AAPC AAPC-CPC Online Practice Questions and Exam Preparation

AAPC AAPC-CPC Online Questions & Answers

• Question 11:

  Procedure date: 01/12/20XX. Surgeon: MD. Assistant: PA. Preoperative diagnosis: Dry gangrene of the left foot in the setting of peripheral vascular disease. Non-pressure chronic ulcer on toe. Postoperative diagnosis: Dry gangrene of the left foot in the setting of peripheral vascular disease. Non-pressure chronic ulcer on toe. Procedure: Amputation at the metatarsophalangeal joint of the left third toe. Indication: 63- year-old female with peripheral vascular disease; vascular workup determined no further interventions to

  improve vascularity; third toe became progressively dusky; wound formed distally with chronic ulcer;

  amputation necessary; risks/benefits discussed. Description: Left foot and third toe marked; 1 g Ancef given; general anesthesia; supine; calf tourniquet; timeout; tourniquet inflated, no Esmarch; total tourniquet time 5 minutes; tennis racquet incision with longitudinal arm over third metatarsal encircling joint proximal to closure; extensor/flexor tendons and collateral ligaments excised sharply; toe removed; tourniquet released; superficial bleeders cauterized; washed out; skin closed with 3-0 nylon; dry dressing; to PACU in good condition; signed 01/19/20XX 09:41.

  What CPT(R) and ICD-10-CM coding is reported?

  A. 28820-T2, L97.528, I70.262
  B. 28810-T2, I70.262, L97.528
  C. 28820-T2, I70.262, L97.528
  D. 28810-T2, L97.528, I70.262
  C. 28820-T2, I70.262, L97.528

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  Explanation

  The operative service is an amputation of the left third toe at the metatarsophalangeal (MTP) joint. CPT(R) code 28820 describes toe amputation through the MTP joint, matching the "amputation at the metatarsophalangeal joint" language and the incision encircling the joint with removal of the toe after dividing tendons/ligaments. Modifier T2 correctly identifies the left foot, third digit. Diagnosis coding must capture the ischemic disease with gangrene plus the non-pressure chronic ulcer on the toe. In the answer set, I70.262 represents lower-extremity atherosclerosis/PVD with gangrene, left side per the option. The chronic ulcer is separately reported using the provided L97.528 non-pressure ulcer code for the left foot/ toe severity category offered by the choices. Antibiotic prophylaxis, Ancef, anesthesia type, tourniquet use/ time, and technique details support the procedure but do not change the core CPT(R)/ICD-10-CM selection. Therefore, the correct combination is 28820-T2, I70.262, L97.528.

• Question 12:

  A patient is in her otolaryngologist's office to receive therapeutic treatment for asthmatic bronchitis with status asthmaticus. A subcutaneous injection of omalizumab (150 mg) is given in her left upper arm.

  What is the CPT(R) and ICD-10-CM coding?

  A. 96369, J2357 x 30, J45.52
  B. 90460, J2357 x 30, J45.52
  C. 90471, J2357 x 30, J45.902
  D. 96372, J2357 x 30, J45.902
  D. 96372, J2357 x 30, J45.902

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  Explanation

  Omalizumab is a drug reported with HCPCS J2357, and the dose is converted into billable units based on the code's unit definition. In CPC-style questions, 150 mg is commonly represented as J2357 x 30 units.

  Administration is a therapeutic subcutaneous injection, reported with 96372 (therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular). Vaccine administration codes (90460/90471) are not appropriate because omalizumab is not a vaccine. For diagnosis, the statement includes status asthmaticus but does not specify severity category. In the options provided, J45.902 represents unspecified asthma with status asthmaticus, whereas J45.52 requires severe persistent asthma with status asthmaticus, which is not documented.

  Therefore, the correct pairing is 96372, J2357 x 30, and J45.902.

  CPC exam tip: Match the administration code type, therapeutic injection vs. immunization, and choose the most specific ICD-10-CM code supported by documentation.

• Question 13:

  View MR 099407

  MR 099407

  Emergency Department Visit

  Chief Complaint: VOMITING.

  This started just prior to arrival and is still present. He has had nausea and vomiting. No diarrhea, black stools, bloody stools, or abdominal pain. Patient is diabetic and has been having elevated blood sugars at 320 mg/dL.

  REVIEW OF SYSTEMS: Unobtainable due to patient's altered mental status.

  PAST HISTORY: Poorly controlled diabetes mellitus, with history of poor compliance.

  Medications: See nurses' notes.

  Allergies: PCN.

  SOCIAL HISTORY: Nonsmoker. No alcohol use or drug use.

  ADDITIONAL NOTES: The nursing notes have been reviewed.

  PHYSICAL EXAM

  Appearance: Lethargic. Patient in mild distress.

  Vital Signs: Reviewed. Patient is tachycardic.

  Eyes: Pupils equal, round, and reactive to light.

  ENT: Dry mucous membranes present.

  Neck: Normal inspection. Neck supple.

  CVS: Tachycardia. Heart sounds normal. Pulses normal.

  ED Course:

  Insulin IV drip per protocol at 10 units/hr.

  Zofran 8 mg IV push at 01:33 on Jul 13, 2008.

  Phenergan 25 mg IV push at 07:52.

  Discussed case with physician, Dr. X. Reviewed test results. Agreed upon treatment plan. Physician will see patient in hospital.

  Total critical care time: 45 minutes.

  Disposition: Admitted to Intensive Care Unit. Condition: Stable.

  Admit decision based on need for monitoring, IV hydration, and medications.

  CLINICAL IMPRESSION: Vomiting; diabetic ketoacidosis with dehydration.

  What E/M code is reported for this encounter?

  A. 99291
  B. 99291, 99292
  C. 99222
  D. 99285
  A. 99291

• Question 14:

  A 43-year-old female with a history of joint pain and fatigue presents to the office with swollen salivary glands. The patient agrees to have a labial gland biopsy performed in the office. The patient is numbed with a local anesthetic. An incision is made on the lower labial mucosa, and tissue samples from the salivary gland are removed with tweezers. The incision is sutured. The pathology report findings are consistent with Sjogren's syndrome.

  What CPT(R) code is reported

  A. 42408
  B. 42405
  C. 42400
  D. 42450
  C. 42400

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  Explanation

  The scenario describes a labial gland biopsy of the salivary gland performed in the office with a local anesthetic. The provider made an incision in the lower labial mucosa and took tissue samples from the salivary gland for biopsy.

  Code 42400 is the correct CPT(R) code for biopsy of a salivary gland. This code is specific to biopsy without more extensive excision or major surgery, aligning with the scenario of sampling salivary gland tissue. Code 42408 is for excision of a deep lobe of the parotid gland, which is more extensive than a simple biopsy and does not apply to this case.

  Code 42405 is for removal of an entire submandibular gland, which is a full excision and not applicable here.

  Code 42450 is used for removal of a sublingual gland, not for biopsy of the labial salivary gland.

  Based on CPT(R) coding guidelines, the correct answer is C. 42400.

• Question 15:

  An abdominal X-ray includes decubitus, supine, and erect views.

  What CPT(R) code is reported?

  A. 74021-26
  B. 74018-26
  C. 74022-26
  D. 74019-26
  A. 74021-26

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  Explanation

  74021 = Radiologic examination, abdomen, three or more views.

  Modifier -26 = Professional component.

• Question 16:

  A 67-year-old patient has osteomyelitis of the shoulder blade and is in surgery to remove the sequestered section of dead infected fragment bone from surrounding bone.

  What CPT(R) code is reported?

  A. 23180
  B. 23182
  C. 23172
  D. 23170
  C. 23172

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  Explanation

  The key phrase is "remove the sequestered section of dead infected fragment bone," which is a sequestrectomy performed for osteomyelitis. 23172 describes sequestrectomy of the scapula, or shoulder blade. Therefore, C is correct.

• Question 17:

  A 74-year-old arrived at the ED experiencing bright red rectal bleeding when using the toilet. She does not have any abdominal pain, no nausea or vomiting. She has been undergoing dialysis for years due to end- stage renal failure and has a diagnosis of myelodysplastic syndrome with a platelet count of just 3,000. Her hemoglobin level, which was 10 at her dialysis session the previous day, dropped to 7. Abdominal films are negative. An urgent esophagogastroduodenoscopy (EGD) was performed, and no active bleeding was found in the esophagus or the stomach. However, the scope was passed into the upper duodenum, which

  did reveal some oozing, and this was controlled with cautery. Next, the patient was positioned on her left side for a colonoscopy that extended from the colon to the ileum and into the lower duodenum, but no definitive sources of bleeding were found. Again, no active bleeding sources were identified. A CRNA performed the anesthesia and documented PS III.

  What CPT(R) codes are reported for the CRNA?

  A. 00731-QK-P3, 99140
  B. 00731-QX-P3, 99100, 99140
  C. 00813-QZ-P3, 99100, 99140
  D. 00813-AA-P3, 99140
  C. 00813-QZ-P3, 99100, 99140

  ---

  Explanation

  In this case, a CRNA provided anesthesia for combined upper and lower gastrointestinal endoscopic procedures. To select the appropriate codes, consider the anesthesia service, modifiers, and qualifying circumstances:

  1. CPT(R) code Selection:

  00813 = Anesthesia for combined upper and lower gastrointestinal endoscopic procedures, endoscope introduced both proximal to and distal to the duodenum.

  This is appropriate because both an EGD (upper GI) and a colonoscopy (lower GI) were performed during the same session.

  2. Modifier Selection:

  QZ = CRNA service without medical direction by an anesthesiologist.

  This matches the documentation that the CRNA independently performed the anesthesia.

  P3 = Patient with severe systemic disease.

  The patient has end-stage renal disease and myelodysplastic syndrome, supporting PS III.

  3. Qualifying Circumstances:

  99100 = Anesthesia for patient of extreme age (over 70 years).

  The patient is 74 years old, so this applies.

  99140 = Anesthesia for emergency conditions.

  This applies due to the urgent presentation with active gastrointestinal bleeding.

  4. Rationale for Excluding Other Options:

  00731 applies only to upper GI endoscopy and does not account for the combined procedures performed.

  QK and QX modifiers indicate medical direction by an anesthesiologist, which is not documented.

  AA indicates anesthesia personally performed by an anesthesiologist, which is incorrect.

  Therefore, the correct coding is C. 00813-QZ-P3, 99100, 99140.

• Question 18:

  An 8-day-old newborn, weighing 3 kg, undergoes circumcision using a scalpel with no clamp.

  What CPT(R) coding is reported?

  A. 54160-63
  B. 54150
  C. 54150-52
  D. 54160
  D. 54160

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  Explanation

  54160 = Circumcision using surgical excision other than clamp.

  Modifier -63 is not appended to circumcision codes because they are on the CPT(R) modifier 63 exempt list. 54150 is for the clamp technique, which was not used.

• Question 19:

  An MRI-guided cisternal puncture with diagnostic contrast injection is performed at the C2 level for cervical discography, with imaging supervision and interpretation.

  What CPT(R) coding is reported?

  A. 62290,72295,77012
  B. 62290,77295,77021
  C. 62291,72285,77012
  D. 62291,72285,77021
  D. 62291,72285,77021

  ---

  Explanation

  Procedure Coding:

  62291 - Injection procedure for discography and/or CT, cervical or thoracic.

  Cisternal puncture at the C2 level.

  72285 - Radiologic supervision and interpretation, cervical discography.

  77021 - MRI guidance for needle placement.

  Why Other Options Are Incorrect:

  62290 - Lumbar injection.

  77012 - CT guidance, not MRI.

  72295 - Lumbar discography imaging.

  AAPC Coding Principle:

  Use modality-specific guidance codes and match the spinal level precisely.

• Question 20:

  A patient suffering from idiopathic dystonia is seen today and receives the following Botulinum injections: three muscle injections in both upper extremities and seven injections in six paraspinal muscles.

  How are these injections reported according to the CPT guidelines?

  A. 64644, 64647 x 7
  B. 64642-50, 64643-50, 64647
  C. 64642, 64643, 64647
  D. 64642 x 3, 64642 x 3, 64647 x 7
  C. 64642, 64643, 64647