CPC Certified Professional Coder (CPC) Exam Questions and Answers

The procedure performed is a bilateral screening mammogram with computer-aided detection (CAD). CPT code 77067 is for bilateral screening mammography with CAD. ICD-10-CM code Z12.31 is for an encounter for screening mammogram for malignant neoplasm of the breast. Z80.3 is for a family history of malignant neoplasm of the breast. Therefore, the correct coding is 77067, Z12.31, Z80.3. References: CPT® Professional Edition (current year), ICD-10-CM (current year).

The patient is undergoing a cardiac catheterization with a CRNA providing monitored anesthesia care (MAC). Code 00520 is for anesthesia for heart catheterization procedures. Modifier QX indicates CRNA service with medical direction by a physician, QS indicates MAC, and P5 indicates a patient with a severe systemic disease that is a constant threat to life. Thus, the correct code and modifier combination is 00520-QX-QS-P5.References: CPT® Professional Edition (current year), AMA.

For drug testing for cocaine and methamphetamines with a single analysis using direct optical observation and a subsequent confirmation for cocaine, the appropriate codes are:

80305 for the initial drug test (presumptive).

80353 for the confirmation test of cocaine.

References:

AMA's CPT® Professional Edition (current year)

The procedure involves the aspiration of fluid from an ovarian follicle to retrieve the egg under radiologic guidance.

Procedure Description:

Aspiration needle insertion.

Puncture of the ovary and preovulatory follicle.

Withdrawal of fluid containing the egg.

Radiologic guidance was used.

CPT® Coding:

58976: Aspiration of ovarian follicle(s) with ultrasound guidance.

References:

AMA's CPT® Professional Edition (current year).

CPT® Assistant for detailed coding guidelines on reproductive procedures.

The Office of Inspector General (OIG) provides compliance program guidance to form the basis of a voluntary compliance program for provider practices. This guidance is intended to help healthcare providers develop effective internal controls to monitor adherence to applicable statutes, regulations, and program requirements of Federal healthcare programs. The OIG issues various compliance guidelines and resources to assist organizations in establishing comprehensive compliance programs to prevent fraud, waste, and abuse.References: OIG Compliance Program Guidance, AMA's CPT® Professional Edition, and healthcare compliance resources.

For a procedure involving the placement of a 6-French sheath and catheter into the coronary artery, advancing to the left ventricle, performing ventriculography with power injection of contrast agent, obtaining pressures in the left heart, and imaging the coronary arteries, the correct CPT® code is 93458. This code includes all the components of the described procedure.

References:

AMA's CPT® Professional Edition (current year)

The scenario describes an emergency basic life support (BLS) ambulance service. The appropriate HCPCS Level II code for BLS emergency transport is A0429.

Modifier QN indicates that the service was provided by an ambulance supplier, and SH indicates the services were provided in an emergency situation.

References:

HCPCS Level II, current year

The patient presented for a follow-up visit for chronic conditions, including hypokalemia, hypertension, and esophageal reflux. During this visit, the physician reviewed and discussed lab results, managed prescriptions, and noted that there were no new symptoms or complaints.

The level of service provided included an appropriate history and exam, as well as the management of multiple chronic conditions, which aligns with the criteria for CPT® code 99214. This code is used for an established patient office or other outpatient visit that requires at least 2 of the following 3 key components: a detailed history, a detailed examination, and medical decision-making of moderate complexity.

References:

CPT® Professional Edition, AMA

Evaluation and Management Coding Guidelines

The code 99471 is used for initial inpatient neonatal critical care, per day, for the evaluation and management of a critically ill infant or young child. Given the scenario where a 4-year-old critically ill child is admitted to the PICU and requires intensive care management, this code is appropriate as it reflects the critical care provided beyond the emergency department services. References: CPT® Professional Edition (current year), AMA.

Procedure: Hepatitis B vaccine administration for a Medicare patient on dialysis.

CPT® and HCPCS Codes:

G0010: Administration of Hepatitis B vaccine.

90740: Hepatitis B vaccine, dialysis or immunosuppressed patient dosage, 3-dose schedule.

ICD-10-CM Codes:

Z23: Encounter for immunization.

N18.6: End-stage renal disease.

Z99.2: Dependence on renal dialysis.

Code Selection Justification: G0010 is used for the administration of the vaccine for Medicare patients, and 90740 captures the specific vaccine for dialysis patients. The ICD-10 codes represent the encounter for vaccination and the patient's dialysis status.

References:

AMA CPT® Professional Edition (current year)

ICD-10-CM (current year)

HCPCS Level II (current year)

The outermost protective layer of the skin is called the epidermis. It serves as a barrier to protect the body against environmental elements, pathogens, and helps to retain moisture. The epidermis itself is composed of several sub-layers, with the stratum corneum being the outermost layer.References: ICD-10-CM (current year), Chapter 12: Diseases of the Skin and Subcutaneous Tissue (L00-L99).

The CPT code 31625 is used for bronchoscopy with a transbronchial lung biopsy. This includes the use of fluoroscopic guidance, as described in the scenario.

References:

AMA's CPT® Professional Edition (current year)

For this scenario, two surgeons are working together, each as a primary surgeon. Therefore, the correct coding requires the use of the modifier -62, which indicates co-surgeons.

The transthoracic approach to excise the damaged portion of the vertebral body is coded with 63087.

The insertion of the bone graft and metal plate is coded with 63088.

Both codes are appended with modifier -62 to indicate that two surgeons worked together as primary surgeons on this case.

References:

AMA's CPT® Professional Edition (current year)

ICD-10-CM (current year)

HCPCS Level II (current year)

Warthin's tumor, also known as papillary cystadenoma lymphomatosum, is a benign tumor of the salivary glands, most commonly affecting the parotid gland. It typically presents as a painless, slow-growing mass near the angle of the jaw.References: ICD-10-CM, medical dictionaries, and oncology textbooks

The procedure involved the placement of an intra-aortic balloon pump (IABP) through the right common femoral artery for a patient with acute MI and severe left main arteriosclerotic coronary artery disease.

Procedure Description:

Placement of an intra-aortic balloon pump (IABP).

Right common femoral artery approach.

Confirmation of good waveform and securement of the catheter.

CPT® Coding:

33975: Insertion of intra-aortic balloon assist device, percutaneous.

References:

AMA's CPT® Professional Edition (current year).

CPT® Assistant for detailed coding guidelines on cardiac procedures.

Dacryocystitis is the inflammation of the lacrimal sac, which is part of the tear drainage system located in the inner corner of the eye. The lacrimal sac is connected to the nasolacrimal duct, which drains tears into the nasal cavity. Inflammation in this area can cause pain, redness, and swelling near the inner corner of the eye.References: ICD-10-CM, medical dictionaries

The human shoulder is composed of three main bones: the clavicle (collarbone), scapula (shoulder blade), and humerus (upper arm bone). These bones form the shoulder joint, which is one of the most flexible and mobile joints in the human body, allowing for a wide range of motion.References: AMA's CPT® Professional Edition (current year), Musculoskeletal System section.

The Roux-en-Y anastomosis of the extrahepatic biliary duct to the gastrointestinal tract is a specific surgical procedure that involves connecting the biliary duct to the gastrointestinal tract.

Procedure Description: Roux-en-Y anastomosis of the extrahepatic biliary duct involves creating a direct connection between the biliary duct and the gastrointestinal tract.

Procedure Specificity: The procedure is complex and involves extensive surgical technique and anastomosis.

Coding Decision:

CPT® 47780 specifically describes the Roux-en-Y anastomosis of the extrahepatic biliary duct to the gastrointestinal tract.

References:

AMA's CPT® Professional Edition (current year).

CPT® Assistant for detailed coding guidelines on biliary and gastrointestinal procedures.

Bilateral salpingo-oophorectomy: This involves the removal of both fallopian tubes and ovaries.

Right and left fallopian tubes: Both fallopian tubes are removed.

Left ovary: Only the left ovary is removed.

Abdominal incision: The procedure is performed via an abdominal approach.

58720: Salpingo-oophorectomy, complete or partial, unilateral or bilateral (separate procedure).

The procedure involves the removal of both fallopian tubes and one ovary, making 58720 the appropriate code.

References:

AMA's CPT® Professional Edition (current year)

ICD-10-CM (current year), HCPCS Level II (current year)

For the excision of an 11 cm lesion with a rotation flap repair, the appropriate CPT codes are 14001 for the adjacent tissue transfer or rearrangement (12 sq cm flap) and 11606-51 for the excision of a malignant lesion including margins, face, ears, eyelids, nose, lips; excised diameter over 4.0 cm. Modifier 51 indicates multiple procedures. The detailed operative report specifies the lesion size and the technique used, justifying these codes.References: CPT® Professional Edition (current year), AMA.

For a patient with a mass in the left lower lung suspected to be cancer that is currently documented as a tumor of uncertain behavior, with existing ovarian cancer with metastases to the liver, the ICD-10-CM codes are:

D38.1: Neoplasm of uncertain behavior of bronchus and lung.

C56.9: Malignant neoplasm of unspecified ovary.

C78.7: Secondary malignant neoplasm of liver and intrahepatic bile duct.

D38.1 is used because the behavior of the lung tumor is uncertain, and C56.9 and C78.7 are used to document the known primary and metastatic cancers.

References:

ICD-10-CM guidelines

AMA's CPT® Professional Edition (current year)

CPT® code 49083 describes an abdominal paracentesis with imaging guidance, such as ultrasound. This code includes the imaging guidance as part of the procedure, so it is not necessary to separately report the ultrasonic guidance.

References:

AMA's CPT® Professional Edition (current year), Code 49083

The mediastinum is an anatomical region located in the thoracic cavity. It is bounded by the sternum in front, the vertebral column at the back, and is situated between the lungs. It contains the heart, trachea, esophagus, thymus, and other structures, but it is not itself an organ. Therefore, the correct answer is that it is a location in the chest.References: ICD-10-CM, Medical Anatomy and Physiology textbooks

The procedure involves eustachian tube inflation to remove serous mucoid fluid in the right ear of a 2-year-old patient with chronic otitis media.

Procedure Description:

Eustachian tube inflation to remove fluid.

General anesthesia.

Incision to the tympanum and suctioning of thick mucoid fluid.

CPT® Coding:

69421-RT: Eustachian tube inflation, transnasal or transoral; with catheterization, including general anesthesia. The modifier -RT indicates the right ear.

References:

AMA's CPT® Professional Edition (current year).

CPT® Assistant for detailed coding guidelines on eustachian tube procedures.

The procedure involves a laparoscopic partial colectomy where the surgeon removes the proximal colon and terminal ileum, then reconnects the cut ends of the distal ileum and remaining colon.

Procedure Description:

Laparoscopic partial colectomy.

Removal of the proximal colon and terminal ileum.

Anastomosis of the distal ileum and remaining colon.

CPT® Coding:

44204: Laparoscopy, surgical; colectomy, partial, with anastomosis.

ICD-10-CM Coding:

C18.2: Malignant neoplasm of ascending colon.

References:

AMA's CPT® Professional Edition (current year).

ICD-10-CM for corresponding diagnosis codes.

Procedure: Albumin Cobalt Binding (ACB) test to determine ischemic nature of chest pain.

CPT® Code:

83857: This code is used for the Albumin Cobalt Binding test.

Code Selection Justification: The ACB test specifically measures ischemia-modified albumin, making 83857 the appropriate code for this laboratory test.

References:

AMA CPT® Professional Edition (current year)

ICD-10-CM (current year)

HCPCS Level II (current year)

The injection into the trochanteric bursa under ultrasonic guidance is coded with CPT® 20611, which describes an injection of a major joint or bursa with ultrasound guidance. The modifier -LT indicates the procedure was performed on the left side.

References:

AMA's CPT® Professional Edition (current year), Code 20611