AAPC AAPC-CPC Online Practice Questions and Exam Preparation

AAPC AAPC-CPC Online Questions & Answers

• Question 271:

  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. They understood the risks involved, which included but were not limited to risks of general anesthesia, infection, bleeding, wound dehiscence, and poor scar formation. They understood the scar would likely widen as the child grows because of the location and age of the patient. They consented to proceed.

  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 had been marked. This was injected with Lidocaine with epinephrine, total of 6 cc of 1% with 1:100,000. After

  an adequate amount of time, a #15 blade was used to sharply excise this full thickness. This was passed

  to pathology for review. The wound required limited undermining in the deep subcutaneous plane on both sides for approximately 1.5 cm in order to allow mobilization of the skin for closure. The skin was then closed in a layered fashion using 3-0 Vicryl on the dermis and then 4-0 Monocryl running subcuticular in the skin. The wound was cleaned and dressed with Dermabond and Steri-Strips. The patient was then turned over to anesthesia for extubation and taken to the recovery room in stable condition. There were no complications.

  What CPT(R) coding is reported?

  A. 12032, 11406-51
  B. 12002, 11406-51
  C. 12032, 11606-51
  D. 12002, 11606-51
  D. 12002, 11606-51

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  Explanation

  Benign lesion excision:

  11406 = Excision of benign lesion, trunk/extremities, 4.1-5.0 cm.

  Closure:

  Layered closure with undermining = intermediate repair.

  12032 = Intermediate repair, trunk/extremities, 2.6-7.5 cm.

  Modifier -51 may be appended to the secondary procedure.

  Correct coding: 12032, 11406-51.

• Question 272:

  A complete 7-view X-ray of the lumbosacral spine, including bending views, is performed.

  What CPT(R) code is reported?

  A. 72084
  B. 72080
  C. 72020
  D. 72114
  D. 72114

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  Explanation

  72114 = Radiologic examination, lumbosacral spine, complete, with bending views.

  The other codes represent fewer views or different spine regions.

• Question 273:

  A patient with severe diverticulitis in the sigmoid colon presents to surgery for a partial colectomy. The physician performs an exploratory laparoscopic laparotomy to verify the location of the diverticulitis. Once identified, it was noted that there was bleeding from the diverticulitis. The physician transects the descending colon and then transects at the line of the rectum. The physician mobilizes the splenic flexure in order to create a colostomy with the proximal portion of the remaining colon. The distal portion of the colon is closed. The physician washes the patient's abdomen with saline, removes all trocars and instruments, and then closes the abdomen with sutures.

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

  A. 44206, 44213-51, K57.41
  B. 44212, 44213-51, K57.41
  C. 44206, 44213, K57.33
  D. 44212, 44213, K57.33
  D. 44212, 44213, K57.33

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  Explanation

  Procedure Coding (CPT(R)):

  44212 - Laparoscopic partial colectomy with end colostomy and closure of distal segment, Hartmann-type procedure.

  Correct because:

  Sigmoid/descending colon resection.

  Proximal colostomy created.

  Distal rectal stump closed.

  44213 - Laparoscopic mobilization of splenic flexure.

  Separately reportable because:

  Mobilization was necessary to exteriorize the colon for colostomy.

  Not bundled into 44212.

  Modifier not required because this is add-on code logic.

  Diagnosis Coding (ICD-10-CM):

  K57.33 - Diverticulitis of large intestine without perforation or abscess, with bleeding.

  Documentation supports:

  Diverticulitis.

  Active bleeding.

  No abscess reported.

  Why Other Options Are Incorrect: Option A / B - 44206 = colectomy with anastomosis, which was not performed.

  Option A / B - K57.41 includes abscess, which is not documented.

  Option C - Incorrect primary colectomy code.

  CPT(R) and ICD-10-CM Guideline Alignment:

  Hartmann procedure does not include anastomosis.

  Bleeding elevates diagnosis specificity.

  Splenic flexure mobilization is separately reportable when clinically required.

• Question 274:

  Dr. Carter sees Mrs. White at the Spring Valley Nursing Facility. He saw her last month after she was admitted to the facility. Today is a follow-up visit. She is doing well. He documented a medically appropriate history and exam. The patient has osteoporosis, hypertension, dementia, CAD, CHF, and type 2 diabetes (moderate number and complexity of problems). He reviews 4 labs and telemetry (moderate data). He adds a Cardizem prescription for better control of her blood pressure, which is moderate risk.

  What CPT(R) code does Dr.

  Carter report for the visit?

  A. 99309
  B. 99307
  C. 99308
  D. 99305
  A. 99309

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  Explanation

  This is a subsequent nursing facility care visit.

  MDM Analysis:

  Problems: Multiple chronic conditions = Moderate.

  Data: 4 labs + telemetry = Moderate.

  Risk: Prescription drug management = Moderate.

  99309 - Subsequent nursing facility care, moderate MDM.

  Why others are incorrect:

  99307 / 99308 - Lower-level subsequent nursing facility care.

  99305 - Initial nursing facility care.

• Question 275:

  An 87-year-old male with a history of atrioventricular block and prior dual-chamber pacemaker implantation presents to the cardiology clinic for an in-person device evaluation. The physician performs a full electronic analysis of the pacemaker system, assessing atrial and ventricular lead function, battery status, sensing thresholds, and pacing thresholds. After the assessment, the pacemaker settings are adjusted to optimize heart rate response.

  What CPT(R) code is reported?

  A. 93281
  B. 93284
  C. 93283
  D. 93280
  D. 93280

  ---

  Explanation

  93280 = Programming device evaluation, dual-lead pacemaker system.

  Includes interrogation, analysis, and reprogramming.

  Other options:

  93281 = Single-lead system.

  93283 / 93284 = ICD device services.

  Thus, 93280 is correct.

• Question 276:

  Which place of service code is submitted on the claim for a service that is performed in a skilled nursing facility?

  A. 32
  B. 20
  C. 22
  D. 31
  D. 31

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  Explanation

  POS 31 is used to indicate that a service was performed in a skilled nursing facility (SNF). This setting provides skilled nursing care and rehabilitation services under medical supervision and is distinctly defined by CMS.

  Exclusion of Other Codes:

  POS 32 represents a nursing facility (NF), which provides custodial care rather than skilled medical care;

  therefore, it is not appropriate for services performed in an SNF.

  POS 20 represents an urgent care facility and does not apply to long-term or post-acute care settings.

  POS 22 represents an outpatient hospital setting and is not applicable to services performed in a skilled nursing facility.

  Coding Guidelines:

  According to CMS Place of Service code definitions, accurate reporting requires selecting the code that precisely reflects the setting in which the service was rendered. Skilled nursing facilities must be reported with POS 31, not POS 32.

  Final Answer: 31

• Question 277:

  A patient is sent to the hospital by his family care provider for admission due to a high fever and neck pain.

  The patient is admitted to the hospital to rule out bacterial meningitis. The hospitalist admits the patient and orders a CBC, CMR, blood culture, CT of the head and chest, and a lumbar puncture (spinal tap). After review of the results, he determines the patient has bacterial meningitis and starts the patient on IV antibiotics.

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

  A. 99222, R50.81, M54.2
  B. 99284, G00.9
  C. 99222, G00.9
  D. 99264, R50.81, M54.2
  C. 99222, G00.9

  ---

  Explanation

  99222 = Initial hospital inpatient care, moderate MDM

  Extensive diagnostic workup supports moderate complexity.

  Final diagnosis established during admission

  Diagnosis Coding:

  G00.9 - Bacterial meningitis, unspecified

  Do not code symptoms (fever, neck pain) once a definitive diagnosis is confirmed.

  Why others are incorrect:

  99284 - ED visit 99264 - Inpatient consultation code deleted from CPT Symptom-only diagnosis codes are inappropriate when a definitive diagnosis is established.

• Question 278:

  A temporary steroid-releasing sinus implant is placed in the ethmoid sinus.

  What HCPCS Level II code is reported?

  A. C2617
  B. C1877
  C. S1091
  D. C9600
  A. C2617

  ---

  Explanation

  C2617 = Implant, sinus, drug-eluting, absorbable

• Question 279:

  Full Case: Preoperative diagnosis: Recurrent dysphagia. Postoperative diagnosis: Hiatal hernia with

  obstruction. Procedure: EGD with dilation. Consent: PAR conference; informed consent signed;

  premedication given. Position/monitoring:

  left lateral decubitus; monitored with BP cuff and pulse oximeter throughout. Topical: Hurricaine spray to posterior pharynx. Scope passage: flexible endoscope passed under direct visualization through cricopharyngeus into esophagus; advanced with identification of EG junction into stomach; rugal folds

  visualized; advanced to antrum/pylorus; pylorus cannulated; duodenal bulb and second portion visualized;

  retroflexed views of cardia/fundus/lesser curvature. Dilation technique: guidewire placed in antrum; scope removed; wire positioned by markings; #14 French dilator passed into stomach area; esophageal dilation performed over guidewire. Findings: tortuous/shortened esophagus; large sliding hiatal hernia; EG junction

  approximately 30 cm; stomach abnormal with very large sliding hiatal hernia; duodenum normal.

  What CPT(R) coding is reported?

  A. 43235, 43248
  B. 43235, 43249
  C. 43249
  D. 43248
  D. 43248

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  Explanation

  The documented service is an upper GI endoscopy (EGD) with esophageal dilation performed using a guidewire and a passed dilator, "dilation performed over the guidewire." In CPT(R), when a therapeutic endoscopic service is performed, you report the therapeutic EGD code, not the separate diagnostic EGD code, because diagnostic visualization is inherent in performing the therapeutic procedure. Therefore, 43235 (diagnostic EGD) is not additionally reported. The key distinction between the dilation codes offered is the method: 43248 describes EGD with esophageal dilation using a guidewire technique, bougie/dilator passed over a guidewire, which matches the narrative: guidewire placed in the antrum, scope removed, and a dilator passed over the guidewire into the stomach area. Code 43249 generally reflects balloon dilation of the esophagus performed endoscopically; the note does not describe balloon inflation, diameter, or balloon equipment. The hiatal hernia findings and dysphagia indication support medical necessity but do not change code selection. Thus, the correct CPT(R) code is 43248 alone.

• Question 280:

  What modifier is appended to indicate that during the postoperative period, a procedure is performed that was planned, more extensive than the original procedure, or done for therapeutic reasons?

  A. 26
  B. 78
  C. 56
  D. 58
  D. 58

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  Explanation

  Modifier58is used when a subsequent procedure during the postoperative period isstaged or relatedto the original procedure and meets one of these classic criteria: (1) planned/prospective (staged), (2) more extensive than the original, or (3) therapeutic following a diagnostic procedure.

  It signals that the later procedure is not an unplanned complication but part of a planned course of care or an escalation of treatment. This is different from modifier78, which is for anunplanned returnto the operating room/procedure room during the postoperative period for arelated procedure(often due to complications) and typically doesnotrestart the global period. Modifier26is theprofessional componentmodifier for certain diagnostic services, not a global surgical modifier. Modifier56is not the appropriate postoperative modifier for staged/related surgical services. For CPC exam accuracy, associate58with staged/planned/more extensive/therapeutic-after-diagnostic, and78with unplanned return to OR.