AAPC - CERTIFIED PROFESSIONAL
CODER (CPC) CERTIFICATION FINAL
EXAM (2026/2027)
1. According to HIPAA, which of the following is considered a ‘Covered Entity’?
A. A health insurance company (Payer)
B. A software company providing generic word processing tools
C. A fitness club that does not process health insurance claims
D. A life insurance company
Answer: A
Conceptual Explanation: Covered entities under HIPAA include health plans, health care
clearinghouses, and health care providers who conduct certain financial and administrative
transactions electronically.
2. A patient undergoes a core needle biopsy of the right breast under ultrasound guidance.
How is this procedure coded?
A. 19100, 76942-RT
B. 19081-RT
,C. 19083-RT
D. 19102, 76942
Answer: C
Conceptual Explanation: CPT 19083 includes the biopsy and the ultrasound guidance in a
single code. Code 19100 is for biopsy without imaging guidance.
3. When a patient has a condition that is described as both acute and chronic, and the ICD-10-
CM index provides separate subentries for both, how should they be sequenced?
A. Code only the chronic condition
B. Code the chronic condition first, followed by the acute condition
C. Code the acute condition first, followed by the chronic condition
D. Code only the acute condition
Answer: C
Conceptual Explanation: ICD-10-CM Official Guidelines for Coding and Reporting state
that if the same condition is described as both acute (subacute) and chronic, and separate
subentries exist, code both and sequence the acute (subacute) code first.
4. Which modifier is used to indicate that a procedure was discontinued due to a threat to the
patient’s well-being after anesthesia was administered in an ASC?
A. Modifier 53
B. Modifier 73
, C. Modifier 74
D. Modifier 52
Answer: C
Conceptual Explanation: Modifier 74 is used for discontinued procedures after anesthesia
administration in an ASC or Hospital Outpatient setting. Modifier 53 is used by physicians
in their office/practice.
5. A patient is diagnosed with Type 2 Diabetes and stage 4 chronic kidney disease (CKD).
What is the correct ICD-10-CM coding?
A. E11.9, N18.4
B. E11.22, N18.4
C. E11.21, N18.4
D. N18.4, E11.22
Answer: B
Conceptual Explanation: The ICD-10-CM convention ‘with’ presumes a causal relationship
between DM and CKD. E11.22 covers DM with CKD, and N18.4 identifies the stage.
6. Anesthesia is provided for an 80-year-old patient with severe systemic disease who is
undergoing a total hip replacement. What physical status modifier and qualifying
circumstance code should be added?
A. P2, 99100
CODER (CPC) CERTIFICATION FINAL
EXAM (2026/2027)
1. According to HIPAA, which of the following is considered a ‘Covered Entity’?
A. A health insurance company (Payer)
B. A software company providing generic word processing tools
C. A fitness club that does not process health insurance claims
D. A life insurance company
Answer: A
Conceptual Explanation: Covered entities under HIPAA include health plans, health care
clearinghouses, and health care providers who conduct certain financial and administrative
transactions electronically.
2. A patient undergoes a core needle biopsy of the right breast under ultrasound guidance.
How is this procedure coded?
A. 19100, 76942-RT
B. 19081-RT
,C. 19083-RT
D. 19102, 76942
Answer: C
Conceptual Explanation: CPT 19083 includes the biopsy and the ultrasound guidance in a
single code. Code 19100 is for biopsy without imaging guidance.
3. When a patient has a condition that is described as both acute and chronic, and the ICD-10-
CM index provides separate subentries for both, how should they be sequenced?
A. Code only the chronic condition
B. Code the chronic condition first, followed by the acute condition
C. Code the acute condition first, followed by the chronic condition
D. Code only the acute condition
Answer: C
Conceptual Explanation: ICD-10-CM Official Guidelines for Coding and Reporting state
that if the same condition is described as both acute (subacute) and chronic, and separate
subentries exist, code both and sequence the acute (subacute) code first.
4. Which modifier is used to indicate that a procedure was discontinued due to a threat to the
patient’s well-being after anesthesia was administered in an ASC?
A. Modifier 53
B. Modifier 73
, C. Modifier 74
D. Modifier 52
Answer: C
Conceptual Explanation: Modifier 74 is used for discontinued procedures after anesthesia
administration in an ASC or Hospital Outpatient setting. Modifier 53 is used by physicians
in their office/practice.
5. A patient is diagnosed with Type 2 Diabetes and stage 4 chronic kidney disease (CKD).
What is the correct ICD-10-CM coding?
A. E11.9, N18.4
B. E11.22, N18.4
C. E11.21, N18.4
D. N18.4, E11.22
Answer: B
Conceptual Explanation: The ICD-10-CM convention ‘with’ presumes a causal relationship
between DM and CKD. E11.22 covers DM with CKD, and N18.4 identifies the stage.
6. Anesthesia is provided for an 80-year-old patient with severe systemic disease who is
undergoing a total hip replacement. What physical status modifier and qualifying
circumstance code should be added?
A. P2, 99100
