AAPC CPC Dumps

Procedure Coding (CPT®):

59821 – Induced abortion, by vaginal suppository, amniotic fluid injection, or other medical means

Used for fetal demise at ≥14 weeks gestation

Labor was medically induced and fetus delivered

Diagnosis Coding (ICD-10-CM):

O36.4XX0 – Maternal care for intrauterine death, not applicable or unspecified

Correct maternal record diagnosis

Z3A.19 – 19 weeks gestation

Required per ICD-10-CM guidelines for obstetric encounters

Why Other Options Are Incorrect:

A / D – ICD-9 code (002.1) is invalid

C – Missing required gestational age code

A sphincter is a muscular ring that encircles a lumen (or passage) and contracts to control the flow of substances through it. Sphincters are found throughout the body in areas such as the gastrointestinal tract (e.g., the lower esophageal sphincter, pyloric sphincter, anal sphincter) and the urinary system (e.g., urethral sphincter), where they regulate the passage of food, waste, and other materials.

A. Stricture refers to an abnormal narrowing of a passage or duct in the body, often due to scarring or disease, not a muscular ring.

B. Snare is a surgical instrument, not a structure within the body.

D. Sinus refers to a cavity or channel within bone or tissue, unrelated to muscle control of flow.

Therefore, the correct answer is C. Sphincter.

The emergent endovascular repair of an infrarenal abdominal aortic aneurysm with an aorto-aortic tube endograft is coded with CPT 34702. This code includes the deployment of the endograft and the necessary balloon angioplasty for sealing the proximal and distal attachment zones.

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.

99393 = Preventive visit, established patient, age 5–11

Preventive codes are based on age and patient status, not time since last visit

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.

Emergency department visit with high severity

99285 = High complexity ED E/M

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

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).

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)

47000 = Percutaneous liver biopsy

77021 = MRI guidance for needle placement

Multiple cores are included in the biopsy code

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.

72080 – Radiologic examination, spine; thoracolumbar junction, 2 views

Correct anatomy and number of views

Why Other Options Are Incorrect:

72020 – Single view only

72114 / 72084 – Standing or scoliosis series

1. Procedure and CPT® Code Selection:

The patient underwent a lymphangiography of both arms in an outpatient radiology setting to evaluate suspected lymphangitis.

CPT® Code 75803 is for bilateral lymphangiography of an extremity. This code covers lymphangiography procedures where multiple images are obtained in the study of lymphatic channels and nodes in an extremity.

2. Modifier for Bilateral Procedure:

Modifier 50 is applied to indicate that the procedure was performed bilaterally (on both arms). This modifier appropriately reflects the bilateral nature of the lymphangiography.

3. Rationale for Excluding Other Options:

Code 75801 is for lymphangiography of a single extremity and does not apply to bilateral procedures.

Code 75801-50 (option B) would indicate bilateral use of a code meant for a single extremity, which is not appropriate when a specific bilateral code, 75803, is available.

Option C, without the bilateral modifier, would not indicate that both arms were examined.

4. AAPC and CPT® Coding Guidelines:

AAPC guidelines specify using 75803 for bilateral lymphangiography procedures of extremities, and Modifier 50 is applied for clarity on bilateral involvement.

Therefore, the correct answer is D. 75803-50.

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

The patient is an established patient presenting with bilateral thyroid nodules and has a detailed history and examination performed.

Procedure Description:

Detailed history and examination of bilateral thyroid nodules.

Review of systems and physical examination.

Assessment and plan for a percutaneous biopsy.

CPT® Coding:

99214: Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and moderate medical decision making.

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

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

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

CPT® and HCPCS Codes:

G0010: Administration of Hepatitis B vaccine.

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

ICD-10-CM Codes:

Z23: Encounter for immunization.

N18.6: End-stage renal disease.

Z99.2: Dependence on renal dialysis.

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

AMA CPT® Professional Edition (current year)

ICD-10-CM (current year)

HCPCS Level II (current year)

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.

1. Procedure and CPT® Code Selection:

The patient underwent a percutaneous needle biopsy of the liver with ultrasound guidance to assess primary biliary cirrhosis.

Code 47000 is the CPT® code for a percutaneous liver biopsy. This code encompasses the biopsy procedure itself.

Ultrasound guidance is commonly inherent to biopsy procedures, and guidance is not separately reported if the main code (47000) includes the technique used.

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

ICD-10-CM Code K74.5 is the correct code for primary biliary cirrhosis, which is specifically indicated in this case.

K74.3 is the code for other specified cirrhosis of the liver but is less specific than K74.5, making K74.5 the appropriate choice here.

3. Exclusion of Other Codes:

Code 47100 (option A) is for an open liver biopsy, which does not apply to this percutaneous procedure.

Codes 10005 (biopsy with imaging guidance) and 76942 (ultrasound guidance) would be redundant or incorrect since the main procedure code, 47000, sufficiently describes a percutaneous liver biopsy.

4. AAPC and CPT® Coding Guidelines:

AAPC guidelines state that guidance is included in certain biopsy codes when performed for the targeted organ, such as in 47000 for a liver biopsy.

Therefore, based on CPT® and ICD-10-CM coding rules, the correct answer is C. 47000, K74.5.

73522 = Bilateral hips with pelvis, 3–4 views

Modifier -76 = Repeat procedure by the same physician

Modifier -51 identifies multiple procedures

1. Procedure Details and CPT® Code Selection:

The patient is undergoing stage 2 treatment for double outlet right ventricle (DORV) with a removal of the pulmonary artery band and transposition repair of the great vessels.

Code 33779 is specific for correction of a double outlet right ventricle, with transposition of the great arteries. This code accurately reflects the procedure performed, including the complex repair involving the transposition of the pulmonary trunk and aortic root.

Code 33953 is used to report the initiation of extracorporeal membrane oxygenation (ECMO), which was used to maintain oxygenation during the procedure.

Code 33985 is for the termination of ECMO following the surgical repair once heart function has resumed. Both 33953 and 33985 accurately document the initiation and termination of ECMO during this complex heart repair.

2. Modifier Selection:

Modifier 78 (unplanned return to the operating room for a related procedure during the postoperative period) is appropriate here. This is a subsequent stage in the treatment plan, but due to the complexity and specific surgical intervention required, it is treated as a return to the OR for related procedure coding.

Modifier 58 (staged or related procedure during the postoperative period) would not be as suitable here because the procedure involves a new return to the OR.

3. AAPC and CPT® Coding Guidelines:

AAPC guidelines support the use of specific modifiers (78 for unplanned return) and appropriate ECMO codes (33953 and 33985) in complex cardiac cases requiring bypass and staged treatment.

Thus, the correct CPT® codes based on CPT® and AAPC coding standards are C. 33779-78, 33953-78, 33985-78.

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

Z30.2 = Encounter for sterilization

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

62272 = Lumbar puncture with catheter for CSF drainage

77012 = CT guidance for needle placement

50236 – Radical nephrectomy with partial ureterectomy and rib resection, open approach

Includes:

Kidney removal

Partial ureter removal

Rib resection

Correct for renal cell carcinoma

Increased complexity due to prior surgery does not change CPT code, but may support modifier -22

Why Other Options Are Incorrect:

50545 / 50548 – Laparoscopic/robotic nephrectomy

50225 – Simple nephrectomy (no ureter or rib resection)

Brackets [ ] in the ICD-10-CM Alphabetic Index are used to identify manifestation codes.

These codes cannot be reported as the principal diagnosis and must be sequenced after the underlying condition.

This is a frequently tested ICD-10-CM guideline concept.

1. Problem Type Selection:

Miranda is following up on her diabetes, which is a chronic condition. Her blood sugars are controlled, indicating that the condition is stable with her current medication regimen.

Stable, chronic illness is defined in the CPT® MDM (Medical Decision Making) Table as a chronic condition that is under control and not currently worsening, even if ongoing management is required. This aligns with the patient's diabetes being well-managed with her prescribed medications.

2. Rationale for Excluding Other Options:

A. Acute, uncomplicated illness or injury is not applicable as diabetes is a chronic condition, not an acute issue.

B. Minimal problem refers to conditions that are minor or self-limited and typically require little to no treatment, which does not apply to chronic conditions like diabetes.

D. Stable, acute illness would refer to an acute condition that has stabilized, whereas diabetes is a chronic condition, not acute.

3. AAPC and CPT® Coding Guidelines:

According to the CPT® MDM Table, a "Stable, chronic illness" is the correct classification for a follow-up encounter on a controlled chronic condition like diabetes.

Therefore, the correct answer is C. Stable, chronic illness.

Procedure Coding (CPT®):

33533 – CABG, arterial graft; single arterial graft (LIMA to LAD)

Correct for left internal mammary artery → LAD

33519 – CABG, venous grafts; three coronary venous grafts

Saphenous vein grafts placed to:

Obtuse marginal

Ramus intermedius

Posterior descending artery

Total = 3 venous grafts

33508 – Endoscopic harvest of saphenous vein

Separately reportable only when endoscopic

Add-on code (no modifier required)

Why Other Options Are Incorrect:

A / C – Incorrect arterial graft code (33536 = multiple arterial grafts)

B – Incorrect venous graft count (33512 = two grafts)

CPT® Guideline Reference:

CABG codes are selected based on:

Type of conduit (arterial vs venous)

Number of distal anastomoses

Endoscopic harvest is add-on and separately reportable

The correct CPT® code for a therapeutic drug test to monitor the total level of carbamazepine is 80156. The ICD-10-CM code G40.909 is used for epileptic seizures, not otherwise specified, which aligns with the patient's condition being treated for seizures.

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+

88299 = Unlisted cytogenetic study

Other unlisted codes are for chemistry, immunology, or pathology

74150 = CT abdomen without contrast

Other codes describe MRI or combined studies

1. Procedure and CPT® Code Selection:

The test performed is a therapeutic drug assay to measure the concentration of vancomycin in the patient’s blood.

CPT® Code 80184 is specific for a therapeutic drug assay of vancomycin, making it the correct code to report for this test.

2. Rationale for Excluding Other Options:

Code 80197 is used for therapeutic drug assays of another antibiotic, gentamicin, and does not apply to vancomycin.

Code 80202 is for measuring the levels of cyclosporine, another drug, and is not relevant to vancomycin.

Code 80299 is for an unlisted therapeutic drug assay, which is unnecessary since a specific code (80184) exists for vancomycin.

3. AAPC and CPT® Coding Guidelines:

According to AAPC guidelines, specific therapeutic drug assay codes, like 80184 for vancomycin, should be used when available.

Therefore, the correct answer is C. 80184.

The patient has undergone a left total knee arthroplasty and subsequently received a femoral nerve block for postoperative pain management. CPT code 01402 is used for anesthesia for total knee arthroplasty. Code 64447-59-LT is for a femoral nerve block (single injection) for postoperative pain management, with modifier 59 indicating a distinct procedural service and LT indicating the left side. Therefore, the appropriate codes are 01402 and 64447-59-LT.

In CPT® Surgery Guidelines, a "separate procedure" code is used to identify a service that is typically performed as part of a larger procedure and should not be coded separately when it is an integral component of that primary service. However, it may be reported independently if it is performed alone or is unrelated to the primary procedure.

A. is true because a separate procedure may be reported if it is performed independently or is unrelated to the primary procedure.

B. is true, as "separate procedure" codes are not reported in addition to the code for the primary procedure when they are part of the total procedure.

C. is correct because "separate procedure" designation indicates that the service is often part of a more comprehensive procedure but can be reported separately when performed alone.

D. is false because modifier 79 is not used for unrelated "separate procedures." Instead, modifier 59 is typically used to indicate a "distinct procedural service" when reporting a separate procedure that is unrelated to the primary service.

Therefore, the correct answer is D. To identify a service designated as a "separate procedure" that is reported with an unrelated primary service, append modifier 79 to the code.

The outermost protective layer of the skin is called the epidermis. It serves as a barrier to protect the body against environmental elements, pathogens, and helps to retain moisture. The epidermis itself is composed of several sub-layers, with the stratum corneum being the outermost layer.

ICD-10-CM (current year), Chapter 12: Diseases of the Skin and Subcutaneous Tissue (L00-L99).

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.

1. Procedure and CPT® Code Selection:

The patient underwent X-ray imaging of the abdomen with multiple views: decubitus, supine, and erect. This is a comprehensive study that includes different positioning to evaluate the abdomen.

CPT® Code 74022 is appropriate for an abdominal X-ray with a minimum of three views. This code accurately reflects the multiple views taken in this scenario.

2. Modifier 26:

Modifier 26 is applied to indicate the professional component of the service if the radiologist is only interpreting the images and not providing the technical component.

3. Rationale for Excluding Other Options:

Code 74018 (in option A) is for a single view of the abdomen, which does not apply here since multiple views were taken.

Code 74019 (in option C) covers two views of the abdomen, which is insufficient for this three-view study.

Code 74021 (in option D) represents an abdominal X-ray with more limited or focused views and does not align with the comprehensive three-view study described.

4. AAPC and CPT® Coding Guidelines:

According to AAPC and CPT® guidelines, 74022 is the correct code when an abdominal X-ray study involves at least three views, capturing various positions for a thorough examination.

Therefore, the correct answer is B. 74022-26.

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.

In this encounter, the correct coding order follows ICD-10-CM guidelines for coding multiple conditions when AIDS (B20) is documented, as it takes precedence. The patient's diagnosis of AIDS, documented with code B20, is reported as the primary diagnosis since it is a chronic condition. The M17.31 code is used to document unilateral primary osteoarthritis of the right knee, unrelated to AIDS but causing the patient's knee pain.

Explanation of each answer choice:

A. B20, M17.31: Correctly lists AIDS (B20) as the primary diagnosis and osteoarthritis of the right knee (M17.31) as the secondary diagnosis.

B. Z21, M08.861: Z21 represents asymptomatic HIV, not AIDS, which is incorrect here, and M08.861 is the code for juvenile idiopathic arthritis, not relevant in this case.

C. M17.11, B20: Incorrect as M17.11 is for unilateral primary osteoarthritis of the right knee, not left, and does not prioritize B20 as required.

D. M17.31, B20: Incorrect because it does not list B20 as the primary diagnosis, which is necessary per coding guidelines when AIDS is documented.

Thus, the correct answer is A. B20, M17.31.

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.

33016 = Pericardiocentesis, including imaging guidance (e.g., ultrasound) when performed.Because the code already includes imaging guidance, you do not separately report 76942.So the correct coding is 33016 only → B.

CPT® code 36252 describes selective catheter placement of the main renal artery with angiography of both kidneys, which matches the procedure of selectively catheterizing the right and left renal arteries and performing angiography. Additionally, CPT® code 75625-26 is for an abdominal aortography with interpretation and report. The -26 modifier indicates that the professional component of the service was performed.

Procedure Coding:

49186 – Excision or destruction of intra-abdominal tumors, 1–4 tumors

Four tumors excised → correct code selection

Size does not alter code selection once tumor count is determined

Diagnosis Coding:

C48.2 – Malignant neoplasm of peritoneum, unspecified

Pathology confirms malignancy

C76.2 is used for ill-defined sites, not appropriate when peritoneum is specified

Why Other Options Are Incorrect:

B – 49187 is for 5 or more tumors

D – K66.8 = non-malignant peritoneal disorder

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.

Colposcopy of the Cervix: This involves a visual examination of the cervix using a colposcope.

Biopsy and Endocervical Curettage: The procedures performed include taking a biopsy and scraping the lining of the cervical canal.

CPT Code 57454: This code represents a colposcopy of the cervix with biopsy and endocervical curettage.

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.

The procedure involves a tympanoplasty with a radical mastoidectomy and removal of a cholesteatoma from the middle ear, including grafting of the eardrum without ossicular chain reconstruction.

Procedure Description:

Tympanoplasty.

Radical mastoidectomy.

Removal of cholesteatoma from the middle ear.

Grafting technique used to repair the eardrum without ossicular chain reconstruction.

CPT® Coding:

69645: Tympanoplasty with mastoidectomy (including canalplasty, atticotomy and/or middle ear surgery), radical or complete, with removal of cholesteatoma; with mastoid obliteration.

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

CPT® Assistant for detailed coding guidelines on otolaryngology procedures.

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.

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)

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.

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.

An esophagogastroduodenoscopy (EGD) was performed with the removal of a polyp using hot biopsy forceps.

Procedure Description:

An EGD was performed.

A polyp was found in the duodenum and removed with hot biopsy forceps.

CPT® Coding:

43250: Esophagogastroduodenoscopy, flexible, transoral; with removal of tumor(s), polyp(s), or other lesion(s) by hot biopsy forceps.

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

CPT® Assistant for detailed coding guidelines on endoscopic procedures.

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

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

C56.9: Malignant neoplasm of unspecified ovary.

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

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

ICD-10-CM guidelines

AMA's CPT® Professional Edition (current year)

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.

A41.52 = Sepsis due to Enterococcus.

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

No additional code for severe sepsis is documented.

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.

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.

According to ICD-10-CM coding guidelines for substance use, abuse, and dependence, when multiple levels (use, abuse, and dependence) of the same substance are documented, only the highest level of severity is coded. The hierarchy is as follows: dependence > abuse > use.

D. If both use and dependence are documented, assign only the code for dependence is correct, as dependence represents the highest severity level and supersedes both use and abuse.

A. is incorrect because if both use and abuse are documented without dependence, only abuse would be coded as it is of a higher severity than use.

B. is incorrect because all three codes (use, abuse, dependence) should not be reported together; only the highest level should be coded.

C. is incorrect because if both abuse and dependence are documented, only dependence (the higher severity level) should be coded, not abuse.

Therefore, the correct answer is D. If both use and dependence are documented, assign only the code for dependence.

In coding burns, ICD-10-CM guidelines indicate that each burn site is coded separately, specifying the degree, location, and extent of the burn. Additionally, a code for total body surface area (TBSA) burned is included when burns cover more than 10% of the body. Here’s the breakdown:

1. T24.311A: Represents a third-degree burn on the left thigh, initial encounter.

2. T24.312A: Represents a third-degree burn on the right thigh, initial encounter.

3. T21.21XA: Represents a second-degree burn on the anterior chest wall, initial encounter.

4. T21.23XA: Represents a second-degree burn on the upper back, initial encounter.

5. T31.21: Represents burns with 20–29% TBSA involvement, with third-degree burns covering 10–19% of the TBSA.

Explanation of incorrect answers:

A includes an incorrect TBSA code (T31.21).

B has the correct codes but lists an incorrect TBSA code for third-degree burns.

C uses incorrect burn site codes for the areas involved and incorrect TBSA percentages.

Therefore, the correct answer is D. T24.311A, T24.312A, T21.21XA, T21.23XA, T31.21, which accurately captures the burns' degrees, locations, and TBSA.

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

30901 = Control of anterior epistaxis, limited, any method

30903/30905/30906 are for extensive packing or posterior epistaxis

29827: Arthroscopic rotator cuff repair is correctly coded as 29827.

29828: Arthroscopic biceps tenodesis is an additional procedure and should be coded as 29828 with modifier -51 (Multiple Procedures).

29824: Arthroscopic claviculectomy (partial resection of the distal clavicle) is coded as 29824 with modifier -51.

29826: Arthroscopic subacromial decompression, including coracoacromial ligament release, is coded as 29826.

All these procedures were performed arthroscopically and documented in the operative report, justifying the use of these codes and the use of modifier -51 for multiple procedures.

CPT® Professional Edition, AMA

1. Procedure and CPT® Code Selection:

The patient underwent a 7-view X-ray of the lumbosacral spine, which included bending views. A complete set of views is captured.

CPT® Code 72114 is appropriate for a complete lumbosacral spine X-ray with a minimum of six views. This code includes comprehensive imaging, such as bending and other specialized views, which were taken in this scenario.

2. Rationale for Excluding Other Options:

Code 72020 is for a single-view X-ray of the spine, which is not adequate to describe a 7-view series.

Code 72080 is for a two- or three-view X-ray of the thoracolumbar spine, which does not cover the full set of seven views described in this scenario.

Code 72084 represents a complete thoracic spine study with multiple views but does not specifically cover the lumbosacral spine, which is the focus of this X-ray examination.

3. AAPC and CPT® Coding Guidelines:

According to AAPC and CPT® guidelines, 72114 is the correct choice for a complete lumbosacral spine study involving multiple views, including specialized views like bending.

Therefore, the correct answer is C. 72114.

New patient in community residential facility

Moderate MDM → 99344

Total time = 90 minutes

Base time exceeded → 99417 appropriate

Why others are incorrect:

99345 – High MDM (not documented)

Missing prolonged service code

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 the procedure involving access to the subclavian vein and advancing a catheter to the inferior vena cava for injection and imaging, the following codes are used:

36010 for the catheter placement.

75825-26 for the supervision and interpretation of the imaging.

Modifier -26 indicates the professional component of the radiological supervision and interpretation.

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.

47563: Laparoscopic cholecystectomy with cholangiography is coded as 47563. The report details the laparoscopic removal of the gallbladder with intraoperative cholangiography.

74300-26: The radiological supervision and interpretation for the cholangiography is coded as 74300 with modifier -26 (Professional Component) since the interpretation was done by the physician.

CPT® Professional Edition, 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.

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.

Per CPT® E/M guidelines, time spent on separately reported services is excluded from total E/M time calculations.

Repair of wound dehiscence → CPT 13160 (complex repair, secondary closure)

Occurs during global period and is unplanned → Modifier -78

Modifier -58 is for staged or planned procedures.

Procedure Coding:

72158 – MRI, lumbar spine; without contrast, followed by with contrast

Single comprehensive code

Diagnosis Coding:

M54.42 – Low back pain with sciatica, left side

Why Other Options Are Incorrect:

B / C – Incorrectly unbundling MRI codes

D – Coding additional unspecified low back pain is inappropriate

Fascia debridement → 11043 (first 20 sq cm)

Subcutaneous debridement → 11042

Multiple anatomical sites → Modifier -59

Add-on code 11045 for additional subcutaneous surface area

1. Procedure and CPT® Code Selection:

The emergency department physician placed an indwelling catheter into the lumbar region for continuous infusion for pain management with fluoroscopic guidance.

CPT® Code 62327 is appropriate for injection or catheter placement for continuous infusion of anesthetic or analgesic in the lumbar or sacral region using imaging guidance.

CPT® Code 77003 represents the fluoroscopic guidance used during the catheter placement, which is separately reportable in this case.

2. Rationale for Excluding Other Options:

Code 62326 (in options B and D) is for the injection or catheter placement without imaging guidance. Since fluoroscopic guidance was specifically mentioned, 62327 is the appropriate choice.

Code 77003 must be reported separately when fluoroscopy is used in conjunction with 62327 for pain management catheter placement.

3. AAPC and CPT® Coding Guidelines:

According to AAPC guidelines, the combination of 62327 and 77003 is correct when catheter placement for continuous infusion is performed with fluoroscopic guidance.

Therefore, the correct answer is C. 62327, 77003.

80324 – Drug test(s), definitive, qualitative or quantitative, LC/MS; acetaminophen

LC-MS = definitive testing

Acetaminophen is specifically identified by 80324

Why others are incorrect:

60143 / 80299 – Therapeutic drug assays (obsolete or nonspecific)

B0329 – HCPCS code (not appropriate here)

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

CPT® code 46255 describes the excision of both internal and external hemorrhoids, which matches the procedure described. The ICD-10-CM codes K64.0 (First degree hemorrhoids) and K64.4 (Residual hemorrhoids) describe the conditions treated.

11403 = Excision of benign lesion, trunk, 2.1–3.0 cm

Simple closure is included in excision codes

No separate closure code is reported.

Correct answer: A

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

20552 = Injection(s); single or multiple trigger points, 1–2 muscles

Total muscles injected = 2 (trapezius + pectoralis)

Number of injections does not determine code selection—number of muscles does

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.

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

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

Left ovary: Only the left ovary is removed.

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

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

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

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

Procedure Description:

Laparoscopic partial colectomy.

Removal of the proximal colon and terminal ileum.

Anastomosis of the distal ileum and remaining colon.

CPT® Coding:

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

ICD-10-CM Coding:

C18.2: Malignant neoplasm of ascending colon.

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

ICD-10-CM for corresponding diagnosis codes.

99285 = High-complexity ED visit

I21.4 = NSTEMI

Chest pain symptoms are not coded once MI is diagnosed

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

69209 = Cerumen removal using irrigation

69210 = Cerumen removal using instrumentation

Different techniques on different ears require separate codes with laterality modifiers

Established patient with moderate MDM

99214 aligns with CPC exam standards

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.

Service location = campground → domiciliary/home visit

Patient is new

99344 = New patient domiciliary visit, moderate MDM

Prolonged Services:

Additional 25 minutes beyond base time

99417 is used for prolonged services with office/home E/M codes

Why others are incorrect:

99349 – Established patient

99204 – Office visit (wrong location)

CPT® code 27566 involves excision of the patella. Given the surgical description provided, this code is appropriate as the patella was severely damaged and removed entirely.

Patient's Condition: Dislocated patella with cartilage breakdown and severe damage.

Surgical Procedure: The surgeon made an incision, dissected through soft tissue, exposed, and completely removed the patella.

Coding Decision: CPT® 27566 is chosen because it specifies excision of the patella. The modifier LT indicates the procedure was performed on the left side.

24300 = Manipulation of elbow under anesthesia

Anesthesia codes (01710) are not reported by the surgeon, only by the anesthesiologist

24605 is for closed treatment of elbow dislocation, which is not documented

Medical terms often consist of a root word and a suffix.

Hepat/o = liver

-itis = inflammation

Therefore, hepatitis literally means inflammation of the liver.

The incorrect options refer to inflammation of other body parts:

Dermatitis – inflammation of the skin

Gastritis – inflammation of the stomach

Arthritis – inflammation of the joints

Hence, the correct answer is C. Hepatitis.

The procedure documented is a modified Fontan procedure → 33615 (Fontan-type single-ventricle repair per the choices given).

The congenital diagnosis documented is double inlet ventricle → Q20.2.

Why the other options are incorrect based on the statements provided:

Q20.4 is not “double inlet ventricle” as stated in the question.

Adding Q20.1 is not supported by the documentation (the question only states double inlet ventricle).

Therefore, the best match is 33615, Q20.2 → A.

49083 – Abdominal paracentesis, diagnostic or therapeutic; with imaging guidance

This code includes imaging guidance (ultrasound or fluoroscopy).

Per CPT® guidelines, do not separately report fluoroscopy or ultrasound guidance with 49083.

The procedure was performed in the hospital, but CPT coding does not change based on site of service.

Why Other Options Are Incorrect:

A (49082) – Used without imaging guidance

B / D – Imaging guidance codes (77001, 77002) are bundled into 49083 per CPT® and NCCI edits

Official CPT® Guidance:

When a paracentesis is performed with imaging guidance, report 49083 only.

The patient had a post-operative complication (cardiac tamponade) following a previous CABG surgery, requiring a return to the operating room for exploration and evacuation of a blood clot. This is coded using CPT code 32658 (Exploration, mediastinum, with or without drainage; for postoperative hemorrhage, drainage of abscess, or to locate foreign body). Modifier 78 is appended to indicate an unplanned return to the operating room by the same physician following the initial procedure for a related procedure during the postoperative period.

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.

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.

E08.3213 = Diabetes due to underlying condition with mild NPDR with macular edema, bilateral

E24.9 = Cushing’s syndrome (underlying condition)

Z79.84 = Long-term use of oral hypoglycemic drugs

Sequencing follows ICD-10-CM guidelines for secondary diabetes.

49190 = Excision of peritoneal tumor greater than 10 cm

C48.2 = Malignant neoplasm of peritoneum

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.

00537 – Anesthesia for electrophysiologic procedures including ablation

Patient is otherwise healthy → P1

Why others are incorrect:

00532 – Pacemaker insertion

01922 – MRI

01026 – Lower extremity procedures

74021 = Abdomen, complete, including decubitus and erect views

-26 = Professional component