CPC/CPT CODING EXAM – QUESTIONS AND ANSWERS |
VERIFIED AND WELL DETAILED ANSWERS | PLUS RATIONALES |
GUARANTEED PASS | LATEST EXAM UPDATE
Core Domains
Medical Terminology and Anatomy
ICD-10-CM Diagnostic Coding
CPT Evaluation and Management (E/M) Services
CPT Surgery, Anesthesia, Radiology, Pathology, and Medicine
Sections
HCPCS Level II Coding
Coding Guidelines and Official Coding Conventions
Healthcare Regulatory Compliance, HIPAA, and Billing Ethics
This comprehensive examination is designed to evaluate professional
competency and proficiency in medical coding using current
classification systems. The assessment measures the candidate's
mastery of procedural coding, diagnostic attribution, and healthcare
documentation analysis across diverse clinical specialties. Featuring a
rigorous multiple-choice and complex clinical scenario-based structure,
the test challenges candidates to interpret operative reports, medical
charts, and billing notes accurately. Special emphasis is placed on real-
world application, regulatory compliance, adherence to official coding
guidelines, and critical decision-making in clinical financial operations to
ensure optimal integrity within healthcare reimbursement systems.
SECTION ONE: QUESTIONS 1–100
Question 1
A patient presents to the outpatient clinic for a routine screening
colonoscopy. During the procedure, the gastroenterologist identifies and
removes two benign polyps via hot biopsy forceps from the sigmoid
colon.
,A. 45378, 45384-59
B. 45384-33
C. 45378-33, 45384-59
🟢 D. 45384-33
🔴 Explanation: When a screening colonoscopy is performed and
results in a biopsy or the removal of a lesion (such as a polyp) during
the same session, the screening code is not reported separately.
Instead, code 45384 for colonoscopy with removal of lesion(s) by hot
biopsy forceps is reported with modifier 33 to designate preventive
services.
Question 2
What is the primary purpose of appending modifier 25 to an Evaluation
and Management (E/M) service code?
A. To report a significant, separately identifiable E/M service by the
same physician on the same day as a procedure or other service
B. To indicate that the service was provided by a qualified non-
physician practitioner working under general supervision
C. To denote that the procedure performed was staged or related to a
previous surgical intervention during the global period
D. To override a National Correct Coding Initiative (NCCI) edit for two
distinct surgical procedures performed on separate anatomical sites
🟢 A. To report a significant, separately identifiable E/M service by the
same physician on the same day as a procedure or other service
🔴 Explanation: Modifier 25 is used to indicate that on the day a
procedure or service identified by a CPT code was performed, the
patient's condition required a significant, separately identifiable E/M
service above and beyond the usual pre-procedure and post-procedure
care associated with the procedure.
Question 3
A patient undergoes an open excision of a benign lipoma measuring 4.5
cm located on the posterior trunk. According to the CPT Integumentary
System guidelines, how should this procedure be coded?
,A. 11406
🟢 B. 21931
C. 11404
D. 21930
🔴 Explanation: Excision of soft tissue tumors, such as a lipoma, of the
back or flank (trunk) is classified under the musculoskeletal system
(codes 21930-21933) rather than integumentary excision codes (11400-
11406), based on the depth and subfascial vs. subcutaneous nature of
the lesion. A lipoma excision on the trunk typically falls under
subcutaneous or subfascial excision codes depending on depth; code
21931 specifically covers excision of a soft tissue tumor of the back or
thorax, subcutaneous, 3.0 cm to 5.0 cm.
Question 4
Which of the following conditions is considered a "chronic condition"
according to general medical coding and quality reporting definitions?
A. Acute appendicitis
B. Type 2 diabetes mellitus
C. Simple laceration of the forearm
D. Acute bacterial pneumonia
🟢 B. Type 2 diabetes mellitus
🔴 Explanation: Chronic conditions are those that last a year or more
and require ongoing medical attention or limit activities of daily living.
Type 2 diabetes mellitus is a chronic, lifelong systemic disease,
whereas appendicitis, lacerations, and bacterial pneumonia are acute
illnesses.
Question 5
A 45-year-old female undergoes a unilateral total mastectomy with
immediate insertion of a tissue expander. What is the correct CPT code
assignment for this combined procedure?
A. 19303, 11981
B. 19301, 11935
, 🟢 C. 19303, 11940
D. 19306, 11982
🔴 Explanation: Code 19303 represents a mastectomy, total (simple).
When a tissue expander is inserted during the same operative session
as the mastectomy, the appropriate tissue expander insertion code
(such as 11940 for tissue expander placement in breast reconstruction)
is reported in addition to the mastectomy code, provided it is not
explicitly bundled into a single comprehensive code.
Question 6
When coding for an inpatient hospital admission, where is the principal
diagnosis defined?
A. The condition established after study to be chiefly responsible for
occasioning the admission of the patient to the hospital for care
B. The diagnosis listed by the attending physician on the final discharge
summary as the primary cause of death or recovery
C. The symptom or sign that caused the patient to first seek emergency
department evaluation prior to admission
D. Any chronic comorbid condition that requires continuous
pharmacological management throughout the hospital stay
🟢 A. The condition established after study to be chiefly responsible for
occasioning the admission of the patient to the hospital for care
🔴 Explanation: The Uniform Hospital Discharge Data Set (UHDDS)
defines the principal diagnosis as the condition established after study
to be chiefly responsible for occasioning the admission of the patient to
the hospital for care.
Question 7
A patient is diagnosed with malignant hypertension with acute renal
failure. How is this sequenced and coded in ICD-10-CM?
A. Code acute renal failure first, followed by malignant hypertension
B. Code essential hypertension without mention of malignancy, followed
by acute kidney injury
VERIFIED AND WELL DETAILED ANSWERS | PLUS RATIONALES |
GUARANTEED PASS | LATEST EXAM UPDATE
Core Domains
Medical Terminology and Anatomy
ICD-10-CM Diagnostic Coding
CPT Evaluation and Management (E/M) Services
CPT Surgery, Anesthesia, Radiology, Pathology, and Medicine
Sections
HCPCS Level II Coding
Coding Guidelines and Official Coding Conventions
Healthcare Regulatory Compliance, HIPAA, and Billing Ethics
This comprehensive examination is designed to evaluate professional
competency and proficiency in medical coding using current
classification systems. The assessment measures the candidate's
mastery of procedural coding, diagnostic attribution, and healthcare
documentation analysis across diverse clinical specialties. Featuring a
rigorous multiple-choice and complex clinical scenario-based structure,
the test challenges candidates to interpret operative reports, medical
charts, and billing notes accurately. Special emphasis is placed on real-
world application, regulatory compliance, adherence to official coding
guidelines, and critical decision-making in clinical financial operations to
ensure optimal integrity within healthcare reimbursement systems.
SECTION ONE: QUESTIONS 1–100
Question 1
A patient presents to the outpatient clinic for a routine screening
colonoscopy. During the procedure, the gastroenterologist identifies and
removes two benign polyps via hot biopsy forceps from the sigmoid
colon.
,A. 45378, 45384-59
B. 45384-33
C. 45378-33, 45384-59
🟢 D. 45384-33
🔴 Explanation: When a screening colonoscopy is performed and
results in a biopsy or the removal of a lesion (such as a polyp) during
the same session, the screening code is not reported separately.
Instead, code 45384 for colonoscopy with removal of lesion(s) by hot
biopsy forceps is reported with modifier 33 to designate preventive
services.
Question 2
What is the primary purpose of appending modifier 25 to an Evaluation
and Management (E/M) service code?
A. To report a significant, separately identifiable E/M service by the
same physician on the same day as a procedure or other service
B. To indicate that the service was provided by a qualified non-
physician practitioner working under general supervision
C. To denote that the procedure performed was staged or related to a
previous surgical intervention during the global period
D. To override a National Correct Coding Initiative (NCCI) edit for two
distinct surgical procedures performed on separate anatomical sites
🟢 A. To report a significant, separately identifiable E/M service by the
same physician on the same day as a procedure or other service
🔴 Explanation: Modifier 25 is used to indicate that on the day a
procedure or service identified by a CPT code was performed, the
patient's condition required a significant, separately identifiable E/M
service above and beyond the usual pre-procedure and post-procedure
care associated with the procedure.
Question 3
A patient undergoes an open excision of a benign lipoma measuring 4.5
cm located on the posterior trunk. According to the CPT Integumentary
System guidelines, how should this procedure be coded?
,A. 11406
🟢 B. 21931
C. 11404
D. 21930
🔴 Explanation: Excision of soft tissue tumors, such as a lipoma, of the
back or flank (trunk) is classified under the musculoskeletal system
(codes 21930-21933) rather than integumentary excision codes (11400-
11406), based on the depth and subfascial vs. subcutaneous nature of
the lesion. A lipoma excision on the trunk typically falls under
subcutaneous or subfascial excision codes depending on depth; code
21931 specifically covers excision of a soft tissue tumor of the back or
thorax, subcutaneous, 3.0 cm to 5.0 cm.
Question 4
Which of the following conditions is considered a "chronic condition"
according to general medical coding and quality reporting definitions?
A. Acute appendicitis
B. Type 2 diabetes mellitus
C. Simple laceration of the forearm
D. Acute bacterial pneumonia
🟢 B. Type 2 diabetes mellitus
🔴 Explanation: Chronic conditions are those that last a year or more
and require ongoing medical attention or limit activities of daily living.
Type 2 diabetes mellitus is a chronic, lifelong systemic disease,
whereas appendicitis, lacerations, and bacterial pneumonia are acute
illnesses.
Question 5
A 45-year-old female undergoes a unilateral total mastectomy with
immediate insertion of a tissue expander. What is the correct CPT code
assignment for this combined procedure?
A. 19303, 11981
B. 19301, 11935
, 🟢 C. 19303, 11940
D. 19306, 11982
🔴 Explanation: Code 19303 represents a mastectomy, total (simple).
When a tissue expander is inserted during the same operative session
as the mastectomy, the appropriate tissue expander insertion code
(such as 11940 for tissue expander placement in breast reconstruction)
is reported in addition to the mastectomy code, provided it is not
explicitly bundled into a single comprehensive code.
Question 6
When coding for an inpatient hospital admission, where is the principal
diagnosis defined?
A. The condition established after study to be chiefly responsible for
occasioning the admission of the patient to the hospital for care
B. The diagnosis listed by the attending physician on the final discharge
summary as the primary cause of death or recovery
C. The symptom or sign that caused the patient to first seek emergency
department evaluation prior to admission
D. Any chronic comorbid condition that requires continuous
pharmacological management throughout the hospital stay
🟢 A. The condition established after study to be chiefly responsible for
occasioning the admission of the patient to the hospital for care
🔴 Explanation: The Uniform Hospital Discharge Data Set (UHDDS)
defines the principal diagnosis as the condition established after study
to be chiefly responsible for occasioning the admission of the patient to
the hospital for care.
Question 7
A patient is diagnosed with malignant hypertension with acute renal
failure. How is this sequenced and coded in ICD-10-CM?
A. Code acute renal failure first, followed by malignant hypertension
B. Code essential hypertension without mention of malignancy, followed
by acute kidney injury
