AAPC CPB - Practice Exam A
55-year-old female presents to the office with ongoing history of type I diabetes which
has been controlled with insulin. During the exam the physician notes that gangrene has
set in due to the diabetic peripheral angiopathy on her left great toe. Patient is
recommended to see a general surgeon for treatment of the gangrene on her left great
toe.
A. I96, E10.9, Z79.4
B. E11.52, I96, Z79.4
C. E10.52
D. I96, E11.52 - ANS - C. E10.52
A dermatologist performed an excision of a squamous cell carcinoma from the patients
forehead with a 1.2 cm excised diameter. The excision site required an intermediate
wound closure measuring 1.8 cm. What is/are the correct code(s)?
A. 11642
B. 11442
C. 11642, 12051-51
D. 11442, 12051-51 - ANS - C. 11642, 12051-51
A document provided to Medicare patients explaining their financial responsibility if
Medicare denies a service is a(n):
A. Notice of Financial Liability
B. Advance Beneficiary Notice
C. Insurance waiver
D. Explanation of Benefits - ANS - B. Advance Beneficiary Notice
A female patient who was involved in an auto accident presents to the emergency
department (ED) for evaluation. She does not have any complaints. The provider
evaluates her and determines there are no injuries. The provider informs the patient to
come back to the ED or see her primary care physician if she develops any symptoms.
How is the claim processed for this encounter?
A. The medical insurance is billed primary and the auto insurance is billed secondary.
, B. The auto insurance is billed primary and the medical insurance is billed secondary.
C. Bill the medical insurance first to receive a denial and then submit with the remittance
advice to the auto insurance.
D. Bill only the medical insurance because the auto insurance only covers damage to
the vehicle, not medical expenses. - ANS - B. The auto insurance is billed primary and
the medical insurance is billed secondary.
A HCPCS/CPT® code is assigned "1" in the MUE file. What does this indicate?
A. Code pairs cannot be reported together.
B. Codes can be reported together if documented. Append modifier 59.
C. The code can only be reported for one unit of service on a single date of service.
D. Medically unlikely the code pair is performed together. - ANS - C. The code can
only be reported for one unit of service on a single date of service.
A Medicare card will list which of the following:
I. Effective date of coverage
II. Home address
III. Telephone Number
IV. Entitled to Part A and/or Part B
V. When coverage ends
VI. Name of Primary Care Physician
A. I - VI
B. I, IV
C. I-III, VI
D. I, II, IV, V - ANS - B. I, IV
A new patient presents for her annual exam and has no complaints. She is scheduled to
see the physician assistant (PA). How should services be billed ?
A. Bill under the PA.
B. A new patient can be billed incident to the physician.
C. The PA cannot see new patients.
D. Reschedule the patient with the physician - ANS - A. Bill under the PA.
A patient covered by a PPO is scheduled for knee replacement surgery. The biller
contacts the insurance carrier to verify benefits and preauthorize the procedure. The
carrier verifies the patient has a $500 deductible which must be met. After the
55-year-old female presents to the office with ongoing history of type I diabetes which
has been controlled with insulin. During the exam the physician notes that gangrene has
set in due to the diabetic peripheral angiopathy on her left great toe. Patient is
recommended to see a general surgeon for treatment of the gangrene on her left great
toe.
A. I96, E10.9, Z79.4
B. E11.52, I96, Z79.4
C. E10.52
D. I96, E11.52 - ANS - C. E10.52
A dermatologist performed an excision of a squamous cell carcinoma from the patients
forehead with a 1.2 cm excised diameter. The excision site required an intermediate
wound closure measuring 1.8 cm. What is/are the correct code(s)?
A. 11642
B. 11442
C. 11642, 12051-51
D. 11442, 12051-51 - ANS - C. 11642, 12051-51
A document provided to Medicare patients explaining their financial responsibility if
Medicare denies a service is a(n):
A. Notice of Financial Liability
B. Advance Beneficiary Notice
C. Insurance waiver
D. Explanation of Benefits - ANS - B. Advance Beneficiary Notice
A female patient who was involved in an auto accident presents to the emergency
department (ED) for evaluation. She does not have any complaints. The provider
evaluates her and determines there are no injuries. The provider informs the patient to
come back to the ED or see her primary care physician if she develops any symptoms.
How is the claim processed for this encounter?
A. The medical insurance is billed primary and the auto insurance is billed secondary.
, B. The auto insurance is billed primary and the medical insurance is billed secondary.
C. Bill the medical insurance first to receive a denial and then submit with the remittance
advice to the auto insurance.
D. Bill only the medical insurance because the auto insurance only covers damage to
the vehicle, not medical expenses. - ANS - B. The auto insurance is billed primary and
the medical insurance is billed secondary.
A HCPCS/CPT® code is assigned "1" in the MUE file. What does this indicate?
A. Code pairs cannot be reported together.
B. Codes can be reported together if documented. Append modifier 59.
C. The code can only be reported for one unit of service on a single date of service.
D. Medically unlikely the code pair is performed together. - ANS - C. The code can
only be reported for one unit of service on a single date of service.
A Medicare card will list which of the following:
I. Effective date of coverage
II. Home address
III. Telephone Number
IV. Entitled to Part A and/or Part B
V. When coverage ends
VI. Name of Primary Care Physician
A. I - VI
B. I, IV
C. I-III, VI
D. I, II, IV, V - ANS - B. I, IV
A new patient presents for her annual exam and has no complaints. She is scheduled to
see the physician assistant (PA). How should services be billed ?
A. Bill under the PA.
B. A new patient can be billed incident to the physician.
C. The PA cannot see new patients.
D. Reschedule the patient with the physician - ANS - A. Bill under the PA.
A patient covered by a PPO is scheduled for knee replacement surgery. The biller
contacts the insurance carrier to verify benefits and preauthorize the procedure. The
carrier verifies the patient has a $500 deductible which must be met. After the
