AAPC CPB PRACTICE EXAM
QUESTIONS WITH 100% CORRECT
ANSWERS
A CRNA is performing a case personally without medical direction from an
anesthesiologist. Which modifier is appropriately reported for the CRNA services?
A. QX
B. QZ
C. QK
D. QS - Answer- B. QZ
Patient presents to her physician 10 weeks following a true posterior wall myocardial
infarction. The patient is still exhibiting symptoms of chronic ischemic heart disease.
The physician reviews the current medications to confirm the patient is compliant and
discusses a heart-healthy diet and exercise. What is the correct ICD-10-CM code for
this condition?
A. I25.9
B. I21.29
C. I21.21
D. I25.2 - Answer- A. I25.9
10-year-old girl is scheduled for her yearly physical exam with her pediatrician .At the
time of her visit, the patient complains of watery eyes, scratchy throat, and stuffy nose
for the past two days. The physician first performs a complete physical. Then he also
evaluates and treats the patient for a URI supported with separate documentation of an
expanded problem focused exam and low medical decision making. What CPT®
code(s) is/are reported for this visit?
A. 99393, 99213-25
B. 99393
C. 99213
D. 99393-25, 99213 - Answer- A. 99393, 99213-25
The patient is admitted for radiation therapy for metastatic bone cancer, unknown
primary. What ICD-10-CM codes should be reported?
,A. C79.51, C80.1, Z51.0
B. C80.1, C79.51, Z51.0
C. Z51.0, C79.51, C80.1
D. Z51.0, C80.1, C79.51 - Answer- C. Z51.0, C79.51, C80.1
60-year-old woman is seeking help to quit smoking. She makes an appointment to see
Dr. Lung for an initial visit. The patient has a constant cough due to smoking and some
shortness of breath. No night sweats, weight loss, night fever, CP, headache, or
dizziness. She has tried patches and nicotine gum, which has not helped. Patient has
been smoking for 40 years and smokes 2 packs per day. She has a family history of
emphysema. A limited three system exam was performed. Dr. Lung discussed in detail
the pros and cons of medications used to quit smoking. Counseling and education was
done face to face for 20 minutes on smoking cessation of the 30 minute visit.
Prescriptions for Chantix and Tetracycline were given. The patient to follow up in 1
month. A chest X-ray and cardiac work up was ordered. Select the appropriate CPT®
code(s) for this visit:
A. 99203, 99354
B. 99214, 99354
C. 99214
D. 99407 - Answer- D. 99407
A 14-year-old male patient fell while skateboarding. He went to the emergency
department at the local hospital. The diagnosis was a fracture of the upper right arm.
The ICD-10-CM codes reported were S42.301A, V00.131A, and Y93.51.Is this correct?
A. No; the codes reported should be S43.309B, V00.131B, Y93.51
B. No; the codes reported should be V00.131B, Y93.51, S42.309D
C. No; the codes reported should be V00.131A, Y93.51, S42.301A
D. Yes; the ICD-10-CM codes reported are correct - Answer- D. Yes; the ICD-10-CM
codes reported are correct
Obstetrician A recommends a new type of cancer treatment for patient who has ovarian
cancer. Before the patient's private insurance company approves the treatment, the
insurer mandates Obstetrician B (in a different practice) to conduct a physical
examination of the patient. What modifier should obstetrician B append to the E/M
consultation code?
A. Modifier 25
B. Modifier 24
C. Modifier 32
D. Modifier 59 - Answer- C. Modifier 32
,Joe and Mary are a married couple and both carry insurance from their employers. Joe
was born on February 23, 1977 and Mary was born on April 4, 1974. Using the birthday
rule, who carries the primary insurance for their children for billing?
A. Joe, because he is the male head of the household.
B. Mary, because her date of birth is the 4th and Joe's date of birth is the 23rd.
C. Mary, because her birth year is before Joe's birth year.
D. Joe, because his birth month and day are before Mary's birth month and day. -
Answer- D. Joe, because his birth month and day are before Mary's birth month and
day.
Which type of managed care insurance allows patients to self-refer to out-of-network
providers and pay a higher co-insurance/copay amount?
I. HMO
II. PPO
III. EPO
IV. POS
V. Capitation
A. II
B. IV
C. II and IV
D. II, III, and V - Answer- C. II and IV
A patient covered by a PPO is scheduled for knee replacement surgery. The biller
contacts the insurance carrier to verify benefits and preauthorize the procedure. The
carrier verifies the patient has a $500 deductible which must be met. After the
deductible, the PPO will pay 80% of the claim. The contracted rate for the procedure is
$2,500. What is the patient's responsibility?
A. $400
B. $500
C. $900
D. $1,600 - Answer- C. $900
When a nonparticipating provider files a claim for a patient to BC/BS, how is the
payment processed?
A. The payment is sent to the patient and the patient must pay the provider.
B. The payment is sent to the provider if the provider agrees to accept assignment.
C. The payment is sent to the provider regardless if he accepts assignment.
D. The claim is not paid because the provider is not participating in the plan. - Answer-
A. The payment is sent to the patient and the patient must pay the provider.
, Which of the following TRICARE options is/are available to active duty service
members?
A. TRICARE Select
B. TRICARE Prime
C. TRICARE For Life
D. TRICARE Young Adult - Answer- B. TRICARE Prime
A Medicare card will list which of the following:
I. Effective date of coverage
II. Home address
III. Telephone Number
IV. Entitled to Part A and/or Part B
V. When coverage ends
VI. Name of Primary Care Physician
A. I - VI
B. I, IV
C. I-III, VI
D. I, II, IV, V - Answer- B. I, IV
In which of the following scenarios is Medicare the secondary payer?
I. A 65 year-old patient who is collecting her deceased spouse's Medicare benefits and
has a supplemental insurance
II. A 72 year-old patient who participates in the group health insurance of his employer
III. A 66 year-old patient is injured at work and the employer does not offer health
insurance as a benefit of employment
IV. A 55 year-old patient who is on disability through Social Security and qualifies for
Medicaid and Medicare
A. I-IV
B. II and III
C. I and IV
D. None - Answer- B. II and III
When a patient has Medicare primary and AARP as Medigap, what is entered on the
CMS-1500 claim form in item 9d for the Insurance Plan Name or Program Name for
Medicare to cross over the claim?
A. Plan name followed by "MEDIGAP"
B. Plan Payer ID followed by "MEDIGAP"
C. COBA Medigap claim-based identifier (ID)
D. Leave blank - Answer- C. COBA Medigap claim-based identifier (ID)
QUESTIONS WITH 100% CORRECT
ANSWERS
A CRNA is performing a case personally without medical direction from an
anesthesiologist. Which modifier is appropriately reported for the CRNA services?
A. QX
B. QZ
C. QK
D. QS - Answer- B. QZ
Patient presents to her physician 10 weeks following a true posterior wall myocardial
infarction. The patient is still exhibiting symptoms of chronic ischemic heart disease.
The physician reviews the current medications to confirm the patient is compliant and
discusses a heart-healthy diet and exercise. What is the correct ICD-10-CM code for
this condition?
A. I25.9
B. I21.29
C. I21.21
D. I25.2 - Answer- A. I25.9
10-year-old girl is scheduled for her yearly physical exam with her pediatrician .At the
time of her visit, the patient complains of watery eyes, scratchy throat, and stuffy nose
for the past two days. The physician first performs a complete physical. Then he also
evaluates and treats the patient for a URI supported with separate documentation of an
expanded problem focused exam and low medical decision making. What CPT®
code(s) is/are reported for this visit?
A. 99393, 99213-25
B. 99393
C. 99213
D. 99393-25, 99213 - Answer- A. 99393, 99213-25
The patient is admitted for radiation therapy for metastatic bone cancer, unknown
primary. What ICD-10-CM codes should be reported?
,A. C79.51, C80.1, Z51.0
B. C80.1, C79.51, Z51.0
C. Z51.0, C79.51, C80.1
D. Z51.0, C80.1, C79.51 - Answer- C. Z51.0, C79.51, C80.1
60-year-old woman is seeking help to quit smoking. She makes an appointment to see
Dr. Lung for an initial visit. The patient has a constant cough due to smoking and some
shortness of breath. No night sweats, weight loss, night fever, CP, headache, or
dizziness. She has tried patches and nicotine gum, which has not helped. Patient has
been smoking for 40 years and smokes 2 packs per day. She has a family history of
emphysema. A limited three system exam was performed. Dr. Lung discussed in detail
the pros and cons of medications used to quit smoking. Counseling and education was
done face to face for 20 minutes on smoking cessation of the 30 minute visit.
Prescriptions for Chantix and Tetracycline were given. The patient to follow up in 1
month. A chest X-ray and cardiac work up was ordered. Select the appropriate CPT®
code(s) for this visit:
A. 99203, 99354
B. 99214, 99354
C. 99214
D. 99407 - Answer- D. 99407
A 14-year-old male patient fell while skateboarding. He went to the emergency
department at the local hospital. The diagnosis was a fracture of the upper right arm.
The ICD-10-CM codes reported were S42.301A, V00.131A, and Y93.51.Is this correct?
A. No; the codes reported should be S43.309B, V00.131B, Y93.51
B. No; the codes reported should be V00.131B, Y93.51, S42.309D
C. No; the codes reported should be V00.131A, Y93.51, S42.301A
D. Yes; the ICD-10-CM codes reported are correct - Answer- D. Yes; the ICD-10-CM
codes reported are correct
Obstetrician A recommends a new type of cancer treatment for patient who has ovarian
cancer. Before the patient's private insurance company approves the treatment, the
insurer mandates Obstetrician B (in a different practice) to conduct a physical
examination of the patient. What modifier should obstetrician B append to the E/M
consultation code?
A. Modifier 25
B. Modifier 24
C. Modifier 32
D. Modifier 59 - Answer- C. Modifier 32
,Joe and Mary are a married couple and both carry insurance from their employers. Joe
was born on February 23, 1977 and Mary was born on April 4, 1974. Using the birthday
rule, who carries the primary insurance for their children for billing?
A. Joe, because he is the male head of the household.
B. Mary, because her date of birth is the 4th and Joe's date of birth is the 23rd.
C. Mary, because her birth year is before Joe's birth year.
D. Joe, because his birth month and day are before Mary's birth month and day. -
Answer- D. Joe, because his birth month and day are before Mary's birth month and
day.
Which type of managed care insurance allows patients to self-refer to out-of-network
providers and pay a higher co-insurance/copay amount?
I. HMO
II. PPO
III. EPO
IV. POS
V. Capitation
A. II
B. IV
C. II and IV
D. II, III, and V - Answer- C. II and IV
A patient covered by a PPO is scheduled for knee replacement surgery. The biller
contacts the insurance carrier to verify benefits and preauthorize the procedure. The
carrier verifies the patient has a $500 deductible which must be met. After the
deductible, the PPO will pay 80% of the claim. The contracted rate for the procedure is
$2,500. What is the patient's responsibility?
A. $400
B. $500
C. $900
D. $1,600 - Answer- C. $900
When a nonparticipating provider files a claim for a patient to BC/BS, how is the
payment processed?
A. The payment is sent to the patient and the patient must pay the provider.
B. The payment is sent to the provider if the provider agrees to accept assignment.
C. The payment is sent to the provider regardless if he accepts assignment.
D. The claim is not paid because the provider is not participating in the plan. - Answer-
A. The payment is sent to the patient and the patient must pay the provider.
, Which of the following TRICARE options is/are available to active duty service
members?
A. TRICARE Select
B. TRICARE Prime
C. TRICARE For Life
D. TRICARE Young Adult - Answer- B. TRICARE Prime
A Medicare card will list which of the following:
I. Effective date of coverage
II. Home address
III. Telephone Number
IV. Entitled to Part A and/or Part B
V. When coverage ends
VI. Name of Primary Care Physician
A. I - VI
B. I, IV
C. I-III, VI
D. I, II, IV, V - Answer- B. I, IV
In which of the following scenarios is Medicare the secondary payer?
I. A 65 year-old patient who is collecting her deceased spouse's Medicare benefits and
has a supplemental insurance
II. A 72 year-old patient who participates in the group health insurance of his employer
III. A 66 year-old patient is injured at work and the employer does not offer health
insurance as a benefit of employment
IV. A 55 year-old patient who is on disability through Social Security and qualifies for
Medicaid and Medicare
A. I-IV
B. II and III
C. I and IV
D. None - Answer- B. II and III
When a patient has Medicare primary and AARP as Medigap, what is entered on the
CMS-1500 claim form in item 9d for the Insurance Plan Name or Program Name for
Medicare to cross over the claim?
A. Plan name followed by "MEDIGAP"
B. Plan Payer ID followed by "MEDIGAP"
C. COBA Medigap claim-based identifier (ID)
D. Leave blank - Answer- C. COBA Medigap claim-based identifier (ID)
