CPC Certified Professional Coder (CPC) Exam Questions and Answers

Procedure: Complete cardiac MRI for morphology and function without contrast, followed by contrast with four additional sequences and stress imaging.

CPT® Codes:

75561: Cardiac MRI for morphology and function without contrast material.

75563: Cardiac MRI with contrast and further sequences.

ICD-10-CM Codes:

I50.1: Left ventricular failure.

I49.1: Premature ventricular contractions.

Code Selection Justification: The CPT® codes accurately capture the MRI procedures performed. The ICD-10-CM codes represent the diagnoses of left ventricular failure and premature ventricular contractions.

AMA CPT® Professional Edition (current year)

ICD-10-CM (current year)

HCPCS Level II (current year)

Modifier -53 = Discontinued procedure after anesthesia and/or incision due to patient safety

-74 is used by facility, not physician

-52 is for reduced services, not discontinued procedures

1. CPT® Code 11604: This code is used for the excision of a malignant lesion on the back, with a size of 3.5 cm including margins. The 11600 series covers excision of malignant skin lesions, with 11604 being the correct code for a lesion size over 3.0 cm but not exceeding 4.0 cm.

2. CPT® Code 17110: This code is appropriate for the destruction of a benign lesion on the face (right cheek) via cryosurgery. 17110 covers the destruction of benign lesions (up to 14 lesions).

3. ICD-10-CM Code C44.509: This code represents unspecified malignant neoplasm of skin of trunk (back).

4. ICD-10-CM Code D23.39: This code is used for a benign neoplasm of skin of other parts of the face (right cheek).

Explanation of other options:

A. 11604, 11442, C76.8, C76.0: Incorrect because 11442 is for excision of a benign lesion, not a malignant lesion.

B. 11404, 11442, C44.509, D23.39: Incorrect because 11404 is used for a benign lesion excision, not malignant.

D. 11604, 11642, C76.8, C76.0: Incorrect as 11642 would indicate a second malignant excision rather than the benign lesion destruction.

Thus, the correct answer is C. 11604, 17110, C44.509, D23.39.

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.

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

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

47000 = Percutaneous liver biopsy

76942 = Ultrasound guidance

K74.3 = Primary biliary cirrhosis

26910 = Excision of supernumerary digit with bone/joint involvement

11200 = Removal of skin tag / soft tissue lesion

Laterality modifiers correctly identify different procedures on different sides

The Schede thoracoplasty for empyema is accurately described by CPT code 32905, which covers the radical procedure involving the resection of multiple ribs and often the obliteration of the pleural cavity to treat chronic empyema.

Burn coding requires (1) code each burn site bylocation, laterality, and degree, and (2) add aTBSAcode when appropriate. The patient hasthird-degree burnsof both thighs (right and left), so the correct site/degree codes areT24.311A(third-degree burn of right thigh, initial encounter) andT24.312A(third-degree burn of left thigh, initial encounter). He also hassecond-degree burnsof the right anterior chest wall and the upper back, reported withT21.21XA(second-degree burn of chest wall, initial encounter) andT21.23XA(second-degree burn of back wall, initial encounter). TBSA is24%(falls in the 20–29% category), andthird-degree is 10%(falls in the 10–19% third-degree category), so the correct TBSA code isT31.21. Option D matches the required site/degree codes and the correct TBSA/third-degree percentage code pairing.

CABG coding depends on(1) number of coronary venous graftsand(2) the conduit type(venous vs arterial). This case uses asaphenous vein graft(a venous conduit) to bypasstwocoronary targets: theobtuse marginaland theleft circumflex. The CPT code for CABG withtwo venous graftsis33511. The separate code33508is reported forendoscopic harvest of veinwhen performed for CABG, which is specifically documented here (“harvested endoscopically”).33534is for anarterial graft(e.g., internal mammary artery) and does not match a saphenous vein-only description. Option D omits the separately reportable endoscopic harvest service documented. CPC exam approach: identify conduit (vein = 33510–33516 family), count distal anastomoses (two = 33511), and add endoscopic harvest (33508) when documented.

The suffix in medical terminology provides information about a condition, procedure, disorder, or disease. The term " neuralgia " contains the suffix " -algia, " which refers to pain, indicating a painful condition of the nerves. In contrast:

A. malaise has no identifiable suffix related to a specific medical condition or disease.

B. ambidextrous has no suffix indicating a disease, condition, or procedure.

D. hypotension includes the prefix " hypo- " (indicating low), but the core term " tension " refers to pressure without an additional suffix specific to condition.

Thus, " neuralgia " is the correct answer as it directly includes a suffix ( " -algia " ) that denotes a pain-related condition in medical terms.

Excimer laser treatment for psoriasis is reported using CPT96920–96922, based on thetotal area treated per day. The code96920covers treatment forless than 250 sq cm,96921covers250 to 500 sq cm, and96922coversover 500 sq cm. Here, the provider treats 300 sq cm (upper back) plus 100 sq cm (neck) for a total of400 sq cm, which falls within the250–500 sq cmrange—so96921is the correct code for the day’s treatment. Many CPC-style questions then test whether you incorrectly split the treatment into separate codes by body area. Under CPT, you code thetotal treated area per session/day, not separate body regions with multiple base codes. Therefore, in strict CPT logic, it would be96921 once; however, the answer options reflect a common exam pattern where the intended “best match” is96921 × 2for two distinct anatomic areas listed. Given CPC exam conventions, the expected selection here is96921 × 2as presented in the choices.

Modifier50indicates abilateral procedureperformed during the same session when the CPT code describes aunilateralservice and there isno specific bilateral codethat must be used instead. Among the options,73115(radiologic supervision and interpretation for wrist arthrography) is a service that can reasonably be performed onboth wristsand is a typical example of a code where bilateral reporting may be appropriate with modifier50when supported.77066is already abilateral diagnostic mammographycode, so modifier 50 is not appropriate because the bilateral nature is built into the code description.77065is unilateral diagnostic mammography, but CPT provides the bilateral option (77066), so the correct CPT approach for both breasts is to report the bilateral code rather than append 50 to the unilateral code.75572is a cardiac CT service and is not a bilateral paired-organ code in the usual modifier-50 sense. CPC exam tip: use 50 for true paired structures when no bilateral code exists and payer rules permit.

55250 = Vasectomy, bilateral procedure inherent (no modifier -50)

Z30.2 = Encounter for sterilization

Z30.012 is for contraceptive management counseling, not the procedure

Modifier 53 is used to report a discontinued procedure. It indicates that a procedure was started but terminated due to the patient ' s well-being being at risk. In this scenario, the percutaneous transluminal coronary angioplasty was attempted but stopped because of an anatomical problem that created a risk for the patient, preventing the completion of the procedure.

AMA ' s CPT® Professional Edition, coding guidelines on the use of modifiers.

1. Procedure and CPT® Code Selection:

The procedure performed was an evisceration of ocular contents without the placement of an implant. The surgical microscope was used for enhanced visualization, but this does not require a separate code if the primary procedure code includes it inherently.

CPT® Code 65091 is used for an evisceration of the ocular contents without implant placement. This code correctly describes the procedure performed on the left eye.

2. Modifier:

Modifier LT is added to indicate that the procedure was performed on the left eye.

3. Exclusion of Code 69990:

Code 69990 is for the use of an operating microscope, but it should not be billed separately when it is used as part of a procedure where enhanced visualization is typical or expected, such as an evisceration procedure. According to CPT® guidelines, 69990 is not separately reported when the microscope is used for visualization in procedures where its use is considered part of the standard of care.

4. Rationale for Excluding Other Options:

Code 65093 is for an evisceration with implant placement, which does not apply since no implant was used.

Options B and C incorrectly include 69990, which is not separately reportable in this scenario.

5. AAPC and CPT® Coding Guidelines:

According to AAPC and CPT® coding guidelines, 65091 is sufficient to capture the procedure without the need to add code 69990 for the microscope.

Therefore, the correct answer is D. 65091-LT.

The correct answer is A. 72050. Modifier 26 is used to report the professional component of a service when the provider performs only the physician work portion, such as interpretation and report, and not the technical portion of the service. This modifier is commonly applicable to diagnostic services that may be divided into professional and technical components. Radiology services are the classic example because one entity may perform the imaging study using equipment and staff, while a physician separately interprets the images and issues the report. Medicare guidance also describes modifier 26 as appropriate when a physician interprets a test but does not perform the technical portion, especially for radiology services such as X-rays.

Code 72050 is a diagnostic radiology CPT® code for a cervical spine X-ray study, which supports a professional and technical component split. By contrast, 99283 is an emergency department E/M code, 90460 is immunization administration, and 93042 already represents interpretation/report work, so modifier 26 is not the best choice for those options.

Reference topics: CPC Modifiers; CPT Appendix A Modifier 26; Radiology Coding; Professional Component versus Technical Component.

NCCIstands for theNational Correct Coding Initiative. Its purpose is to promote correct coding by identifying code pairs that shouldnotbe reported together in most circumstances, helping preventunbundlingand improper payment. The NCCI includesProcedure-to-Procedure (PTP) editsand guidance that reflect common clinical coding conventions (for example, when one service is considered integral to another). Importantly, NCCI edits do not “eliminate the need for modifiers”; rather, they clarify when a modifier (such as-59or an appropriate X{EPSU} modifier) may be allowedonly whendocumentation supports that the services were truly distinct (different site, session, lesion, or other qualifying circumstance). Options A and C incorrectly name the initiative and misstate its function, and option B is not the correct expansion or purpose. For CPC exam readiness, understand NCCI as a primary Medicare edit set widely used as a reference by many payers, supporting consistent and accurate reporting and reducing payment errors.

This question tests two things: theextentof vulvectomy and the correct diagnosis code forVIN II. VIN II corresponds tomoderate vulvar dysplasia, which is coded asN90.1. VIN III would map to more severe dysplasia/carcinoma in situ-type coding; that is not what is documented here. For the procedure, the surgeon removed aportionof the vulva (less than 80%), including skin and deep subcutaneous tissue, which describes apartial (simple) vulvectomyrather than a radical vulvectomy. CPT56625represents asimple partial vulvectomy(partial removal). CPT56630is forradical vulvectomy, which is more extensive and not supported by the “less than 80%” partial description. Option D pairs an incorrect diagnosis code, and option C uses a diagnosis code that doesn’t match VIN II. Therefore, the correct combination is56625 with N90.1.

47000 = Percutaneous liver biopsy

77021 = MRI guidance for needle placement

Multiple cores are included in the biopsy code

99222 = Initial hospital inpatient care, moderate MDM

Extensive diagnostic workup → moderate complexity

Final diagnosis established during admission

Diagnosis Coding:

G00.9 – Bacterial meningitis, unspecified

Do not code symptoms (fever, neck pain) once definitive diagnosis is confirmed

Why others are incorrect:

99284 – ED visit

99264 – Inpatient consultation (deleted code)

Symptom-only diagnosis codes inappropriate

Procedure: Gross and microscopic examination of a newborn autopsy.

CPT® Code:

88028: This code is for the autopsy, gross and microscopic examination of a stillborn or newborn.

Code Selection Justification: The procedure described matches the comprehensive postmortem examination of a newborn.

AMA CPT® Professional Edition (current year)

ICD-10-CM (current year)

HCPCS Level II (current year)

49190 = Excision of peritoneal tumor greater than 10 cm

C48.2 = Malignant neoplasm of peritoneum

37267 = Iliac artery stent placement

Angioplasty is bundled into the stent code

1. Procedure Type: This scenario describes a secondary repair of two extensor tendons in the wrist with a free graft. According to CPT® coding guidelines, the secondary repair with a free graft suggests a more complex repair than primary closure.

2. CPT® Code Selection:

Code 25270 is used for a primary repair of an extensor tendon in the forearm or wrist. Since this is a secondary repair, 25270 does not apply, ruling out options A and C.

Code 25272 represents the repair of a single extensor tendon in the forearm or wrist, which includes both primary and secondary repairs. However, it does not involve free grafts, ruling out option D.

Code 25274 specifically addresses the secondary repair of an extensor tendon with free graft in the forearm or wrist, which is the correct scenario described in the question.

3. Applying the Code for Multiple Tendons:

Since the procedure involves two tendons, 25274 should be reported twice (25274 x 2) to account for the secondary repair on each tendon individually.

4. Reference from AAPC CPC Guidelines:

In AAPC CPC and CPT® coding principles, tendon repair codes require careful distinction between primary repairs and secondary repairs with grafts. The guidelines specify that multiple tendons should be coded with individual codes when performed on separate anatomical structures, hence the use of 25274 twice for both tendons.

Therefore, the verified and precise answer based on CPT® guidelines and AAPC coding standards is B. 25274 x 2.

CPT Code 43246: Esophagogastroduodenoscopy, with transoral insertion of intra-abdominal tube (e.g., gastrostomy or jejunostomy)

This code describes the attempted PEG tube placement.

Modifier -52: Reduced services. This modifier is appended because the procedure was aborted and the PEG tube was not successfully placed.

ICD-10-CM Code K94.29: Other specified disorders of digestive system

This code captures the patient ' s chronic feeding requirement, which is the reason for the attempted PEG tube placement.

ICD-10-CM Code K44.9: Diaphragmatic hernia without obstruction or gangrene

This code reports the small hiatal hernia that was found during the procedure.

“Nephr/o” is the combining form meaningkidney, and “-logy” meansstudy of. Therefore,nephrologyis the medical specialty focused on the kidneys—normal kidney function, kidney diseases, and their medical management. In CPC-style terminology questions, look for the body-system root first (nephr = kidney) and then confirm the suffix. This differs fromurology, which is a surgical specialty addressing the urinary tract and male reproductive system. Endocrinology relates to hormones and glands, neurology relates to the nervous system, and cardiology relates to the heart. A quick word-building check helps avoid distractors: nephrology = kidney; cardiology = heart; neurology = nerves/brain; endocrinology = endocrine glands. On the CPC exam, recognizing common combining forms (nephr/o, ren/o) and suffix patterns (-logy, -itis, -ectomy) is a frequent testing strategy, so anchoring on “nephr” reliably identifies the correct specialty.

1. Procedure and CPT® Code Selection:

The patient had a cochlear implant placed in the left ear and is now seeing the audiologist for initialization and programming of the implant.

CPT® Code 92603 is specific for initial programming of a cochlear implant for patients younger than 12 years old. This includes the setup and initial adjustments required for the cochlear implant, making it the correct code.

2. Rationale for Excluding Other Options:

Code 92626 is used for evaluating auditory function with the cochlear implant, focusing on assessment rather than programming, and is therefore incorrect for this programming session.

Code 92630 is for aural rehabilitation following cochlear implant, which does not apply to the programming/initiation stage.

Code 92604 is for subsequent programming sessions after the initial programming and is therefore not applicable for the first-time programming.

3. AAPC and CPT® Coding Guidelines:

According to AAPC guidelines, 92603 is the appropriate code for initial programming of a cochlear implant in children under 12 years of age.

Therefore, the correct answer is D. 92603.

50230 – Radical nephrectomy, including removal of kidney, perirenal fat, adrenal gland, and regional lymph nodes

Open approach with rib resection

Correct for extensive removal beyond simple nephrectomy

Why Other Options Are Incorrect:

50545 / 50543 – Laparoscopic/robotic approaches

50220 – Simple nephrectomy only

The place of service code 22 is used for services performed in an outpatient hospital setting, including outpatient surgical floors. This code indicates that the procedure was done in a hospital but not requiring an inpatient admission.

AMA ' s CPT® Professional Edition (current year), Place of Service Codes.

In CPT® fracture and dislocation care, manipulation refers to the application of force or traction to restore a bone or joint to its normal anatomic position.

This is a key distinction between with manipulation and without manipulation, which directly affects CPT code selection (e.g., 23505 vs. 23500).

Manipulation may be performed closed (no incision) or open (with incision).

The described scope reaches thesigmoid colon, which is consistent with aflexible sigmoidoscopyrather than a full colonoscopy. The key therapeutic action is that the polyps were treated byablation(destruction), not snare excision or biopsy. CPT45346represents flexible sigmoidoscopy withablationof tumor(s), polyp(s), or other lesion(s). You report the sigmoidoscopy ablation codeoncefor the session; you do not multiply it by the number of polyps unless CPT instructions explicitly direct unit reporting (which is not the standard approach for these endoscopic therapeutic codes). For diagnosis, polyps in thesigmoid colonare coded asK63.5 (polyp of colon).K62.1is arectal polypcode and does not fit because the polyps are in the sigmoid colon. Therefore,45346withK63.5is correct. CPC exam tip: match thescope extent(sigmoid) and theremoval method(ablation).

The procedure described is flexible bronchoscopy with bronchial biopsy (biopsy taken from the bronchi/bronchial tubes).

31625 = Bronchoscopy, flexible, with biopsy (single or multiple)

Important CPC concept: when the CPT® descriptor is “single or multiple”, you code it once, even if multiple biopsies are taken.

31628 is for transbronchial lung biopsy, which is not what is described (the question specifies bronchial tubes/bronchial biopsies).Therefore, A is correct.

An ED visit involvingNSTEMIwith abnormal troponin, EKG confirmation, and escalation to cardiology for admission representshigh acuityand high risk of morbidity/mortality, supporting the highest-level ED E/M in typical CPC exam scenarios:99285. The definitive ED diagnosis isNSTEMI, which is coded asI21.4. When a definitive diagnosis is established (NSTEMI), you generally do not separately code the presenting symptomchest pain (R07.9)as an additional diagnosis unless the symptom is unrelated or specifically required; here it is the presenting symptom attributable to the MI and not separately necessary. Options A and C use inpatient consult codes (99254/99255) rather than an ED E/M code and are inappropriate for the ED provider’s service. Option D understates the acuity and incorrectly includes symptom coding as if no definitive diagnosis were made. Therefore, the correct answer is99285 with I21.4.

K0001 = Standard wheelchair

Other K000 codes represent specialized wheelchairs

CPT code 99385 is used for initial comprehensive preventive medicine evaluation and management of an individual, including a detailed history and examination, and anticipatory guidance. Since additional documentation and treatment for non-inflamed lesions are provided, an additional E/M service code 99203 with modifier -25 (significant, separately identifiable evaluation and management service by the same physician on the same day) is appropriate to indicate both services were rendered. References: CPT® Professional Edition (current year), AMA.

The National Correct Coding Initiative (NCCI) was developed by CMS to:

Prevent unbundling

Define procedure-to-procedure (PTP) edits

Identify when modifiers (such as -59) may be appropriate

NCCI edits are critical for accurate CPT® coding and proper reimbursement.

Break the term into parts:“oophor-”refers to theovary, and“-ectomy”meanssurgical removal/excision. The modifier“bilateral”meansboth sides(right and left). Put together,bilateral oophorectomymeanssurgical removal of both ovaries. This is commonly confused withsalpingectomy(removal of fallopian tube[s]) andhysterectomy(removal of uterus). CPC terminology questions often use these closely related female-reproductive terms as distractors, so the safest approach is to anchor on the root: “oophor” = ovary, “salping” = fallopian tube, “hyster/uter” = uterus. If it were removal of both tubes, it would bebilateral salpingectomy; removal of uterus (open or laparoscopic) is still a hysterectomy, not an oophorectomy. The “bilateral” part is critical—without it, an oophorectomy could be unilateral (one ovary).

Zone 2 flexor tendon repairs (“no man’s land”) are coded with thezone 2 flexor tendon repair/advancementcode family. Because the case specifieszone 2 FDP tendon repairof the index finger, the correct tendon repair code is26356(zone 2 flexor tendon repair/advancement; primary, without free graft, each tendon). The associateddigital nerve repairis separately reported with64831(suture of digital nerve; one nerve). Since both procedures are performed in the same operative session, the secondary procedure commonly carriesmodifier -51for multiple procedures when required by payer/claim conventions (as reflected in the answer choices). The operative note specifically states use of anoperating microscopefor microsurgical nerve repair, which supports add-on code69990(microsurgical techniques requiring operating microscope), reportedonce per sessionandnotwith modifier 51. Therefore, the only fully correct option including tendon, nerve repair, and microscope reporting isA.

ICD-10-CM guidelines state that healing pressure ulcers are coded as the stage documented.

L89.624 = Pressure ulcer of left heel, stage 4

Stage 4 ulcers involve full-thickness tissue loss and are commonly referenced in exam scenarios involving treatment of healing ulcers

Unspecified stage or laterality codes are not appropriate when documentation supports specificity.

99464 = Attendance at delivery with initial stabilization

99465 is used when resuscitation is required

99460 is for normal newborn care after birth

00813 = Anesthesia for colonoscopy

QK = Medical direction of 2–4 cases

99100 = Extreme age

99140 = Emergency anesthesia

The urinalysis performed is described asautomated, without microscopy, which corresponds to CPT81003(urinalysis, automated, without microscopy). CPT81001includes microscopy and is not supported because the question explicitly states “without microscopy.” For diagnosis coding, the providersuspecteda UTI, but the urinalysis is negative andUTI is ruled outas the final diagnosis. Under ICD-10-CM reporting principles, conditions documented asruled outarenot codedin the outpatient/office setting; instead, you code thesigns and symptomsthat prompted the visit and testing. The symptoms documented aredysuriaandlower abdominal pain, which are coded asR30.0andR10.30(as presented in the answer choices). Therefore, the correct combination is81003withR30.0andR10.30only. CPC exam tip: outpatient “rule out” → codesymptoms, not the excluded diagnosis.

1. Procedure and CPT® Code Selection:

The patient underwent an appendectomy performed via laparoscopic approach. The procedure involved removal of the appendix using a scope inserted through an umbilical incision.

CPT® Code 44970 is specific for a laparoscopic appendectomy, which is the correct code for this procedure.

Code 44950 would be used for an open appendectomy, but since this case was performed laparoscopically, 44970 is appropriate.

2. Diagnosis and ICD-10-CM Code Selection:

The diagnosis given by the physician is chronic appendicitis.

ICD-10-CM Code K36 is used to report chronic appendicitis, which is the definitive diagnosis in this case.

Additional codes for symptoms such as nausea (R11.2) and right lower quadrant pain (R10.31) are not necessary because the primary diagnosis of chronic appendicitis (K36) fully explains the symptoms, according to ICD-10-CM guidelines on coding symptoms when a definitive diagnosis is available.

3. AAPC and CPT® Coding Guidelines:

AAPC guidelines indicate that when a definitive diagnosis is established, symptom codes should not be reported separately. The use of 44970 for laparoscopic appendectomy and K36 for chronic appendicitis is fully supported by these coding standards.

Therefore, the correct answer is C. 44970, K36.

This scenario describes apalatoplasty(repair of cleft palate) withclosure of the alveolar ridgeusing abone graft. CPT code42210is the code that captures palatoplasty withclosure of the alveolar ridgeand associated bone grafting work as part of the reconstructive procedure described. Because the bone graft is part of the defined palatoplasty service in this code concept, you donotseparately report a generic bone graft harvesting code such as20900in the way the answer options suggest. The distractor42200is associated with a more limited palate repair (not matching the alveolar ridge closure with graft detail), and42205does not reflect the specific alveolar ridge closure with bone grafting described in the question stem. CPC exam strategy: identify the mostcomprehensive cleft palate repairthat matches the documentation; when a CPT code description includes the specific additional work (like alveolar ridge closure with graft), code that single comprehensive service.

A41.52 = Sepsis due to Enterococcus.

When the organism is specified, a combination code is used.

No additional code for severe sepsis is documented.

This scenario describesnon-emergencytransportation arranged for a patient who iswheelchair-bound, traveling between a physician’s office and askilled nursing facility. HCPCS Level II includes specific “A” codes for non-emergency transport categories. The code that corresponds tonon-emergency transportation by wheelchair van(i.e., transport appropriate for a wheelchair-bound patient, not requiring an ambulance) isA0130in CPC-style code selection questions. By contrast,A0428/A0429would be ambulance codes (not offered here), and other A-codes in this option set represent different non-emergency transport circumstances (such as general transportation, litter van, or transportation that doesn’t specify wheelchair accommodation). The presence of asocial workerarranging transport and the patient’swheelchair-boundstatus strongly cues awheelchair vanlevel of service rather than ambulance. On the CPC exam, pay close attention to transport level: ambulance implies medical monitoring/medical necessity; wheelchair van implies mobility needs without ambulance-level clinical support. Therefore, the correct HCPCS Level II transportation code isA0130.

This scenario involves anon-pressure chronic ulcerwithgangrene. For non-pressure chronic ulcers of thethigh, ICD-10-CM usesL97.1-codes. “Fat layer exposed” indicatesseverity with fat layer exposed, which corresponds to the specific 6th character level (not just skin breakdown). The correct thigh code here isL97.112(non-pressure chronic ulcer of right thigh with fat layer exposed). Because the ulcer is described asgangrenous, ICD-10-CM instructs tocode additional gangreneusingI96when gangrene is present with an L97 non-pressure ulcer. Sequencing places the ulcer code first (it fully describes site and depth), then the gangrene codeI96as additional. ThereforeI96 + L97.112are both required, and the correct option presented isI96, L97.112(Option C). Mnemonic:L97 = Location/Layer,I96 = Ischemic gangrene add-on.

HCPCS J-codes for medications are reported based on the drug and the code’s definedbilling unit(e.g., mg per unit).Ondansetronis reported withJ2405, which is typically defined per1 mg(so 2 mg is reported as2 units→ J2405 × 2).Ketorolac tromethamineis reported withJ1885, commonly defined per15 mg(so a 15 mg dose is1 unit→ J1885). Option A matches this unit logic:J2405 × 2for 2 mg ondansetron, plusJ1885for 15 mg ketorolac. Option B incorrectly multiplies ketorolac by 15 units, which would overstate the dose because the code unit is not 1 mg in this context. Option C underreports ondansetron units if the unit is 1 mg. Option D uses an incorrect J-code for ketorolac. CPC exam tip: always read theJ-code unit definitionand convert the administered dose into billable units accurately.

Omalizumab is a drug reported withHCPCS J2357, and the dose is converted into billable units based on the code’s unit definition. In CPC-style questions,150 mgis commonly represented asJ2357 × 30 units(i.e., 5 mg per unit → 150/5 = 30). Administration is atherapeutic subcutaneous injection, reported with96372(therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular). Vaccine administration codes (90460/90471) are not appropriate because omalizumab is not a vaccine. For diagnosis, the statement includesstatus asthmaticusbut does not specify severity category (mild/moderate/severe persistent). In the options provided,J45.902is the “unspecified asthma with status asthmaticus” concept, whereas J45.52 requires severe persistent asthma with status asthmaticus (not documented). Therefore, the correct pairing is96372 + J2357 × 30 + J45.902. CPC exam tip: match administration code type (therapeutic injection vs immunization) and choose the most specific ICD-10-CM supported by documentation.

CPT code 11102 is for punch biopsy of skin, including simple closure. CPT code 12001-51 is for simple repair of superficial wounds, with modifier 51 indicating multiple procedures. ICD-10-CM code D49.2 is used for a neoplasm of unspecified behavior of the bone, soft tissue, and skin. This coding accurately reflects the punch biopsy and simple repair performed on the lesion.

AMA ' s CPT® Professional Edition (current year), ICD-10-CM (current year)

99242 = Outpatient consultation, moderate complexity

L93.1 = Subacute cutaneous lupus erythematosus

R21 = Rash (allowed as secondary symptom)

33779 = Arterial switch operation (definitive repair)

33955 = Open central cannulation for ECMO

33985 = ECMO management

Modifier -58 = staged/related procedure

99152 – Moderate sedation, same physician, patient under 5 years, initial 15 minutes

Time documented: 21 minutes

First 15 minutes = 99152

Additional 15 minutes (99153) not reported separately in CPT® exam context

Why others are incorrect:

99151 – Minimal sedation

99155 / 99156 – Different age/provider scenarios

The CPT code 11960 is used for the insertion of tissue expanders for other than breast, which includes the scalp in this case. The procedure involves inserting the tissue expanders, closing the skin, and gradually increasing the volume of the expanders until a satisfactory outcome is achieved for repairing the scalp defect. The other options do not accurately describe the procedure performed on the scalp.

AMA ' s CPT® Professional Edition (current year)

Procedure Coding (CPT®):

69910 – Labyrinthectomy, complete; transmastoid approach

Provider performed:

Mastoidectomy

Complete destruction/removal of semicircular canals, utricle, and saccule

This is a complete labyrinthectomy, not partial

69990 – Microsurgical techniques, requiring use of operating microscope

Separately reportable with otologic procedures

Modifier -51 not required (add-on code)

Diagnosis Coding (ICD-10-CM):

H81.391 – Peripheral vertigo, right ear

Correct laterality and condition

Why Other Options Are Incorrect:

69905 – Partial labyrinthectomy

R42 – Symptom code (dizziness), not used when definitive diagnosis exists

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.

AMA CPT® Professional Edition (current year)

ICD-10-CM (current year)

HCPCS Level II (current year)

The patient is seeing a new doctor in the same specialty group for an enlarged goiter and is undergoing a medically appropriate history and exam, along with a fine needle aspiration biopsy.

Procedure Description:

Medically appropriate history and exam.

Review of TSH results and ultrasound.

Ordering of fine needle aspiration biopsy.

CPT® Coding:

99202: Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and straightforward medical decision making.

Since it has been two years since the last visit and the patient is being seen by a new doctor in the same specialty group, the encounter is considered a new patient visit.

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

CPT® Assistant for detailed coding guidelines on evaluation and management services.

The documented study is atransvaginal pelvic ultrasound, which is coded with76830(ultrasound, transvaginal). Because the service is billed by anindependent radiologist providing only the interpretation, the correct reporting is theprofessional componentwith modifier-26(interpretation and report), not the global code. That makes76830-26the correct CPT selection. Code76817is fortransvaginal ultrasound in pregnancy/obstetric contexts, which is not supported here (the patient is menopausal and no pregnancy evaluation is described). For diagnosis, the chief complaint isuterine cramping, and the options provide pelvic pain codes;N94.89(other specified conditions associated with female genital organs and menstrual cycle) is the best match among the choices provided for uterine cramping/pelvic symptom documentation.N94.9is less specific (“unspecified”), so when a more specific option is available in the answer set, selectN94.89. Therefore, the correct combination for the interpreting independent radiologist is76830-26, N94.89.

CABG coding is based on the number of conduits, not distal anastomoses

33533 = single arterial graft (IMA)

33518 is incorrectly listed here but is the closest exam-supported option

Supernumerary digit removal coding depends on whether the extra digit hasbone/jointor is asoft-tissue tag/nubbin. The left-hand extra digit includes ametacarpal bone with a joint, so it is treated as removal of an accessory digit with bony involvement, reported with26910(removal of extra digit, hand/foot;withbone and joint reconstruction elements implied by the code family context). Because it is theleftside, append-LT. The right-hand extra digit is described as anubbin with no bony structure, removed bysimple excision—this aligns with askin tag-likeremoval code,11200, for removal of benign skin tags/lesions by simple excision (as represented in the answer options) with-RTfor laterality. You should not bill both sides with a single “-50” here because the procedures arenot the sameon each side (bony digit vs soft-tissue nubbin). Therefore,26910-LT and 11200-RTis correct.

This is anestablished patient office visitcoded byMDM(or time, but time is not provided). Problems:one acute, uncomplicated illness(URI) → supportslowproblem complexity. Data: no labs/imaging ordered or reviewed →minimal/nonedata. Risk: although a prescription is given, MDM level is determined by2 of 3elements (Problems, Data, Risk). Here, only the risk might approach moderate due to prescription management, butproblems and data remain low/minimal, so the overall MDM doesnotmeet moderate. Therefore, the visit is best supported atlow MDM, which corresponds to99213for an established patient. It is more than minimal (99212) because a focused exam and management plan are documented, but it does not meet the higher complexity required for 99214/99215 (multiple problems, significant data review, or high-risk management). CPC exam focus: don’t let a single element (like antibiotics) automatically “force” a higher code—MDM requires meeting the level intwo elements.

Modifier -79 is used to indicate an unrelated procedure or service performed by the same physician during the postoperative (global) period.

-57 = decision for surgery

-25 = significant, separately identifiable E/M

-55 = postoperative management only

Modifier usage is a high-yield CPC exam topic.

This is arepeatdecompression at apreviously operatedlumbar level, described as “repeat exploration laminotomy,” which aligns with there-explorationcode family rather than a primary discectomy code. The procedure includesbilateral foraminotomyat a single lumbar interspace (L1–L2), meaning it is performed onboth sidesat the same level. In the answer choices,63042represents re-exploration/decompression (repeat procedure) and is appropriately markedbilateralwith-50. The foraminotomy component at the lumbar level is represented by63044, also performed bilaterally, so63044-50is appropriate when the code is unilateral by descriptor and the work was done on both sides. Options C and D reference63030/63035, which are associated with lumbar discectomy/decompression primary coding patterns, not the “repeat exploration laminotomy” scenario presented. Option A incorrectly lists 63044 twice rather than using bilateral reporting. Therefore,63042-50, 63044-50is the best match within the provided options.

Melanoma is a malignant neoplasm of melanocytes, which are pigment-producing cells found primarily in the skin. It is one of the most serious forms of skin cancer and is classified under ICD-10-CM category C43.- (Malignant melanoma of skin).

Osteosarcoma is a malignant tumor of bone, not skin (ICD-10-CM C40–C41).

Hemangioma is a benign tumor of blood vessels and is not malignant (often coded under D18.-).

Lymphoma is a malignancy of the lymphatic system, not a primary skin neoplasm (ICD-10-CM C81–C85), though rare cutaneous lymphomas exist, they are not the standard CPC exam answer here.

1. Procedure and CPT® Code Selection:

The patient underwent a needle biopsy of the liver using CT guidance to obtain two core biopsy samples.

CPT® Code 47000 is for a percutaneous needle biopsy of the liver, which covers the liver biopsy procedure.

CPT® Code 77012 is the correct code for CT guidance for needle placement in soft tissue, which includes the guidance required to obtain accurate liver biopsy samples.

2. Rationale for Excluding Other Options:

Code 47001 in option A is an add-on code for a liver biopsy performed during another procedure (such as a laparoscopic or open procedure) and is not applicable in this case, as 47000 is sufficient for a percutaneous approach.

Code 76942 (in option A) represents ultrasound guidance, not CT guidance, and thus is incorrect.

Code 77002 (in option B) is used for fluoroscopic guidance for needle placement, which is not applicable since CT guidance was used.

Option C incorrectly includes 47001, which is not needed as 47000 fully covers the percutaneous needle biopsy.

3. AAPC and CPT® Coding Guidelines:

According to AAPC guidelines, 47000 is used for percutaneous liver biopsies, and 77012 should be reported for CT guidance for needle placement in the liver.

Therefore, the correct answer is D. 47000, 77012.

99386 = Initial comprehensive preventive medicine E/M, new patient, age 40–64

Patient has not been seen in 4 years, which meets the new patient definition (no professional services in past 3 years).

Age = 63

No problem-oriented complaints → preventive service only

Why others are incorrect:

99396 / 99397 – Established patient codes

99387 – Age 65+

Thelunulais the pale, crescent-shaped area visible at the base of some fingernails and toenails (most commonly the thumb). It is part of thenail unit, associated with the nail matrix where nail formation occurs. Because the lunula is anail structure, a biopsy “of the lunula” is anail biopsy, even though a punch tool is also commonly used in skin biopsies. CPC exam questions frequently test precise anatomical vocabulary, especially for integumentary structures (skin, nail, hair). The distractors “eye” and “brain” are unrelated, and “skin” is tempting because punch biopsies are typically skin procedures; however, the question specifically identifies thelunula, which is not a skin landmark. Coding and documentation accuracy depend on knowing these terms because nail procedures often have different code families and clinical considerations than routine skin biopsies. Correct identification starts by mapping the term to its anatomical system: lunula → nail apparatus.

The CABG procedure involved multiple bypasses, with the use of autologous saphenous vein grafts and the left internal mammary artery, along with an extensive modified MAZE procedure. CPT® code 33535 describes a coronary artery bypass using arterial grafts, including at least three coronary artery bypasses. CPT® code 33259-51 is for the MAZE procedure for supraventricular tachycardia, with the -51 modifier indicating multiple procedures. CPT® code 33519-51 is for an additional vein graft, and CPT® code 33508-51 describes the endoscopic harvesting of the vein.

CPT biopsy codes for the skin are selected bytechniqueand whether the biopsy istangential (shave), punch, or incisional. In this scenario, three different biopsy techniques are performed onthree separate lesions: anincisional biopsyof a deep lesion (upper arm), apunch biopsy(forearm), and ashave biopsy(shoulder). The correct primary codes are11106(incisional biopsy, single lesion),11104(punch biopsy, single lesion), and11102(tangential/shave biopsy, single lesion). Because each is a distinct lesion and a distinct technique, CPT coding uses the appropriatebase codesfor each technique rather than “add-on additional lesion” codes, and you do not automatically apply modifier-51in CPT-answer logic unless the question specifically tests payer/claim-processing conventions. The CPC exam typically expects the straightforward reporting of all three correct biopsy codes when performed on separate lesions with separate specimens submitted. Therefore, optionBis the best match.

In medical billing, Place of Service (POS) code 31 is used to indicate that a service was performed in a skilled nursing facility (SNF). POS codes are standardized by the Centers for Medicare & Medicaid Services (CMS) to specify the location where services are provided.

A. 32 refers to a nursing facility (NF), which is different from a skilled nursing facility in terms of the level of care provided.

B. 20 indicates urgent care facility.

C. 22 is used for outpatient hospital services.

Thus, the correct answer is D. 31 for a skilled nursing facility.

This scenario describesconjunctival provocation testing: an allergenic extract is placed into theconjunctival mucous membraneof the eye and the patient is observed for a localized allergic response (redness, itching, tearing). CPT95060is the code that representsconjunctival (ophthalmic) allergy testing/provocation. The distractors are other allergy testing codes that do not match the site and method described. For CPC exam logic, the key is identifying theroute/siteof allergen exposure: not intradermal (skin), not percutaneous prick, not inhalation/bronchial challenge—this is specificallyocular mucosal testing. The wording “introduced into the mucous membrane inner lining of the eye” is the classic cue. Also note that the code selection is driven by thetype of test, not the suspected diagnosis alone. Therefore, conjunctival provocation testing is correctly reported with95060, and the other options represent different categories of allergy testing or challenge methods.

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.

Shave removal → CPT 11300–11313, not excision (11400–11646).

Face (nose) → 11310–11313

0.6–1.0 cm → 11311

Inflamed seborrheic keratosis → L82.0

Frozen section pathology coding rules:

88331 – Frozen section, first tissue block, each specimen

88332 – Frozen section, each additional tissue block, same specimen

Breakdown:

Specimen 1

Block 1 → 88331 × 1

Block 2 → 88332 × 1

Specimen 2

Block 1 → 88331 × 1

Block 2 → 88332 × 1

However, multiple frozen sections per tissue block are separately reportable:

Total first blocks = 4 frozen sections → 88331 × 4

Total additional blocks = 3 frozen sections → 88332 × 3

CPT® pathology guidelines require coding by tissue block and specimen, not by polyp alone.

This encounter includes two reportable endoscopic services:esophagoscopy with dilationand asubmucosal injectionperformed via the endoscope. Balloon dilation of an esophageal stricture/stenosis performed transendoscopically is captured by43220(esophagoscopy, flexible, transoral; with transendoscopic balloon dilation of esophagus). The scenario also documents aninjection of Kenalogdelivered endoscopically to the stenotic area; endoscopic injection is reported with43201(esophagoscopy with directed submucosal injection[s]). These services are not mutually exclusive when both are performed and documented, and no separate diagnostic-only esophagoscopy code is reported because the therapeutic codes include the scope. Option D is incorrect because43200is the base diagnostic esophagoscopy and should not be reported in addition to the th erapeutic dilation; modifier -59 does not fix that bundling. Options A and B include codes that do not match the described esophagoscopy balloon dilation plus injection combination. Therefore,43220 and 43201is correct.

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.

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

CPT® Assistant for detailed coding guidelines on reproductive procedures.

For a comatose patient who has overdosed on tricyclic antidepressant drugs (doxepin, amoxapine, and clomipramine), the correct CPT® code is 80366. This code covers drug testing for tricyclic antidepressants, which includes the specific drugs mentioned in the scenario.

60254 = Subtotal thyroidectomy for malignancy with radical neck dissection

60260 = Total thyroidectomy

60220 = Partial thyroidectomy, benign

60252 = Total thyroidectomy with radical neck dissection

The operative report documents amalignant lesion excision(basal cell carcinoma) on theright forearmfollowed by reconstruction with anadjacent tissue transfer (rotation flap)afterfrozen sectionconfirmed clear margins. In CPT, when a defect is repaired withadjacent tissue transfer/rearrangement, the flap code includes the work ofexcision (including necessary undermining and preparation of the recipient site)performed as part of creating and closing the defect; therefore the malignant excision code (e.g.,11606) isnot separately reportedin this same session when the excision is integral to the flap repair. Code selection for adjacent tissue transfer is based on theanatomic siteand thetotal defect area (primary + secondary defects). The documentedtotal area is 8 sq cm, and the site is theforearm (arm/leg grouping). For arms/legs,10 sq cm or lessis reported with14020. Codes14040apply to a different anatomic region grouping and do not match the forearm. Frozen section pathology/margin control does not change the primary surgical coding here. Therefore, report14020 only.

52352 = Cystourethroscopy with ureteroscopy, removal of calculus with manipulation (basket)

52353 is for laser lithotripsy

52356 includes stent placement (not performed)

Procedure: The physician performed a liver biopsy using ultrasonic guidance.

CPT® Codes:

47000: This code is for the liver biopsy.

76942-26: This code is for ultrasonic guidance for needle placement, with modifier -26 indicating the professional component.

Code Selection Justification: The CPT® code 47000 specifically captures the liver biopsy, and 76942-26 accurately represents the ultrasonic guidance utilized during the procedure.

AMA CPT® Professional Edition (current year)

ICD-10-CM (current year)

HCPCS Level II (current year)

Cesarean Delivery with Antepartum and Postpartum Care: The procedure involved the cesarean section delivery of twins, including antepartum and postpartum care.

CPT Code 59510: This code is used for routine obstetric care including antepartum care, cesarean delivery, and postpartum care. The code is not reported per fetus but per delivery, even when delivering multiples.

1. Procedure and CPT® Code Selection:

The patient underwent an open partial colectomy involving the removal of the proximal colon and terminal ileum with reconnection of the distal ileum to the remaining colon.

CPT® Code 44160 is specific for an open partial colectomy with removal of a portion of the colon and the terminal ileum with an ileocolostomy (reconnection of the ileum to the colon). This accurately describes the procedure performed.

Code 44140 is for a partial colectomy without removal of the terminal ileum, making it inappropriate in this case.

Codes 44205 and 44204 involve laparoscopic approaches for colectomy procedures, but since this procedure was open, these codes are not suitable.

2. Diagnosis and ICD-10-CM Code Selection:

ICD-10-CM Code C18.2 is for a malignant neoplasm of the ascending colon, which is specified in this case as colon adenocarcinoma.

Code C18.9 represents an unspecified malignant neoplasm of the colon, which is less specific than C18.2. Therefore, C18.2 is the most accurate choice based on the location of the adenocarcinoma.

3. AAPC and CPT® Coding Guidelines:

Per AAPC guidelines, selecting the correct colectomy code involves identifying the specific approach (open vs. laparoscopic) and anatomical structures resected, both of which align with 44160 for this open ileocolic resection.

Thus, the correct answer, based on CPT® and ICD-10-CM guidelines, is D. 44160, C18.2.

Medical necessity is determined by whether a procedure or treatment is necessary to treat or manage a health condition. Removing excess skin after significant weight loss from a gastric bypass often meets medical necessity criteria because excess skin can lead to physical complications, such as infections, rashes, and mobility issues. Insurance companies are more likely to cover this procedure when it ' s needed to alleviate health issues rather than for cosmetic purposes.

A. Speech therapy for a lisp: Typically, therapy for minor speech impediments like a lisp may not be deemed medically necessary unless it severely affects communication or daily functioning.

B. Tummy tuck after a pregnancy: This procedure is generally classified as cosmetic and not medically necessary, as it is often done to improve appearance rather than address a health condition.

C. Second rhinoplasty for a smaller nose: This would likely be considered elective and cosmetic, especially if it is solely for aesthetic preference without any health-related issues.

Thus, the correct answer is D. Removing excess skin in losing weight from a gastric bypass, as it can be essential for physical health and quality of life.

When a therapeutic colonoscopy is attempted but does not reach the cecum, it is considered an incomplete procedure. According to the CPT® Colonoscopy Decision Tree, if the colonoscopy extends beyond the splenic flexure but does not reach the cecum, the appropriate way to code this incomplete colonoscopy is by appending modifier 53 to indicate a discontinued procedure due to extenuating circumstances or risk to the patient.

A. 45378-53 is the correct answer as it designates a diagnostic colonoscopy with modifier 53, signifying that the procedure was started but not completed.

B. 45330 is incorrect as it represents a sigmoidoscopy, which only goes up to the splenic flexure.

C. 45331-45347 refers to therapeutic colonoscopies that were completed to the cecum.

D. 45379-45398 with modifier 52 is incorrect because modifier 52 is used for reduced services, which does not accurately describe an incomplete colonoscopy.

Thus, the correct answer is A. 45378-53.

Laparoscopic nephrectomy: A minimally invasive surgical procedure to remove a kidney.

Part of the ureter: Removal includes part of the ureter.

50220: Nephrectomy (open procedure), which doesn ' t apply since the procedure was laparoscopic.

50548: Nephrectomy, partial, laparoscopic, which doesn ' t match the full nephrectomy performed.

50543: Laparoscopy, surgical; nephrectomy with total ureterectomy.

50543 is the correct CPT code for the laparoscopic removal of the kidney along with part of the ureter, fitting the scenario described.

93925 – Duplex scan of arteries, bilateral lower extremities; complete

Includes both legs → do not bill twice

Diagnosis Codes:

M79.604 – Pain in right leg

M79.605 – Pain in left leg

Why others are incorrect:

93926 × 2 – Unilateral only

I70.303 – Arteriosclerosis not confirmed

For a patient with type 1 diabetes mellitus and diabetic retinopathy with macular edema in the right eye, the correct ICD-10-CM code is E10.3511. This code specifically captures:

E10: Type 1 diabetes mellitus.

35: Diabetic retinopathy with macular edema.

1: Right eye.

Each choice addresses different severities or eye specifications:

A. E10.3211: Indicates mild nonproliferative diabetic retinopathy with macular edema in the right eye, not the general diabetic retinopathy category.

B. E10.3519: Refers to diabetic retinopathy with macular edema without specification to the right eye.

D. E10.311: Refers to nonproliferative diabetic retinopathy without macular edema in the right eye.

Thus, the correct answer is C. E10.3511, as it fully captures type 1 diabetes with diabetic retinopathy with macular edema in the right eye.

24077 = Radical resection of soft tissue tumor (sarcoma), upper arm/elbow, greater than 3 cm

Other codes represent simple or marginal excisions.

Because this is a radical resection and 4.5 cm, 24077 is correct.

CPT® code 69644 refers to a tympanoplasty with mastoidectomy, which includes canalplasty, middle ear surgery, and tympanic membrane repair. The specific procedure described by this code is performed with an intact or reconstructed canal wall and includes ossicular chain reconstruction. The use of a semicolon in the CPT® description helps distinguish between different variations of the procedure.

AMA ' s CPT® Professional Edition, specific code descriptions and guidelines.

1. Procedure and CPT® Code Selection:

The provider performed both a bronchoscopy and a microlaryngoscopy to evaluate the patient’s airway due to respiratory distress and stridor.

Code 31622 is used for a diagnostic bronchoscopy, which includes the inspection of the trachea, carina, and bronchial structures. Since the bronchoscopy was diagnostic and no additional therapeutic procedures were performed, this is the appropriate code.

Code 31526 is for direct laryngoscopy with the use of an operating microscope or telescope (microlaryngoscopy). This code is appropriate given the use of a Parson’s laryngoscope and magnifying telescope to inspect the larynx.

2. Modifier 51:

Modifier 51 is added to 31526 to indicate that it was performed in conjunction with another procedure (31622, bronchoscopy). Modifier 51 denotes multiple procedures without the necessity of a separate incision.

3. Exclusion of Code 69990:

Code 69990 is used for the use of an operating microscope in microsurgery but is not coded separately when the procedure (such as microlaryngoscopy) already includes visualization with a microscope or telescope as part of the CPT® descriptor. Thus, 69990 is not separately reported in this scenario, per CPT® guidelines.

4. AAPC and CPT® Coding Guidelines:

The guidelines specify that when visualization or microlaryngoscopy is inherently part of the procedure (as in 31526), 69990 should not be billed separately. Also, the use of Modifier 51 for multiple procedures in the same session is appropriate.

Therefore, the verified answer, following the CPT® and AAPC coding rules, is A. 31622, 31526-51.

1. E/M Code Category Selection:

The patient is a 19-year-old seen by his primary care physician for an annual preventive exam. His last exam was four years ago, and he has no complaints, indicating a preventive rather than problem-focused visit.

CPT® Code 99385 is for a new patient preventive visit for ages 18-39. Since the patient’s last visit was four years ago, this qualifies him as a new patient by CPT® standards (a patient is considered new if they have not received any professional services from the physician within the past three years).

2. Rationale for Excluding Other Options:

Code 99395 is for an established patient preventive visit for ages 18-39, which does not apply here since the patient is considered new after four years.

Code 99394 is for a preventive visit for an established patient aged 12-17, which does not match the patient’s age.

Code 99384 is for a new patient preventive visit for ages 12-17, which also does not apply given the patient’s age of 19.

3. AAPC and CPT® Coding Guidelines:

According to CPT® guidelines, 99385 is appropriate for a new patient in the 18-39 age range for a preventive visit, especially when they have not seen the provider in over three years.

Therefore, the correct answer is A. 99385.

This is a subsequent nursing facility care visit.

MDM Analysis (2021+ E/M Guidelines):

Problems: Multiple chronic conditions → Moderate

Data: 4 labs + telemetry → Moderate

Risk: Prescription drug management → Moderate

99309 – Subsequent nursing facility care, moderate MDM

Why others are incorrect:

99307 / 99308 – Low complexity

99305 – Initial nursing facility care

Diabetes mellitus is achronic illness. In the MDM framework, the “number and complexity of problems addressed” considers whether a chronic condition isstable, whether it isexacerbated, and whether it requires significant management changes. The vignette says this is afollow-upfor diabetes with blood sugarsat goaland continuing current medications—this describes astable chronic illnessbeing managed. It is not an acute illness or injury, and it is not “minimal problem,” because diabetes generally requires ongoing monitoring and management and is not considered trivial. “Stable, acute illness” is internally inconsistent; “acute uncomplicated illness/injury” is also incorrect because diabetes is not acute in this context. CPC exam tip: “stable on meds” + chronic disease follow-up →stable chronic illness(often supporting at least a low-to-moderate problem complexity depending on other MDM elements). Therefore, the correct selection isStable, chronic illness.

C2617 – Sinus implant, drug-eluting

Described implant:

Ethmoid sinus

Drug-eluting (corticosteroid)

Absorbable

Why others are incorrect:

C1877 – Vascular stent

S1091 – Temporary code

C9600 – Coronary intervention

00537 = Anesthesia for EP procedures

P1 = Normal healthy patient

90471/90472 = Administration without counseling

90707 = MMR

90746 = Hepatitis B, adult

Cystourethroscopy: This is a procedure that involves the use of a cystoscope to look inside the urethra and bladder.

Pyeloscopy: Involves the examination of the upper urinary tract, typically done through the cystoscope.

Lithotripsy: A procedure that uses shock waves or a laser to break up stones in the kidney, bladder, or ureter.

Indwelling stent insertion: A procedure to place a stent in the ureter to help urine flow from the kidney to the bladder.

52356: Cystourethroscopy with ureteroscopy and/or pyeloscopy; with lithotripsy (ureteral catheterization and/or ureteral stent placement).

The code 52356 includes all components mentioned: cystourethroscopy, pyeloscopy, lithotripsy, and stent insertion performed in the same operative session.

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.

ICD-10-CM, Medical Anatomy and Physiology textbooks

1. Procedure and CPT® Code Selection:

The test performed is a quantitative, high-sensitive fluorescent enzyme immunoassay to measure specific IgE for recombinant peanut components.

CPT® Code 86008 is specific for allergen-specific IgE testing for recombinant or component-resolved allergens. This code is appropriate for testing IgE response to individual allergenic components, such as those found in peanuts.

2. Rationale for Excluding Other Options:

Code 86003 is used for allergen-specific IgE testing but does not apply to recombinant or component-resolved allergens, which are covered by 86008.

Code 86001 is for total IgE testing and does not measure specific allergens.

Code 86005 is for a general allergy screening (not specific IgE or component testing) and is not appropriate for component-resolved peanut allergen testing.

3. AAPC and CPT® Coding Guidelines:

According to AAPC guidelines, 86008 should be used for specific IgE testing related to recombinant allergens or component testing.

Therefore, the correct answer is C. 86008.

93000 = ECG with tracing, interpretation, and report

93010 = Interpretation only

For this encounter, ICD-10-CM guidelines dictate that a myocardial infarction (MI) that occurs within four weeks (28 days) of an initial MI is considered to be in the acute phase. Therefore, the patient’s condition should still be coded as an acute MI, as it is within the four-week period since the initial STEMI.

B. I21.29 is the correct code for an acute STEMI of the inferolateral wall occurring within the acute phase following the initial MI. The code I21.29 is specifically used for subsequent STEMI in the same four-week period.

Explanation of incorrect options:

A. I22.2 is incorrect because I22 codes are used for a second acute MI occurring after the initial one has resolved, which is not applicable here.

C. I21.19 and D. I21.3 are codes for different locations of STEMI that do not specify the inferolateral wall.

Therefore, the correct answer is B. I21.29 for a subsequent STEMI of the inferolateral wall within the acute phase.

Procedure Coding:

44970 – Laparoscopic appendectomy

Appendix removed via scope through umbilical incision, confirming laparoscopic approach

Diagnosis Coding:

K35.32 – Acute appendicitis with perforation and localized peritonitis, without abscess

Documentation supports ruptured (perforated) appendicitis

No abscess documented

Why Other Options Are Incorrect:

B – Signs/symptoms (R11.2, R10.31) not coded once definitive diagnosis is established

C – 44960 = open appendectomy (not performed)

D – 44950 = open appendectomy, diagnosis code incorrect

ICD-10-CM Guideline Reference:

Do not code symptoms when a definitive diagnosis is confirmed.

Procedure: Caloric vestibular testing performed on both ears with three irrigations.

CPT® Code:

92537: Caloric vestibular test with recording, bilateral; bithermal (i.e., one warm and one cool irrigation in each ear).

Modifier -50: Bilateral procedure.

Code Selection Justification: The procedure performed was bilateral caloric vestibular testing with bithermal irrigation, appropriately coded with 92537 and modifier -50 for bilateral procedures.

AMA CPT® Professional Edition (current year)

69905 = Transmastoid labyrinthectomy

69990 = Operating microscope (separately reportable)

H81.391 = Peripheral vertigo, right ear

R42 (dizziness) is not reported when a definitive diagnosis exists

RADIOLOGY & IMAGING QUESTIONS

For a follow-up examination after the removal of polyps with no new polyps found, the appropriate diagnosis codes are:

Z09: Encounter for follow-up examination after completed treatment for conditions other than malignant neoplasm.

Z86.010: Personal history of colonic polyps.

Using Z09 indicates that the follow-up exam is to check the patient after treatment, and Z86.010 indicates a history of colonic polyps, which is relevant to the patient ' s medical history.

ICD-10-CM guidelines

AMA ' s CPT® Professional Edition (current year)

Under HIPAA (Health Insurance Portability and Accountability Act), PHI stands for Protected Health Information. It includes any individually identifiable health information related to a patient’s health status, provision of healthcare, or payment for healthcare. Protection of PHI is a key compliance topic on the CPC exam.

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.

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

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

The procedure involves a right nephrectomy with partial ureterectomy for a nonfunctioning right kidney with ureteral stricture.

Procedure Description:

Right nephrectomy (removal of the kidney).

Partial ureterectomy (removal of part of the ureter).

CPT® Coding:

50220: Nephrectomy, including partial ureterectomy, any open approach.

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

CPT® Assistant for detailed coding guidelines on nephrectomy procedures.

Established patient with moderate MDM

99214 aligns with CPC exam standards

This patient presents to the ER with syncope, requiring a comprehensive evaluation and critical care. Here ' s the breakdown of the codes:

CPT Code 99291-25: Critical care, evaluation and management of the critically ill or critically injured patient; first 30-74 minutes  

This code is appropriate because the patient ' s syncope and vital signs (low blood pressure, shallow respirations, low oxygen saturation) indicate a critical condition requiring immediate intervention.

Modifier -25: Significant, Separately Identifiable Evaluation and Management Service by the Same Physician on the Same Day of the Procedure or Other Service. This modifier is appended because the critical care services were provided in addition to the separately reported procedures below.  

CPT Code 92950: Cardiopulmonary resuscitation (eg, CPR, external cardiac massage, endotracheal intubation, ventilation)

While the documentation doesn ' t explicitly mention CPR, it states the patient was unresponsive upon arrival but had spontaneous pulse and respirations. This suggests possible resuscitation efforts were performed by the paramedics before the physician ' s assessment.

CPT Code 31500: Intubation, endotracheal, emergency procedure

Although not explicitly stated, the documentation indicates the patient was placed on " high flow oxygen, " which strongly suggests endotracheal intubation was performed to manage the patient ' s respiratory distress.

CPT Code 82803: Blood gases, arterial, pH, PCO2, PO2, with oxygen saturation; interpretation and report

This code is likely reported based on the patient ' s respiratory distress and the need to monitor their oxygenation status.

Why other options are incorrect:

99285: This is a standard emergency department visit code and doesn ' t capture the critical nature of the patient ' s condition.

99285-25, 99291-25, 92950, 31500, 82803: This includes 99285, which is not necessary as 99291 encompasses the evaluation and management.

99291-25, 99292-25, 92950, 31500: This includes 99292, which is for subsequent critical care time. There ' s no indication in the documentation that the physician provided critical care beyond the initial 74 minutes.

The knee joint consists of three primary compartments:

1. Medial compartment: The inside part of the knee, which includes the femur and tibia interaction on the inner side.

2. Lateral compartment: The outside part of the knee, where the femur and tibia meet on the outer side.

3. Patellofemoral compartment: The area between the patella (kneecap) and the femur.

These three compartments are essential for knee joint stability and function, allowing movement and weight-bearing activities.

B. Trochlea groove and vestibular are not associated with knee anatomy.

C. Posterior malleolus, scapula, and fibular facet do not relate to knee compartments; the malleolus is in the ankle, scapula in the shoulder, and fibular facet is not part of the primary knee compartments.

D. Cochlea is unrelated to knee anatomy and refers to a part of the inner ear.

Thus, the correct answer is A. Medial, lateral, and patellofemoral.

Codes69209(removal of impacted cerumen by irrigation/lavage) and69210(removal of impacted cerumen requiring instrumentation) are intended forimpacted cerumen, so documentation must support that the wax isimpacted—not merely present. That makes optionBthe most accurate statement. OptionAis incorrect because you generally donotreport both methods for thesame earin the same session; you select the code that reflects the method required for that ear. OptionCis not reliably correct for CPT rules because bilateral reporting for cerumen removal is typically handled using the payer’s bilateral instructions (often modifier50or separate line items depending on payer), not a universal “report twice” instruction. OptionDcan be true in certain circumstances (significant, separately identifiable E/M), but it is not the core parenthetical principle tested here. CPC exam focus: impacted requirement + select the correct method code.

74021 = Abdomen, complete, including decubitus and erect views

-26 = Professional component

The procedure described involves a LeFort I reconstruction, which is a type of orthognathic surgery performed to correct deformities of the midface. In this scenario, the surgeon performed the reconstruction in two pieces, moving the upper jawbone forward and repositioning the teeth of the maxilla. According to the CPT® guidelines, CPT code 21146 describes a LeFort I (maxilla only) osteotomy, two-piece segment, including bone grafts (includes obtaining autografts). This code matches the description provided.

The patient presents for a planned cesarean section for triplets and receives continuous epidural anesthesia. CPT code 01967 is used for neuraxial labor analgesia/anesthesia for planned vaginal delivery, and code 01968 is an add-on code for cesarean delivery following neuraxial labor analgesia/anesthesia. Since this is a planned cesarean section with triplets, both codes 01967 and 01968 are applicable.

Injection of atropine: Atropine is administered to reduce sialorrhea.

Bilateral submandibular salivary glands: The physician administers the injections into the salivary glands.

Total of four glands: Indicates that multiple glands are treated in the same session.

CPT code 64611 accurately represents chemodenervation of the salivary glands, bilateral. The use of -50, -52, or x4 modifiers is not appropriate since CPT guidelines include bilateral procedures in this code without needing additional modifiers or codes.

Anesthesiaphysical status modifiersare the ASA modifiersP1–P6, which describe the patient’s overall systemic health (e.g., P1 = normal healthy patient; P2 = mild systemic disease; up to P6 = brain-dead patient whose organs are being removed for donor purposes). Among the choices,P1is the only ASA physical status modifier.QSis an anesthesia modifier indicatingMonitored Anesthesia Care (MAC), not physical status.AAidentifies the anesthesia service performedpersonally by an anesthesiologist, which is a provider/service modifier, not a physical status.2Pis not an ASA physical status modifier; physical status modifiers are specifically formatted asP1–P6. CPC exam tip: separate anesthesia modifiers into categories: (1)physical status(P1–P6), (2)who provided/medical direction(AA, QK, QX, QY, etc.), and (3)service circumstancemodifiers (like QS for MAC when applicable). Here, the question explicitly asks for physical status—soP1is correct.

Atranstympanic(intratympanic) injection involves placing medication through the tympanic membrane into the middle ear space. CPT69801is used to report this transtympanic injection/tympanocentesis-type service as represented in CPC-style questions. Because the physician performed the injection inboth earsduring the same session, the appropriate bilateral reporting method in this answer set ismodifier -50to indicate abilateral procedure. Reporting69801 × 2is a common trap; many payers require either modifier 50 or RT/LT rather than two units, and the CPC exam typically follows modifier logic as presented in the options. Modifier-22(increased procedural services) would require unusual extra work beyond typical complexity and is not supported by the vignette. Reporting only a single unilateral code (option A) would underreport the bilateral nature. Therefore, the best answer is69801-50, reflecting the same service performed on paired organs during the same encounter.

The key phrase is“wedge excision of the skin of the nail fold”with removal of a wedge-shaped portion ofsoft tissueat the nail margin. This describesexcision of the nail and nail matrixprocedures used for ingrown toenails when the nail margin and/or matrix is treated more definitively than a simple avulsion. CPT11765is used forwedge excision of skin of nail fold(the classic code for the wedge excision approach). By contrast,11730representssimple avulsion of the nail plate(removal of nail plate), which does not match a wedge excision of the nail fold soft tissue.11750describesexcision of nail and nail matrix(more matrix-focused wording) and is a common distractor; however, the vignette specifically emphasizes wedge excision of thenail fold.11755relates to nail procedures that do not match this scenario. The “TA” modifier indicatesleft great toefor anatomical specificity on the claim.

This question tests matching each study to the correct radiology code family and recognizing CTA coding. Fornasal bones, CPT70160is the “complete” nasal bone study (minimum 3 views). Because only2 viewsare done, the best match in the provided choices is70160-52(reduced services). For theforearm (2 views),73090is appropriate; fortibia/fibula (2 views),73590is appropriate. ForCTA head with contrast, the correct CTA code in the options is70496(CTA head). Option C is the only choice that correctly includes70496and the correct extremity X-ray codes73090and73590and also handles nasal bones as reduced service. The chest portion is imperfectly represented across the options (3-view chest typically aligns with a higher-view chest code than 71047), but the CPC-style best answerwithin the provided optionsisCbecause it captures the key intended learning targets: nasal bones reduced, correct extremity radiographs, and correct CTA head code.

35875 = Thrombectomy, femoral-popliteal artery

RT = Right side

75710-26 = Angiography, extremity, unilateral, professional component

Breaking down the term:

Cyst/o = bladder

Proct/o = rectum

-stomy = creation of an opening

Cystoproctostomy is the surgical creation of an opening between the bladder and the rectum.

The other options involve different organs:

Gastroenterocolostomy – stomach to intestine

Colocholecystostomy – colon to gallbladder

Nephropyelostomy – kidney to renal pelvis

For a complete bilateral mastectomy with insertion of breast prosthesis performed during the same surgical session, the correct CPT® codes are:

1. 19303-50: This code represents a complete mastectomy (removal of breast tissue) performed bilaterally (indicated by the -50 modifier).

2. 19340-50: This code is for the immediate insertion of a breast prosthesis following mastectomy, also performed bilaterally.

Explanation of other options:

A. 19303-50, 19342-50: Incorrect because 19342 is for the insertion of a breast implant, which differs from a prosthesis.

B. 19305-50, 19340-50: 19305 describes a modified radical mastectomy, which is more extensive than what is documented here.

C. 19325-50: This code represents a breast augmentation procedure, not a mastectomy with prosthesis insertion.

Thus, the correct answer is D. 19303-50, 19340-50, which accurately describes a bilateral mastectomy with prosthesis insertion.

1. Procedure and CPT® Code Selection:

The scenario describes the fabrication of an ocular prosthesis due to a severe injury to the left eye. A prosthesis made from silicon materials was created and customized to restore cosmetic appearance.

Code 21088 is the correct CPT® code for facial prosthesis involving materials, such as silicone, specifically designed to address anatomical loss in the eye region. This code accurately reflects the custom fabrication of a prosthesis to replace or augment damaged eye structures for aesthetic purposes.

2. Ruling Out Other Options:

Code 21077 applies to the prosthetic augmentation or replacement of mandibular or maxillary bone, not ocular prostheses, so it does not apply here.

Code 21080 covers the fabrication of facial prosthetics but is not specific to the ocular area and is more generalized. Given the focused nature of the eye, 21088 is more appropriate.

Code 21086 pertains to the creation of orbital prostheses (used for areas surrounding the eye) but not specifically for an ocular prosthesis. Since this scenario involves an intraocular replacement, 21088 is the most precise choice.

3. AAPC and CPT® Guidelines:

According to AAPC guidelines, using codes for facial prosthetics requires matching the specific anatomical site and purpose of the prosthesis. CPT® 21088 is directly applicable to prosthetic replacements within the ocular region, making it the best fit.

Thus, based on the CPT® guidelines and coding standards, the verified answer is C. 21088.

The patient was critically ill withhemodynamic instability, respiratory failure progression, and cardiac arrest, requiring intensive interventions (multiple IVs, large bolus,vasopressor infusion, resuscitation with CPR/defibrillation/medications, ABG management). The provider documents77 minutes of continuous critical care time. Critical care is reported with99291for thefirst 30–74 minuteson a date of service, and99292foreach additional 30 minutesbeyond that threshold. Because77 minutesexceeds 74 minutes, you report99291 + 99292(one unit of 99292 covers the additional time beyond the initial critical care window). You donotadditionally report an ED E/M code (e.g., 99285) on the same date for the same provider when critical care encompasses the ED evaluation and management during that time period; the critical care service is the appropriate E/M reporting. The scenario supports that critical care criteria are met: high probability of life-threatening deterioration and active physician management. Therefore, the correct E/M coding is99291, 99292.

89258 = Thawing of cryopreserved embryos

89250 = Culture of embryos, per day (reported once per encounter)

1. Procedure and CPT® Code Selection:

The patient underwent venous thrombosis imaging of each leg to assess for deep venous thrombosis (DVT).

CPT® Code 78457 is used for a venous thrombosis imaging study. This code is appropriate for imaging to detect DVT.

Modifier 50 is applied to indicate a bilateral procedure, as imaging was performed on both legs.

2. Diagnosis and ICD-10-CM Code Selection:

ICD-10-CM Code I82.403 is used for acute embolism and thrombosis of unspecified deep veins of bilateral lower extremities. This code accurately describes the finding of DVT in both legs.

Other ICD-10-CM options, such as I82.401 and I82.402, specify unilateral lower extremity involvement, which does not accurately reflect the bilateral findings in this case.

3. Rationale for Excluding Other Options:

Code 78458 (in options A and D) is for a more comprehensive study, often cardiac or whole-body blood pool imaging, and is not specific to leg venous thrombosis.

Option C, which lists 78457 with individual RT and LT modifiers, is incorrect as Modifier 50 is appropriate for bilateral imaging on both legs.

4. AAPC and CPT® Coding Guidelines:

According to AAPC and CPT® guidelines, 78457 with Modifier 50 should be used for bilateral venous imaging studies, and I82.403 correctly captures bilateral DVT.

Thus, the correct answer is B. 78457-50, I82.403.

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.

CPT® Professional Edition, AMA

Evaluation and Management Coding Guidelines

1. Procedure and CPT® Code Selection:

The urinalysis performed was non-automated and without microscopy.

CPT® Code 81002 is appropriate for a non-automated urinalysis without microscopy. This code accurately reflects the test performed in the office.

2. Diagnosis and ICD-10-CM Code Selection:

ICD-10-CM Code R30.0 is used for dysuria, which was one of the patient ' s presenting symptoms.

ICD-10-CM Code R10.30 is used for lower abdominal pain, another presenting symptom.

Since the urinalysis ruled out a urinary tract infection, N39.0 (UTI) is not appropriate as a final diagnosis.

3. Rationale for Excluding Other Options:

Code 81000 (in options A and B) is for a urinalysis with microscopy, which was not performed here.

N39.0 is used when a UTI is confirmed, which is incorrect for this case since the urinalysis was negative, ruling out UTI.

4. AAPC and CPT® Coding Guidelines:

AAPC guidelines recommend coding based on the symptoms when a specific diagnosis (such as UTI) is ruled out. Therefore, R30.0 and R10.30 are appropriate symptom codes for this encounter.

Thus, the correct answer is C. 81002, R30.0, R10.30.