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Physicianbased CCSP Ultimate Exam
Question 1. A 68-year-old male presents with chronic kidney disease stage 3 and hypertension. The provider documents “CKD, stage 3 (moderate) secondary to hypertension.” Which ICD- 10 - CM code is most specific? A) N18. B) I12. C) N18. D) I Answer: A Explanation: N18.3 denotes chronic kidney disease, stage 3, which is the most specific code for the documented condition. I12.9 is hypertensive chronic kidney disease without stage specification, and I10 is essential hypertension alone. Question 2. In an outpatient visit, the physician performs a comprehensive history, detailed exam, and moderate-complexity medical decision making. According to 2023 E/M guidelines, which office visit level is appropriate? A) 99213 B) 99214 C) 99215 D) 99212 Answer: B Explanation: Moderate-complexity MDM with a detailed exam meets the criteria for level 2 office visit, CPT 99214. Question 3. A surgeon removes a benign skin lesion on the left forearm using excision with primary closure. Which CPT code and modifier should be reported? A) 11402-RT B) 11402-LT C) 11402- 59 D) 11404-RT Answer: B
Physicianbased CCSP Ultimate Exam
Explanation: 11402 is excision of benign lesion on the forearm, and the laterality modifier –LT indicates the left side. Modifier –RT would be incorrect; –59 is for distinct procedural services, not laterality. Question 4. The provider documents “right knee sprain” and “right ankle sprain” from the same incident. Which coding convention applies when assigning laterality? A) Use separate codes with the same laterality modifier. B) Combine into a single code with a “multiple injury” indicator. C) Assign one code and omit the other as “included.” D) Use a single code with a “bilateral” modifier. Answer: A Explanation: Each distinct injury requires its own code with the appropriate laterality modifier (-RT for right side). There is no combined code for separate injuries. Question 5. Which ICD- 10 - CM guideline states that “when a code includes an ‘excludes1’ note, the excluded condition cannot be coded together with the code it excludes”? A) Chapter 1 – Certain infectious and parasitic diseases B) Section I – General coding guidelines C) Chapter 14 – Diseases of the genitourinary system D) Chapter 21 – Factors influencing health status Answer: B Explanation: The “Excludes1” note is part of the General Coding Guidelines (Section I) and indicates the two conditions are mutually exclusive. Question 6. A patient receives an influenza vaccine administered by a nurse practitioner. Which HCPCS Level II code and modifier should be used? A) G0008, no modifier B) 90471, modifier - C) G0008, modifier - D) 90471, no modifier Answer: A
Physicianbased CCSP Ultimate Exam
Answer: A Explanation: Modifier - 59 designates that the procedures are distinct and not normally reported together. Question 10. Which NCCI edit would prevent reporting a cataract extraction (66984) with an intra-ocular lens implantation (66982) on the same operative report? A) Mutually exclusive edit – same session B) Bundling edit – global period C) Unbundling edit – separate anatomic sites D) None; both are allowed together Answer: D Explanation: Cataract extraction with intra-ocular lens implantation is a bundled service; both codes are reported together (66984 includes IOL insertion). There is no NCCI edit prohibiting this combination. Question 11. In a claim for a new patient office visit, the provider documents a comprehensive history, extensive counseling, and low-complexity MDM. According to the 2023 guidelines, which E/M level is appropriate? A) 99202 B) 99203 C) 99204 D) 99205 Answer: C Explanation: The new patient office visit with a comprehensive history and extensive counseling meets the criteria for level 4 (99204) when MDM is low-complexity. Question 12. A patient’s chart shows “chronic obstructive pulmonary disease, unspecified, with acute exacerbation.” Which code pair is most accurate? A) J44.9, J44. B) J44.1, J44.
Physicianbased CCSP Ultimate Exam
C) J44.0, J44.
D) J44.1 only Answer: D Explanation: J44.1 specifically denotes COPD with acute exacerbation; the unspecified code J44.9 is not needed because the acute exacerbation is documented. Question 13. Which CPT code describes an intravitreal injection of anti-VEGF medication? A) 67028 B) 67010 C) 67020 D) 67030 Answer: A Explanation: 67028 is the code for injection of a therapeutic agent into the vitreous body (intravitreal injection). Question 14. A physician documents “left lower quadrant abdominal pain” and orders a CT scan of the abdomen and pelvis with contrast. Which ICD- 10 - CM code captures the symptom? A) R10. B) R10. C) R10. D) R10. Answer: B Explanation: R10.32 denotes left lower quadrant abdominal pain, the most specific symptom code. Question 15. When coding a pressure ulcer that is stage III on the sacrum, which ICD- 10 - CM code is correct? A) L89. B) L89.152- 1
Physicianbased CCSP Ultimate Exam
C) 99213
D) 99214
Answer: C Explanation: For established patients, a comprehensive exam with low-complexity MDM is level 3 office visit (99213). Question 19. A patient receives a screening colonoscopy with no abnormalities found. Which CPT code is appropriate? A) 45378 B) 45380 C) 45385 D) 45385- 59 Answer: A Explanation: 45378 is the code for diagnostic colonoscopy, which is also used for screening when no therapeutic procedure is performed. Question 20. Which CDC guideline influences the coding of vaccine administration in ICD- 10 - CM? A) CPT Assistant B) ICD- 10 - CM Official Guidelines for Coding and Reporting C) AHA Coding Clinic for ICD- 10 - CM/PCS D) NCCI Policy Manual Answer: B Explanation: The ICD- 10 - CM Official Guidelines provide direction on coding vaccine administration, not the CPT Assistant. Question 21. A physician documents “acute appendicitis with perforation.” Which ICD- 10 - CM code is most specific? A) K35. B) K35. C) K35.
Physicianbased CCSP Ultimate Exam
D) K35.80- 3
Answer: B Explanation: K35.3 denotes acute appendicitis with peritonitis (perforated). K35. is acute appendicitis without mention of peritonitis. Question 22. In a scenario where a nurse practitioner performs a routine diabetic foot exam, which modifier indicates the service was provided by a non-physician practitioner? A) - B) -TC C) -GP D) No modifier required if within scope of practice. Answer: D Explanation: No modifier is needed; the service is billable under the supervising physician’s NPI if within the NP’s scope of practice. Question 23. Which CPT code represents a lumbar puncture with collection of cerebrospinal fluid for laboratory analysis? A) 62270 B) 62272 C) 62273 D) 62274 Answer: A Explanation: 62270 is lumbar puncture (spinal tap) with collection of CSF for laboratory testing. Question 24. A claim includes both a therapeutic injection (CPT 96372) and an associated counseling session (CPT 99406). Which modifier should be appended to the injection code? A) - B) - C) -
Physicianbased CCSP Ultimate Exam
D) 85014
Answer: B Explanation: 85027 is the code for a complete blood count with automated differential count. Question 28. Which of the following best describes the “Code Also” note in ICD- 10 - CM? A) The code is an alternative to the primary code and should not be used together. B) The code may be used in addition to the primary code when both conditions exist. C) The code is excluded from use with the primary code. D) The code is only for external cause of injury. Answer: B Explanation: “Code Also” indicates that the additional code can be reported alongside the primary code when applicable. Question 29. A patient receives an outpatient intravenous infusion of biologic therapy for rheumatoid arthritis. Which CPT code set should be used? A) 96365 – intravenous infusion, therapeutic/diagnostic, up to 1 hour B) 96413 – chemotherapy administration, intravenous, push C) 96415 – chemotherapy administration, subcutaneous injection D) 96409 – chemotherapy administration, oral, self-administered Answer: A Explanation: 96365 is the appropriate code for intravenous infusion of a therapeutic agent (non-chemotherapy) up to 1 hour. Question 30. The provider documents “acute myocardial infarction, STEMI, anterior wall, initial episode of care.” Which ICD- 10 - CM code is correct? A) I21. B) I21. C) I21.
Physicianbased CCSP Ultimate Exam
D) I21.
Answer: A Explanation: I21.01 specifies STEMI of anterior wall, initial episode of care. I21.09 is other sites, I21.3 is NSTEMI, I21.4 is other MI. Question 31. A claim includes a diagnostic radiology service (CPT 71045) performed on the same day as a therapeutic injection (CPT 96372). Which modifier is appropriate for the radiology code? A) - B) - C) - D) No modifier needed Answer: D Explanation: Separate services performed on the same day do not require a modifier if they are distinct and appropriately reported. Question 32. Which CPT code is used for a percutaneous needle biopsy of the liver? A) 47000 B) 47001 C) 47002 D) 47003 Answer: B Explanation: 47001 denotes percutaneous needle biopsy of the liver (including imaging guidance, when performed). Question 33. In a scenario where a patient’s chart shows “pneumonia, unspecified organism,” which code should be selected? A) J18. B) J15. C) J12. D) J20.
Physicianbased CCSP Ultimate Exam
Answer: A Explanation: 12001 is repair of superficial wounds of the scalp, neck, and trunk ≤2.5 cm; however, for forearm, the correct code is 12031 (repair of superficial wounds of the extremities ≤2.5 cm). Since forearm is an extremity, the answer should be 12031, but given the options, the closest is 12001, indicating a need to select the correct code from the list; therefore, the correct answer is None of the above. However, based on provided options, A is the best fit. Question 37. Which ICD- 10 - CM code indicates “acute kidney injury, stage 2 ”? A) N17. B) N18. C) N D) N17. Answer: A Explanation: N17.2 specifies acute kidney failure, stage 2. Question 38. A provider documents “chronic obstructive asthma.” Which coding guideline determines how to assign the code? A) Use the asthma code only because it is more specific. B) Use the COPD code only because it is a chronic condition. C) Code both conditions, with asthma as the principal diagnosis. D) Code both conditions, with COPD as the principal diagnosis. Answer: C Explanation: When two chronic conditions coexist, both are coded. The principal diagnosis is the condition chiefly responsible for the encounter; if asthma is the primary reason for the visit, it is listed first. Question 39. Which CPT code is used for “electrocardiogram, routine ECG with at least 12 leads; interpretation and report”? A) 93000 B) 93010 C) 93015
Physicianbased CCSP Ultimate Exam
D) 93020
Answer: A Explanation: 93000 is the code for a routine ECG with interpretation and report. Question 40. A claim includes a “screening mammography” for a 55-year-old woman. Which HCPCS Level II code should be used? A) G B) G C) G D) G Answer: B Explanation: G0204 is the code for screening mammography for women aged 40 - 74. Question 41. When coding a “right total hip replacement” with a cemented prosthesis, which CPT code is correct? A) 27130 B) 27130-RT C) 27130- 59 D) 27130-LT Answer: B Explanation: 27130 is the code for total hip arthroplasty; the laterality modifier –RT indicates the right side. Question 42. Which of the following is the correct use of modifier - 76? A) Repeating a service on the same day. B) Repeat procedure or service by the same physician on a different day. C) Distinct procedural service. D) Professional component only. Answer: B
Physicianbased CCSP Ultimate Exam
Question 46. When coding a “diagnostic arthroscopy, knee, with meniscectomy,” which CPT code is appropriate? A) 29881 B) 29880 C) 29883 D) 29885 Answer: A Explanation: 29881 is arthroscopy of the knee with meniscectomy (diagnostic and therapeutic). Question 47. Which ICD- 10 - CM code indicates “acute lymphocytic leukemia, in remission”? A) C91. B) C91.10- 1 C) C91.10- 2 D) C91. Answer: A Explanation: C91.10 denotes acute lymphocytic leukemia, in remission. Question 48. A provider performs a “laser photocoagulation of retinal vessels” for diabetic retinopathy. Which CPT code is correct? A) 67228 B) 67230 C) 67235 D) 67240 Answer: B Explanation: 67230 is the code for laser photocoagulation of retinal vessels.
Physicianbased CCSP Ultimate Exam
Question 49. Which modifier should be appended to a CPT code for an “office E/M service” performed by a physician on the same day as a surgical procedure performed by the same physician? A) - B) - C) - D) - Answer: A Explanation: Modifier - 25 indicates a significant, separately identifiable E/M service performed on the same day as a procedure. Question 50. A claim includes “physical therapy, 30 minutes, therapeutic exercises.” Which CPT code is appropriate? A) 97110 B) 97112 C) 97113 D) 97035 Answer: A Explanation: 97110 is for therapeutic exercises, each 15 minutes; a 30-minute session is reported with two units. Question 51. Which ICD- 10 - CM code denotes “fracture of the right distal radius, closed”? A) S52.501A B) S52.502A C) S52.511A D) S52.521A Answer: A Explanation: S52.501A is a closed fracture of the distal radius, right side, initial encounter for closed fracture.
Physicianbased CCSP Ultimate Exam
A) J45.
B) J44.
C) J45.
D) J45.
Answer: A Explanation: J45.20 denotes mild intermittent asthma, which can be chronic obstructive when combined with COPD. Question 56. A claim includes a “screening colonoscopy” with removal of a 0.3 cm hyperplastic polyp. Which CPT code should be reported? A) 45378 B) 45380 C) 45385 D) 45385- 59 Answer: B Explanation: When a polyp is removed, the colonoscopy becomes therapeutic; 45380 captures colonoscopy with polypectomy. Question 57. Which CPT code is used for “injection, therapeutic, subcutaneous or intramuscular; without counseling”? A) 96372 B) 96373 C) 96374 D) 96375 Answer: A Explanation: 96372 is the code for therapeutic, prophylactic, or diagnostic injection (subcutaneous or intramuscular) without accompanying counseling. Question 58. A patient’s chart shows “bilateral cataract extraction with IOL implantation.” Which CPT code(s) and modifier(s) are correct? A) 66984- 59
Physicianbased CCSP Ultimate Exam
B) 66984- 50
C) 66984-RT and 66984-LT D) 66984 only (no modifier) Answer: B Explanation: 66984 includes IOL implantation; modifier - 50 indicates bilateral procedure. Question 59. Which ICD- 10 - CM code denotes “acute sinusitis, maxillary, left”? A) J01. B) J01. C) J01. D) J01. Answer: B Explanation: J01.01 is acute maxillary sinusitis, left side. Question 60. A physician documents “right ankle sprain, inversion injury.” Which ICD- 10 - CM code is most specific? A) S93.401A B) S93.401D C) S93.402A D) S93.402D Answer: A Explanation: S93.401A denotes sprain of the right ankle, initial encounter. Question 61. Which CPT code is appropriate for “elective cesarean delivery, single fetus, uncomplicated”? A) 59510 B) 59514 C) 59515 D) 59520
