CPT PRACTICE EXAM– QUESTIONS AND ANSWERS | VERIFIED
AND WELL DETAILED ANSWERS PLUS RATIONALES |
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1. A patient presents to an outpatient surgical center for an arthroscopic repair of a torn
right rotator cuff. During the same operative session, the orthopedic surgeon performs a
subacromial decompression and a distal clavicle excision. How should the professional
coding specialist report these procedures?
A. Report the rotator cuff repair code and the distal clavicle excision code as an unbundled
procedure pair.
B. Report the primary arthroscopic rotator cuff repair code, and review current CPT
guidelines and National Correct Coding Initiative (NCCI) edits to determine if the
subacromial decompression and distal clavicle excision are bundled or eligible for separate
reporting with an appropriate modifier.
C. Report only the subacromial decompression because it encompasses all shoulder work.
D. Report three separate surgical units with modifier 51 applied to all lines.
Comprehensive coding for shoulder arthroscopy requires verifying NCCI edits and CPT
guidelines, as certain components like subacromial decompression are often inclusive of the
primary procedure unless distinct anatomical portals or specific modifier exceptions apply.
2. A 45-year-old female undergoes a routine screening colonoscopy performed via the
rectum to the cecum. During the procedure, the gastroenterologist identifies and removes
two benign polyps via hot biopsy forceps from the ascending colon. How should this
outpatient encounter be coded?
A. Report a screening colonoscopy code with a modifier indicating a screening service
transformed into a diagnostic or therapeutic procedure, or follow specific payer guidelines
regarding polyp removal during screening.
B. Report a diagnostic colonoscopy code only, ignoring the screening origin.
C. Report code 45378 for diagnostic inspection without mention of polyps.
D. Report an open abdominal exploration code.
When a screening colonoscopy results in the biopsy or removal of a lesion, coding guidelines
and specific payer policies direct the assignment of codes that accurately capture both the
screening intent and the therapeutic intervention performed.
,3. An established patient visits a multispecialty clinic for a comprehensive evaluation of
chronic back pain. The physician performs a detailed history, a detailed examination, and
medical decision-making of moderate complexity. The total face-to-face time spent with the
patient is 35 minutes, primarily consisting of counseling on physical therapy options and
medication management. Which outpatient evaluation and management (E/M) code is
appropriate under current office visit guidelines?
A. 99211
B. 99213
C. 99214
D. 99215
Office or other outpatient visit codes for established patients are selected based on the level of
medical decision-making (MDM) or the total time spent on the date of the encounter.
Moderate complexity MDM or a time range of 30 to 39 minutes supports code 99214.
4. A cardiologist performs a percutaneous transluminal coronary angioplasty (PTCA) in
the left anterior descending (LAD) coronary artery and places a drug-eluting stent in the
same vessel during the same operative session. How is this intervention correctly reported
in CPT?
A. Report both the angioplasty and the stent placement separately without restriction.
B. Report only the stent placement code, as angioplasty performed in the same vessel
during the same session is considered bundled into the stent insertion code.
C. Report the angioplasty code only and disregard the stent.
D. Report an open coronary artery bypass graft (CABG) code.
According to CPT guidelines and NCCI rules, percutaneous transluminal coronary
angioplasty is inclusive of stent placement within the same vessel and cannot be billed as a
separate standalone procedure.
5. A patient undergoes an excision of a malignant melanoma of the back with a 1.5 cm
lesion diameter and a 0.5 cm margin on all sides, resulting in a total excised diameter of 2.5
cm. The excision requires intermediate repair of the surgical wound. How should the
surgeon report the excision?
A. Select the excision code based on the total excised diameter (lesion size plus narrowest
margin required on each side) and the anatomical location.
B. Measure only the original clinical lesion size prior to excision.
,C. Report an open biopsy code only.
D. Report the repair code as the primary surgical procedure.
CPT guidelines for excision of benign or malignant lesions dictate that measurement must
include the lesion diameter plus the narrowest margins required for complete removal,
determining the precise code selection.
6. A pediatric patient is brought to the outpatient clinic for administration of the initial
dose of the measles, mumps, and rubella (MMR) vaccine. The qualified healthcare
professional provides face-to-face counseling to the parent regarding vaccine safety and
immunization schedules prior to administration. How should the visit and vaccine be
coded?
A. Report only the vaccine product code.
B. Report the immunization administration code along with the specific vaccine product
code, ensuring counseling is captured where applicable under administrative rules.
C. Report an inpatient critical care code.
D. Report a surgical debridement code.
Immunization reporting requires separate coding for both the administration service (per
vaccine component) and the specific vaccine product code supplied, adhering to strict CPT
sequencing and coding instructions.
7. A general surgeon performs an open ventral hernia repair with mesh implantation for a
recurrent reducible hernia in an adult patient. How is this procedure classified in CPT?
A. Code selection depends on whether the hernia is initial or recurrent, reducible or
incarcerated/strangulated, and the type of repair technique including mesh placement.
B. Code selection is based solely on the patient's room charge.
C. Report a simple skin suture code.
D. Report an exploratory laparotomy code without hernia specification.
Hernia repair codes in CPT are highly specific, requiring precise documentation regarding
clinical presentation (initial vs. recurrent, reducible vs. incarcerated) and surgical
methodology.
, 8. An orthopedic surgeon performs an open reduction and internal fixation (ORIF) of an
ankle fracture involving both the medial and lateral malleoli. How should this surgical
intervention be reported?
A. Report separate codes for each individual bone fracture treated in the body.
B. Report the specific comprehensive ORIF code that describes the bimalleolar ankle
fracture repair.
C. Report a closed casting code only.
D. Report an arthroscopic knee debridement code.
CPT provides dedicated codes for multi-site fracture repairs such as bimalleolar and
trimalleolar ankle fractures, which encompass the comprehensive surgical management of the
involved malleoli.
9. A patient undergoes an esophagogastroduodenoscopy (EGD) for persistent epigastric
pain. During the diagnostic visualization, the gastroenterologist performs a biopsy of a
suspicious gastric lesion and removes a separate small polyp via hot snare technique from
the duodenum. How should the coding specialist report these services?
A. Report only the diagnostic EGD code.
B. Report the EGD code with biopsy and the EGD code with snare technique separately if
performed via distinct methods or sites, adhering to specific CPT multiple-procedure
instructions and NCCI guidelines.
C. Report an open stomach resection.
D. Report a colonoscopy code.
When multiple distinct endoscopic modalities (such as biopsy and snare technique) are
performed during the same operative session, CPT coding rules allow reporting of the specific
intervention codes subject to correct coding edits.
10. A patient presents for a diagnostic bilateral screening mammography. During the
examination, the radiologist identifies an area of architectural distortion in the left breast
and immediately performs a diagnostic digital mammography view of both breasts to
clarify the finding. How should the facility and professional services be reported?
A. Report only the screening mammography code.
B. Report the diagnostic mammography codes, or combine screening and diagnostic codes
according to payer-specific rules and national coding guidelines when screening transitions
to diagnostic evaluation.
AND WELL DETAILED ANSWERS PLUS RATIONALES |
GUARANTEED PASS | LATEST EXAM UPDATE | EXAM PREP |
STUDY GUIDE | PRACTICE TEST| DOWNLOAD INSTANT PDF
1. A patient presents to an outpatient surgical center for an arthroscopic repair of a torn
right rotator cuff. During the same operative session, the orthopedic surgeon performs a
subacromial decompression and a distal clavicle excision. How should the professional
coding specialist report these procedures?
A. Report the rotator cuff repair code and the distal clavicle excision code as an unbundled
procedure pair.
B. Report the primary arthroscopic rotator cuff repair code, and review current CPT
guidelines and National Correct Coding Initiative (NCCI) edits to determine if the
subacromial decompression and distal clavicle excision are bundled or eligible for separate
reporting with an appropriate modifier.
C. Report only the subacromial decompression because it encompasses all shoulder work.
D. Report three separate surgical units with modifier 51 applied to all lines.
Comprehensive coding for shoulder arthroscopy requires verifying NCCI edits and CPT
guidelines, as certain components like subacromial decompression are often inclusive of the
primary procedure unless distinct anatomical portals or specific modifier exceptions apply.
2. A 45-year-old female undergoes a routine screening colonoscopy performed via the
rectum to the cecum. During the procedure, the gastroenterologist identifies and removes
two benign polyps via hot biopsy forceps from the ascending colon. How should this
outpatient encounter be coded?
A. Report a screening colonoscopy code with a modifier indicating a screening service
transformed into a diagnostic or therapeutic procedure, or follow specific payer guidelines
regarding polyp removal during screening.
B. Report a diagnostic colonoscopy code only, ignoring the screening origin.
C. Report code 45378 for diagnostic inspection without mention of polyps.
D. Report an open abdominal exploration code.
When a screening colonoscopy results in the biopsy or removal of a lesion, coding guidelines
and specific payer policies direct the assignment of codes that accurately capture both the
screening intent and the therapeutic intervention performed.
,3. An established patient visits a multispecialty clinic for a comprehensive evaluation of
chronic back pain. The physician performs a detailed history, a detailed examination, and
medical decision-making of moderate complexity. The total face-to-face time spent with the
patient is 35 minutes, primarily consisting of counseling on physical therapy options and
medication management. Which outpatient evaluation and management (E/M) code is
appropriate under current office visit guidelines?
A. 99211
B. 99213
C. 99214
D. 99215
Office or other outpatient visit codes for established patients are selected based on the level of
medical decision-making (MDM) or the total time spent on the date of the encounter.
Moderate complexity MDM or a time range of 30 to 39 minutes supports code 99214.
4. A cardiologist performs a percutaneous transluminal coronary angioplasty (PTCA) in
the left anterior descending (LAD) coronary artery and places a drug-eluting stent in the
same vessel during the same operative session. How is this intervention correctly reported
in CPT?
A. Report both the angioplasty and the stent placement separately without restriction.
B. Report only the stent placement code, as angioplasty performed in the same vessel
during the same session is considered bundled into the stent insertion code.
C. Report the angioplasty code only and disregard the stent.
D. Report an open coronary artery bypass graft (CABG) code.
According to CPT guidelines and NCCI rules, percutaneous transluminal coronary
angioplasty is inclusive of stent placement within the same vessel and cannot be billed as a
separate standalone procedure.
5. A patient undergoes an excision of a malignant melanoma of the back with a 1.5 cm
lesion diameter and a 0.5 cm margin on all sides, resulting in a total excised diameter of 2.5
cm. The excision requires intermediate repair of the surgical wound. How should the
surgeon report the excision?
A. Select the excision code based on the total excised diameter (lesion size plus narrowest
margin required on each side) and the anatomical location.
B. Measure only the original clinical lesion size prior to excision.
,C. Report an open biopsy code only.
D. Report the repair code as the primary surgical procedure.
CPT guidelines for excision of benign or malignant lesions dictate that measurement must
include the lesion diameter plus the narrowest margins required for complete removal,
determining the precise code selection.
6. A pediatric patient is brought to the outpatient clinic for administration of the initial
dose of the measles, mumps, and rubella (MMR) vaccine. The qualified healthcare
professional provides face-to-face counseling to the parent regarding vaccine safety and
immunization schedules prior to administration. How should the visit and vaccine be
coded?
A. Report only the vaccine product code.
B. Report the immunization administration code along with the specific vaccine product
code, ensuring counseling is captured where applicable under administrative rules.
C. Report an inpatient critical care code.
D. Report a surgical debridement code.
Immunization reporting requires separate coding for both the administration service (per
vaccine component) and the specific vaccine product code supplied, adhering to strict CPT
sequencing and coding instructions.
7. A general surgeon performs an open ventral hernia repair with mesh implantation for a
recurrent reducible hernia in an adult patient. How is this procedure classified in CPT?
A. Code selection depends on whether the hernia is initial or recurrent, reducible or
incarcerated/strangulated, and the type of repair technique including mesh placement.
B. Code selection is based solely on the patient's room charge.
C. Report a simple skin suture code.
D. Report an exploratory laparotomy code without hernia specification.
Hernia repair codes in CPT are highly specific, requiring precise documentation regarding
clinical presentation (initial vs. recurrent, reducible vs. incarcerated) and surgical
methodology.
, 8. An orthopedic surgeon performs an open reduction and internal fixation (ORIF) of an
ankle fracture involving both the medial and lateral malleoli. How should this surgical
intervention be reported?
A. Report separate codes for each individual bone fracture treated in the body.
B. Report the specific comprehensive ORIF code that describes the bimalleolar ankle
fracture repair.
C. Report a closed casting code only.
D. Report an arthroscopic knee debridement code.
CPT provides dedicated codes for multi-site fracture repairs such as bimalleolar and
trimalleolar ankle fractures, which encompass the comprehensive surgical management of the
involved malleoli.
9. A patient undergoes an esophagogastroduodenoscopy (EGD) for persistent epigastric
pain. During the diagnostic visualization, the gastroenterologist performs a biopsy of a
suspicious gastric lesion and removes a separate small polyp via hot snare technique from
the duodenum. How should the coding specialist report these services?
A. Report only the diagnostic EGD code.
B. Report the EGD code with biopsy and the EGD code with snare technique separately if
performed via distinct methods or sites, adhering to specific CPT multiple-procedure
instructions and NCCI guidelines.
C. Report an open stomach resection.
D. Report a colonoscopy code.
When multiple distinct endoscopic modalities (such as biopsy and snare technique) are
performed during the same operative session, CPT coding rules allow reporting of the specific
intervention codes subject to correct coding edits.
10. A patient presents for a diagnostic bilateral screening mammography. During the
examination, the radiologist identifies an area of architectural distortion in the left breast
and immediately performs a diagnostic digital mammography view of both breasts to
clarify the finding. How should the facility and professional services be reported?
A. Report only the screening mammography code.
B. Report the diagnostic mammography codes, or combine screening and diagnostic codes
according to payer-specific rules and national coding guidelines when screening transitions
to diagnostic evaluation.
