[CERTIFIED PROFESSIONAL CODER (CPC) EXAM] – EXAM-STYLE QUESTIONS AND
ANSWERS | VERIFIED AND WELL DETAILED ANSWERS | PLUS RATIONALES |
GUARANTEED PASS | 2026/27 LATEST UPDATE | EXAM PREP | STUDY GUIDE |
PRACTICE TEST
1. A 45-year-old patient presents with a history of chronic obstructive
pulmonary disease (COPD) and is being evaluated for a new onset of shortness
of breath. The provider performs a comprehensive history and exam, and the
medical decision making (MDM) is of high complexity. Which of the following
scenarios would most accurately support a level 5 established patient office
visit?
A. The provider reviews a chest X-ray, orders a pulmonary function test, and
prescribes a new maintenance inhaler.
B. The provider reviews a CT scan of the chest, prescribes a course of oral
corticosteroids, and discusses the risks of long-term oxygen therapy.
C. The provider orders a complete blood count (CBC) and a basic metabolic panel
(BMP), and adjusts the patient's current bronchodilator dosage.
D. The provider performs a bedside spirometry test, reviews the results of a
recent arterial blood gas (ABG) analysis, and counsels the patient on smoking
cessation.
Correct Answer: B. The provider reviews a CT scan of the chest, prescribes a
course of oral corticosteroids, and discusses the risks of long-term oxygen
therapy.
Rationale: A level 5 established patient visit (99215) requires a comprehensive
history and exam and high MDM. High MDM includes at least one of the following:
two or more chronic conditions with exacerbation or progression, an acute or
,chronic illness that poses a threat to life or bodily function, or a drug therapy
requiring intensive monitoring. In option B, the provider is managing a complex
chronic condition (COPD) with an exacerbation, prescribing a high-risk medication
(corticosteroids), and discussing a therapy that requires close monitoring (oxygen
therapy). Option A, while thorough, represents moderate MDM, and options C and
D represent lower levels of MDM.
2. A patient presents with a laceration on their left forearm that requires 8 cm
of layered closure of the deep and subcutaneous tissues. The provider also
performs a debridement of devitalized tissue from the wound. What is the
correct code assignment for this procedure?
A. 12034-59
B. 12034, 11042-51
C. 12034, 11042
D. 13132
Correct Answer: C. 12034, 11042
Rationale: 12034 is the correct code for intermediate repair of a wound on the
forearm with layered closure of the deep and subcutaneous tissues. The
debridement of devitalized tissue is separately reported with code 11042. The
debridement code is not bundled into the repair code because it represents a
distinct procedural service. Modifier -51 is not necessary because these services are
typically reported together without the modifier, and the National Correct Coding
Initiative (NCCI) allows these codes to be billed together when medically necessary.
Option A incorrectly uses modifier -59, which is not required for this combination.
Option D, 13132, is for complex repairs, which is not indicated in the scenario.
,3. A surgeon performs a total abdominal hysterectomy with bilateral salpingo-
oophorectomy for a malignant neoplasm of the uterus. During the same
operative session, the surgeon also performs a staging lymphadenectomy.
What is the correct coding approach for this scenario?
A. Report the hysterectomy and the lymphadenectomy as separate procedures.
B. Report only the hysterectomy, as the lymphadenectomy is considered integral
to the procedure.
C. Report the lymphadenectomy as an add-on code to the hysterectomy.
D. Report only the lymphadenectomy, as it is the more complex procedure.
Correct Answer: C. Report the lymphadenectomy as an add-on code to the
hysterectomy.
Rationale: In CPT coding, a staging lymphadenectomy is reported as an add-on
code (+38747) when performed in conjunction with a total abdominal
hysterectomy for malignancy. Add-on codes are never reported alone and are
always appended to the primary procedure. The primary procedure, the
hysterectomy, is reported with the appropriate code (e.g., 58150). Option A is
incorrect because a separate procedure code is not used for the lymphadenectomy,
as it is an add-on service. Option B is incorrect because the lymphadenectomy is a
separate, identifiable service. Option D is incorrect because the hysterectomy
remains the primary procedure.
4. What is the primary purpose of the National Correct Coding Initiative (NCCI)
edits?
, A. To prevent duplicate billing and overpayment for services.
B. To define which procedures are considered cosmetic and non-reimbursable.
C. To establish a fee schedule for Medicare Part B services.
D. To ensure that all services are billed with a valid ICD-10-CM code.
Correct Answer: A. To prevent duplicate billing and overpayment for services.
Rationale: The NCCI edits are designed to promote proper coding and prevent
improper payments by identifying pairs of codes that should not be reported
together in specific circumstances. These edits ensure that services that are integral
to a primary procedure are not billed separately, thereby preventing overpayment.
Option B is incorrect because cosmetic procedures are defined by other policies.
Option C is incorrect, as fee schedules are determined by the Centers for Medicare
& Medicaid Services (CMS) through other mechanisms. Option D is incorrect
because NCCI deals primarily with CPT procedure codes, not ICD-10-CM diagnosis
codes.
5. A provider is evaluating a 6-month-old infant for a well-child visit. The infant
has no current illnesses or injuries and is meeting all developmental milestones.
The provider performs a comprehensive history and exam and provides
anticipatory guidance. Which of the following ICD-10-CM codes should be
reported as the primary diagnosis?
A. Z00.129
B. Z00.121
C. Z00.110
D. Z00.111
ANSWERS | VERIFIED AND WELL DETAILED ANSWERS | PLUS RATIONALES |
GUARANTEED PASS | 2026/27 LATEST UPDATE | EXAM PREP | STUDY GUIDE |
PRACTICE TEST
1. A 45-year-old patient presents with a history of chronic obstructive
pulmonary disease (COPD) and is being evaluated for a new onset of shortness
of breath. The provider performs a comprehensive history and exam, and the
medical decision making (MDM) is of high complexity. Which of the following
scenarios would most accurately support a level 5 established patient office
visit?
A. The provider reviews a chest X-ray, orders a pulmonary function test, and
prescribes a new maintenance inhaler.
B. The provider reviews a CT scan of the chest, prescribes a course of oral
corticosteroids, and discusses the risks of long-term oxygen therapy.
C. The provider orders a complete blood count (CBC) and a basic metabolic panel
(BMP), and adjusts the patient's current bronchodilator dosage.
D. The provider performs a bedside spirometry test, reviews the results of a
recent arterial blood gas (ABG) analysis, and counsels the patient on smoking
cessation.
Correct Answer: B. The provider reviews a CT scan of the chest, prescribes a
course of oral corticosteroids, and discusses the risks of long-term oxygen
therapy.
Rationale: A level 5 established patient visit (99215) requires a comprehensive
history and exam and high MDM. High MDM includes at least one of the following:
two or more chronic conditions with exacerbation or progression, an acute or
,chronic illness that poses a threat to life or bodily function, or a drug therapy
requiring intensive monitoring. In option B, the provider is managing a complex
chronic condition (COPD) with an exacerbation, prescribing a high-risk medication
(corticosteroids), and discussing a therapy that requires close monitoring (oxygen
therapy). Option A, while thorough, represents moderate MDM, and options C and
D represent lower levels of MDM.
2. A patient presents with a laceration on their left forearm that requires 8 cm
of layered closure of the deep and subcutaneous tissues. The provider also
performs a debridement of devitalized tissue from the wound. What is the
correct code assignment for this procedure?
A. 12034-59
B. 12034, 11042-51
C. 12034, 11042
D. 13132
Correct Answer: C. 12034, 11042
Rationale: 12034 is the correct code for intermediate repair of a wound on the
forearm with layered closure of the deep and subcutaneous tissues. The
debridement of devitalized tissue is separately reported with code 11042. The
debridement code is not bundled into the repair code because it represents a
distinct procedural service. Modifier -51 is not necessary because these services are
typically reported together without the modifier, and the National Correct Coding
Initiative (NCCI) allows these codes to be billed together when medically necessary.
Option A incorrectly uses modifier -59, which is not required for this combination.
Option D, 13132, is for complex repairs, which is not indicated in the scenario.
,3. A surgeon performs a total abdominal hysterectomy with bilateral salpingo-
oophorectomy for a malignant neoplasm of the uterus. During the same
operative session, the surgeon also performs a staging lymphadenectomy.
What is the correct coding approach for this scenario?
A. Report the hysterectomy and the lymphadenectomy as separate procedures.
B. Report only the hysterectomy, as the lymphadenectomy is considered integral
to the procedure.
C. Report the lymphadenectomy as an add-on code to the hysterectomy.
D. Report only the lymphadenectomy, as it is the more complex procedure.
Correct Answer: C. Report the lymphadenectomy as an add-on code to the
hysterectomy.
Rationale: In CPT coding, a staging lymphadenectomy is reported as an add-on
code (+38747) when performed in conjunction with a total abdominal
hysterectomy for malignancy. Add-on codes are never reported alone and are
always appended to the primary procedure. The primary procedure, the
hysterectomy, is reported with the appropriate code (e.g., 58150). Option A is
incorrect because a separate procedure code is not used for the lymphadenectomy,
as it is an add-on service. Option B is incorrect because the lymphadenectomy is a
separate, identifiable service. Option D is incorrect because the hysterectomy
remains the primary procedure.
4. What is the primary purpose of the National Correct Coding Initiative (NCCI)
edits?
, A. To prevent duplicate billing and overpayment for services.
B. To define which procedures are considered cosmetic and non-reimbursable.
C. To establish a fee schedule for Medicare Part B services.
D. To ensure that all services are billed with a valid ICD-10-CM code.
Correct Answer: A. To prevent duplicate billing and overpayment for services.
Rationale: The NCCI edits are designed to promote proper coding and prevent
improper payments by identifying pairs of codes that should not be reported
together in specific circumstances. These edits ensure that services that are integral
to a primary procedure are not billed separately, thereby preventing overpayment.
Option B is incorrect because cosmetic procedures are defined by other policies.
Option C is incorrect, as fee schedules are determined by the Centers for Medicare
& Medicaid Services (CMS) through other mechanisms. Option D is incorrect
because NCCI deals primarily with CPT procedure codes, not ICD-10-CM diagnosis
codes.
5. A provider is evaluating a 6-month-old infant for a well-child visit. The infant
has no current illnesses or injuries and is meeting all developmental milestones.
The provider performs a comprehensive history and exam and provides
anticipatory guidance. Which of the following ICD-10-CM codes should be
reported as the primary diagnosis?
A. Z00.129
B. Z00.121
C. Z00.110
D. Z00.111
