Fundamentals of CPC (Certified Professional Coder) | 100% Correct Answers | 2025/2026 Edition | Verified & Updated

1 Fundamentals of CPC (Certified Professional Coder) | 100% Correct Answers | 2025/2026 Edition | Verified & Updated What is the impact of coding a procedure without proper documentation of medical necessity? Without proper documentation of medical necessity, a claim may be denied by insurers, as they may determine that the service or procedure was not justified. Accurate and thorough documentation is essential to support the clinical need for the procedure and ensure reimbursement. Explain the difference between an "open" and "closed" fracture and how they are coded. An open fracture involves a break in the skin or a wound that communicates with the fracture site, while a closed fracture does not involve the skin. The coding differs, with open fractures typically requiring a more specific, higher-level code due to the increased complexity of treatment. What are the coding requirements for a "routine" versus "emergency" surgery? Routine surgeries are typically elective and scheduled in advance, whereas emergency surgeries are performed as a result of an urgent medical condition. The coding for emergency surgeries requires more detailed documentation, including the reason for the urgency and the immediate nature of the procedure. How do you handle coding for a procedure performed during the same encounter as another unrelated procedure? Each procedure should be coded separately using appropriate CPT codes, with modifiers used to indicate that the procedures were performed during the same encounter but were not related to one another. Modifier 59 may be used to indicate that the procedures were distinct and separate. What is the role of the HIC code in medical coding, and how does it affect claims submission? The Health Insurance Claim (HIC) code is used by the Centers for Medicare and Medicaid Services (CMS) to identify specific insurance plans and policies. It affects claims submission by ensuring that claims are correctly directed to the appropriate payer for reimbursement. How do you code for a routine physical examination for a new patient? A routine physical examination for a new patient is coded using a preventive medicine code (e.g., CPT ) depending on the age of the patient. The code should reflect the complexity of the examination and the time spent on preventive care services. What is the difference between a diagnostic code and a procedural code, and why is it important to distinguish between them? A diagnostic code (ICD-10-CM) represents a patient's condition or disease, while a procedural code (CPT or ICD-10-PCS) represents the treatment or service provided. It is crucial to distinguish between them to ensure accurate claims submission and appropriate reimbursement for services rendered. How does coding for a follow-up visit differ from coding for an initial visit? A follow-up visit typically involves less extensive documentation than an initial visit, as the physician is primarily reviewing the patient's progress. The coding for follow-up visits will reflect fewer E/M elements than an initial visit, affecting the level of reimbursement. What is the purpose of the "CPT Assistant" and how does it aid coders in the coding process? The CPT Assistant is an official publication by the American Medical Association (AMA) that provides guidance and clarification on the correct use of CPT codes. It helps coders by offering authoritative interpretations and examples to ensure accurate and compliant coding practices. How does the concept of "bundling" affect the coding of multiple procedures performed during the same session? Bundling refers to grouping related procedures together under a single code, which prevents double billing for services that are typically performed together. It ensures that multiple procedures are not separately reimbursed when they are part of a single comprehensive service. What are the key considerations when coding for a patient's long-term medication management during an office visit? When coding for long-term medication management, the coder must ensure that the patient’s medication history, ongoing treatment, and any changes or adjustments are documented. The visit’s complexity and medical necessity will guide the selection of the appropriate E/M code. 2 How does coding for a procedure performed during a global period differ from coding a procedure performed outside of that period? Procedures performed during a global period are generally considered part of the original procedure, and therefore, should not be coded separately unless they meet specific criteria for additional reimbursement. Procedures outside of the global period are coded independently with appropriate billing. How does the physician's involvement in a service affect the code selection for that service? The physician's involvement determines the level of service provided and the code selection. Services requiring the physician's direct involvement, such as performing a procedure, may warrant higher-level codes compared to services performed by non-physician providers or staff. What is the importance of using the correct ICD-10 code for a patient's diagnosis, and how does it impact reimbursement? Using the correct ICD-10 code ensures that the diagnosis is accurately represented, which affects the reimbursement amount. Incorrect codes can lead to claim denials or underpayment as the insurer may question the medical necessity or appropriateness of the treatment. Explain the difference between a primary diagnosis and a secondary diagnosis and when each should be used. A primary diagnosis is the main condition responsible for the patient’s visit, while a secondary diagnosis refers to additional conditions that coexist and may affect treatment. Both diagnoses must be properly documented to reflect the full scope of care provided and ensure proper reimbursement. What role do payer policies play in the coding and reimbursement process? Payer policies dictate how services are coded, billed, and reimbursed based on their specific rules. Coders must stay updated on payer guidelines to avoid incorrect coding and ensure timely reimbursement for services rendered. What is the purpose of coding audits, and how do they impact the work of a CPC? Coding audits are performed to review coding accuracy and compliance with regulations. They help identify areas of improvement, prevent fraud, and ensure the integrity of claims. Audits impact CPCs by requiring them to maintain high standards of coding accuracy and documentation. 3 How does the application of modifiers like Modifier 51 affect the reimbursement for multiple procedures performed during a single encounter? Modifier 51 is used to indicate multiple procedures performed during the same encounter. It typically reduces the reimbursement for the second and subsequent procedures to reflect the fact that they are part of a single surgical session, ensuring appropriate payment levels. What are the requirements for coding a "never event" and why is it critical to report these accurately? "Never events" refer to serious, preventable errors that should not occur in healthcare settings, such as wrong-site surgeries. Reporting these events accurately is critical for patient safety, regulatory compliance, and ensuring that healthcare providers are held accountable for their actions. What is the purpose of the ICD-10-CM coding system, and how does it impact the healthcare billing process? The ICD-10-CM system is used to classify and code all diagnoses, symptoms, and procedures recorded in conjunction with hospital care in the United States. It ensures accurate coding for billing, data collection, and reimbursement. How does the principle of "medical necessity" influence the selection of CPT codes for billing purposes? Medical necessity ensures that the services or procedures provided are appropriate for the patient's condition and are required for the diagnosis or treatment. It impacts CPT code selection by confirming the procedure's relevance and appropriateness. What is the difference between a comprehensive code and a limited code in the context of E/M (Evaluation and Management) services? A comprehensive code represents a service that includes a broad range of elements, such as a full examination and extensive decision-making. A limited code is used when fewer elements are involved, typically for less complex or less thorough services. Explain the concept of "global period" and its significance in billing for surgical procedures. The global period is the span of time during which all services related to a surgery, such as follow up care, are included in the initial surgical code’s payment. This reduces the need for separate billing for routine postoperative care. How do modifiers, such as Modifier 25, affect the coding and reimbursement for office visits? 4 Modifier 25 indicates that a significant, separately identifiable E/M service was performed on the same day as another procedure. It ensures that the E/M service is reimbursed in addition to the procedure performed, provided it is clinically justified. What are the key differences between ICD-10-PCS and ICD-10-CM coding systems? ICD-10-PCS is used for inpatient procedural coding, while ICD-10-CM is used for diagnosis coding in both inpatient and outpatient settings. PCS is more complex, dealing with procedures and treatments, whereas CM focuses on diseases and conditions. Describe how coding for a "bilateral" procedure differs from coding for a unilateral procedure. A bilateral procedure is coded with an additional modifier (Modifier 50) to indicate that the procedure was performed on both sides of the body, whereas a unilateral procedure is coded only once without the need for a modifier. What documentation is necessary to support the use of a high-level E/M code for a patient visit? High-level E/M codes require detailed documentation of the patient’s history, examination, and decision-making process. This includes a comprehensive review of the patient’s condition, the complexity of the diagnosis, and the medical necessity for the chosen treatment. Explain the concept of "incident to" services and when they are appropriate to use in coding. "Incident to" services refer to services provided by non-physician healthcare providers, such as nurse practitioners or physician assistants, under the supervision of a physician. They are used when the service is directly related to the physician’s plan of care and complies with Medicare guidelines. What is the role of the National Correct Coding Initiative (NCCI) edits in ensuring proper coding? NCCI edits are used to prevent improper coding by identifying pairs of codes that should not be reported together due to clinical or logical reasons. These edits help prevent billing errors and ensure compliance with Medicare and other insurers. How does the coding of a preventive service differ from diagnostic services, and what are the implications for reimbursement? Preventive services are designed to prevent disease or detect conditions early and are often covered at no cost to the patient under specific healthcare policies. Diagnostic services are used to 5 evaluate symptoms or conditions and may require cost-sharing by the patient. These differences affect reimbursement policies and coding choices. What guidelines should be followed when coding for a diagnostic test or procedure? The coder should ensure that the correct code is assigned based on the type of diagnostic test, the reason for the test, and the results if available. Proper documentation must support the reason for testing, as it affects both coding accuracy and reimbursement. Describe the importance of accurate coding for anesthesia services, and how the anesthesia time is calculated. Accurate coding for anesthesia services requires documenting the time spent administering anesthesia and monitoring the patient. Anesthesia time is calculated from the moment the anesthesiologist starts preparing the patient until the moment the patient is stable enough to be released from anesthesia care. How do outpatient services differ from inpatient services in terms of coding and reimbursement? Outpatient services are coded using the ICD-10-CM system for diagnosis and CPT codes for procedures, while inpatient services often involve additional coding systems like ICD-10-PCS for procedures. Reimbursement for outpatient services is typically done on a fee-for-service basis, while inpatient services may be covered under bundled payment or DRG (Diagnosis-Related Group) systems. What is the significance of the place of service (POS) code when submitting claims? The POS code indicates the location where a service was provided and helps determine reimbursement rates. For example, services performed in a hospital outpatient setting might have different reimbursement rates than those performed in a physician’s office. How do you code for a re-excision of tissue following an initial excision procedure? Re-excision should be coded with a CPT code for the excision of the tissue, along with a modifier (such as Modifier 78) to indicate that the procedure was a related, but separate, service performed during the global period of the initial excision. 6 A 52 year-old male with basal cell carcinoma of the forehead has outpatient surgery to excise the basal cell carcinoma with reconstruction using an advancement flap. The 2.0 cm lesion with margins was excised with a diameter using a 15-blade scalpel down to the level of the subcutaneous tissue, totaling a primary defect of 4.0 sq cm. Electrocautery was used for hemostasis. An adjacent tissue transfer of 5.0 sq cm was taken from the upper right cheek and was advanced into the primary defect. Which CPT® code(s) is (are) reported? A. 14040 B. 14040, 11642-51 C. 14040, 11442-51 D. 15574 A. 14040 A 31 year-old male with a hypertrophic scar on the left side of his neck to have a skin graft. The scar is continually irritated by his clothing. Procedure: After the proper induction of anesthesia, the subcutaneous tissue of the neck beneath the scar was infiltrated with crystalloid solution containing epinephrine to minimize blood loss. The scar was then excised down to viable dermis to prepare the site for the skin graft leaving a 40 cm defect. Hemostasis was obtained with epinephrine soaked pads. Skin was harvested from the patient's thigh in a split thickness fashion and was used to cover the 40 sq cm defect created by the surgery. The graft was secured with skin staples, and then dressed with fine mesh gauze followed by medication-soaked gauze. The donor site was dressed with mesh followed by Adaptic™, followed by a dry dressing and an Ace wrap. What is (are) the CPT® code(s)? A. 15115, 15004-51 B. 15120 C. 1 C. 15120, 15004-51 A 46 year-old female presents to have multiple lesions destroyed. Five benign lesions on her face are destroyed and 16 actinic keratoses on her left arm are destroyed. The CPT® code(s) to report is (are): 7 A. 17000, 17003, 17110-51 B. 17004, 17110-51 C. 17004 D. 17004 x 16, 17110-51 x 5 B. 17004, 17110-51 A 32 year-old female with chronic low back pain is scheduled with a pain specialist for trigger point injections. The patient is appropriately prepped and the area anesthetized. The provider palpates the area of muscles to determine the location of the trigger points. Six injections of a corticosteroid are slowly injected into two muscle groups. A. 20553 B. 20552 x 6 C. 20551 x 2 D. 20552 D. 20552 A 40 year-old woman fractured her second metatarsal of her left foot when a can of vegetables fell on her foot. The metatarsal neck fracture is 100% volar displaced and will be treated by an orthopedic surgeon in the outpatient clinic. When the patient is appropriately prepped and anesthetized, the provider adjusts the fractured fragment by exerting pushing or pulling force on the foot to reduce the fracture. An x-ray is taken to confirm the reduction of the fracture is aligned. Her foot is placed the in a cast. She will return in four weeks for follow-up. Which CPT® code is reported? A. 28465-LT B. 28476-LT C. 28475-LT D. 28485-LT C. 28475-LT 8 A 47 year-old patient was previously treated with external fixation for a Type IIIA left lateral condyle tibial fracture. There is now nonunion of the left proximal tibia, and he is admitted for open reduction of tibia with bone grafting. The surgeon makes an incision and exposes the tibial nonunion and debrides the fibrous tissue. A sliding bone graft from the nearby tibia is obtained and slid into the defect between the bone fragments. The two ends of the fracture fragments are joined together and secured with a plate and screws. The bleeding is controlled and the wound is closed in layers. What CPT® and ICD-10-CM codes are reported? A. 27722-LT, S82.122N B. 27724-LT, S82.122S C. 27722-LT, S82.102N D. 27724-LT, S82.102C A. 27722-LT, S82.122N A lesion was found in the upper left lung. The patient presents for a biopsy. After induction of general endotracheal anesthesia, the patient was placed in semi-lateral position with left side up and prepped. A thoracoscope was introduced and a diagnostic wedge biopsy was performed and the specimen was sent for frozen section. The report came back as cancer, and a thoracoscopic left lung segmentectomy was performed. Report the CPT® code(s). A. 32663-LT B. 32669-LT C. 32669-LT, 32608-59 D. 32666-LT B. 32669-LT Report removal and replacement of a permanent implantable defibrillator system with dual transvenous leads. A. 33249 B. 33249, 33243-51, 33241-51 C. 33249, 33244-51, 33241-51 9 D. 33262 C. 33249, 33244-51, 33241-51 A patient receiving chemotherapy for left upper-inner quadrant breast cancer via a left tunneled central venous catheter with port is admitted to outpatient surgery for a check of the line which is partially obstructed. Using fluoroscopy a fibrin sheath is removed via a separate puncture. Removal of the fibrin sheath does not increase the central line flow, so the decision is made to replace the tunneled central line with subcutaneous port, through the same venous access. Report the CPT® and ICD-10-CM codes. A. 36561, 36596-51, T80.219A, C50.212 B. 36582, 36595-51, T82.598A, C50.212 C. 36582, T82.598A, C50.212 D. 36563, T80.219A, C50.212 B. 36582, 36595-51, T82.598A, C50.212 A 44 year-old female presents for a hemorrhoidectomy. A rubber band ligation of two internal hemorrhoids is performed. After this a thrombosed external hemorrhoid was excised. Bleeding is controlled with cautery, and the area is left open for drainage. Report the CPT® codes. A. 46945, 46255-51 B. 46221, 46250-51 C. 46221, 46320-51 D. 46945, 46320-51 C. 46221, 46320-51 A 66 year-old patient is anesthetized and draped. The radiologist places a catheter through the skin into the bile duct to drain the bile. Contrast is then injected and cholangiography is performed. Using ultrasound imaging the radiologist documents the presence of sludge and a stone in the common bile duct. The radiologist secures the external end of the catheter with a suture and attaches the catheter to an external drainage bag. Report the CPT® code(s). A. 47536 10 B. 47531, 76942-26 C. 47533, 76942-26 D. 47533 D. 47533 Preoperative Diagnosis: Tumor of the left tongue.Operative Diagnosis: Tumor of the left tongue.Procedure: Glossectomy to a portion of left side of tongueAnesthesia: GeneralProcedure: After adequate general anesthesia was obtained and the patient intubated with a nasal tracheal tube, the tongue was grasped with a towel clip and a self-retaining mouth retractor inserted. The tongue was retracted from the oral cavity and a suture ligature was placed at the far side of the lesion at the anterior tonsillar pillar, and a second traction suture was placed on the ante¬rior portion of the tongue opposite the towel clip. Then using the carbon dioxide laser on medium high wattage, the lesion was excised taking a through-and-through incision, with the carbon dioxide laser in which less than half of the left side of the tongue. Hemostasis was assured by individual ligature of 2-0 black silk and use of the carbon dioxide laser as A. 41120 A 26 year-old female, at 37 weeks of gestation, presents to hospital for the planned delivery of her second child. Her first pregnancy resulted in a cesarean delivery. Her wish is to attempt a vaginal delivery, and after a short labor a healthy baby girl was delivered. The obstetrician who delivered the baby also provided the antepartum care and will follow the patient for postpartum care. Code the delivery and the diagnoses for the maternal record. A. 59610, O34.219, Z37.0, Z3A.37 B. 59618, O34.219, Z38.00, Z3A.37 C. 59620, O34.219, Z38.00, Z3A.37 D. 59612, O34.219, Z37.0, Z3A.37 A. 59610, O34.219, Z37.0, Z3A.37 A patient presents to the operating suite for a transurethral resection of bladder tumors. A cystourethroscope is passed through the urethra into the bladder revealing the right trigone and lateral wall of the bladder and two tumors are visualized. The smallest tumor is 2.5 cm and the largest tumor measures 5.5 cm. The tumors are excised with no perforations to the bladder. What CPT® code is (are) reported? A. 52240 x 2 B. 52235 C. 52240, 52235 11 D. 52240 D. 52240 A 35 year-old with an abnormal pap smear of the cervix is scheduled for a cervical conization. The provider determines the size of the lesion and places a grounding pad. Lidocaine is injected into the cervix. A loop electrode is used to excise the lesion. Bleeding is controlled with electrocautery and the patient is taken to the recovery room. Code the procedure and the diagnosis. A. 57520, R87.619 B. 57460, R87.618 C. 57522, R87.619 D. 57461, R87.618 C. 57522, R87.619 A CT scan reveals that a 30 year-old man has a posterior fossa abscess. Six months ago, he was crossing a parking lot and was hit by a car and sustained a head injury with loss of consciousness for two days. He has regained his pre-existing mental state. During his hospital stay he developed pneumonia, and the abscess is due to his traumatic injury and his complication of pneumonia. He underwent craniotomy for excision of the posterior fossa brain abscess. Pathology identified the abscess as MSSA staphylococcus aureus. What CPT® and ICD-10-CM codes are reported? A. 61522, G06.0, B95.61, B94.8, S06.9X5S B. 61321, G06.0, A49.01, B94.8, S06.9X5S C. 61320, G06.0, B95.61, B94.8, S06.9X5S D. 61514, G06.0, A94.01, B94.8, S06.9X5S A. 61522, G06.0, B95.61, B94.8, S06.9X5S A patient two weeks ago had a right partial thyroidectomy for thyroid cancer. He has a planned return to the OR in undergoing complete removal of the remaining right thyroid by the same surgeon, because the margins were not clear of cancer for the last surgery. Report the CPT® and ICD-10-CM. A. 60271-58, C73, Z85.850 12 B. 60240-78-RT, Z85.850 C. 60260-58-RT, C73 D. 60260-78, C73 C. 60260-58-RT, C73 PROCEDURE: Lumbar epidural corticosteroid injection. PREOPERATIVE DIAGNOSES: 1. Displacement with myelopathy. 2. Degeneration of lumbar disc. POSTOPERATIVE DIAGNOSES: 1. Displacement with myelopathy. 2. Degeneration of lumbar disc. ANESTHESIA: Local PROCEDURE IN DETAIL:The patient was then placed is sitting position on the table in the outpatient surgical suite. The lumbar area was prepped with a Betadine solution and draped in the usual sterile fashion. The lumbar vertebrae were identified. The L3-L4 interspace was identified and skin infiltrated with 1 cc of 1% lidocaine. An 18-gauge Tuohy needle was used to enter the epidural space with loss of resistance technique. No heme, CSF, or paresthesia were noted during needle placement. Total volume of 5 cc of 80 mg methylprednisolone and preservative free saline were injected with ease. Motor function was monitored by having patient move toes. The needle was removed C. 62322 A 23 month-old critically ill child is admitted to the PICU from the ER with respiratory failure by the admitting provider. The provider performs endotracheal intubation and pharmacologic support along with cardiovascular monitoring in the PICU. The provider documents a comprehensive history and exam and orders are written after treatment is initiated. What is the CPT ® code for this encounter? A. 99471 B. 99291 C. 99285-25, 31500 13 D. 99475-25, 31500 A. 99471 This 55 year-old female returning to the orthopedic office still complaining of right knee pain after her knee replacement 6 months ago and the pain has been increasing. A detailed history, expanded problem focused exam and low medical decision making was documented. The patient is concerned about the thrombosis or joint infection. The orthopedic physician documented 25 minutes of the 40-minute visit was spent counseling on what the symptoms would be if she had an infection or thrombosis and answering further questions. She was reassured that her pain was an overuse condition and she was instructed to ice her knee twice a day and avoid stairs. What E/M service is reported? A. 99212 B. 99213 C. 99214 D. 99215 D. 99215 A 80 year-old male is seen by his provider in his assisted living facility today for a follow-up visit. His diabetes has not been in control and his insulin is adjusted. His blood pressure has been stable and he will continue the same Coreg dosage. He reports decreased energy, fatigue and an overall sadness. He will be evaluated for depression.A detailed history, detailed exam and moderate medical decision making were documented in his chart. What E/M service is reported? A. 99309 B. 99336 C. 99326 D. 99304 B. 99336 A 55 year-old with PS 3 had the insertion of a dual pacemaker performed under MAC anesthesia provided by an anesthesiologist. The total anesthesia time was one hour and 15 minutes. Report the services of the anesthesiologist. A. 00530-AA-QS-P3 B. 00530-AA-P3 14 C. 00530-QY-QS-P3 D. 00530-AD-P3 A. 00530-AA-QS-P3 A patient with lacerations of the right hand is taken to the operating room for tendon repair of all five f ingers and repair of the laceration. The anesthesiologist gives the patient a right axillary block. The block appears to be working well and the patient is taken to the OR and prepped for the hand surgery. The anesthesiologist monitors the patient and provides oxygen throughout the case. The patient is PS 1. Report this case for the anesthesiologist. A. 01710-AA-P1 B. 01710-AA-QS-P1 C. 01810-AA-P1 D. 01810-AA-QS-P1 C. 01810-AA-P1 A healthy 24 year-old primigravida is admitted to the hospital in active labor. She has decided that she wants an epidural for her vaginal delivery. She is seen by the CRNA who inserts a continuous lumbar epidural for neuraxial anesthesia. Three hours later the patient is taken to the OR for an emergency C section for a prolapsed cord. The same CRNA administers general endotracheal anesthesia for an emergency cesarean section. Code the services of the CRNA. A. 01967-QZ-P1, 01968-QZ-P1, 99140 B. 01968-QZ-P1, 99140 C. 01967-QZ-P1, 01968-QZ-P1 D. 01967-QX-P1, 01968-QX-P1, 99140 A. 01967-QZ-P1, 01968-QZ-P1, 99140 Patient is undergoing radiation treatment. He has two treatments daily for 5 days at 8 AM and 4 PM and then one treatment per day at 8 AM for five days. The entire radiation treatment started on Monday, June 1 and ended on Friday, June 12th with a total of 15 treatments. The oncologist examined the patient, reviewed port films, reviewed the dosimetry, dose delivery, and treatment parameters, and patient set up and signed all documentation for the treatment on each day of treatment. How are these services for the entire span of the treatment reported? A. 77427 15 B. 77427 x 3 C. 77427 x 15 D. 77427 x 5 B. 77427 x 3 A patient is taken to the inpatient cardiac cath lab and after 1% Lidocaine injection, a left femoral artery puncture is performed. A catheter is advanced into the aorta to a position just above the renal arteries. Contrast is injected and aortography is performed. The catheter is then manipulated into the right common iliac and contrast is injected. The catheter then is pulled back to the left common iliac and contrast is injected. The physician documents that there is moderate arteriosclerosis of the abdominal aorta with a 5 cm aneurysm just below the renal arteries. Both the right and left iliacs of the lower extremities show stenosis of 50% in the common iliacs. There is narrowing of 40% in the right superficial femoral artery. What CPT® codes are reported for the physician's services? A. 36245, 75630-26, 75716-26 B. 36245, 75625-26, 75716-26 C. 36245, 75630-26, 75710-26 D. 36245, 75625-26, 75710-26 B. 36245, 75625-26, 75716-26 Magnetic resonance imaging of the heart for morphology and function is first performed without contrast followed by contrast, with stress imaging. Velocity flow mapping was also performed. A cardiologist contracted by the hospital (not an employee of the hospital) provided the supervision and interpretation for the procedure. What are the CPT® codes reported for the cardiologist? A. 75561-26, 75565-26, 93015 B. 75563-26, 75565-26, 93016, 93018 C. 75563-26, 75565-26, 93015 D. 75561-26, 75565-26, 93016, 93018 B. 75563-26, 75565-26, 93016, 93018 A 40 year-old woman has been trying to get pregnant for 3 years. After consultation with her gynecologist, she decides to begin in vitro fertilization (IVF). During one of her IVF cycles, an embryo is harvested for cryopreservation and storage. 16 What CPT® codes are used for this procedure? A. 89258, 89342 B. 89352, 89356 C. 89258, 89346 D. 89342, 89346 A. 89258, 89342 A comprehensive metabolic panel to evaluate metabolic process in the body and a 24-hour urine for total protein for a patient that has Type 1 diabetes with complications are sent to the lab. What CPT® coding is reported by the lab? A. 80053 B. 80053, 84156 C. 80053, 84160 D. 80053, 84155 B. 80053, 84156 A 32 year-old female was poisoned. An autopsy is performed to gather and preserve evidence for the police investigation and court of law. What code is reported? A. 88040 B. 88036 C. 80500 D. 88323 A. 88040 Two-year old Mitchell is brought to the ED with a foreign body lodged in his left ear. Mitchell is uncooperative and moderate sedation is needed to remove the foreign body. The ED physician uses Ketamine IV for sedation and a registered nurse is present to monitor the patient. The patient was monitored for 30 minutes of sedation and the ED physician was successful in removing a glass bead from Mitchell's ear. 17 What moderate sedation codes are reported for the ED physician? A. 99155, 99157 B. 99156, 99157 C. 99151, 99153 D. 99152, 99153 C. 99151, 99153 Mary was recently divorced after 20 years of marriage. She is having trouble adjusting to this new lifestyle and schedules an appointment with a clinical psychologist to help her with this transition. Her f irst psychotherapy visit is 45 minutes. How would the psychologist code the visit? A. 90833-AH B. 90839-AH C. 90832-AH D. 90834-AH D. 90834-AH Mark returned from a 3-day business trip with an itchy rash on his scalp, trunk, arms and legs. The OTC treatments he tried have not helped. He suspects he is allergic to something from his hotel room. He makes an appointment with an allergist to see if he can get some relief and to determine what he's allergic to. The allergist applies three patches to Mark's back containing a group of test substances. Mark is to return in 48 hours for the allergist to remove the patches and examine the skin. The results indicate Mark has allergic contact dermatitis caused by laundry soap. The laundry soap used by the hotel is most likely the cause. What CPT® coding is reported? A. 95052 x 3 B. 95044 C. 95052 D. 95044 x 3 D. 95044 x 3 Mrs. Lane has BC/BS and is returning to her gynecologist for an annual gynecological exam. During the breast exam, a small lump is palpated. Since it has been three years since Mrs. Lane's last mammogram, 18 the physician schedules a diagnostic mammography for the next day. Mrs. Lane was visibly distraught and the remainder of the exam was postponed. How would you code for the annual gynecological exam? A. S0613 B. G0439 C. S0610 D. S0612 cDB Tim goes to the Urgent Care Center to see if he can get some relief for his continued nausea and vomiting cause by motion sickness. He went deep-sea fishing yesterday and has not been able to shake the persistent nausea and vomiting. He receives 25mg of Benadryl IM to relieve the symptoms. How would you code for the Benadryl? A. J1200 x 25 B. Q0163 C. J1245 x 3 D. J1200 D. J1200 Mr. Sands has been treated and followed for Stage 4 metastatic bladder cancer over the last three years. New lymph node metastases were recently discovered and his oncologist recommended hospice care. Mr. Sands would like to have home hospice. The oncologist contacted the hospice agency to initiate the service. The hospice agency ordered a hospital bed, with mattress and side rails, semi-electric head and foot adjustment to be delivered to the Mr. Sands home the following week. What HCPCS Level II code is reported? A. E0294-RR B. E0260-RR C. E0261-RR D. E0255-RR B. E0260-RR 19 Mrs. Frederick presents to her primary care provider with wrist pain. It's been hurting for two weeks and she has no recollection of any injury. The provider suspects this may be arthritis but orders an X-ray to rule out any injury. She is to use aspirin for the pain and return in one-week for follow-up of the X-ray. Any further tests or treatment will be discussed at that visit. The provider documents a diagnosis of wrist pain. Select the correct diagnosis code(s). A. M25.539 B. G89.11, M25.539 C. M25.539, G81.21 D. M25.531, M25.532 D. J45.909 Ms. Johnson is in her provider's office for two days of wheezing, shortness of breath and coughing during the night. A rescue inhaler is prescribed for quick relief of the symptoms with a final diagnosis of asthma. She is to return in three months for follow-up or sooner if the symptoms increase. Select the correct diagnosis code(s). A. R06.2, R06.02, R05, J45.909 B. J45.20 C. J45.909, R06.2, R06.02, R05 D. J45.909 CDB A 30 year-old developed a keloid scar as a result of a third degree burn on the right thigh. What ICD-10-CM coding is reported? A. L91.0, T24.311S B. T24.311A, L91.0 C. T24.311S, L91.0 D. T24.311S cDB What type of tendon in the hand is found in Zone 2, No Man's Land? 20 A. Extensor B. Palmer C. Flexor D. Peroneal C. Flexor Cranial Nerve VII is what type of nerve? A. Facial Nerve B. Optic Nerve C. Vagus Nerve D. Trigeminal Nerve cDB The Digestive Systems includes which combination? A. Liver, kidney, epiglottis B. Pancreas, esophagus, kidney C. Stomach, rectum, gall bladder D. Nasopharynx, liver, pancreas What is the definition of sequela? A. A chronic condition. B. An impending condition. C. A late effect. D. An acute condition. C. Stomach, rectum, gall bladder C. A late effect. The diagnosis Graves' disease involves which body system? A. Integumentary B. Endocrine C. Musculoskeletal D. Lymphatic B. Endocrine 21 Which one is NOT part of the large intestine? A. Jejunum B. Ascending C. Sigmoid D. Transverse cDB According to the Anesthesia guidelines when does anesthesia time start and ends: Anesthesia Start Time: 7:00 am(Preparing the patient for induction of anesthesia) Surgery Start Time: 7:15 am Surgery End Time: 9:30 am Anesthesia End Time: 9:45 am (Anesthesiologist no longer in attendance) A. 7:00 am - 9:30 am B. 7:00 am - 9:45 am C. 7:15 am - 9:30 am D. 7:15 am - 9:45 am B. 7:00 am - 9:45 am What CPT® code does not get modifier 51 appended to it? A. 33221 B. 32674 C. 31653 D. None of the above B. 32674 22 What is the correct full code description for CPT® code 27077? A. Radical resection of tumor; innominate bone, total B. Innominate bone, total C. Radical resection of tumor; wing of ilium, 1 pubic or ischial ramus or symphysis pubis; innominate bone, total D. Radical resection tumor A. Radical resection of tumor; innominate bone, total Medicare Administrative Contractors (MAC) are responsible for interpreting national policies into regional policies. What are these policies called? A. NCD B. NCCI C. LCD D. ABN C. LCD The HIPAA Privacy Rule protects the privacy of individually identifiable health information (PHI). Which of the below is a violation of the Privacy Rule? A. Disclose PHI to a relative without consent of the patient B. Disclose PHI for treatment activities of a healthcare provider C. Disclose PHI to another covered entity for payment D. Disclose PHI to another covered entity for healthcare operations without consent of the patient A. Disclose PHI to a relative 23