AAPC CPC Practice Exam D
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 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. 23
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.
What is the full CPT® code description for 61535?
A. Craniotomy with elevation of bone flap; for subdural implantation of an electrode array, for long-term
seizure monitoring; for removal of epidural or subdural electrode array, without excision of cerebral
tissue (separate procedure)
B. Craniotomy with elevation of bone flap; for removal of epidural or subdural electrode array, without
excision of cerebral tissue (separate procedure)
C. For removal of epidural or subdural electrode array, without excision of cerebral tissue (separate
procedure)
D. For excision of epileptogenic focus without electrocorticography during surgery; for removal of
epidural or subdural electrode array, without excision of cerebral tissue (separate procedure) - Answer-
B. Craniotomy with elevation of bone flap; for removal of epidural or subdural electrode array, without
excision of cerebral tissue (separate procedure)
In the CPT® codebook the description for code 61535 is indented which means the description from
61533 up to the semicolon is the beginning of the full description for 61535.
Which Z code category can ONLY be reported as a first listed diagnosis code?
A. Z67
B. Z69
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 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. 23
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.
What is the full CPT® code description for 61535?
A. Craniotomy with elevation of bone flap; for subdural implantation of an electrode array, for long-term
seizure monitoring; for removal of epidural or subdural electrode array, without excision of cerebral
tissue (separate procedure)
B. Craniotomy with elevation of bone flap; for removal of epidural or subdural electrode array, without
excision of cerebral tissue (separate procedure)
C. For removal of epidural or subdural electrode array, without excision of cerebral tissue (separate
procedure)
D. For excision of epileptogenic focus without electrocorticography during surgery; for removal of
epidural or subdural electrode array, without excision of cerebral tissue (separate procedure) - Answer-
B. Craniotomy with elevation of bone flap; for removal of epidural or subdural electrode array, without
excision of cerebral tissue (separate procedure)
In the CPT® codebook the description for code 61535 is indented which means the description from
61533 up to the semicolon is the beginning of the full description for 61535.
Which Z code category can ONLY be reported as a first listed diagnosis code?
A. Z67
B. Z69
