AAPC AAPC-CPC Online Practice Questions and Exam Preparation

AAPC AAPC-CPC Online Questions & Answers

• Question 311:

  A patient is going to have placement of a myringotomy tube. This tube is placed in the ______ to drain excess fluid.

  A. Ear
  B. Lymph node
  C. Lung
  D. Tear duct
  A. Ear

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  Explanation

  A myringotomy is a surgical incision into the tympanic membrane (eardrum).

  A myringotomy tube, also called a ventilation tube, is placed in the ear to allow drainage of fluid from the middle ear and to equalize pressure.

  Therefore, the correct answer is Option A, Ear.

• Question 312:

  Which circumstance supports medical necessity for payment by the insurance company?

  A. Speech therapy for a lisp.
  B. Tummy tuck after a pregnancy.
  C. Second rhinoplasty for a smaller nose.
  D. Removing excess skin in losing weight from a gastric bypass.
  D. Removing excess skin in losing weight from a gastric bypass.

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  Explanation

  Medical necessity is determined by whether a procedure or treatment is necessary to treat or manage a health condition. Removing excess skin after significant weight loss from a gastric bypass often meets medical necessity criteria because excess skin can lead to physical complications, such as infections, rashes, and mobility issues. Insurance companies are more likely to cover this procedure when it is needed to alleviate health issues rather than for cosmetic purposes. Option

  A. Speech therapy for a lisp: Typically, therapy for minor speech impediments like a lisp may not be deemed medically necessary unless it severely affects communication or daily functioning. Option

  B. Tummy tuck after a pregnancy: This procedure is generally classified as cosmetic and not medically necessary, as it is often done to improve appearance rather than address a health condition. Option

  C. Second rhinoplasty for a smaller nose: This would likely be considered elective and cosmetic, especially if it is solely for aesthetic preference without any health-related issues. Thus, the correct answer is Option

  D. Removing excess skin after losing weight from a gastric bypass, as it can be essential for physical health and quality of life.

• Question 313:

  The surgeon performs Roux-en-Y anastomosis of the extrahepatic biliary duct to the gastrointestinal tract on a 45-year-old patient.

  What CPT code is reported?

  A. 47785
  B. 47780
  C. 47740
  D. 47760
  B. 47780

• Question 314:

  A 7-year-old boy is brought to the pediatric clinic by his mother. She reports that her son is complaining of discomfort in both ears and hearing loss in the left ear for the past two days. The pediatrician diagnoses impacted cerumen. With the mother's consent, the pediatrician removes impacted cerumen using water irrigation in the right ear. In the left ear, the cerumen impaction is removed using instrumentation.

  What CPT(R) coding is reported?

  A. 69209-LT.69210-RT
  B. 69210-50
  C. 69209-RT.69210-LT
  D. 69209-50
  C. 69209-RT.69210-LT

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  Explanation

  69209-RT = Removal of impacted cerumen using irrigation. 69210-LT = Removal of impacted cerumen using instrumentation.

  Coding rules applied:

  Different techniques = different CPT(R) codes.

  Different ears = RT/LT modifiers, not modifier -50.

  Why the other options are incorrect: Option A - Modifiers are reversed.

  Option B / D - Modifier -50 is inappropriate when different CPT(R) codes are used.

• Question 315:

  A three-year-old patient is in the operative suite for stage 2 of treatment for double outlet right ventricle.

  The patient previously had the pulmonary artery banded and is returning for removal of the pulmonary band and transposition repair of the great vessels via aortic pulmonary reconstruction. The surgeon performs a time-out and pre-incision review of respiration and BP, then the previous sternal incision site is inspected and lightly painted with povidone. Next, the surgeon reopens the sternal cavity and inserts central cannulae in the IVC, SVC, and ascending aorta for extracorporeal membrane oxygenation (ECMO) bypass. Chemical cardioplegia is initiated, stopping the heart, and ECMO is initiated. A physician assistant monitors vitals and oxygenation until heart function resumes. The surgeon carefully incises and removes the Dacron band encircling the pulmonary artery, with nominal need for dilation. A section of coronary ostia is removed and sutured to the root of the pulmonary trunk. The pulmonary trunk and aortic root are then transected and transposed to allow for ideal cardiac circulation. Once structural integrity is visually confirmed, the physician assistant is permitted to administer the cardioplegia reversal solution, and the surgeon removes the central cannulae after heart function safely resumes. The sternotomy is closed, and the patient is transported to the NICU.

  What CPT(R) codes are reported for the surgery today?

  A. 33778-78, 33953-78, 33985-78
  B. 33779-58, 33953-58, 33985-58
  C. 33779-78, 33953-78, 33985-78
  D. 33778-58, 33955-58, 33985-58
  C. 33779-78, 33953-78, 33985-78

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  Explanation

  Procedure Details and CPT(R) code

  Selection: The patient is undergoing stage 2 treatment for double outlet right ventricle (DORV) with removal of the pulmonary artery band and transposition repair of the great vessels. Code 33779 is specific for correction of double outlet right ventricle with transposition of the great arteries. This code accurately reflects the procedure performed, including the complex repair involving transposition of the pulmonary trunk and aortic root.

  Code 33953 is used to report initiation of extracorporeal membrane oxygenation (ECMO), which was used to maintain oxygenation during the procedure.

  Code 33985 is for termination of ECMO following the surgical repair once heart function has resumed.

  Both 33953 and 33985 accurately document the initiation and termination of ECMO during this complex heart repair.

  Modifier Selection:

  Modifier 58 is appropriate because this is a staged or related procedure during the postoperative period.

  The patient is returning for stage 2 of a planned treatment process.

  Modifier 78 is used for an unplanned return to the operating room for a related procedure during the postoperative period and is not appropriate for a planned staged repair.

  AAPC and CPT(R) coding

  Guidelines: AAPC and CPT(R)guidelines support the use of modifier 58 for staged or planned related procedures during the postoperative period. ECMO codes may be reported when separately documented and not otherwise included in the primary procedure.

  Thus, the correct CPT(R) codes based on CPT(R) and AAPC coding standards are B. 33779-58, 33953- 58, 33985-58.

• Question 316:

  A patient returns for embryo transfer. The lab thaws cryopreserved embryos and cultures them for two additional days.

  What CPT(R) coding is reported?

  A. 89258, 89250
  B. 89352, 89250
  C. 89342 x3, 89250 x3
  D. 89352 x3, 89250 x3
  B. 89352, 89250

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  Explanation

  89352 = Thawing of cryopreserved embryo(s).

  89250 = Culture of oocyte(s)/embryo(s), less than 4 days.

  The lab thawed cryopreserved embryos and cultured them for two additional days. The thawing is reported with 89352, and the embryo culture is reported with 89250.

  Therefore, the correct answer is B. 89352, 89250.

• Question 317:

  Full Case: Established patient office visit.

  CC: Bilateral thyroid nodules.

  HPI: 54-year-old evaluated for bilateral thyroid nodules; thyroid ultrasound last week showed multiple thyroid masses likely multinodular goiter; patient can feel left-sided nodules; denies dysphagia; denies unexplained weight loss/gain; family history of thyroid cancer (maternal grandmother); otherwise no

  problems except palpable right-sided thyroid mass.

  ROS: Constitutional negative (chills/fever/weight change). ENT negative (hearing loss/trouble swallowing/ voice change). GI negative (distention/pain/bleeding/bowel changes/N/V). Endocrine negative (cold/heat intolerance).

  PE: Vitals BP 140/72, P 96, R 16, T 97.6, SpO2 97%, wt 89.8 kg, ht 165.1 cm. General alert, cooperative,

  no distress. Head normocephalic. Throat moist, no lesions, no thrush. Neck: no adenopathy, supple,

  trachea midline, thyromegaly present, no carotid bruit, no JVD. Lungs clear. Heart regular rhythm/rate, normal S1/S2, no murmur/gallop/rub/click. Lymph nodes: no palpable adenopathy.

  Assessment/Plan: Multinodular goiter; patient will have a percutaneous biopsy (minor procedure).

  What E/M code is reported?

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

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  Explanation

  This is anestablished patientoffice visit coded byMDM(no total time documented). Problems addressed include achronic condition(multinodular goiter/thyroid nodules) requiring evaluation with malignancy risk considerations (family history of thyroid cancer and palpable mass). The plan includes apercutaneous biopsy, which is aminor procedureplanned, increasing management complexity compared with reassurance-only follow-up. Data reviewed includes at leastreview of an ultrasound from last weekshowing multiple thyroid masses consistent with multinodular goiter (outside test review), which supports data element involvement. Risk is at leastmoderatebecausedecision for a minor procedureis documented in the plan (with procedure-related risk assessment implicit). While ROS is largely negative and exam is not extensive enough alone to drive code selection, MDM supports amoderate leveloverall, aligning with99214for established patients. It is more complex than 99213 due to planned invasive diagnostic procedure and risk assessment, but does not reach 99215 because there is no high-risk management (e.g., major surgery decision, severe exacerbation, or intensive data complexity).

• Question 318:

  A woman at 36-weeks gestation goes into labor with twins. Fetus 1 is an oblique position, and the decision is made to perform a cesarean section to deliver the twins.The obstetrician who delivered the twins, provided the antepartum care, and will provide the postpartum care.

  What CPT coding is reported for the twin delivery?

  A. 59510, 59515
  B. 59510 x 2
  C. 59510, 59514, 59515
  D. 59510
  C. 59510, 59514, 59515

• Question 319:

  A patient is having X-ray imaging of his abdomen following a traumatic episode. Decubitus, supine, and erect views are performed on the abdomen.

  What CPT(R) code is reported?

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

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  Explanation

  The patient underwent X-ray imaging of the abdomen with three views: decubitus, supine, and erect.

  CPT(R) code 74021 is reported for a radiologic examination of the abdomen with three or more views.

  Modifier 26 is appended to indicate the professional component when only the interpretation is reported.

  Code 74018 is for a single-view abdomen X-ray.

  Code 74019 is for a two-view abdomen X-ray.

  Code 74022 is for a complete acute abdomen series that includes abdominal views and a single-view chest X-ray. A chest X-ray is not documented in this scenario.

  Therefore, the correct answer is D. 74021-26.

• Question 320:

  A woman who is 19 weeks pregnant is taken to the hospital from her doctor's office due to detection of no fetal heartbeat and fetal death. Due to the stage of pregnancy, labor is initiated, and the fetus is delivered.

  What CPT(R) and ICD-10-CM codes are reported for the delivery of the fetus on the maternal record?

  A. 59820, O02.1, Z3A.19
  B. 59821, O36.4XX0, Z3A.19
  C. 59820, O36.4XX0
  D. 59821, O02.1
  B. 59821, O36.4XX0, Z3A.19

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  Explanation

  Procedure Coding (CPT(R)):

  59821 = Induced abortion by vaginal suppository, amniotic fluid injection, or other medical means.

  Used for fetal demise at 14 weeks gestation or more.

  Labor was medically induced, and the fetus was delivered.

  Diagnosis Coding (ICD-10-CM):

  O36.4XX0 = Maternal care for intrauterine death, not applicable or unspecified.

  Correct maternal record diagnosis.

  Z3A.19 = 19 weeks gestation.

  Required per ICD-10-CM guidelines for obstetric encounters.

  Why the other options are incorrect: Option A / D - O02.1 does not match the maternal care diagnosis used for this encounter.

  Option C - Missing the required gestational age code.