AAPC AAPC-CPC Online Practice Questions and Exam Preparation

AAPC AAPC-CPC Online Questions & Answers

• Question 161:

  A patient presents to the OR for removal of a subcutaneous cardiac rhythm monitor system 14 months after the device was implanted.

  What is the CPT(R) code for this service?

  A. 33272
  B. 33241
  C. 33273
  D. 33286
  D. 33286

  ---

  Explanation

  A "subcutaneous cardiac rhythm monitor" describes an implantable loop recorder or insertable cardiac monitor placed under the skin for long-term rhythm surveillance. When the entire monitor system is removed, CPT provides a specific removal code rather than using pacemaker/ICD removal codes. 33286 is the CPT code for removal of an insertable cardiac monitor.

  The timing, 14 months after implantation, supports that this is not an immediate post-op revision but a standard removal after monitoring is complete or the device is no longer needed.

  The distractors represent other cardiac device services: 33241 is removal of an implantable defibrillator pulse generator, not a loop recorder. 33272/33273 relate to other cardiac device procedures rather than removal of an insertable monitor.

  CPC strategy: Identify the device category, loop recorder/insertable cardiac monitor, and match the service, removal, to the dedicated code. This avoids incorrectly reporting pacemaker/ICD codes, which are different devices with different procedural work and coding families.

• Question 162:

  A female patient had an FNA biopsy with ultrasound guidance on two separate nodules in the upper-outer quadrant of left breast.

  What CPT and ICD-10-CM codes are reported?

  A. 10005, 10006, N63.21
  B. 10005, 10006, 76942, N60.02
  C. 10021, 10004, 76942, N60.21
  D. 10005, 10005-59, N63.21
  B. 10005, 10006, 76942, N60.02

• Question 163:

  A woman with vulvar intraepithelial neoplasia (VIN II) undergoes a partial vulvectomy (<80%) with removal of skin and deep subcutaneous tissue.

  What CPT(R) and ICD-10-CM codes are reported?

  A. 56625, N90.1
  B. 56633, D07.1
  C. 56620, N90.3
  D. 56630, N90.1
  B. 56633, D07.1

  ---

  Explanation

  56633 = Radical partial vulvectomy.

  Deep subcutaneous tissue involvement = radical, not simple.

  VIN II is coded as D07.1, carcinoma in situ of vulva, per ICD-10-CM guidelines.

• Question 164:

  Patient has cervical spondylosis with myelopathy. The surgeon performed a bilateral posterior laminectomy with facetectomies at each level and foraminotomies performed between interspaces C5-C6 and C6-C7.

  Bilateral decompression of the nerve roots is achieved.

  What CPT coding is reported?

  A. 63045, 63048
  B. 63040-50, 63043, 63043
  C. 63050-50
  D. 63015
  A. 63045, 63048

• Question 165:

  Refer to the supplemental information when answering this question: View MR 065174

  What E/M code is reported for this encounter?

  A. 99213
  B. 99215
  C. 99212
  D. 99214
  A. 99213

  ---

  Explanation

  To determine the correct E/M code, we need to consider the three key components: history, examination, and medical decision making (MDM).

  History:

  The documentation indicates an expanded problem-focused history. This is supported by the detailed history of present illness, including the patient's description of symptoms, family history, and review of systems with pertinent positives and negatives.

  Examination:

  The examination is also expanded problem-focused. The physician focused on the relevant systems, including the head, neck, and throat, and documented specific findings related to the chief complaint, such as thyromegaly.

  Medical Decision Making:

  The MDM is low. The physician is evaluating a new problem with a low level of risk. Although further workup is planned, this alone does not automatically increase the MDM complexity.

  Based on these components, 99213 is the most appropriate code.

  Why other options are incorrect: 99212: Requires a problem-focused history and examination, which is less comprehensive than what was documented. 99214 and 99215: Require a higher level of MDM and/or a more detailed examination. The documentation does not support this level of service.

  References:

  CPT Codes 99211-99215: Office or other outpatient visit for the evaluation and management of an established patient. 1995 and 1997 Documentation Guidelines for Evaluation and Management Services: These guidelines provide detailed criteria for selecting the appropriate E/M code based on history, examination, and MDM.

• Question 166:

  An orthopedic surgeon evaluated a patient in the emergency room two months after a surgical repair of a right radius and ulnar shaft fracture. After reinjury, imaging shows a displaced proximal fixation screw and malunion of only the radial shaft. The same surgeon performs surgery to repair the malunion using a graft from the hip.

  What CPT(R) and diagnosis codes are reported?

  A. 25420-58, T84.124A, S52.301P
  B. 25405-78, T84.122A, S52.301P
  C. 25400-78, T84.122A, S52.301A
  D. 25415-76, T84.124A, S52.301A
  B. 25405-78, T84.122A, S52.301P

  ---

  Explanation

  This is a return to the operating room during the postoperative period, two months after the original fracture repair, by the same surgeon, and the new surgery is related to the original condition/hardware, so a postoperative modifier is needed. The scenario describes a complication-related problem, hardware displacement with malunion, requiring operative correction, which aligns with modifier -78, unplanned return to the OR for a related procedure during the postoperative period. Diagnosis coding includes a complication of an internal orthopedic device: T84.122A corresponds to displacement of internal fixation device of bones of forearm, initial encounter for the complication. The fracture condition being treated is a malunion of the right radius shaft; malunion is captured with the fracture code and the 7th character P for subsequent encounter for fracture with malunion: S52.301P. Among the options, 25405-78 is the correct procedural selection provided for repair of malunion in this context, as tested by the item, paired with T84.122A and S52.301P. Therefore, option B is correct.

• Question 167:

  A 26-year-old male presents with a deep laceration from a kitchen knife to his right hand. The surgeon washes the open wound with sterile saline. Clamps are applied. The provider cleans the vessel and prepares the edges of the wound. She then repairs the bleeding vessel with sutures. The clamps are removed, and the provider uses a Doppler probe to check the blood flow pattern through the repaired vessel.

  What CPT(R) code is reported?

  A. 35207-RT
  B. 35206-RT
  C. 35702-RT
  D. 35236-RT
  A. 35207-RT

  ---

  Explanation

  1. Procedure and CPT(R) code

  Selection:

  The scenario describes the repair of a bleeding vessel in the patient's right hand. The procedure involved clamping, cleaning, preparing the wound, suturing the vessel, and confirming blood flow post-repair using a Doppler probe.

  Code 35207 is the correct CPT(R) code for repair of a blood vessel in the hand or finger. This code specifically covers repair of an injured vessel in the hand. Code 35206 is for vessel repair in the upper arm or elbow, which does not apply to this case because the injury is located in the hand.

  Code 35702 is for exploration of a vessel but does not describe vessel repair, making it unsuitable for this procedure.

  Code 35236 pertains to repair of vessels in the lower extremity and is not relevant here.

  2. Modifier:

  Modifier RT is used to indicate that the procedure was performed on the right side of the body.

  3. AAPC and CPT(R) coding

  Guidelines:

  AAPC guidelines specify the use of codes in the 35201-35286 series for direct repair of blood vessels in specific anatomical areas. For hand vessel repair, 35207 is the precise and recommended code according to CPT(R)guidelines.

  Thus, based on CPT(R)guidelines and procedural details, the verified answer is Option A. 35207-RT.

• Question 168:

  Which one of the following is an anesthesia physical status modifier?

  A. 2P
  B. QS
  C. P1
  D. AA
  C. P1

  ---

  Explanation

  Anesthesia physical status modifiers are the ASA modifiers P1-P6, which describe the patient's overall systemic health, for example, P1 = normal healthy patient; P2 = mild systemic disease; up to P6 = brain-dead patient whose organs are being removed for donor purposes. Among the choices, P1 is the only ASA physical status modifier. QS is an anesthesia modifier indicating Monitored Anesthesia Care (MAC), not physical status. AA identifies the anesthesia service performed personally by an anesthesiologist, which is a provider/service modifier, not a physical status. 2P is not an ASA physical status modifier; physical status modifiers are specifically formatted as P1-P6. CPC exam tip: Separate anesthesia modifiers into categories:

  (1) physical status (P1-P6), (2) who provided/medical direction (AA, QK, QX, QY, etc.), and (3) service circumstance modifiers, like QS for MAC when applicable. Here, the question explicitly asks for physical status, so P1 is correct.

• Question 169:

  A patient underwent a colonoscopy where the gastroenterologist biopsied two polyps from the colon. Each polyp was sent to pathology as separately identified specimens. The gastroenterologist requested a pathology consult while the patient was still on the table. Tissue blocks and frozen sections were prepared and examined as follows:

  Specimen 1:

  First tissue block - Three frozen sections Second tissue block - One frozen section

  Specimen 2:

  First tissue block - Two frozen sections Second tissue block - One frozen section

  What CPT(R) coding is reported?

  A. 88331 x 4, 88332 x 3
  B. 88331, 88332
  C. 88331 x 2, 88332 x 2
  D. 88331 x 3, 88332 x 2
  A. 88331 x 4, 88332 x 3

  ---

  Explanation

  Frozen section pathology coding rules:

  88331 - Frozen section, first tissue block, each specimen 88332 - Frozen section, each additional tissue block, same specimen

  Breakdown:

  Specimen 1

  Block 1 - 88331 x 1

  Block 2 - 88332 x 1

  Specimen 2

  Block 1 - 88331 x 1

  Block 2 - 88332 x 1

  Correct reporting is based on the first tissue block for each specimen and each additional tissue block from the same specimen, not on the number of frozen sections cut from each block.

  Therefore, the correct coding is 88331 x 2 and 88332 x 2.

• Question 170:

  Preoperative diagnosis: Right thigh benign congenital hairy nevus.

  Postoperative diagnosis: Right thigh benign congenital hairy nevus.

  Operation performed: Excision of right thigh benign congenital nevus, excision size with margins 4.5 cm and closure size 5 cm.

  Anesthesia: General.

  Intraoperative antibiotics: Ancef.

  Indications: The patient is a 5-year-old girl who presented with her parents for evaluation of her right thigh congenital nevus. It has been followed by pediatrics and thought to have changed over the past year.

  Family requested excision.

  Description of procedure:

  The patient was seen preoperatively in the holding area, identified, and then brought to the operating room.

  Once adequate general anesthesia had been induced, the patient's right thigh was prepped and draped in standard surgical fashion.

  An elliptical excision measuring 6 x 1.8 cm was marked and excised full thickness. The specimen was sent to pathology.

  The wound required limited undermining in the deep subcutaneous plane on both sides (~1.5 cm) to allow mobilization of the skin for closure.

  The skin was then closed in a layered fashion using 3-0 Vicryl in the dermis and 4-0 Monocryl subcuticular closure.

  No complications.

  What CPT(R) and ICD-10-CM codes are reported?

  A. 11406, 12032, D22.71
  B. 11404, 12032, D22.71
  C. 11606, 12032, C43.71
  D. 11406, D22.71
  A. 11406, 12032, D22.71

  ---

  Explanation

  11406 = Excision, benign lesion including margins, except skin tag, trunk, arms, or legs; excised diameter over 4.0 cm 12032 = Intermediate repair of wounds of scalp, axillae, trunk and/or extremities; 2.6 cm to 7.5 cm

  D22.71 = Melanocytic nevi of right lower limb, including hip