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CPC Exam Prep
Abnormal chest x-ray Z00. R90. R91. Z00.01 - R91. Since the chest x-ray was only stated as "abnormal," a code for nonspecific abnormal findings of lung field, code R91. A patient with severe mental retardation and cerumen impactions in both ears was unable to be cleared in the office. Using surgical instrumentation, the canal was cleared of impacted cerumen bilaterally. 69200 69210 69210- 69205-50 - 69210- Assign code 69210-50 for bilateral removal of impacted cerumen. Cerumen was cleared with surgical instrumentation and, therefore, was assigned code 69210. The remaining selections are for removal of a foreign body of the external ear and, therefore, not appropriate. Gastroscope was introduced through the mouth and passed into the stomach, through the pylorus and into the second portion of the duodenum. Just inferior to the Z-line, a small polyp was identified and cold biopsied. Rectal exam was performed, and colonoscope was advanced to the cecum. Multiple sessile polyps were removed utilizing snare and cauterized. There were two other tiny polyps that were ablated due to their size.
A total of three (3) procedures were performed, therefore, three (3) CPT codes would be assigned. Both colonoscopy and esophagogastroduodenoscopy (EGD) were performed. The colonoscopy involved fulgurating polyps (45388) and polypectomy by snare (45385-51). The cauterization of the snared polypectomy is not separately reportable to control bleeding created by the excision. An EGD was also performed with biopsy, which would be assigned 43239. The remaining selections did not include the fulguration of polyps and, therefore, would not be correct. A 67-year-old patient with known CAD and a history of MI was admitted for CABG. A portion of the right radial vein was procured for bypass grafting, and then proceeded to perform two coronary venous bypass grafts. 33511, 35500 33511 33510, 33534 33510, 35500 - 33511, 35500 Assign one code for the vein grafting, 2 vessels (code 33511), as well as a code for harvesting the radial vein (code 35500). Surgical pathology submitted to the pathologist is as follows: three surgical specimens taken from a liver biopsy. 88305 × 3 88305 88307 × 3 88307 -
Anesthesia coding and billing always require the following elements: CPT code, physical status modifier, and time units CPT code and modifier code CPT code, physical status modifier, and qualifying circumstance CPT Code - CPT code, physical status modifier, and time units A CPT code, physical status modifier, and time will always be reported. Office visit for follow-up for stable diabetes mellitus. Patient has multiple medical problems; however, all appear stable at this time. No complaints of diplopia, excessive thirst. She has been symptom-free except for some lower back pain in the past few weeks. Exam completed for back, heart, and lungs. Glucose level normal. Assessment: diabetes type II stable. MDM was documented as low. 99203 99214 99213 99202 - 99213 For an established patient, only 99213 and 99214 would be correct. Since the MDM was stated as low, CPT code 99213 would be correct in this instance. Diagnostic cystourethroscopy is performed, which reveals 2 cm ureter stone. 52310
Only diagnostic cystourethroscopy was performed, therefore, 52000 would be assigned. Surgical pathology, oophorectomy, non-neoplastic 88300 88305 88307 88304 - 88305 Surgical pathology for oophorectomy is assigned code 88305 per surgical pathology examples in CPT. The coder should refer to the Surgical Pathology code listing for each level to determine the most appropriate level for the specific specimen. Ovary with or without tube(s) is listed under CPT code
A 45-year-old man presents with severe neck pain. The physician examines the patient and makes the diagnosis of cervical nerve impingement and injects an anesthetic agent into the cervical plexus using three injections. 64999 64413 × 3 64405 64400 × 3 - 64999 Injection into the cervical plexus is assigned code 64999 as the three injections are considered one procedure. In addition, an unlisted procedure is assigned only once to describe the complete procedure. The remaining selections are for nerve injections as well, however, to the occipital nerve
31628 x 2, 31632 x 31628, 31632 - 31628, 31632 Transbronchial biopsies are assigned codes based on each lobe; therefore, 31628 should be assigned for the first lobe and 31632 for the additional lobe. The remaining selections also contain codes for transbronchial biopsies; however, they do not represent the number of lobes involved (CPT code 31628, 32628 × 2, 32632 × 2) or represent biopsies not performed transbronchially (CPT code 31625) and, therefore, would not be appropriate. Excision of lipoma, shoulder, extending into the deep subcutaneous tissue 23075 23076 11600 11400 - 23075 Code found under Excision, Shoulder, Tumor Soft Tissue, Subcutaneous Tissue, less than 3 cm. As the lesion was specified as a lipoma extending into the deep subcutaneous, the code selection would be from the musculoskeletal section of CPT. Therefore, codes from the integumentary section (11400, 11600) would not be appropriate. CPT code 23076 would be for excision of a lesion of the shoulder, however, extending into the subfascial layer rather than the subcutaneous. A patient with Paget's disease of the bone receives an intravenous infusion of Aredia that begins at 12:29 p.m. and ends at 4:11 p.m. Code this drug administration service. 96365 × 2 96365, 96366 × 3 96365, 96366, 96366, 96366 96365 - 96365, 96366 × 3
Assigned code 96365 for the first hour, and 96366 for three additional hours of IV infusion. CPT code 96365 would be assigned for initial hour of infusion, from 12:29 to 1:29. Subsequent hours of infusion are assigned for each additional hour, therefore, 1:29-2:29 would be one additional hour, 2:29-3:29 would be the second additional hour, and 3:29-4:11 (at least one half of the hour must be met) would be assigned for the third additional hour. Since the code is specified as "each" additional hour, it would be assigned in units. Anesthesia services for emergency C-section on a 29-year-old normally healthy female with eclampsia 01961-P1, 99140 01961-P 01960-P1, 99140 01960-P1 - 01961-P1, 99140 Anesthesia code 01961 is for Cesarean delivery, and physical status modifier is P1 (normally healthy female documented), with qualifying circumstance code 99140 as stated as emergency. Since the delivery was performed by C-section, CPT anesthesia code 01960 for vaginal delivery would not be correct. Since the procedure requires a physical status modifier -P1 should be appended as well as the qualifying circumstance 99140, for code 01961-P1, 99140. Which of the following is NOT a part of the computer planning service for intensity-modulated radiation therapy (IMRT)? Inverse treatment planning Creating highly conformal radiation dose distribution Verification of treatment setup and interpretation of verification methodology Verification of positional accuracy - Creating highly conformal radiation dose distribution
63050 × 4
MRI chest 71550 71551 71552 71555 - 71550 MRI chest is assigned 71550 without contrast as it was not stated otherwise. All of the selections are for MRI imaging, however, with contrast (CPT code 71551), with and without contrast (CPT 71552), while CPT code 71555 is for an MRA of the chest. Tachycardia refers to irregular heartbeat. rapid heartbeat. slow heartbeat. sick sinus syndrome. - rapid heartbeat. Rhythm ECG, 1-3 leads, interpretation and report only
Code 93042 should be assigned for Rhythm ECG, when interpretation and report only is performed. Application of knee immobilizer, left 29345-LT 29505-LT 29345 29505 - 29505-LT No fracture repair; only application of long leg splint. Code 29505-LT. The remaining choices are for casts (29345-LT, 29345) instead of splints. CPT code 29505 requires modifier -LT to indicate the splint was applied to the left leg, therefore, the selection without the modifier would not be the most correct answer. Anesthesia time is assigned in the days/units column in increments of 10 minutes. minutes. 15 minutes. 10 or 15 minutes depending on carrier. - 10 or 15 minutes depending on carrier Time is assigned based on 10- or 15-minute increments depending on the carrier. Which code(s) would be utilized for a critically ill 20-day-old patient initial care?
Bilateral endoscopic maxillary antrostomies were performed (31267-50) as well as bilateral ethmoidectomies (31254-50), which would also need modifier -51 appended for multiple surgical procedures. Only the correct selection has the appropriate modifier assignments and correct sequencing. X-rays taken and interpreted, bilateral standing knees, AP 73560-RT, 73560-LT 73560, 73560- 73565 73560 - 73565 CPT code 73565 is assigned for bilateral standing needs; therefore, there is no need to assign modifier -50. CPT code 73560 is for 1-2 views of the knee and does not encompass X-rays performed bilaterally and including standing views. Cystoscopy was introduced into the bladder. Tumor measuring 2 cm was located on the bladder. Using cutting current, this was resected and particles removed through the evacuator. Tumor measuring 1 cm was located on the bladder base, which was also resected along with a third tumor, 2 cm, located on the upper portion of the bladder. 52235, 52234- 52235 52235, 52235-59, 52235- 52235 x3 - 52235 CPT coding guidelines per CPT Assistant indicate the largest lesion only should be assigned, therefore, 52235 should be assigned for the 2.0 cm lesion removed cystourethroscopically.
Left heart catheterization with left ventriculogram and right coronary vessels to perform PTCA right coronary and left circumflex. Intracoronary stent right coronary ×2, left circumflex ×1, left descending vessel × 92928-RC, 92929-LC, 92929-LD 93458, 92920-LC, 92921-RC, 92928-RC, 92929-LC, 92929-LC 92928-RC, 92929-LC, 92929-LD, 92921-RC, 92921-LC 93458, 92928-RC, 92929-LC, 92929-LC - 92928-RC, 92929-LC, 92929-LD As the left heart catheterization is the "approach" by which the interventional procedures are performed, it would not be codeable. Therefore, 92928 is assigned for right coronary (only one per vessel), 92929-LC for left circumflex, and 92929-LD for left descending. Codes for interventions are assigned only once per vessel. Since three (3) vessels were treated, a total of three (3) codes only would be appropriate. Percutaneous liver biopsy. The upper right abdomen was prepped and 18-gauge coaxial needle was inserted into the right lobe of the liver. Needle tip was placed within one of the lesions and core biopsies × 3 were obtained. 47010 47000 47100 47000 X3 - 47000 When percutaneous liver biopsies are performed by needle, code 47000 is assigned. This code is assigned only once regardless of the number of biopsies/specimens obtained. None of the remaining selections are for percutaneous liver biopsy and, therefore, are not appropriate. CPT code 47000 is assigned only once without regard to the number of biopsies that are obtained percutaneously. Treatment of molluscum contagiosum by cryotherapy. Patient was given light sedation and the two lesions were exposed. Curettage was attempted, but the lesions were not easily removed; therefore, cryotherapy was used to treat each of the lesions through two freeze/thaw cycles.
Since both repairs/closures are of simple complexity (as not stated otherwise) and in the same anatomical grouping (both on the hand), the two (2) repairs would be summed together (2.5 cm + 0.5 cm = 3.0 cm) and assigned 12002 for simple repair, hand, 2.6-7.5 cm. The remaining choices are the wrong anatomical grouping that does not include the hand, the wrong size (CPT 12001 is for 2.5 < cm), or the wrong complexity (12031 is an intermediate repair) and are, therefore, incorrect. Liver biopsy due to elevated liver enzymes. The area of biopsy site was chosen and a small nick was made on the skin and advanced to the liver capsule. Patient was told to hold her breath, biopsy gun was inserted into the liver, and the obtained biopsy was sent to pathology. 47010 47000 47399 47100 - 47399 Biopsies were not obtained by needle or wedge and, since there are no other codes for liver biopsies, would assign unlisted liver, 47399. Ulcer at the second MPJ was circumscribed and removed in toto. An Apligraft skin graft was prepared, cut, and sutured into place. 15240 15156 15150 15275 - 15275 An Apligraf skin graft was applied, which codes to a skin substitute graft. Since the size was not specified, CPT code 15275 for skin substitute graft, 25 sq cm or less, hands, digits, would be assigned. CPT code 15240 represents a full thickness skin graft; however, the scenario specifies that an Apligraf skin substitute was utilized. CPT code 15156 is an "add-on" code and may not be assigned without the parent/primary code and, therefore, is incorrect. CPT code 15150 is for an autograft (skin derived from one's self), while the scenario specifies that a skin substitute was utilized.
Established patient presents for 3-year-old annual exam. Comprehensive history and exam and moderate MDM were performed based on CPT guidelines. Appropriate anticipatory guidance was provided during the encounter. Assign the appropriate E/M code(s) and modifier(s). 99212 99382 99392 99214 - 99392 Since the patient is established, a preventive medicine E/M exam for a three-year-old would be assigned the code 99392. The use of office/outpatient visit codes would be inappropriate as the services were preventive, and, therefore, a code from the preventive medicine codes should be assigned. Therefore, 99212 and 99214 are both incorrect. Code 99382 would be incorrect as it is for a new patient, whereas, the patient was established. CT-guided lung biopsy. An appropriate area was cleansed and an 18-gauge spring-loaded needle was inserted into a 6 × 5 cm mass in the right base. Three cores of tissue were removed into the biopsy needle. 32408 32097 32400 39000 - 32408 When a lung biopsy is performed via needle, code 32408 would be assigned. None of the remaining selections are for lung biopsy. CPT code 32400 would be assigned for a biopsy of the pleura, performed percutaneously, but not the lung. The remaining procedures, CPT 32097 and 39000 are not for biopsy procedure. Renal ultrasound. Small area of echogenicity with shadowing in the midleft kidney that could represent a small calculus. Exam of right kidney is negative. Urinary bladder is not visualized. 76776
Abdomen, vulva, and vagina were prepped and the cervix was visualized extending outside the vagina. Anterior incision was made 2 cm from cervix. The denuded strip was approximately 2-3 cm in width. The denuded strip was grasped with the clamp, and posterior incision made. Procedure was completed by suturing the anterior vaginal mucosa to the posterior vaginal mucosa and then successive suturing to elevate the uterus and anterior bladder wall. 57100 57110 57120 57130 - 57120 The suturing of the vagina is performed with strips to correct prolapsed vagina. Assign code 57120. Digital rectal examination was performed and no masses were palpable. Scope was introduced to the cecum. The scope was withdrawn, and there were several areas of liquid stools at various stages. In the sigmoid region, there were two polyps adjacent to each other, both less than 5 mm, which were hot biopsied and sent to pathology. 45380, 48384- 45380 45384 45384 x2 - 45380 Modifier -26 indicates May be used in all sections of CPT Radiology codes for supervision/interpretation Supervision and interpretation only was performed for the service described in the CPT code description.
Only utilized in E/M section - Supervision and interpretation only was performed for the service described in the CPT code description. Modifier -26 is assigned for interpretation and supervision. It is not specific to radiology, although perhaps used more frequently in that section. Migraine headache with aura G43. G43. G43. G43.1 - G43. Only one (1) of the choices is for migraine headache, with aura, ICD-10 code G43.109. G43.909 is migraine without status migrainous, however, does not include with aura. G43.10 requires an additional digit in order to be complete. G43.1 also requires additional digits to be a valid ICD- code. Level II surgical pathology codes are utilized for specimens that are not removed for suspected malignant, but other reasons. True False - True Level II surgical pathology is intended for surgical specimens that are not suspected of malignancy per guidelines in the CPT Surgical Pathology section. Injection, ceftazidime, 750 mg
