AAPC CHAPTER 9 EXAM QUESTIONS
AND CORRECT ANSWERS
A surgeon performs a high thoracotomy with resection of a single lung segment on a
57-year-old who is currently a heavy smoker who had presented with a six-month
history of right shoulder pain that radiates to the chest. An apical lung biopsy had
confirmed lung cancer. What CPT® and ICD-10-CM codes are reported? - Answer-
32484, C34.10, F17.210: Rationale: A segment of the lung is removed. In the CPT®
Index look for Removal/Lung/Single Segment. This directs you to code 32484.
We have a confirmed diagnosis of apical lung cancer, a cancer in an upper lobe, which
is code C34.10 (no indication of right or left lung). The term apical means the tip of a
pyramidal or rounded structure, so apical lung cancer means the tumor/cancer is
located at the top or upper lobe of the lung. We find this by looking in the Table of
Neoplasms for Neoplasm, neoplastic/lung/upper lobe and select from the Primary
Malignant column which directs you to code C34.1-. Verification in the Tabular List
indicates the code requires five characters. There is no indication which side of the lung
has cancer, report code C34.10 for unspecified lung. There is also an instructional note
under category C34 to use additional code for tobacco use. Code F17.210 is reported to
indicate the patient is a smoker. Look for Dependence/drug NEC/nicotine/cigarettes
which directs you to code F17.210. Verification in the Tabular List confirms code
selection.
A 3-year-old girl is playing with a marble and sticks it in her nose. Her mother is unable
to dislodge the marble so she takes her to the physician's office. The physician removes
the marble with hemostats. What CPT® and ICD-10-CM codes are reported? - Answer-
30300, T17.1XXA
An ICU diabetic patient who has been in a coma for weeks as the result of a head injury
becomes conscious and begins to improve. The physician performs a tracheostomy
closure and since the scar tissue is minimal, the plastic surgeon is not needed. What
CPT® and ICD-10-CM codes are reported for this procedure? - Answer- 31820, Z43.0,
S06.9X9D, E11.9:Rationale: In the CPT® Index look for Tracheostomy/Surgical
Closure/without Plastic Repair. This directs you to code 31820.
In the ICD-10-CM Alphabetic Index look for Attention (to)/tracheostomy which directs
you to Z43.0. It is reported as a primary code because the closure of the tracheostomy
is the reason for the procedure performed. Diabetic coma (E11.641) is not reported
because the coma resulted from a head injury not diabetes. Coma would not be
reported because it is resolved and the patient no longer has it. In the Alphabetic Index
look for Injury/head directing you to S09.90-. Verification in the Tabular List has an
, Excludes 1 note that indicates head injury with LOC is to be coded in the S06.9 series.
Choose S06.9X9D for unspecified intracranial injury with LOC of unspecified duration,
subsequent encounter. Diabetes found by looking for Diabetes/type 2 which directs the
coder to E11.9. Verification in the Tabular List confirms code selection.
The provider performs a diagnostic thoracoscopy followed by the thoracoscopic excision
of a pericardial cyst. What CPT® code(s) is/are reported? - Answer- 32661
In the CPT® Index look for Thoracoscopy/Surgical/with Excision Pericardial Cyst,
Tumor and/or Mass and you are directed to 32661.
A patient's nose was hit with a baseball during a high school baseball game. At that time
reconstruction was performed with local grafts. Patient returns now as an adult,
discontent with the bony prominence along the bony pyramid and flat look of the tip of
the nose. He underwent major repair with osteotomies and nasal tip work. What CPT®
code is reported? - Answer- 30450:Rationale: The procedure performed now is a
secondary rhinoplasty due to unfavorable results from the initial rhinoplasty. In the
CPT® Index look for Rhinoplasty/Secondary directing you to code range 30430-30450.
Code selection is based on the reason for the repair and the extensiveness of the
repair. 30450 reports a major secondary revision including osteotomies and nasal tip
work
A patient with AML (Acute Myelogenous Leukemia) has just learned his sister is an HLA
(Human Leukocyte Antigen) match for him. Stem cells taken from the donor (the
patient's sister) will be transplanted into the patient to help with his treatment. What
CPT® code is used to report the harvesting of the stem cells from the donor (his sister)?
- Answer- 38205:Rationale: In the CPT® Index look for Stem Cell/Harvesting. This
directs you to code range 38205, 38206. Code selection is based on whether it is
allogenic (from a donor) or autologous (from the patient). This is allogenic making
38205 the correct code choice.
A patient is seen in the OR for removal of a hepatic adenoma, which has invaded the
diaphragm. The resection of the diaphragm portion of the mass was repaired with
primary sutures. What CPT® code is reported for the diaphragmatic mass resection -
Answer- 39560: Rationale: In the CPT® Index, look up Resection/Diaphragm, which
directs you to code range 39560-39561. Code selection depends on the type of repair.
The repair is with primary sutures which is considered a simple repair making 39560 the
correct code choice.
A 43-year-old female is seen in the emergency room with severe epistaxis. She said
this is a common occurrence for her during the cold dry months of winter and this is why
she is here for the third time this week. Extensive bilateral posterior cautery and packing
is again required to control the hemorrhage.
What CPT® code is reported for the procedure? (Note: Do not code the E/M) - Answer-
30906-50:Rationale: Epistaxis is the term for nasal hemorrhage. In the CPT® Index,
look up Packing, Nasal Hemorrhage and you are directed to code range 30901-30906.
AND CORRECT ANSWERS
A surgeon performs a high thoracotomy with resection of a single lung segment on a
57-year-old who is currently a heavy smoker who had presented with a six-month
history of right shoulder pain that radiates to the chest. An apical lung biopsy had
confirmed lung cancer. What CPT® and ICD-10-CM codes are reported? - Answer-
32484, C34.10, F17.210: Rationale: A segment of the lung is removed. In the CPT®
Index look for Removal/Lung/Single Segment. This directs you to code 32484.
We have a confirmed diagnosis of apical lung cancer, a cancer in an upper lobe, which
is code C34.10 (no indication of right or left lung). The term apical means the tip of a
pyramidal or rounded structure, so apical lung cancer means the tumor/cancer is
located at the top or upper lobe of the lung. We find this by looking in the Table of
Neoplasms for Neoplasm, neoplastic/lung/upper lobe and select from the Primary
Malignant column which directs you to code C34.1-. Verification in the Tabular List
indicates the code requires five characters. There is no indication which side of the lung
has cancer, report code C34.10 for unspecified lung. There is also an instructional note
under category C34 to use additional code for tobacco use. Code F17.210 is reported to
indicate the patient is a smoker. Look for Dependence/drug NEC/nicotine/cigarettes
which directs you to code F17.210. Verification in the Tabular List confirms code
selection.
A 3-year-old girl is playing with a marble and sticks it in her nose. Her mother is unable
to dislodge the marble so she takes her to the physician's office. The physician removes
the marble with hemostats. What CPT® and ICD-10-CM codes are reported? - Answer-
30300, T17.1XXA
An ICU diabetic patient who has been in a coma for weeks as the result of a head injury
becomes conscious and begins to improve. The physician performs a tracheostomy
closure and since the scar tissue is minimal, the plastic surgeon is not needed. What
CPT® and ICD-10-CM codes are reported for this procedure? - Answer- 31820, Z43.0,
S06.9X9D, E11.9:Rationale: In the CPT® Index look for Tracheostomy/Surgical
Closure/without Plastic Repair. This directs you to code 31820.
In the ICD-10-CM Alphabetic Index look for Attention (to)/tracheostomy which directs
you to Z43.0. It is reported as a primary code because the closure of the tracheostomy
is the reason for the procedure performed. Diabetic coma (E11.641) is not reported
because the coma resulted from a head injury not diabetes. Coma would not be
reported because it is resolved and the patient no longer has it. In the Alphabetic Index
look for Injury/head directing you to S09.90-. Verification in the Tabular List has an
, Excludes 1 note that indicates head injury with LOC is to be coded in the S06.9 series.
Choose S06.9X9D for unspecified intracranial injury with LOC of unspecified duration,
subsequent encounter. Diabetes found by looking for Diabetes/type 2 which directs the
coder to E11.9. Verification in the Tabular List confirms code selection.
The provider performs a diagnostic thoracoscopy followed by the thoracoscopic excision
of a pericardial cyst. What CPT® code(s) is/are reported? - Answer- 32661
In the CPT® Index look for Thoracoscopy/Surgical/with Excision Pericardial Cyst,
Tumor and/or Mass and you are directed to 32661.
A patient's nose was hit with a baseball during a high school baseball game. At that time
reconstruction was performed with local grafts. Patient returns now as an adult,
discontent with the bony prominence along the bony pyramid and flat look of the tip of
the nose. He underwent major repair with osteotomies and nasal tip work. What CPT®
code is reported? - Answer- 30450:Rationale: The procedure performed now is a
secondary rhinoplasty due to unfavorable results from the initial rhinoplasty. In the
CPT® Index look for Rhinoplasty/Secondary directing you to code range 30430-30450.
Code selection is based on the reason for the repair and the extensiveness of the
repair. 30450 reports a major secondary revision including osteotomies and nasal tip
work
A patient with AML (Acute Myelogenous Leukemia) has just learned his sister is an HLA
(Human Leukocyte Antigen) match for him. Stem cells taken from the donor (the
patient's sister) will be transplanted into the patient to help with his treatment. What
CPT® code is used to report the harvesting of the stem cells from the donor (his sister)?
- Answer- 38205:Rationale: In the CPT® Index look for Stem Cell/Harvesting. This
directs you to code range 38205, 38206. Code selection is based on whether it is
allogenic (from a donor) or autologous (from the patient). This is allogenic making
38205 the correct code choice.
A patient is seen in the OR for removal of a hepatic adenoma, which has invaded the
diaphragm. The resection of the diaphragm portion of the mass was repaired with
primary sutures. What CPT® code is reported for the diaphragmatic mass resection -
Answer- 39560: Rationale: In the CPT® Index, look up Resection/Diaphragm, which
directs you to code range 39560-39561. Code selection depends on the type of repair.
The repair is with primary sutures which is considered a simple repair making 39560 the
correct code choice.
A 43-year-old female is seen in the emergency room with severe epistaxis. She said
this is a common occurrence for her during the cold dry months of winter and this is why
she is here for the third time this week. Extensive bilateral posterior cautery and packing
is again required to control the hemorrhage.
What CPT® code is reported for the procedure? (Note: Do not code the E/M) - Answer-
30906-50:Rationale: Epistaxis is the term for nasal hemorrhage. In the CPT® Index,
look up Packing, Nasal Hemorrhage and you are directed to code range 30901-30906.
