CPC Certified Professional Coder (CPC) Exam Questions and Answers

65420 = Excision or transposition of pterygium without graft

LT = Left eye

H11.002 = Pterygium of left eye

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.

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

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

1. Procedure and CPT® Code Selection:

The patient underwent a cardiac MRI to assess the morphology and function of the heart under stress, involving both non-contrast and contrast-enhanced imaging. Additionally, pharmacological stress testing was performed to evaluate the coronary arteries.

CPT® Code 75563 is appropriate for a cardiac MRI with both stress and rest imaging, including morphology and function studies with contrast and pharmacologic stress testing. This code accurately captures the entire scope of the MRI study described in this case.

Modifier 26 is applied to indicate the professional component of the service if the cardiologist is providing only the interpretation and not the technical component.

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

ICD-10-CM Code I25.118 is used for atherosclerotic heart disease with unstable angina. This code accurately reflects the diagnosis provided in the scenario.

3. Rationale for Excluding Other Options:

Code 75559 (option B) represents a cardiac MRI without stress testing, which does not cover the pharmacologic stress component performed here.

Code 75557 (in option D) is for a limited cardiac MRI that does not include both stress and non-stress imaging, so it is incorrect for this comprehensive test.

ICD-10-CM Code I25.110 (in options C and D) is for atherosclerosis with angina pectoris without unstable angina, making I25.118 more appropriate given the diagnosis of unstable angina.

4. AAPC and CPT® Coding Guidelines:

AAPC and CPT® guidelines support the use of 75563 for comprehensive cardiac MRI studies with stress testing, both with and without contrast.

Therefore, the correct answer is A. 75563-26, I25.118.

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)

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+

J1071 = Testosterone cypionate, 200 mg per unit

96372 = Therapeutic IM injection

Vaccine admin codes do not apply

ANESTHESIA

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

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.

For a patient diagnosed with sepsis and associated acute respiratory failure, the ICD-10-CM codes are:

A41.9: Sepsis, unspecified organism.

R65.21: Severe sepsis with septic shock.

J96.00: Acute respiratory failure, unspecified whether with hypoxia or hypercapnia.

These codes appropriately capture the severity of the sepsis and the presence of acute respiratory failure.

ICD-10-CM guidelines

AMA ' s CPT® Professional Edition (current year)

According to ICD-10-CM Guidelines, I11A.0 (Resistant hypertension) is used to indicate hypertension that remains uncontrolled despite the use of multiple antihypertensive medications. Resistant hypertension is coded to highlight the severity of the patient’s condition and the difficulty in managing their blood pressure. This code is added as a secondary code to reflect the persistent elevation of blood pressure despite medication.

A. I10 (Essential hypertension) is a general code for primary hypertension but does not specify resistance to treatment.

B. A code from category I27 is related to pulmonary heart diseases, not directly related to hypertension management issues.

D. A code from category I16 (Hypertensive crisis) is used for hypertensive emergencies or urgencies, which are acute episodes, not persistent uncontrolled hypertension despite treatment.

Thus, the correct answer is C. I11A.0, Resistant hypertension.

A myringotomy is a surgical incision into the tympanic membrane (eardrum).

A myringotomy tube (ventilation tube) is placed in the ear to allow drainage of fluid from the middle ear and to equalize pressure.

Therefore, the correct answer is A. Ear.

11200 = removal of up to 15 skin tags

11201 = each additional 10 lesions or part thereof

26 lesions = 15 + 11 → 11201 ×2

Medical terms here are very literal.Peri-meansaround,cardirefers to theheart, and-itismeansinflammation. Sopericarditisis inflammation of thepericardium, thefibrous sac surrounding the heart. “With effusion” indicatesfluid accumulationin that pericardial space (pericardial effusion), which can be clinically important because significant effusion may impair heart filling (tamponade risk), but the question is strictly asking which structure is inflamed. Distractors map to other “card-” terms:myocardium(heart muscle) would be “myocarditis,”endocardium(inner lining of chambers/valves) would be “endocarditis,” and blood vessels supplying the heart arecoronary arteries(inflammation would not be termed pericarditis). On CPC exams, identifyingprefix + root + suffixis the fastest method: peri (around) + cardi (heart) + itis (inflammation) → pericardium inflamed.

The anesthesia code for an axillary block for procedures on the upper arm and elbow, which includes the monitoring by the anesthesiologist throughout the procedure, is 01830. This code is appropriate for anesthesia for all procedures on nerves, muscles, tendons, fascia, and bursae of the shoulder and axilla.

CPT® Professional Edition, AMA

Anesthesia Coding Guidelines

Dr. Burns is providing initial hospital or birthing center care for the evaluation and management of a normal newborn infant. CPT code 99460 is used to report initial hospital or birthing center care, per day, for evaluation and management of a normal newborn infant. This includes a comprehensive history, examination, and medical decision-making. The description of the service provided fits this CPT code accurately. References: CPT® Professional Edition (current year), AMA.

Penile prosthesis coding is determined by thetype of deviceand whether the procedure is asimple insertion, areplacement, or a more complex scenario. Anon-inflatable(malleable or semi-rigid) penile prosthesis is specifically reported withCPT 54416. Inflatable devices are coded differently (commonly with a different code family), and replacement/revision services may also have distinct codes depending on what is removed and replaced. In this question, the vignette is straightforward: erectile dysfunction treated with insertion of anon-inflatable prosthesis—no mention of prior implant, revision, or removal—so the correct code is the primary insertion code for that device type. The distractors include other penile procedures and prosthesis-related codes that do not match “non-inflatable insertion.” CPC exam tip: lock onto “non-inflatable” vs “inflatable,” and then confirm the action isinsertionrather than revision or replacement. That leads to54416.

Cholecyst- = gallbladder

Entero- = intestine

-ostomy = creation of an opening

Cholecystenterostomy is the correct term for surgically creating a connection between the gallbladder and the intestine.

This aligns with surgical terminology commonly tested in the CPT® digestive system section (40000–49999).

CPT Code 62290: Discography, lumbar, single or multiple levels, radiological supervision and interpretation

This code accurately describes the procedure performed. The documentation indicates a lumbar discography was performed at a single level (L3-4) with radiological supervision (C-arm visualization).

ICD-10-CM Code M54.50: Low back pain, unspecified

This code is the most appropriate diagnosis based on the documentation. The preoperative diagnosis states " Low back pain possible spinal stenosis L3-4. " While spinal stenosis was considered, it was not confirmed. The postoperative diagnosis indicates no evidence of spinal stenosis or discogenic pathology. Therefore, the definitive diagnosis is low back pain.

Why other options are incorrect:

62292: This code is for a discography with injection of contrast and/or medication for therapeutic purposes. The documentation doesn ' t indicate any therapeutic injection was performed.

M48.061 and M48.07: These codes represent spinal stenosis, which was not confirmed in the postoperative diagnosis.

Blue Cross Blue Shield is a commercial or private payer, which means it is an insurance company that provides health insurance plans to individuals and groups. In contrast, Medicare and Medicaid are government programs, and the Veterans Health Administration (VHA) is a federal healthcare system for military veterans.

AMA ' s CPT® Professional Edition (current year), Appendix B: Payers and Reimbursement.

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.

Complex (arm, 4 cm) → 13121

Intermediate legs total = 20.5 cm → 12036

Simple face closures coded separately:

12013 (cheek)

12011 (nose)

Modifiers allow separate anatomical reporting.

Correct answer: A

A tympanoplasty repairs aperforated tympanic membrane. The key phrase “doesnotremove the mastoid” means this istympanoplasty without mastoidectomy, which is correctly represented by69631in the answer set. Codes that include mastoid work (or represent different tympanoplasty variants) are incorrect because the documentation explicitly states the mastoid was not removed. Diagnosis coding should reflect both thechronic otitis mediaand theperforation. In the options,H66.92represents otitis media (as offered) andH72.92represents perforation of the tympanic membrane (as offered). Although the clinical story specifies the left ear, the provided diagnosis options do not include laterality; on CPC-style questions, you choose the best match among the answer choices. Therefore, the correct combination within this question’s choices is69631 with H66.92 and H72.92, matching tympanoplasty without mastoidectomy plus the documented conditions.

27380 = Repair, quadriceps muscle

S76.311A = Strain of muscle, fascia, tendon of right thigh, initial encounter

Code selection is based on specific muscle group and laterality

Observation E/M coding is chosen by thetype of serviceprovided on each calendar date. Day 1 includes initiation of observation with significant work (IV insulin drip, multiple labs, discussion with endocrinologist), supporting an observation initial care code. In this option set,99235represents an observation “admit and discharge on same date” style service; however, the patient stays multiple days. The question’s answer choices are structured around using99235as the initial observation care code offered, then a subsequent observation code for day 2, and a discharge code for day 3. Day 2 includes ongoing management with documented time of 25 minutes, supporting asubsequent observation carecode such as99231(as provided). Day 3 isobservation discharge, which is99238(30 minutes or less) given the documented 15 minutes. While the most current observation framework in CPT has evolved, the CPC-style expected pattern in these choices is99235 (initial), 99231 (subsequent), 99238 (discharge). Therefore, optionBmatches the intended coding sequence across the observation stay dates.

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.

73522 = Bilateral hips with pelvis, 3–4 views

Modifier -76 = Repeat procedure by the same physician

Modifier -51 identifies multiple procedures

1. Procedure and CPT® Code Selection:

The procedure involves a tympanoplasty with a radical mastoidectomy to remove a cholesteatoma in the middle ear. Additionally, the procedure includes ossicular chain reconstruction and grafting to repair the eardrum.

CPT® Code 69646 is appropriate for tympanoplasty with a radical mastoidectomy, including removal of the cholesteatoma and ossicular chain reconstruction. This code accurately describes the combination of tympanoplasty, radical mastoidectomy, and ossicular chain reconstruction, making it the correct choice.

2. Rationale for Excluding Other Options:

Code 69643 describes a tympanoplasty with a simple mastoidectomy, which is not appropriate since a radical mastoidectomy was performed.

Code 69645 covers a tympanoplasty with radical mastoidectomy but does not include ossicular chain reconstruction, which was part of this procedure.

Code 69641 is for a tympanoplasty without mastoidectomy, making it incorrect for this case.

3. AAPC and CPT® Coding Guidelines:

According to AAPC and CPT® guidelines, 69646 is the appropriate code when a tympanoplasty includes a radical mastoidectomy with ossicular chain reconstruction, as documented in this case.

Therefore, the correct answer based on CPT® guidelines is D. 69646.

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.

Intermediate repair includes single-layer closure with extensive cleaning, debridement, or removal of debris, or layered closure of one or more deeper layers.

Option B meets the definition due to extensive cleaning and debris removal.

Option C would be a complex repair.

Option D is a simple repair.

Extensive undermining alone does not define intermediate repair.

Selective catheter placement coding follows thehighest-order selective catheterization achievedwithin a vascular family, plus additional selective placements when adifferent vascular familyis entered. Here, access is via femoral artery into theabdominal aorta(nonselective aortic position), then selective advancement into theleft inferior phrenicand further into theleft superior suprarenal (adrenal) artery. The code set offered indicates reporting36245(selective, first-order or initial selective placement as represented by the item’s structure) and36246(additional selective advancement). Imaging is also reported:75731represents the angiographic imaging component matching the described abdominal/visceral angiography in the options. Options with-50are incorrect because the study is on theleftside only, not bilateral. Option C omits a necessary catheter placement level from the option set, and option D substitutes a different catheter placement code while still incorrectly using bilateral imaging. Therefore, optionAbest reflects the catheter placement progression and associated angiography per the question’s choices.

To code for anesthesia services, we select the correct CPT® anesthesia code based on the procedure, modifiers, and physical status of the patient:

00800 represents " Anesthesia for procedures on the lower abdomen not otherwise specified, " which includes procedures like a panniculectomy. The code 00802 is not appropriate here because it is used for lower abdominal procedures involving " major lower abdominal vessels, " which does not apply to a panniculectomy.

AA Modifier indicates that the anesthesia services were personally performed by the anesthesiologist, as stated in the scenario.

P3 Modifier reflects a physical status of 3, which indicates a patient with a " severe systemic disease, " matching the patient ' s documented condition.

The emergency modifier 99140 is not appropriate here, as there is no indication that the procedure was performed under emergency conditions.

Thus, the correct answer is 00800-AA-P3.

Procedure Coding:

56633 – Radical vulvectomy (removal of > 80%), including deep subcutaneous tissue

Documentation supports greater than 80% vulvar removal

Deep tissue involvement confirms radical procedure

Diagnosis Coding:

D07.1 – Carcinoma in situ of vulva

VIN III = high-grade squamous intraepithelial lesion

Classified as carcinoma in situ, not benign dysplasia

Why Other Options Are Incorrect:

56620 / 56625 / 56630 – Partial or simple vulvectomy

N90.1 – Mild vulvar dysplasia (incorrect severity)

ICD-10-CM Official Guideline:

VIN III is coded as D07.1, not N90.x.

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.

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.

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).

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.

Acetaminophen is a specific drug with a dedicated quantitative laboratory code. Even if a lab method such asLC-MSis mentioned, CPC exam questions typically expect you to choose the CPT code that corresponds to theanalyte being measured, not to select a broad “definitive drug testing” category code when a specific drug assay code exists. CPT80143is the established code foracetaminophentesting (quantitative measurement). Codes in the 803xx range are commonly associated with drug screening/testing categories that do not specifically represent acetaminophen as a named analyte in the way CPC questions test. Code80299is an unlisted therapeutic drug assay and is not appropriate when a specific code (80143) exists. Therefore, the correct answer is80143. CPC strategy: when the substance is explicitly named and has a recognized assay code, choose thespecific drug test coderather than an unlisted or generalized testing category. The method (LC-MS) supports “definitive” testing clinically, but the code selection here is driven by the named analyte.

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.

This scenario describes an anterior discectomy and arthroplasty at two levels (L3-L4 and L5-S1) using artificial discs. CPT® code 22857 describes total disc arthroplasty (artificial disc), anterior approach, including discectomy to prepare interspace (other than for decompression), single interspace, lumbar. Since the procedure was performed at two levels, the code should be reported twice.

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

81025 – Urine pregnancy test, by visual color comparison methods

Correct for office-based urine pregnancy testing

Why Other Options Are Incorrect:

81000–81005 – Urinalysis codes, not pregnancy testing

The diagnosis “tracheal stenosis present from birth” is acongenital malformation, which is coded withQ32.1(congenital stenosis of trachea) rather than an acquired tracheal disorder code. For anesthesia coding, tracheoplasty is a major airway/tracheal surgical procedure and maps to the appropriateairway/trachea anesthesiacategory represented by00320in the answer set. Because the patient is aninfant (6 months old), anesthesia qualifies for the extreme age add-on99100(anesthesia for patient of extreme age, under 1 year or over 70 years). Options includingJ39.8reflect an acquired/other tracheal disorder category rather than congenital stenosis, which conflicts with “from birth.” Options that omit 99100 miss the age-related qualifying circumstance. CPC exam strategy: always code congenital conditions withQ-codeswhen documented as present from birth, and remember99100for patients < 1 yearwhen anesthesia qualifying circumstances are reported. Therefore,00320, 99100, Q32.1is correct.

The patient with malignant lymphoma is administered Rituximab (800 mg) and Benadryl (100 mg) intravenously.

Procedure Description:

Administration of Rituximab (800 mg) intravenously.

Administration of Benadryl (100 mg) intravenously.

HCPCS Level II Coding:

J9312: Injection, Rituximab, 10 mg.

For 800 mg, report 80 units of J9312.

J1200: Injection, Diphenhydramine HCl, up to 50 mg.

For 100 mg, report 2 units of J1200.

HCPCS Level II Code Book (current year).

HCPCS Level II coding guidelines for intravenous drug administration.

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.

When hypertension and heart disease are documented together, a cause-and-effect relationship is presumed unless stated otherwise.

Category I11 (Hypertensive heart disease) is used.

Additional codes from I50.- (heart failure) are assigned if applicable.

This follows ICD-10-CM Official Coding Guidelines.

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

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.

The scenario involves a secondary repair of two flexor tendons in the forearm. CPT® code 25272 describes the repair of a secondary flexor tendon injury, including a graft, in the forearm and/or wrist, which fits the description provided. This code should be reported once, as the procedure encompasses the repair of multiple tendons.

The key phrase is “remove the sequestered section of dead infected fragment bone”, which is a sequestrectomy performed for osteomyelitis.

23172 describes sequestrectomy of the scapula (shoulder blade).Therefore, C is correct.

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)

The correct ICD-10-CM coding for this patient is B20, M54.50. The first code, B20, is used for HIV disease, which is a confirmed diagnosis of HIV infection. It’s important to note that this code can be used regardless of whether the patient is symptomatic or asymptomatic, as long as the patient has been diagnosed with HIV.

The second code, M54.50, refers to low back pain, which would be used to report the loin pain described by the patient. " Loin pain " typically refers to pain in the lower back area, and this code specifically covers the general category of low back pain not otherwise specified.

The other options are not as accurate:

A (B20, M54.9) includes a nonspecific code for back pain (M54.9), which does not fully specify the pain’s location.

B (M54.51, B20) incorrectly includes a code for thoracic or lumbar radiculopathy (M54.51), which is not indicated here.

D (M54.50, B20) is similar to the correct answer, but it incorrectly lists the codes in reverse order. It is important to list the HIV diagnosis first in ICD-10-CM.

Reference topics: ICD-10-CM Coding for HIV Disease; Pain Coding

The correct J codes are selected based on the specific medications administered and their quantities:

J2405 represents " ondansetron, 1 mg, " and since the patient received a 2 mg dose, J2405 is reported once with a quantity of 2 mg.

J1885 represents " ketorolac tromethamine, 15 mg, " which matches the single 15 mg dose administered to the patient, so J1885 is reported once.

Each J code is billed according to the precise dosage given, as no multipliers are required beyond the single-unit codes provided in choice A, making it the correct answer.

This is areturn to the operating room during the postoperative period(two months after the original fracture repair) by thesame surgeon, and the new surgery is related to the original condition/hardware, so a postoperative modifier is needed. The scenario describes a complication-related problem (hardware displacement with malunion) requiring operative correction, which aligns withmodifier -78(unplanned return to the OR for a related procedure during the postoperative period). Diagnosis coding includes a complication of internal orthopedic device:T84.122Acorresponds todisplacement of internal fixation device of bones of forearm(initial encounter for the complication). The fracture condition being treated is amalunionof the right radius shaft; malunion is captured with the fracture code and the 7th characterPfor subsequent encounter for fracture with malunion:S52.301P. Among options,25405-78is the correct procedural selection provided for repair of malunion in this context (as tested by the item), paired withT84.122AandS52.301P. Therefore, optionBis 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.

99222: This code is used for initial hospital care, per day, for the evaluation and management of a patient, which requires a detailed or comprehensive history, a detailed or comprehensive examination, and medical decision making of moderate complexity.

The documentation shows a detailed history (including HPI, ROS, PMH, SH, and FH) and a detailed examination (covering multiple organ systems). The medical decision making involves the management of an acute asthma exacerbation, which includes admitting the patient to observation status, administering oral steroids, and planning for further diagnostic testing.

CPT® Professional Edition, AMA

38573 includes comprehensive laparoscopic staging with bilateral pelvic lymphadenectomy and paraaortic sampling

All listed components are bundled into this code

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.

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.

ICD-10-CM, medical dictionaries, and oncology textbooks

When a patient experiences an underdose of insulin due to an insulin pump malfunction, the primary reason for the encounter would be the malfunction itself, which is coded first. The resulting hyperglycemia or hypoglycemia due to the pump failure is a secondary condition. According to ICD-10-CM guidelines, the code for the mechanical complication of the pump (T85.633-) is sequenced first, followed by a code for the diabetes with complication (E11.65 for type 2 diabetes with hyperglycemia).

ICD-10-CM (current year), Chapter 19: Injury, Poisoning and Certain Other Consequences of External Causes (S00-T88), ICD-10-CM Official Guidelines for Coding and Reporting, Section I.C.4.

A diagnostic mammogram performed on both breasts with computer-aided detection (CAD) is reported with CPT® code 77066. This code is used when CAD is utilized to further analyze the images for possible lesions, and it covers both breasts.

The correct answer is A. In the back of the upper leg between the hip and thigh. The hamstrings are a group of muscles located in the posterior thigh, meaning the back portion of the upper leg. Anatomically, the hamstring group includes the biceps femoris, semitendinosus, and semimembranosus muscles. These muscles extend from the pelvis region toward the knee and are primarily responsible for knee flexion and assisting with hip extension. In coding and medical terminology, identifying the correct anatomical location is important because musculoskeletal diagnoses, injuries, repairs, injections, imaging, and rehabilitation services depend on accurate body-region terminology.

The other options describe incorrect anatomical areas. The front of the upper leg is the anterior thigh, mainly associated with the quadriceps muscles. The front of the lower leg refers to the shin or anterior leg compartment. The back of the lower leg is the calf region, which contains muscles such as the gastrocnemius and soleus, not the hamstrings.

Reference topics: CPC Medical Terminology and Anatomy — Musculoskeletal System; Lower Extremity Anatomy; Muscle Groups and Body Regions.

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.

A “recent football injury” indicates anacute traumaticinjury rather than a chronic/old derangement. Acute meniscus tears are coded from theS83.2-category (tear of meniscus, current injury), not theM23.-category (derangement of meniscus due to old tear or injury). The question specifiesmedial meniscus,left knee, and implies aninitial encounterfor the acute injury, so the correct code must include laterality and the 7th characterAfor initial encounter.S83.232Acorresponds to acurrent tear of the medial meniscus, left knee, initial encounter.S83.242Ais a different meniscus specification (not medial).M23.202/M23.204are derangement codes typically used forold tearsor chronic conditions, not an acute recent sports injury. CPC exam tip: “recent injury” →S-codes, “old tear/derangement” →M23. Mnemonic:S = Sudden (acute),M = Mature (old/chronic).

74150 = CT abdomen without contrast

Other codes describe MRI or combined studies

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.

CPT® code 15786 is used for abrasion treatment of a single lesion (e.g., for keratosis) through techniques like dermabrasion (lightly sanding the skin ' s surface). When treating multiple lesions in this manner, each lesion treated should be coded individually.

Since the patient has 5 keratosis lesions treated through sanding, 15786 x 5 accurately represents the procedure for each lesion.

Explanation of other options:

A. 15787 x 5: Incorrect because 15787 is designated for dermabrasion of " additional lesions " and would be used in conjunction with 15786, not alone.

B. 15786, 15787: Incorrect, as it does not account for all five lesions treated.

C. 15786, 15787 x 4: Incorrect, as 15787 is used only when performed in addition to 15786, not as a replacement for each additional lesion.

Therefore, the correct answer is D. 15786 x 5, which accurately reports the treatment of all five lesions.

Asphenoidotomyperformed vianasal/sinus endoscopyis specifically reported withCPT 31287(endoscopic sinus surgery, sphenoidotomy). A diagnostic nasal endoscopy code (such as 31231) is generallynot separately reportedwhen it is integral to performing the surgical endoscopic sinus procedure, so options including 31231-59 are incorrect in typical CPT exam logic unless a distinct, separately identifiable diagnostic endoscopy is clearly documented and medically necessary beyond the surgical approach. The diagnosis describes afracture of the skull baseinvolving the sphenoid sinus without CSF leak; among the offered diagnosis codes,S02.19XAcorrectly represents a skull base fracture category consistent with the scenario’s specificity as presented in the answer choices. Code31291represents a different sinus procedure (not sphenoidotomy). CPC key point: choose the code matching thespecific sinus and surgical action(sphenoidotomy → 31287) and avoid unbundling the diagnostic endoscopy that is part of the operative endoscopic approach.

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)

99285 = High-complexity ED visit

I21.4 = NSTEMI

Chest pain symptoms are not coded once MI is diagnosed

IV hydration is coded byduration. CPT96360is forinitial intravenous hydration(typically the first hour). CPT96361is an add-on code foreach additional hourbeyond the initial hour, reported when the hydration time exceeds 60 minutes and meets the additional-hour threshold. The scenario documents hydration for1 hour and 30 minutes (90 minutes). That supports reporting theinitial hour(96360) plusone additional hour(96361) because the infusion extends beyond the initial hour and reaches the qualifying threshold for an additional hour as defined by CPT time rules (time is rounded/assigned based on midpoints, not per minute). The other options usetherapeutic infusioncodes (96365/96366), which are for medications/drugs, not for hydration with normal saline when the primary purpose is hydration. CPC exam tip: if the service is specifically “hydration” and the fluid is normal saline for dehydration/heat exhaustion, use96360/96361and apply time-based logic.

To accurately code a pressure ulcer in ICD-10-CM, the code must reflect the ulcer ' s location and stage. The codes for pressure ulcers specify both the anatomical site and the stage (extent of tissue damage).

L89.613 represents a pressure ulcer on the right heel at stage 3. The stage is critical as it indicates the severity of the ulcer, with stage 3 involving full-thickness skin loss and possibly visible subcutaneous tissue.

A. L89.609 refers to a pressure ulcer on the heel but without specific staging.

C. L89.619 is for a pressure ulcer on the right heel at stage 4, which indicates a more severe level of tissue damage than stage 3.

D. L89.603 represents a stage 3 pressure ulcer but on the left heel, not the right.

Therefore, the correct answer is B. L89.613 for a stage 3 pressure ulcer on the right heel.

99291: This code is used for the first 30-74 minutes of critical care, evaluation, and management of the critically ill or critically injured patient.

99292: This code is used for each additional 30 minutes of critical care service beyond the first 74 minutes.

The documentation indicates that the patient received a total of 45 minutes of critical care, which involves continuous IV insulin for diabetic ketoacidosis, administration of antiemetics, and admission to the ICU. The critical care time documented justifies the use of 99291 for the first 30-74 minutes and 99292 for each additional 30 minutes.

CPT® Professional Edition, AMA

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.

Malignant lesion destruction → CPT 17260–17286

Trunk/extremities

0.6–1.0 cm → 17261

1.1–2.0 cm → 17262

Both lesions are reported separately.

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.

Procedure Coding (CPT®):

44212 – Laparoscopic partial colectomy with end colostomy and closure of distal segment (Hartmann-type procedure)

Correct because:

Sigmoid/descending colon resection

Proximal colostomy created

Distal rectal stump closed

44213 – Laparoscopic mobilization of splenic flexure

Separately reportable because:

Mobilization was necessary to exteriorize colon for colostomy

Not bundled into 44212

Modifier not required (no multiple-procedure discount with add-on logic)

Diagnosis Coding (ICD-10-CM):

K57.33 – Diverticulitis of large intestine with perforation and bleeding, without abscess

Documentation supports:

Diverticulitis

Active bleeding

No abscess reported

Why Other Options Are Incorrect:

A / B – 44206 = colectomy with anastomosis (not performed)

A / B – K57.41 includes abscess (not documented)

C – Missing splenic flexure add-on explanation

CPT® & ICD-10-CM Guideline Alignment:

Hartmann procedure ≠ anastomosis

Bleeding elevates diagnosis specificity

Splenic flexure mobilization is separately reportable when clinically required

To determine the correct anesthesia code for a cesarean delivery with specific conditions, we review the following codes:

01961 is defined as " Anesthesia for cesarean delivery only, " which aligns with this scenario, as the patient is admitted for a cesarean section.

01960 refers to anesthesia for a vaginal delivery, which does not apply here as the delivery is via cesarean.

01967 is for " Anesthesia for planned vaginal delivery, " which also does not apply due to the cesarean route.

01958 is used for planned vaginal delivery that may involve a complicated scenario, but since the procedure is a cesarean section, this code is not appropriate.

Given that the patient is in labor for a cesarean section and has had a previous external cephalic version, 01961 is the correct answer.

99213-25 = E/M with separate procedure

87880 = Rapid strep test

J02.0 = Streptococcal pharyngitis

Symptoms are not reported with definitive diagnosis

Personal history codes are not appropriate for every encounter. They are reported only when relevant to the reason for the visit. Therefore, option A is false.

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.

50500 = Repair of kidney laceration

N99.72 = Accidental puncture/laceration of genitourinary system during a procedure

S37.062A (traumatic kidney injury) is not used for intraoperative complications

The nephrologist does not report the colectomy, nor modifier -80

49190 = Excision of peritoneal tumor greater than 10 cm

C48.2 = Malignant neoplasm of peritoneum

00537 = Anesthesia for EP procedures

P1 = Normal healthy patient

TSH testing is reported with CPT84443. The scenario describes a workup for possible thyroid dysfunction, but there isno confirmed thyroid diagnosisprovided—only symptoms (fatigue and weight gain). In outpatient coding, when a definitive diagnosis is not established, you code thesigns/symptomsthat justify the test. Therefore, the correct ICD-10-CM codes areR53.83(other fatigue) andR63.5(abnormal weight gain), as offered. You shouldnotassign a thyroid disorder code such asE07.9(unspecified disorder of thyroid) unless the provider documents an actual thyroid disorder diagnosis; suspicion alone does not support it in the outpatient setting. Options C and D list84445, which is not the standard CPT code for TSH measurement in CPC exam coding. This question is testing both correct lab code selection and the outpatient guideline principle of codingsymptomswhen the diagnosis is not confirmed. Hence,84443 with R53.83 and R63.5is correct.

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

Face (nose) → 11310–11313

0.6–1.0 cm → 11311

Inflamed seborrheic keratosis → L82.0

This operative report documents anew permanent dual-chamber pacemaker implantation: creation of a subcutaneouspocket, placement oftwo transvenous leads(oneatrialand oneventricular) via a peel-away sheath, confirmation of thresholds, and connection/insertion of thepulse generatorinto the pocket with layered closure. CPT pacemaker insertion coding is determined by thenumber of chambers/leads placedduring the session.33208is the correct code for insertion of adual-chamberpermanent pacemaker system (atrial and ventricular leads with generator).33206is for asingle-chamber ventricularsystem and33207is for asingle-chamber atrialsystem, so neither matches a dual-lead implantation. Reporting 33206 and 33207 together is not correct because CPT provides the single comprehensive dual-chamber code when both leads are placed. The fluoroscopic guidance and catheterization lab setting support how the leads were placed but do not change the CPT selection, and “challenging due to agitation” does not by itself create a separate reportable service. Therefore, report33208.

1. Procedure and CPT® Code Selection:

The patient underwent a partial nephrectomy (removal of part of the left kidney) via a laparoscopic approach.

CPT® Code 50543 is specifically used for a laparoscopic partial nephrectomy, which is an accurate description of this procedure.

2. Rationale for Excluding Other Options:

Code 50548 is used for a laparoscopic radical nephrectomy, which involves the complete removal of the kidney and surrounding structures; therefore, it does not apply to this partial nephrectomy.

Code 50220 represents an open partial nephrectomy, not a laparoscopic approach, and is therefore incorrect for this procedure.

Code 50546 is for a laparoscopic radical nephrectomy with bilateral removal of kidneys, which is not applicable in this case where only a partial removal of the left kidney was performed.

3. AAPC and CPT® Coding Guidelines:

AAPC and CPT® guidelines indicate that the use of 50543 is appropriate for any laparoscopic partial nephrectomy, regardless of the laterality, and it specifically identifies laparoscopic technique over open surgery.

Therefore, based on CPT® guidelines, the correct answer is C. 50543.

Autopsy CPT coding is based on theextent of the examination(gross only vs gross and microscopic) and whether special anatomic components (such asbrain and spinal cord) are included. The question states the pathologist performedboth gross and microscopicexamination and explicitly included thebrain and spinal cord, which indicates acomprehensive autopsyservice rather than a limited or gross-only autopsy. CPT88028represents a complete autopsy with gross and microscopic examination that includes examination of the central nervous system structures (brain and spinal cord) as part of the comprehensive scope. The other codes listed represent different autopsy levels or components that do not match the “gross and microscopic” plus CNS inclusion described. CPC exam approach: anchor first ongross + microscopic(not gross-only), then look for wording that indicates acomplete autopsy. When the stem highlights “brain and spinal cord,” it is signaling the higher-complexity comprehensive autopsy code selection. Therefore,88028is the correct CPT code.

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.

Basal cell carcinoma is amalignantskin neoplasm, so the excision is coded from11600–11646(malignant lesion excision), not11400–11446(benign lesion excision). The scalp is in the anatomic group that includesscalp/neck/hands/feet/genitalia, and the excised diameterincluding marginsdetermines the malignant excision code range. A size of3.7 cmfalls into the3.1–4.0 cmcategory, which corresponds to11624for malignant excision in that location group. Closure is separately reportable when it is anintermediate (layered) repair, so you add12032(intermediate repair, scalp/axillae/trunk/extremities;2.6–7.5 cm) when documentation supports layered closure beyond simple repair. Diagnosis coding should reflectbasal cell carcinoma of scalp/neck, which isC44.41. Options that use benign excision or benign diagnosis codes are incorrect for basal cell carcinoma.

CPT®: The documentation supports excision of a subcutaneous soft tissue tumor of the hand, size 1.5 cm.

26111 = Excision of tumor/soft tissue of hand or finger, subcutaneous, 1.5 cm or less

26115 would be for a larger size range (not supported by “1.5 cm” in the question).

ICD-10-CM: Pathology confirms subcutaneous hemangioma (benign vascular tumor).

D18.01 = Hemangioma of skin and subcutaneous tissueCodes D21.01/D21.11 are benign neoplasm of connective/soft tissue categories, but the most accurate match here (and the one reflected in the answer choices) is D18.01 for hemangioma of skin/subcutaneous tissue.

Typing correction applied: the options showed “018.01”; the correct ICD-10-CM format is D18.01.

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.

69209 = Cerumen removal using irrigation

69210 = Cerumen removal using instrumentation

Different techniques on different ears require separate codes with laterality modifiers

End-Stage Renal Disease (ESRD) is a condition in which the kidneys fail to work effectively to remove waste products and excess fluids from the blood. This primarily affects the genitourinary system, which includes the kidneys, ureters, bladder, and urethra. Patients with ESRD often require dialysis or a kidney transplant.

ICD-10-CM (current year), Chapter 14: Diseases of the Genitourinary System (N00-N99).

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)

In the CPT® code book, code 35860 describes an " Exploration for postoperative hemorrhage, thrombosis or infection " in multiple areas, specifically including the neck, chest, abdomen, and/or extremity. This code is used when a surgeon explores these areas postoperatively to locate and address complications such as bleeding, clots, or infections.

B, C, and D are incorrect as they do not fully encompass all the areas listed in the actual description of CPT® code 35860, which includes all four regions (neck, chest, abdomen, and extremity).

Thus, the correct answer is A. Exploration for postoperative hemorrhage, thrombosis or infection; neck, chest, abdomen, and/or extremity.

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.

1. Procedure and CPT® Code Selection:

The patient underwent a suppression study involving five glucose tests and five human growth hormone tests.

CPT® Code 80430 represents a suppression panel specifically for growth hormone studies, which includes various assessments for diagnosing abnormal growth.

CPT® Code 82947 is used for each glucose test performed, and since five glucose tests were conducted, it should be coded as 82947 x 5.

CPT® Code 83003 is used for each human growth hormone test performed, and since five tests were conducted, it should be coded as 83003 x 5.

2. Rationale for Excluding Other Options:

Option A lists 82947 x 2 and 83003 without sufficient units to account for the five tests each, which does not match the actual number of tests performed.

Option B omits the suppression panel code 80430, which is necessary for documenting the overall suppression study.

Option D does not provide the correct quantity of glucose and growth hormone tests, which were each performed five times.

3. AAPC and CPT® Coding Guidelines:

According to AAPC guidelines, when a suppression panel includes multiple components that are performed more than once, the specific panel code 80430 should be used along with the correct number of individual component codes.

Therefore, the correct answer is C. 80430, 82947 x 5, 83003 x 5.

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.

93000 = ECG with tracing, interpretation, and report

93010 = Interpretation only

Chest radiography codes are selected by thenumber of viewsperformed. CPT71047is for chest X-ray with2 views, while71048is for chest X-ray with3 or 4 views. When the number of views exceeds a code’s defined range, you generally donotreport the code multiple times per extra view; instead, you select the CPT code that best describes the service family and view count as structured by the code set and payer rules. In CPC-style question design, “6 views of the chest” is often included to test whether you incorrectly multiply per view. The answer options provided do not include a dedicated “6+ view chest” code, and the correct choice in this question’s answer set is to report71048(the higher view-count chest radiograph code offered)once, not “×6” or doubling 2-view codes. Option A and B reflect incorrect per-view/per-unit reporting. Therefore, within the provided choices, the correct answer is71048.

22903 = Excision of soft tissue tumor, abdominal wall, subcutaneous, 3 cm or greater

D49.2 = Neoplasm of unspecified behavior of soft tissue

R codes are not used when a neoplasm is documented

A suppression study is adynamic endocrine testinvolving serial measurements over time. CPT80430represents thesuppression function testitself (the study framework), while the individual lab analytes measured during the test are reported with their specific assay codes based on the test protocol. The scenario includesfive glucose testsandfive human growth hormone (HGH) testsperformed as part of the study. Glucose testing is reported with82947per test, and growth hormone testing is reported with83003per test. Because the stem specifiesfive of each, correct reporting includes80430plus82947 × 5and83003 × 5. Options that report only one unit of 82947/83003 (or reduce the number of tests) fail to reflect the documented serial testing frequency. CPC exam tip: when a dynamic study is described, do not stop at the function test code—also capture theserial analyte measurementswhen the question explicitly provides the number of lab draws/tests. Therefore, the correct coding is80430, 82947 × 5, 83003 × 5.

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.

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.

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.

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)

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.

AMA ' s CPT® Professional Edition (current year), Musculoskeletal System section.

94060 = Spirometry pre- and post-bronchodilator

94010 = Baseline spirometry

J45.21 = Mild intermittent asthma with exacerbation

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

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.

1. E/M Code Category Selection:

The patient was placed in observation care on 12/2/20XX for an acute asthma exacerbation and stayed in observation for a total of 16 hours, with discharge occurring on 12/3/20XX.

The appropriate E/M category for patients in observation care for a period that includes both admission and discharge on separate calendar dates is " Hospital Inpatient or Observation Care Services " , with specific codes for admission and discharge on different dates.

2. Code Range and Specific Codes:

Code Range 99234-99236 applies to cases where observation care includes both admission and discharge, particularly when they occur on different calendar days and the total duration of care is under 24 hours.

For discharge on the subsequent day, 99238-99239 (Hospital Inpatient or Observation Discharge Services) applies, depending on the time spent on discharge.

3. Rationale for Excluding Other Options:

Option B and Option D include Initial Hospital Inpatient or Observation Care codes (99221-99223), which are typically used for admissions to inpatient care rather than for observation care scenarios as presented here.

Option C incorrectly combines Subsequent Inpatient or Observation Care codes (99231-99233), which are used for follow-up days rather than discharge services.

4. AAPC and CPT® Coding Guidelines:

According to CPT® guidelines, the 99234-99236 code range is used when observation care requires both admission and discharge on different dates, and 99238-99239 is appropriate for discharge services.

Therefore, the correct answer is A. Hospital Inpatient or Observation Care Services (Including Admission and Discharge Services) (99234-99236) and Hospital Inpatient or Observation Discharge services (99238-99239).

1. Procedure and CPT® Code Selection:

The scenario describes the removal and replacement of an inflatable penile prosthesis due to erectile dysfunction.

CPT® Code 54416 is specifically used for the removal and replacement of a multi-component inflatable penile prosthesis. This code accurately describes the procedure performed.

2. Rationale for Excluding Other Options:

Code 54401 represents the initial insertion of a multi-component inflatable penile prosthesis but does not cover removal and replacement, making it inappropriate for this scenario.

Code 54400 is for the insertion of a non-inflatable (malleable) penile prosthesis, which does not apply here as the prosthesis is inflatable.

Code 4417 does not exist in the CPT® coding system and is likely a typo or incorrect option.

3. AAPC and CPT® Coding Guidelines:

According to AAPC and CPT® guidelines, 54416 is the correct code when an inflatable prosthesis requires both removal and replacement, without the need for additional modifiers for this procedure.

Therefore, the correct answer based on CPT® guidelines is D. 54416.

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

1. Procedure and CPT® Code Selection:

The procedure involves an incision and drainage (I & D) of a deep abscess (felon) on the palmar surface of the right thumb. A felon is an abscess in the pulp of the fingertip, often involving deep tissue.

Code 26010 is specific for incision and drainage of a finger abscess, which includes the thumb. This code applies to cases where the abscess is drained from a deep tissue level.

Code 26011 is similar but involves the use of extensive drainage or debridement, which is not indicated in this case. Therefore, 26011 is not appropriate here.

Code 10061 refers to incision and drainage of abscesses at different locations on the body but not for specific areas such as the thumb, making it inappropriate in this context.

Code 10140 pertains to the evacuation of hematoma, seroma, or fluid but does not apply to abscesses, so it is not suitable for this scenario.

2. Modifier:

Modifier F5 is added to specify that the procedure was performed on the right thumb.

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

ICD-10-CM Code L02.511 is appropriate for cutaneous abscess of the right finger, as it accurately describes the diagnosis of a felon on the thumb.

L03.011 would represent cellulitis but does not specify an abscess, making it less precise for this case.

4. AAPC and CPT® Coding Guidelines:

The AAPC guidelines for coding finger abscess drainage emphasize the selection of specific codes for deep tissue drainage procedures in extremities. Additionally, correct laterality should be included with the use of modifiers and specific ICD-10-CM codes for an accurate representation of the site and nature of the condition.

Thus, based on the coding standards and guidelines, the verified answer is B. 26010-F5, L02.511.

This is aninitial hospital service(admitted this morning; “reason for admission”), so the correct E/M family isinitial hospital inpatient/observation carerather than subsequent hospital care (99232/99233). The encounter includes a detailed history, comprehensive exam elements focused on abdominal pathology, and meaningful initial management: NPO, IV fluids,IV morphine, ordering and reviewing lab panels, and ordering imaging (ultrasound and HIDA) with possible surgical consultation—supporting at leastmoderate MDM, consistent with99222in typical CPC exam mapping. Diagnosis coding: “rule out cholecystitis” is not a confirmed inpatient discharge diagnosis in the provided note; at this stage the physician’s final assessment isRUQ abdominal pain, rule out cholecystitis. Therefore, you report thesign/symptomcodeR10.11 (right upper quadrant pain)rather thanK81.9(cholecystitis, unspecified), because cholecystitis is not established as definitive in the note. Option A correctly pairs an initial hospital E/M code with the symptom diagnosis supported by documentation.

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.

This is destruction of malignant lesions (SCC).

17261 = Malignant lesion destruction, trunk/arms/legs, 0.6–1.0 cm

17262 = Same location, 1.1–2.0 cm

Feet are included in trunk/arms/legs.

Therefore, 17262, 17261 is correct.

88299 = Unlisted cytogenetic study

Other unlisted codes are for chemistry, immunology, or pathology

S06.0X1A = Concussion with brief LOC

V40.5XXA = Driver injured in collision with fixed object

V47.5XXA = Car accident, driverExternal cause codes correctly describe mechanism and role.

22514 = Vertebroplasty, lumbar (L5)

22515 = Each additional vertebral body (sacrum)

Vertebroplasty codes are inherently bilateral, so modifier -50 is not used

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.

Impending myocardial infarction is reported with I21.3 for a myocardial infarction (acute). The shortness of breath, which is a symptom, is coded separately as R06.02. According to ICD-10-CM guidelines, when a definitive diagnosis is established, the diagnosis code is sequenced first followed by symptom codes.

ICD-10-CM (current year), Chapter 9: Diseases of the Circulatory System (I00-I99), ICD-10-CM Official Guidelines for Coding and Reporting, Section I.C.9.e.4.

Cervical spondylosis with myelopathy: Condition requiring decompressive surgery.

Bilateral posterior laminectomy, facetectomies, foraminotomies: Procedures performed to decompress nerve roots.

Interspaces C5-C6 and C6-C7: Specific levels where the procedures were performed.

CPT code 63045 is used for the initial cervical laminectomy, and 63048 is for each additional segment. The combination covers the decompression across two interspaces.

Rhinoplasty is a surgical procedure performed to reconstruct or reshape the nose. It can be done for cosmetic reasons or to improve breathing function. The term " rhino " refers to the nose, and " plasty " refers to the surgical molding or forming of a part of the body.

AMA ' s CPT® Professional Edition, medical dictionaries

Moderate sedation codes are selected by (1)patient ageand (2) whether the sedation is provided by thesame physician performing the procedureor by a different provider. The stem states theorthopedist provides the sedation and the reduction, so the sedation is provided by thesame physicianwho performs the procedure. For age, the patient is5 years old, which falls into the≥5 yearscategory. Therefore, the correct initial moderate sedation code is99152(moderate sedation provided by the same physician/other qualified provider performing the procedure; patient age 5 years or older; initial 15 minutes). The documented time is21 minutes, which supports only theinitialcode (it does not reach the threshold needed to report an additional 15-minute increment add-on). Code99151is for patientsunder 5 years, so it does not apply. Codes99155/99156are for sedation provided by adifferentprovider than the one performing the procedure. CPC exam tip: age cutoffs matter—exactly 5years old uses the “5 years or older” code set.

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.