96375, J9190 x 2, J1100 x 20, J1644, Z51.11, C18.6 d. 96413, 96375, J9190 x 2, J1100 x 20, Z51.12, C18.8 Correct Answer: a A 5 year-old is brought in to see an allergist for generalized urticaria. The family just recently visited a family member that had a cat and dog. The mother wants to know if her son is allergic to cats and dogs. The child's skin was scratched with two different allergens. The provider waited

15 minutes to check the results. There was a flare up reaction to the cat allergen, but there was no flare up to the dog allergen. The provider included the test interpretation and report in the record. a. 95004 x 2 b. 95027 x 2 c. 95018 x 2 d. 95024 x 2 Correct Answer: a

AAPC CPC Final

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