AAPC CPC Exam Review 2023 Solved 100%

What anatomical or compartment contains all the thoracic viscera except the lungs? - Answer Mediastinum Who is responsible for enforcing the HIPAA security rule - Answer Office of Civil Rights (OCR) ABN - Answer Advance Beneficiary Notice According to the OIG, internal monitoring and auditing should be performed by what means? - Answer Periodic audits What does the abbreviation MAC stand for? - Answer Medicare Administrative Contractor How many lobes make up the RIGHT lung? - Answer the right has 3 lobes the left has 2 lobes Condition in which the endometrial tissue is found outside of the uterus. - Answer Endometriosis A thin membrane lining the chambers of the heart and valves is called the: - Answer endocardium PHI - Answer Protected Health Information What is the TRUE statement in reporting pressure ulcers? - Answer Two codes are assigned when a patient is admitted with a pressure ulcer that evolves to another stage during the admission. The acronym MMRV stands for what? - Answer measles, mumps, rubella, and varicella Which of the following is not part of the small intestine? a. duodenum b. ileum c. jejunum d. cecum - Answer d. cecum Healthcare providers are responsible for developing ______________ policies and procedures regarding privacy in their practices. a. Patient hotline b. Work around procedures c. Fees d. Notices of Privacy Practices - Answer Notices of Privacy Practices A part of the male genital system sitting below the urinary bladder and surrounding the urethra is called the: a. testis b. scrotum c. prostate d. epididymis - Answer c. Prostate What is the Rinne test? a. Test using music as the focal point b. test for hearing loss using a vibrating tuning fork placed at the center of the head c. test using a 2-syllable word with equal stress on each syllable d. test measuring hearing using bone conduction and air conduction - Answer d. test measuring hearing using bone conduction and air conduction What is the difference between entropion and ectropion? A. Entropion is the inward turning of the eyelid and ectropion is the outward turning of the eyelid. B. Entropion is facial droop and ectropion is a facial spasm. C. Entropion is the outward turning of the hands and ectropion is the inward turning of the hands. D. Entropion inward turning of the feet and ectropion is the outward turning of the feet due to muscle disorder. - Answer a. entropion is the inward turning of the eyelid and ectropion is the outward turning of the eyelid. An arteriovenous anastomosis is used to increase blood flow in hemodialysis. Which one of the following describes a direct arteriovenous anastomosis? A. Insertion of a cannula B. A section of artery and a neighboring vein are joined C. A donor's vein is used to connect an artery and a vein D. Radical hysterectomy not otherwise specified E. A synthetic vein is used to connect an artery and a vein - Answer b. a section of the artery and a neighboring vein are joined Ventral, umbilical, spigelian and incisional are types of: A. Surgical approaches B. Hernias C. Organs found in the digestive system D. Cardiac catheterizations - Answer b. hernias When a patient is having a tenotomy performed on the abductor hallucis muscle, where is this muscle located? A. Foot B. Upper Arm C. Upper Leg D. Hand - Answer a. foot Which statement is TRUE when reporting pregnancy codes (O00-O9A): A. These codes can be used on the maternal and baby records. B. These codes have sequencing priority over codes from other chapters. C. Code Z33.1 should always be reported with these codes. D. The seventh character assigned to these codes only indicate a complication during the pregnancy. - Answer B: These codes have sequencing priority over codes from other chapters Which statement is TRUE about reporting codes for diabetes mellitus? A. If the type of diabetes mellitus is not documented in the medical record the default type is E11.- Type 2 diabetes mellitus. B. When a patient uses insulin, Type 1 is always reported. C. The age of the patient is a sole determining factor to report Type 1 . D. When assigning codes for diabetes and its associated condition(s), the code(s) from category E08-E13 are not reported as a primary code. - Answer a. if the type of diabetes mellitus is not documented in the medical record, the default type is E11: type 2 diabetes mellitus Which statement is TRUE for reporting external cause codes of morbidity (V00-Y99)? A. All external cause codes do not require a seventh character. B. Only report one external cause code to fully explain each cause. C. Report code Y92.9 if the place of occurrence is not stated. D. External cause codes should never be sequenced as a first-listed or primary code - Answer d. external cause codes should never be sequenced as a first-listed or primary code What is NOT included in CPT® surgical package? A. Typical postoperative follow-up care B. One related Evaluation and Management service on the same date of the procedure C. Returning to the operating room the next day for a complication resulting from the initial procedure D. Evaluating the patient in the post-anesthesia recovery area - Answer c. returning to the operating room the next day for a complication resulting from the initial procedure What is the term used for inflammation of the bone and bone marrow? A. Chondromatosis B. Osteochondritis C. Costochondritis D. Osteomyelitis - Answer d. osteomyelitis The root word trich/o means: A. Hair B. Sebum C. Eyelid D. Trachea - Answer a. hair Complete this series: Frontal lobe, Parietal lobe, Temporal lobe, ____________. A. Medulla lobe B. Occipital lobe C. Middle lobe D. Inferior lobe - Answer d. occipital lobe A patient is having pyeloplasty performed to treat an uretero-pelvic junction obstruction. What is being performed? A. Surgical repair of the bladder B. Removal of the kidney C. Cutting into the ureter D. Surgical reconstruction of the renal pelvis - Answer d. surgical reconstruction of the renal pelvis A patient that has cirrhosis of the liver just had an endoscopy performed showing hemorrhagic esophageal varices. The ICD-10-CM codes are reported: A. I85.01, K74.69 B. I85.11, K74.60 C. K74.60, I85.11 D. I85.00, K74.69 - Answer In the ICD-10-CM Alphabetic Index look for Varix/esophagus/in/cirrhosis of liver/bleeding referring you to code I85.11. This eliminates multiple choices A and D. In the Tabular List you will see an instructional note above codes I85.10 and I85.11 to Code first underlying disease. For the scenario, cirrhosis of liver (K74.60) is coded first then the esophageal varices with bleeding is coded as a secondary code. Eliminating multiple choice B. correct answer is C. K74.60, I85.11 Which statement is TRUE about Z codes: A. Z codes are never reported as a primary code. B. Z codes are only reported with injury codes. C. Z codes may be used either as a primary code or a secondary code. D. Z codes are always reported as a secondary code. - Answer c. Z codes may be used wither as a primary code or a secondary code Guidelines from which of the following code sets are included as part of the code set requirements under HIPAA? A. CPT® Category III codes B. ICD-10-CM C. HCPCS Level II D. ADA Dental Codes - Answer ICD-10-CM guidelines are the only guidelines specifically mentioned in HIPAA. While HIPAA requires the use of the other code sets listed, there is no specific mention of the other guidelines in the law. This information is found in the ICD-10-CM Official Guidelines for Coding and Reported in you ICD-10-CM codebook: These guidelines are a set of rules that have been developed to accompany and complement the official conventions and instructions provided within the ICD-10-CM itself. These guidelines are based on the coding and sequencing instructions in Volumes I, II and III of ICD-10-CM, but provide additional instruction. Adherence to these guidelines when assigning ICD-10-CM diagnosis and procedure codes is required under the Health Insurance Portability and Accountability Act (HIPAA). Which statement is an example in which a diabetes-related problem exists and the code for diabetes is NEVER sequenced first? A. If the patient has an underdose of insulin due to an insulin pump malfunction. B. If the patient is being treated for secondary diabetes. C. If the patient is being treated for Type 2 diabetes and uses insulin. D. If the patient is diabetic with an associated condition. - Answer a. If the patient has an underdose of insulin due to an insulin pump malfunction. The ICD-10-CM guidelines (Section I.C.4.a.5): An underdose of insulin due to an insulin pump failure should be assigned T85.6-, as the principal or first listed code, followed by code T38.3X6-. Additional codes for the type of diabetes mellitus should also be assigned. Local Coverage Determinations (LCD) are published to give providers information on which of the following? A. Information on modifier use with procedure codes B. CPT® codes that are bundled C. Fee schedule information listed by CPT® code D. Reasonable and necessary conditions of coverage for an item or service - Answer d. Reasonable and necessary conditions of coverage for an item or service Which place of service code is reported on the physician's claim for a surgical procedure performed in an ASC? A. 21 B. 22 C. 24 D. 11 - Answer place of service codes are two digit numerical codes that define the location where the services are performed and reported on the CMS-1500 form. A complete chart of place -of-service codes are located in the front of the CPT book C. 24 If a ST elevation myocardial infarction (STEMI) converts to a non ST elevation myocardial infarction (NSTEMI) due to thrombolytic therapy, how is it reported, according to ICD-10-CM guidelines? A. As unspecified AMI B. As a subendocardial AMI C. As STEMI D. As a NSTEMI - Answer C. as STEMI ICD-10-CM guidelines (Section I.C.9.e.1) indicate: If STEMI converts to NSTEMI due to thrombolytic therapy, it is still coded as STEMI When a person has labyrinthitis what has the inflammation? A. Inner ear B. Brain C. Conjunctiva D. Spine - Answer a. inner ear An angiogram is a study to look inside: A. Female Reproductive System B. Urinary System C. Blood Vessels D. Breasts - Answer c. blood vessels What does oligospermia mean? A. Presence of blood in the semen B. Deficiency of sperm in semen C. Having sperm in urine D. Formation of spermatozoa - Answer b. deficiency of sperm in semen The breakdown of this term: combining form olig/o means too few or too little and spermia refers to the condition of the sperm. The definition is too low or too few sperm. In the Alphabetic Index look for Oligospermia N46.11. In the Tabular List oligospermia is indicated as a type of male infertility. A 45-year-old male is in outpatient surgery to excise a basal cell carcinoma of the right nose and have reconstruction with an advancement flap. The 1.2 cm lesion with an excised diameter of 1.5 cm was excised with a 15-blade scalpel down to the level of the subcutaneous tissue, totaling a primary defect of 1.8 cm. Electrocautery was used for hemostasis. An adjacent tissue transfer of 3 sq cm was taken from the nasolabial fold and was advanced into the primary defect. Which CPT® code(s) is (are) reported? A. 14060 B. 11642, 14060 C. 11642, 15115 D. 15574 - Answer A. 14060 An adjacent tissue transfer (advancement flap) was used to repair a defect on the nose due to an excision of a malignant lesion, eliminating multiple choice answers C and D. The section guidelines in the CPT® codebook for Adjacent Tissue or Rearrangement indicate that the excision of a benign lesion () or a malignant lesion () is included in codes for adjacent tissue transfer (), and are not separately reported. This eliminates multiple choice answer B. A 24-year-old patient had an abscess by her vulva which burst. She has developed a soft tissue infection caused by gas gangrene. The area was debrided of necrotic infected tissue. All of the pus was removed and irrigation was performed with a liter of saline until clear and clean. The infected area was completely drained and the wound was packed gently with sterile saline moistened gauze and pads were placed on top of this. The correct CPT® code is: A. 56405 B. 10061 C. 11004 D. 11042 - Answer c. 11004 The abscess had already burst, with no need to perform an incision to open it, eliminating multiple choice answers A and B. The difference between multiple choice answers C and D, is that the patient is having the debridement performed due to a soft tissue infection in the perineum area. The correct code is 11004 for debridement of necrotized infected tissue on the external genitalia. A 63-year-old man wants a second opinion for his sleep apnea. He decides to go to Dr. S, who his neighbor referred him, to see if Dr. S can provide another type of treatment. Dr. S documents an appropriate history and exam. Patient has had the sleep apnea for the past five months. Sleep is disrupted by frequent awakenings and getting worse due to anxiety and snoring. Current medication that he is on now is not helping him. Which E/M category is reported for this encounter? A. New Patient Office Visit () B. Established Patient Office Visit () C. Office Consultation () D. Observation Care () - Answer What is orchitis? A. Inner ear imbalance B. Lacrimal infection C. Inflammation of testis D. Inflammation of an ilioinguinal hernia - Answer c. inflammation of testis Orchitis is marked by painful swelling of the testis. It may occur without cause, or be the result of infection. The Greek root "orchis" means testicle, and - "itis" is a suffix indicating inflammation or infection. Look in the ICD-10-CM Alphabetic Index for Orchitis referring you to code N45.2. In the Tabular List this code is found under Diseases of the Male Genital Organs (N40-N53). The patient is a 16-year-old female with pelvic pain. Her ultrasound is normal. A laparoscopy found several small cysts in the area of the fallopian tubes. These cysts are called: A. Pilonidal cysts B. Myomas C. Paratubal cysts D. Synovial cysts - Answer C. Paratubal cysts Paratubal cysts are benign, they are frequently found adjacent to the fallopian tubes. Pilonidal cyst develops in the deeper layers of the skin in the lower back near the upper crease of the buttocks. Myomas or leiomyomas are benign tumors of the uterus. Synovial cyst develops in any joint, for example at the back of the knee. Look in the ICD-10-CM Alphabetic Index for, Cyst/paratubal N83.8. Go to the Tabular List and the code indicates where these cysts are located. Which one of the following patients might be documented as having meconium staining? A. Woman with renal failure B. Teenage boy with sickle cell anemia C. Newborn with pneumonia D. Man with alcoholic cirrhosis of liver - Answer c. Newborn with pneumonia Which of the following anatomical sites have septums? A. Nose, heart B. Kidney, lung C. Sternum, coccyx D. Orbit, ovary - Answer a. nose, heart Which place of service code is reported for fracture care performed by an orthopedic physician in the ED? A. 11 B. 20 C. 22 D. 23 - Answer d. Place of service codes are reported on the claim form to identify the site of the service provided. In this case, the services are rendered in the ED which is reported with place of service (POS) 23. The place of service codes can be found in the CPT® codebook. Which one of the following is an example of fraud? A. Reporting the code for ultrasound guidance when used to perform a liver biopsy B. Reporting a biopsy and excision performed on the same skin lesion during the same encounter C. Failing to append modifier 26 on an X-ray that is performed and interpreted in the physician's office D. Reporting a lab panel with an additional lab test that is not included in the lab panel - Answer b. Reporting a biopsy and excision performed on the same skin lesion during the same encounter Answer B is the only example of unbundling of CPT® which would result in a fraudulent claim. According to National Correct Coding Initiative (NCCI) and CPT® coding guidelines, a biopsy performed on the same lesion as an excision during the same encounter is an incidental service and is not reported separately. If ultrasound guidance is performed for a liver biopsy, it is billable. X-rays performed in a physician's office do not require modifier 26, because the physician owns the equipment and performs the interpretation, he bills the global service. Lab panels can be reported with additional lab tests that are not listed in a lab panel. Which Z code category can ONLY be reported as a first listed diagnosis code? A. Z67 B. Z69 C. Z58 D. Z02 - Answer D. Z02 see 1.C.21.c.16 While playing softball a 12-year-old boy sustains a blowout fracture. What is the anatomical location of a blowout fracture? A. Orbit B. Clavicle C. Patella D. Femur - Answer a. orbit A blowout fracture is a fracture of the walls or floor of the orbit. The orbit is the cavity or socket of the skull which the eye and its appendages are situated. In the ICD-10-CM Alphabetic Index look for Fracture, traumatic/orbit/floor (blowout). The root metr/o means: A. Menstruation B. Breast C. Mammary gland D. Uterus - Answer D. Uterus : hint The root word metr/o or metr/i means uterus. In the ICD-10-CM Alphabetic Index look for a main term that starts with metro. You will see the main term Metrorrhexis - see Rupture, uterus. According to the CPT® Appendix L, when performing a selective vascular catheterization, which vessels would you pass through to place the catheter into the right middle cerebral artery? A. Innominate, right common carotid, right exteranl carotid B. Innominate, right subclavian & axillary C. Left common carotid, left internal carotid D. Innominate, the right common, and internal carotid - Answer d. innominate, the right common, and internal carotid Which one of the following statements regarding advanced beneficiary notices (ABN) is TRUE? A. ABN must specify only the CPT® code that Medicare is expected to deny. B. Generic ABN which states that a Medicare denial of payment is possible, or the internist is unaware whether Medicare will deny payment or not is acceptable. C. An ABN must be completed before delivery of items or services are provided. D. An ABN must be obtained from a patient even in a medical emergency when the services to be provided are not covered. - Answer c. An ABN must be completed before delivery of items or services are provided An ABN must include the service that may be denied, an estimated cost of the patient's responsibility if Medicare denies the service and the response for the potential denial. Generic ABNs are not allowed. Signing of the ABN cannot be obtained during a medical emergency. The patient must be stable. The ABN must be signed prior to providing the service.