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BUNDLE FOR AAPC CPC EXAM VERIFIED 2022/2023
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CPC exam prep correctly answered 2022
What part of Medicare covers prescription drug services Part D What is medical coding? Translating medical documentation into codes. Which ... [Show More] is NOT a covered entity of HIPAA... Medicare, Worker's Comp, Dentists, Pharmacies Workers compensation What is an NCD (National Coverage Determination) interpreted at the MAC level considered? LCD (Local Coverage Determinations) When should an ABN (Advance Beneficiary Notification) be signed? when a service is not expected to be covered under medicare The amount on an ABN should be within how much of the cost to a patient? $100 or 25% of cost An entity that processes nonstandard health information they receive from another entity into a standard is considered what? Clearinghouse A covered entity does not include: patients What is PHI? Protected Health Information Intentional billing of services not provided is considered fraud What OIG document should a provider review for potential problem areas that will receive special scrutiny in the upcoming year? OIG Work Plan 5 Body cavities cranial, spinal, thoracic, abdominal, pelvic 5 types of membranes mucous, serous, synovial, meninges, cutaneous 2 layers of the skin epidermis and dermis 5 layers of epidermis stratum corneum, stratum lucidum, stratum granulosum, stratum spinosum, stratum basale 2 layers of dermis papillary and reticular Closed fracture broken bone with no open wound compound fracture bone breaks through the skin comminuted fracture fracture in which the bone is splintered or crushed transverse fracture occurs straight across the bone greenstick fracture bending and incomplete break of a bone; most often seen in children spiral fracture a fracture in which the bone has been twisted apart Colles' fracture fracture of the distal radius at the wrist compression fracture occurs when the bone is pressed together (compressed) on itself (vertebrae) epiphyseal fracture a break at the location of the growth plate, which can affect growth of the bone types of muscle skeletal, cardiac, smooth 3 layers of the heart epicardium, myocardium, endocardium organs of the lymphatic system lymph nodes, lymphatic vessels, thymus gland, spleen, tonsils Central Nervous System (CNS) brain and spinal cord Peripheral Nervous System (PNS) the sensory and motor neurons that connect the CNS to the rest of the body Components of blood plasma, red blood cells, white blood cells, platelets a patient sustaining an injury to her great saphenous vein would have sustained an injury to which anatomical site? leg What is a function of the pancreas? Supplies digestive enzymes. Sebaceous glands are part of which anatomic system? Integumentary What part of the eye refracts light? Lens The myocardium is the thickest around which chamber of the heart? Left ventricle The tunica vaginalis is part of which system? male reproductive Complete the series: Incus, Stapes... Malleus Hemiplegia is a disorder caused by a defect i which anatomic system? Nervous What is the result of a ureteral blockage? Urine will not be able to flow from the kidney to the bladder. What is a term for a renal calculus? Nephrolithiasis What year was the AAPC founded? 1988 Super fascia is in the hypodermis Stratum Lucidum is found In areas such as the palms and soles (Thicker skin) Arteries carry blood away from the heart veins Blood vessels that carry blood back to the heart Capillaries Smallest blood vessels; site of oxygen and waste exchange 3 layers of the eye sclera, choroid, retina anterior segment of eye contains aqueous humor posterior segment of eye contains vitreous humor Leukocytosis refers to increased amount of white blood cells (WBC) what structure of the ear is considered the inner ear? labrynth what type of membrane lines the inner walls of the digestive system? mucous what structure is an internal organ of the male genital system? Cowper's glands The heart receives DEOXYGENATED blood in the right atrium via which vessel? Vena Cavae The heart circulates blood thru the lungs and is sent back to the left atrium of the heart via which vessel? left/right pulmonary veins Where are the basal ganglia located cerebral cortex What is vesicoureteral reflux? retrograde flow of bladder urine into the ureters The posterior vaginal fornix and outer cervical os were prepped... what does os stand for ostium (opening) Recession of left inferior rectus muscle... what anatomic location is being operated on? eye [Show Less]
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CPC 2021 Exam Study Guide verified answers latest update
Documentation (content) Proper code assignment is determined both by _____________ in the medical record and by the unique rules that govern each code set... [Show More] in that instance An auditor The role a coder may take on to verify that the documentation supports the codes the physician has selected Query the physician If the medical record is inaccurate or incomplete, it will not translate properly to the language of codes. What can a coder do in order for the medical record to be complete and accurate so they can bill properly? Quarterly (usually) How often are codes and insurance payment policies updated? NPP Non-Physician Provider (also known as mid-level providers or physician extenders) PA Physician assistant NP Nurse practitioner Commercial and Government The two types of primary insurances Commercial Carriers Private payers that may offer both group and individual plans Medicare The most significant government insurer; a federal health insurance program People over 65, blind or disabled individuals, and people with permanent kidney failure or end-stage renal disease Medicare provides coverage for what kind of people? ESRD end-stage renal disease Medicare Part A Helps cover inpatient hospital care, as well as care provided in skilled nursing facilities, hospice care, and home healthcare, Medicare Part B Covers medically necessary physicians' services, outpatient care, and other medical services (including some preventive services) not covered under Medicare Part A. It can be an optional benefit. Medicare Part C Also called Medicare Advantage, combines the benefits of Medicare Part A, Part B, and-sometimes- Part D. The plans are managed by private insurers approved by Medicare. Medicare Part D A prescription drug program available to all Medicare beneficiaries. Medicaid A health insurance assistance program for some low-income people (especially children and pregnant women) sponsored by federal and state governments. RBRVS Resource-Based Relative Value Scale Resource-Based Relative Value Scale (RBRVS) Medicare payments for physician services are standardized using _____ and are divided into three components. The physician work component, practice expense, and professional liability insurance (PLI) The three components used to determine resource cost for physician services. The Physician Work component Accounts for just over half (52 percent) of a procedure's/service's total relative value and is measured by time it takes to perform a service, technical skill, and physical effort. Practice Expense Accounts for 44 percent of the total relative value for each service and differ by site of service. For example, the expense of providing services in the hospital vs a physician's office. PLI Resource-Based Professional Liability Insurance Professional Liability Insurance (PLI) Accounts for 4 percent of the total relative value for each service CMS website Where can you find Physician Fee Schedule (PFS) information? PFS Physician Fee Schedule Medical Necessity Refers to whether a procedure or service is considered appropriate in a given circumstance NCD National Coverage Determinations National Coverage Determinations (NCD) Explains when Medicare will pay for items or services MAC Medicare Administrative Contractor Medicare Administrative Contractor (MAC) Responsible for interpreting national policies into reginal polices. Local Coverage Determinations (LCD) Regional policies converted from national polices by a Medicare Administrative Contractor (MAC). ABN Advance Beneficiary Notice Advanced Beneficiary Notice (ABN) A standardized form that explains to the patient why Medicare may deny the service or procedure HIPAA The Health Insurance Portability and Accountability Act Health Insurance Portability and Accountability Act (HIPAA) Provides federal protections for protected health information when held by covered entities HIPAA covered entities A healthcare provider, a health plan, and a healthcare clearinghouse PHI Protected Health Information Minimum Necessary requirement A key provision of HIPPA, under which only the _______ protected health information (PHI) should be shared to satisfy a particular purpose. HITECH Health Information Technology for Economic and Clinical Health Act Health Information Technology for Economic and Clinical Health Act (HITECH) Allows patients to request an audit trail showing all disclosures of their health information made through an electronic record. Health Information Technology for Economic and Clinical Health Act (HITECH) Requires that an individual be notified if there is an unauthorized disclosure or use of his or her health information. OIG Office of Inspector General Fraud To purposely bill for services that were never given or to bill for a service that has a high reimbursement than the services provided; The person does not have to possess knowledge of the violation for it to still be a considered offense. Abuse Consists of payment for items or services that are billed by providers in error that should not be paid for by Medicare. Compliance Plan A written set of instructions outlining the [Show Less]
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CPC Exam correctly answered 2022
Abstractor hospital employee who converts documented procedurs and diangoses into medical codes Abuse coding practices that lead to improper reimb... [Show More] ursement by error because they do not meet medical necessity, ex. changing diagnosis to be covered by insurance Accreditation an examination process the healthcare facility goes through to evaluate the facilities policies, procedures, and performance to meet higher standards. Accredited Having seal of approval after being evaluated and demonstrating quality standards Act/ Law/ Statute Legislation passed through Congress and signed by President or passed over his veto Actual Charge The amount the provider charges for medical services or supplies. Not always paid in full. Additional Benefits Health care services not covered by Medicare and are offered through the Medicare Advantage Organization for no additional premium. The benefits must equal the ACR (Adjusted Community Rating) Adjudication Health Insurance Claims process at the insurance company Adjusted Average Per Capita Cost (AAPCC) Estimate of how much Medicare will spend in a year for an average beneficiary Administrative Code Sets Non medical code sets that characterize a general business situation rather than a medical condition. Administrative Costs Medicare, Medicaid, CMS refer to this as their expenses to have the program, operating expenses, program management, etc. Administrative Data Health insurance information stored in automated information system about enrollment, eligibility, claims, etc. Administrative Law Judge (ALJ) hearing officer who presides over appeal conflicts between providers or beneficiaries, and Medicare contractors (MAC's) Administrative Simplification Part of HIPAA authorizing HHS (Health and Human Services) to 1. adopt standards for transactions & code sets; 2. adopt standard identifiers for health plans; 3. adopt standards to protect security & privacy of personally identifiable health information. Administrative Simplification Act Signed 12/17/01 allows HHS (Health & Human Services) to exclude providers from Medicare for HIPAA non-compliance of electronic claims and prohibit paper claims except in certain situations Admission Date The date the patient was admitted for inpatient care, outpatient, or start of care.For hospice, enter effective date of election of hospice benefits. Admitting Diagnosis Diagnosis code indicating patient's diagnosis at admission Admitting Physician The doctor responsible for admitting a patient to the hospital or other inpatient health facility Advance Beneficiary Notification (ABN) A notice from provider to patient that Medicare may deny payment. Patient must sign before services are provider, otherwise patient is not responsible if Medicare does not cover. Advanced Directive Statement written by patient on how they want medical decisions to be made. May include a Living Will or Durable Power of Attorney for healthcare. Allowed Charge Individual charge determination by carrier for a covered service or supply. Ambulatory Care All types of health services that do not require an overnight stay. Ambulatory Care Sensitive Conditions (ACSC) Medical condtions that if treated immediatly and managed properly should not require hospitalization. Ambulatory Payment Classification (APC) Medicare's outpatient prospective payment system in which services are grouped based on the resources needed and payment is fixed within each group Ambulatory Surgery Center (ASC) Outpatient surgery center not located in the hospital. Patient's may stay a few hours up to 1 night. American Hospital Association (AHA) Represents concerns of instituitional providers. They host the National Uniform Billing Committee (NUBC) which consults under HIPAA American Medical Association (AMA) Professional organization maintains CPT code sets, secretariat to National Uniform Claim Committee (NUCC) which consults under HIPAA. ASC payment group rate. ASHIM American Society of Health Informatics Managers, Inc. is a non-profit group of computer professionals that specialize in health information technology (HIT). They are certified through Certified Health Informatics System Professionals (CHISP) Ancillary Services Professional services by a hospital or inpatient facility. Xrays, drugs, labs, etc. Appeal Complaint by hospital or patient about a health care payment Approved Amount The fee Medicare sets as reasonable and pays to the provider. Assigned Claim Claim submittted by a provider who accepts Medicare Assignment Agreeing to acccept Medicare fees as payment in full Attending Physician Licensed physician who certifies the patient services via medical necessity and is primarily responsible for the patient's medical care and treatment. Automated Claim Review Claim review and etermination via system edits and don't require human intervention Basic Benefit Includes Medicare covered benefits (except hospice) and additional benefits Beneficiary The name of a person who has health care insurance through the insurance program Benefit Payment Amount paid by insurance after the deductible and coinsurance have been deducted Benefit Period Episode of care within hospitals & skilled nursing facilities (SNF). Begins on admission and ends 60 days after care has ended Benefits The money or services provided through an insurance policy Board Certified Doctor specializing in certain area of medici [Show Less]
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AAPC CPC Practice Questions with complete solution graded A+
A 46-year-old female had a previous biopsy that indicated positive malignant margins anteriorly on the right side of her neck. A 0.5 cm margin was drawn ou... [Show More] t and a 15 blade scalpel was used for full excision of an 8 cm lesion. Layered closure was performed after the removal. The specimen was sent for permanent histopathologic examination. What are the CPT® code(s) for this procedure? A. 11626 B. 11626, 12004-51 C. 11626, 12044-51 D. 11626, 13132-51, 13133 C. 11626, 12044-51 A 30-year-old female is having 15 sq cm debridement performed on an infected ulcer with eschar on the right foot. Using sharp dissection, the ulcer was debrided all the way to down to the bone of the foot. The bone had to be minimally trimmed because of a sharp point at the end of the metatarsal. After debriding the area, there was minimal bleeding because of very poor circulation of the foot. It seems that the toes next to the ulcer may have some involvement and cultures were taken. The area was dressed with sterile saline and dressings and then wrapped. What CPT® code should be reported? A. 11043 B. 11012 C. 11044 D. 11042 C. 11044 A 64-year-old female who has multiple sclerosis fell from her walker and landed on a glass table. She lacerated her forehead, cheek and chin and the total length of these lacerations was 6 cm. Her right arm and left leg had deep cuts measuring 5 cm on each extremity. Her right hand and right foot had a total of 3 cm lacerations. The ED physician repaired the lacerations as follows: The forehead, cheek, and chin had debridement and cleaning of glass debris with the lacerations being closed with one layer closure, 6-0 Prolene sutures. The arm and leg were repaired by layered closure, 6-0 Vicryl subcutaneous sutures and Prolene sutures on the skin. The hand and foot were closed with adhesive strips. Select the appropriate procedure codes for this visit. A. 99283-25, 12014, 12034-59, 12002-59, 11042-51 B. 99283-25, 12053, 12034-59, 12002-59 C. 99283-25, 12014, 12034-59, 11042-51 D. 99283-25, 12053, 12034-59 D. 99283-25, 12053, 12034-59 A 52-year-old female has a mass growing on her right flank for several years. It has finally gotten significantly larger and is beginning to bother her. She is brought to the Operating Room for definitive excision. An incision was made directly overlying the mass. The mass was down into the subcutaneous tissue and the surgeon encountered a well encapsulated lipoma approximately 4 centimeters. This was excised primarily bluntly with a few attachments divided with electrocautery. What CPT® and ICD-10-CM codes are reported? A. 21932, D17.39 B. 21935, D17.1 C. 21931, D17.1 D. 21925, D17.9 C. 21931, D17.1 Question 5 PREOPERATIVE DIAGNOSIS: Right scaphoid fracture. TYPE OF PROCEDURE: Open reduction and internal fixation of right scaphoid fracture. DESCRIPTION OF PROCEDURE: The patient was brought to the operating room; anesthesia having been administered. The right upper extremity was prepped and draped in a sterile manner. The limb was elevated, exsanguinated, and a pneumatic arm tourniquet was elevated. An incision was made over the dorsal radial aspect of the right wrist. Skin flaps were elevated. Cutaneous nerve branches were identified and very gently retracted. The interval between the second and third dorsal compartment tendons was identified and entered. The respective tendons were retracted. A dorsal capsulotomy incision was made, and the fracture was visualized. There did not appear to be any type of significant defect at the fracture site. A 0.045 Kirschner wire was then used as a guidewire, extending from the proximal pole of the scaphoid distal ward. The guidewire was positioned appropriately and then measured. A 25-mm Acutrak® drill bit was drilled to 25 mm. A 22.5-mm screw was selected and inserted and rigid internal fixation was accomplished in this fashion. This was visualized under the OEC imaging device in multiple projections. The wound was irrigated and closed in layers. Sterile dressings were then applied. The patient tolerated the procedure well and left the operating room in stable condition. What CPT® code is reported for this procedure? A. 25628-RT B. 25624-RT C. 25645-RT D. 25651-RT A. 25628-RT An infant with genu valgum is brought to the operating room to have a bilateral medial distal femur hemiepiphysiodesis done. On each knee, the C-arm was used to localize the growth plate. With the growth plate localized, an incision was made medially on both sides. This was taken down to the fascia, which was opened. The periosteum was not opened. The Orthofix® figure-of-eight plate was placed and checked with X-ray. We then irrigated and closed the medial fascia with 0 Vicryl suture. The skin was closed with 2-0 Vicryl and 3-0 Monocryl®. What procedure code is reported? A. 27470-50 B. 27475-50 C. 27477-50 D. 27485-50 D. 27485-50 The patient is a 67-year-old gentleman with metastatic colon cancer recently operated on for a brain metastasis, now for placement of an Infuse-A-Port for continued chemotherapy. The left subclavian vein was located with a needle and a guide wire placed. This was confirmed to be in the proper position fluoroscopically. A transverse incision was made just inferior to this and a subcutaneous pocket created just inferior to this. After tunneling, the introducer was placed over the guide wire and the power port line was placed with the introducer and the introducer was peeled away. The tip was placed in the appropriate position under fluoroscopic guidance and the catheter trimmed to the appropriate length and secured to the power port device. The locking mechanism was fully engaged. The port was placed in the subcutaneous pocket and everything sat very nicely fluoroscopically. It was secured to the underlying soft tissue with 2-0 silk stitch. What CPT® code(s) is (are) reported for this procedure? A. 36556, 77001-26 B. 36558 C. 36561, 77001-26 D. 36571 C. 36561, 77001-26 Question 8 A CT scan identified moderate-sized right pleural effusion in a 50 year-old male. This was estimated to be 800 cc in size and had an appearance of fluid on the CT Scan. A needle is used to puncture through the chest tissues and enter the pleural cavity to insert a guidewire under ultrasound guidance. A pigtail catheter is then inserted at the length of the guidewire and secured by stitches. The catheter will remain in the chest and is connected to drainage system to drain the accumulated fluid. The CPT® code is: A. 32557 B. 32555 C. 32556 D. 32550 A. 32557 The patient is a 59-year-old white male who underwent carotid endarterectomy for symptomatic left carotid stenosis a year ago. A carotid CT angiogram showed a recurrent 90% left internal carotid artery stenosis extending into the common carotid artery. He is taken to the operating room for re-do left carotid endarterectomy. The left neck was prepped and the previous incision was carefully reopened. Using sharp dissection, the common carotid artery and its branches were dissected free. The patient was systematically heparinized and after a few minutes, clamps were applied to the common carotid artery and its branches. A longitudinal arteriotomy was carried out with findings of extensive layering of intimal hyperplasia with no evidence of recurrent atherosclerosis. A silastic balloon-tip shunt was inserted first proximally and then distally, with restoration of flow. Several layers of intima were removed and the endarterectomized surfaces irrigated with heparinized saline. An oval Dacron patch was then sewn into place with running 6-0 Prolene. Which CPT® code(s) is/are reported? A. 35301 B. 35301, 35390 C. 35302 D. 35311, 35390 B. 35301, 35390 A 52-year-old patient is admitted to the hospital for chronic cholecystitis for which a laparoscopic cholecystectomy will be performed. A transverse infraumbilical incision was made sharply dissecting to the subcutaneous tissue down to the fascia using access under direct vision with a Vesi-Port and a scope was placed into the abdomen. Three other ports were inserted under direct vision. The fundus of the gallbladder was grasped through the lateral port, where multiple adhesions to the gallbladder were taken down sharply and bluntly: The gallbladder appeared chronically inflamed. Dissection was carried out to the right of this identifying a small cystic duct and artery, was clipped twice proximally, once distally and transected. The gallbladder was then taken down from the bed using electrocautery, delivering it into an endo-bag and removing it from the abdominal cavity with the umbilical port. What CPT® and ICD-10-CM codes are reported? A. 47564, K81.2 B. 47562, K81.1 C. 47610, K81.2 D. 47600, K81.1 B. 47562, K81.1 A 70-year-old female who has a history of symptomatic ventral hernia was advised to undergo laparoscopic evaluation and repair. An incision was made in the epigastrium and dissection was carried down through the subcutaneous tissue. Two 5-mm trocars were placed, one in the left upper quadrant and one in the left lower quadrant and the laparoscope was inserted. Dissection was carried down to the area of the hernia where a small defect was clearly visualized. There was some omentum, which was adhered to the hernia and this was delivered back into the peritoneal cavity. The mesh was tacked on to cover the defect. What procedure code(s) is (are) reported? A. 49560, 49568 B. 49652 C. 49653 D. 49652, 49568 B. 49652 The patient is a 50-year-old gentleman who presented to the emergency room with signs and symptoms of acute appendicitis with possible rupture. He has been brought to the operating room. An infraumbilical incision was made which a 5-mm VersaStep™ trocar was inserted. A 5-mm 0- degree laparoscope was introduced. A second 5-mm trocar was placed suprapubically and a 12-mm trocar in the left lower quadrant. A window was made in the mesoappendix using blunt dissection with no rupture noted. The base of the appendix was then divided and placed into an Endo-catch bag and the 12-mm defect was brought out. Select the appropriate code for this procedure: A. 44970 B. 44950 C. 44960 D. 44979 A. 44970 A 45-year-old male is going to donate his kidney to his son. Operating ports where placed in standard position and the scope was inserted. Dissection of the renal artery and vein was performed isolating the kidney. The kidney was suspended only by the renal artery and vein as well as the ureter. A stapler was used to divide the vein just above the aorta and three clips across the ureter, extracting the kidney. This was placed on ice and sent to the recipient room. The correct CPT® code is: A. 50543 B. 50547 C. 50300 D. 50320 B. 50547 A 67-year-old female having urinary incontinence with intrinsic sphincter deficiency is having a cystoscopy performed with a placement of a sling. An incision was made over the mid urethra dissected laterally to urethropelvic ligament. Cystoscopy revealed no penetration of the bladder. The edges of the sling were weaved around the junction of the urethra and brought up to the suprapubic incision. A hemostat was then placed between the sling and the urethra, ensuring no tension. What CPT® code(s) is (are) reported? A. 57288 B. 57287 C. 57288, 52000-51 D. 51992, 52000-51 A. 57288 A 16-day-old male baby is in the OR for a repeat circumcision due to redundant foreskin that caused circumferential scarring from the original circumcision. Anesthetic was injected and an incision was made at base of the foreskin. Foreskin was pulled back and the excess foreskin was taken off and the two raw skin surfaces were sutured together to create a circumferential anastomosis. Select the appropriate code for this surgery: A. 54150 B. 54160 C. 54163 D. 54164 C. 54163 5 year-old female has a history of post void dribbling. She was found to have extensive labial adhesions, which have been unresponsive to topical medical management. She is brought to the operating suite in a supine position. Under general anesthesia the labia majora is retracted and the granulating chronic adhesions were incised midline both anteriorly and posteriorly. The adherent granulation tissue was excised on either side. What code should be used for this procedure? A. 58660 B. 58740 C. 57061 D. 56441 D. 56441 The patient is a 64 year-old female who is undergoing a removal of a previously implanted Medtronic pain pump and catheter due to a possible infection. The back was incised; dissection was carried down to the previously placed catheter. There was evidence of infection with some fat necrosis in which cultures were taken. The intrathecal portion of the catheter was removed. Next the pump pocket was incised and the pump was dissected from the anterior fascia. A 7-mm Blake drain was placed in the pump pocket through a stab incision and secured to the skin with interrupted Prolene. The pump pocket was copiously irrigated with saline and closed in two layers. What are the CPT® and ICD-10-CM codes for this procedure? A. 62365, 62350-51, T85.898A, Z46.2 B. 62360, 62355-51, T85.79XA C. 62365, 62355-51, T85.79XA D. 36590, I97.42, T85.898A C. 62365, 62355-51, T85.79XA The patient is a 73 year-old gentleman who was noted to have progressive gait instability over the past several months. Magnetic resonance imaging demonstrated a ventriculomegaly. It was recommended that the patient proceed forward with right frontal ventriculoperitoneal shunt placement with Codman® programmable valve. What is the correct code for this surgery? A. 62220 B. 62223 C. 62190 D. 62192 B. 62223 What is the CPT® code for the decompression of the median nerve found in the space in the wrist on the palmar side? A. 64704 B. 64713 C. 64721 D. 64719 C. 64721 A 2-year-old male has a chalazion on both upper and lower lid of the right eye. He was placed under general anesthesia. With a #11 blade the chalazion was incised and a small curette was then used to retrieve any granulomatous material on both lids. What CPT® code should be used for this procedure? A. 67801 B. 67805 C. 67800 D. 67808 D. 67808 An 80-year-old patient is returning to the gynecologist's office for pessary cleaning. Patient offers no complaints. The nurse removes and cleans the pessary, vagina is swabbed with betadine, and pessary replaced. For F/U in 4 months. What CPT® and ICD-10-CM codes are reported for this service? A. 99201, Z46.89 B. 99211, Z46.89 C. 99202, Z46.9 D. 99212, Z46.9 B. 99211, Z46.89 Patient was in the ER complaining of constipation with nausea and vomiting when taking Zovirax for his herpes zoster and Percocet for pain. His primary care physician came to the ER and admitted him to the hospital for intravenous therapy and management of this problem. His physician documented a detailed history, comprehensive examination and a medical decision making of moderate complexity. Which E/M service is reported? A. 99285 B. 99284 C. 99221 D. 99222 C. 99221 A 20-day-old infant was seen in the ER by the neonatologist admitting the baby to NICU for cyanosis and rapid breathing. The neonatologist performed intubation, ventilation management and a complete echocardiogram in the NICU and provided a report for the echocardiography which did indicate congenital heart disease. Select the correct codes for the physician service. A. 99468-25, 93303-26 B. 99471-25, 31500, 94002, 93303-26 C. 99460-25, 31500, 94002, 93303-26 D. 99291-25, 93303-26 A. 99468-25, 93303-26 A 42-year-old with renal pelvis cancer receives general anesthesia for a laparoscopic radical nephrectomy. The patient has controlled type 2 diabetes otherwise no other co-morbidities. What is the correct CPT® and ICD-10-CM code for the anesthesia services? A. 00860-P1, C64.9, E11.9 B. 00840-P3, C65.9, E11.9 C. 00862-P2, C65.9, E11.9 D. 00868-P2, C79.02, E11.9 C. 00862-P2, C65.9, E11.9 A healthy 32-year-old with a closed distal radius fracture received monitored anesthesia care for an ORIF of the distal radius. What is the code for the anesthesia service? A. 01830-P1 B. 01860-QS-P1 C. 01830-QS-P1 D. 01860-QS-G9-P1 C. 01830-QS-P1 A 10-month-old child is taken to the operating room for removal of a laryngeal mass. What is (are) the appropriate anesthesia code(s) to report? A. 00320 B. 00326 C. 00320, 99100 D. 00326, 99100 B. 00326 A catheter is placed in the left common femoral artery which was directed into the right the external iliac (antegrade). Dye was injected and a right lower extremity angiogram was performed which revealed patency of the common femoral and profunda femoris. The catheter was then manipulated into the superficial femoral artery (retrograde) in which a lower extremity angiogram was performed which revealed occlusion from the popliteal to the tibioperoneal artery. What are the procedure codes that describe this procedure? A. 36217, 75736-26 B. 36247, 75716-26 C. 36217, 75756-26 D. 36247, 75710-26 D. 36247, 75710-26 56-year-old female is having a bilateral mammogram with computer aid detection conducted as a screening because the patient has a family history of breast cancer. She does not presently have signs or symptoms of breast disease. What radiological services are reported? A. 77065 x 2 B. 77065, 77066 C. 77067 D. 77066 C. 77067 A 63-year-old patient with bilateral ureteral obstruction presents to an outpatient facility for placement of a right and left ureteral stent along with an interpretation of a retrograde pyelogram. What codes should be reported? A. 52332, 74425 B. 52332-50, 74420-26 C. 52005, 74420 D. 52005-50, 74425-26 B. 52332-50, 74420-26 Patient is coming in for a pathological examination for ischemia in the left leg. The first specimen is 1.5 cm of a single portion of arterial plaque taken from the left common femoral artery. The second specimen is 8.5 x 2.7 cm across x 1.5 cm in thickness of a cutaneous ulceration with fibropurulent material on the left leg. What surgical pathology codes should be reported for the pathologist? A. 88304-26, 88302-26 B. 88305-26, 88304-26 C. 88307-26, 88305-26 D. 88309-26, 88307-26 B. 88305-26, 88304-26 During a craniectomy the surgeon asked for a consult and sent a frozen section of a large piece of tumor and sent it to pathology. The pathologist received a rubbery pinkish tan tissue measuring in aggregate 3 x 0.8 x 0.8 cm. The entire specimen is submitted in one block and also a gross and microscopic examination was performed on the tissue. The frozen section and the pathology report are sent back to the surgeon indicating that the tumor was a medulloblastoma. What CPT® code(s) will the pathologist report? A. 80500 B. 88331-26, 88307-26 C. 80502 D. 88331-26, 88332-26, 88304-26 B. 88331-26, 88307-26 Physician orders a basic (80047) and comprehensive metabolic (80053) panels. Select the code(s) on how this is reported. A. 80053, 80047 B. 80053 C. 80047, 82040, 82247, 82310, 84075, 84155, 84460, 84450 D. 80053, 82330 D. 80053, 82330 A 4-year-old is getting over his cold and will be getting three immunizations in the pediatrician's office by the nurse. The first vaccination administered is the Polio vaccine intramuscularly. The next vaccination is the live influenza (LAIV3) administered in the nose. The last vaccination is the Varicella (live) by subcutaneous route. What CPT® codes are reported for the administration and vaccines? A. 90713, 90658, 90716, 90460, 90461 x 2 B. 90713, 90660, 90716, 90460, 90461 x 1 C. 90713, 90660, 90716, 90471, 90472, 90474 D. 90713, 90658, 90716, 90471, 90472, 90473 C. 90713, 90660, 90716, 90471, 90472, 90474 [Show Less]
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AAPC Official CPC Certification Study Guide Notes already passed graded A+
"hold harmless clause" * found in some non-Medicare health plan contracts * prohibits billing to patient for anything beyond deductibles and co-pays. ... [Show More] A compliance plan may offer several benefits, including: * more accurate payment of claims * fewer billing mistakes * improved documentation and more accurate coding * less chance of violating self-referral and anti-kickback status A healthcare clearing house is a entity that processes nonstandard health information they receive from another entity into a standard format A key provision in HIPAA is the Minimum Necessary requirement. this means only the minimum necessary protected health information should be shared to satisfy a particular purpose. A medically necessary service is the least radical service/procedure that allows for effective treatment of the patients' complaint or condition A patient sustaining an injury to her great saphenous vein would have sustained injury to which of anatomical site? Leg APC Ambulatory Payment Classification ARRA American Recovery and Reinvestment Act (of 2009) ASC Ambulatory Surgical Centers Abuse consists of payment for items or services that are billed by providers in error that should not be paid for by Medicare. An ABN protects the provider's financial interest by creating a paper trail that CMS requires before a provider can bill the patient for payment if Medicare denies coverage for the stated service or procedure. An entity that processes nonstandard health information they receive from another entity into a standard format is considered what? Clearinghouse As a part of Health Care Reform, the Affordable Care Act of 2010 amended the definition of fraud to remove the __________ requirement intent By statute, all work RVUs, must be examined no less often than every 5 years CF Coversion Factor - fixed dollar amount used to translate the RVUs into fees CMS Centers for Medicare and Medicaid CMS developed polices regarding medical necessity are based on regulations found in title XVIII, $1862(a) of the Social Security Act CMS will accept the ____________ for either a "potentially non=covered" service or for a statutorily excluded service CMS-R-131 CMS-R-131 ABN form or Advance Beneficiary Notice which explains to the patient why Medicare may deny the particular service or procedure. CPT Current Procedural Terminology CY 2013 Conversion Factor $25.0008 Commercial (non-Medicare) may develop their own medical policies which do not follow Medicare guidelines and are specified in private contracts between the payer and practice or provider DRG Diagnosis Related Group Does Medicare Part B generally require a yearly deductable and copayment? yes E/M OR E&M Evaluation and Management EHR Electronic Health Record Formula for Calculating Facility Payment amounts [(Work RVU Work GPCI) + (Transitioned Facility PE RVU PE GPCI) + (MP RVU MP GPCI)] CF Formula for Non-Facility Pricing Amount [(Work RVU Work GPCI) + (Transitioned Non-Facility PE RVU PE GPCI) + (MP RVU MP GPCI)] (CF) GPCI Geographic Practice Cost Index GPCI is used to realize the varying cost based on geographic location HCPCS Healthcare Common Procedure Coding System HHS Department of Health and Human Services HIPAA provides federal protections for personal health information when held by covered entities. HIPAA stands for Health Insurance Portability and Accountability Act of 1996 HITECH The Health Information Technology for Economic and Clinical Health Act HITECH allows patients to request an audit trail showing all disclosures of their health information made through an electronic record. HITECH requires that an individual be notified if there is an unauthorized disclosure or use of his or her health information. HITECH was enacted as part of the American Recovery and Reinvestment Act of 2009 (ARRA) HMO Health Maintenence Organization Hemiplegia is a disorder caused by a defect in which anatomic system? nervous ICD-9-CM International Classification of Disease, 9th Clinical Modification IF: Work RVUs = 0.48 Work GPCI = 1.000 Practice Expense CPCI = 0.943 MP GPCI = 0.572 transitioned non-facility practice RVUs = 0.70 Calculate non-facility pricing amount for cpt code 99212 using 2011 CF of $33.9764 $39.51 Non-facility pricing amount [Show Less]
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AAPC CPC Practice Exam F Correctly answered 2022/2023
What is the patient's right when it involves making changes in the personal medical record? A. Patient must work through an attorney to revise any porti... [Show More] on of the personal medical information. B. They should be able to obtain copies of the medical record and request corrections of errors and mistakes. C. It is a violation of federal health care law to revise a patient medical record. D. Revision of the patient medical record depends solely on the facility's compliance program policy. B. They should be able to obtain copies of the medical record and request corrections of errors and mistakes. Under HIPAA regulations, patients have the right to receive a copy of their medical record and request that errors are corrected. https://www.hhs.gov/hipaa/for-individuals/medical-records/index.html Which modifier is appended to a CPT®, for which the provider had a patient sign an Advance Beneficiary Notice (ABN) form because there is a possibility the service may be denied because the patient's diagnosis might not meet medical necessity for the covered service? A. GJ B. GA C. GB D. GY B. GA An Advance Beneficiary Notice (ABN) is a waiver of liability. When a patient has been informed a service that is otherwise covered by Medicare but might not be covered in a particular instance an ABN is signed by the patient prior to receiving the service. To inform Medicare the ABN has been signed, append modifier GA. If an ABN is signed, the claim is the patient's responsibility if the claim is denied. This modifier is listed in the HCPCS Level II codebook. 00:29 01:38 Which statement regarding an ICD-10-CM coding conventions is TRUE? A. If the same condition is described as both acute and chronic and separate subentries exist in the Alphabetic Index at the same indentation level, code only the acute condition. B. Sequela (Late effect) codes are reported for a current acute phase of the injury or illness C. An ICD-10-CM code is still valid even if it has not been coded to the full number of characters required for that code. D. Signs and symptoms that are integral to the disease process should not be assigned as additional codes, unless otherwise instructed. D. Signs and symptoms that are integral to the disease process should not be assigned as additional codes, unless otherwise instructed. Multiple choice D is the correct answer, according to the ICD-10-CM Official Coding Guidelines, I.B.5. indicates not to report signs and symptoms that are integral to a definitive diagnosis and are not assigned unless otherwise instructed. When the same condition is diagnosed as acute and chronic and there is a separate code for both, report both codes (I.B.8). Sequela (Late Effect) codes are the residual effect (condition produced) after the acute phase of an illness or injury has terminated (I.B.10). An ICD-10-CM code is not valid unless it is coded to the highest level of specificity. Do not rely solely on the ICD-10-CM Alphabetic Index to Diseases and Injuries to select the correct code. The term paracentesis found in CPT® code 49082 means: A. A procedure performed to drain fluid that has accumulated in the abdominal cavity B. Biopsy of an abdominal mass C. Removal of tissue samples from the abdominal cavity by an open approach D. Removal of a cyst located in the abdominal cavity A. A procedure performed to drain fluid that has accumulated in the abdominal cavity The term breaks down as follows: prefix par or para refers near, beside or outside and the suffix -centesis refers to puncture or insertion of the insertion of a needle to withdraw fluids. As it relates to code 49082 the surgical procedure is performed by inserting a needle in the abdominal (peritoneal) cavity to drain fluid that has accumulated, or to obtain a fluid sample for testing. hich term is one who has an overload of sodium? A. Hyperkalemia B. Hyperpotassemia C. Hypernatremia D. Hypercalcemia C. Hypernatremia In the ICD-10-CM Alphabetic Index look for each of the listed terms. Cross reference each code in the Tabular List to note a brief definition. Hypernatremia is the when one has too much sodium in the system. Hypernatremia is indexed to code E87.0. Complete this series: Pulmonary, Aortic, Mitral, and ________are valves of the heart. A. Tricuspid B. Superior Vena Cava C. Carotid D. Atrium A. Tricuspid Tricuspid is the first heart valve that blood encounters as it enters into the heart. Superior Vena Cava is a vein that returns blood to the heart from the head, neck and both upper extremities. Carotid is a major artery located in the front of the neck. Atrium is one of the two upper receiving chambers of the heart. An illustration of the heart is found in the Professional Edition of the CPT® codebook in the Cardiovascular System Table of Contents or look in the CPT® Index for Valve and you will note a complete valve listing. Which one of the following is a disorder in causing paralysis of the facial nerve? A. Exotropia B. Tarsal tunnel syndrome C. Brachial plexus lesions D. Bell's palsy D. Bell's palsy Exotropia is an outward deviation of the eye. The muscles of the eye are controlled by the fourth cranial nerve. The facial nerve is the seventh cranial nerve. This distinction can be found in illustrations and written information within your ICD-10-CM and CPT® codebooks. Tarsal tunnel syndrome is nerve impingement in the foot, and brachial plexus lesions refer to a complex of nerves found between the neck and armpit. Bell's palsy, is a common disorder of the facial nerve, and causes an inability to control facial muscles of expression. It may be caused by a brain tumor, stroke, or Lyme disease, but can be idiopathic and transient. In the ICD-10-CM Alphabetic Index look for Palsy/Bell's (see also Palsy, facial). What is ascites? A. Fluid in the abdomen B. Enlarged liver and spleen C. Abdominal malignancy D. Abdominal tenderness A. Fluid in the abdomen In ascites, fluid collects in the peritoneal cavity of the abdomen. Ascites is typically caused by cirrhosis, malignancy, or heart failure. It is usually managed medically but may be treated with paracentesis. Look in the ICD-10-CM Alphabetic Index for Ascites (abdominal) referring you to code R18.8. In the Tabular List under category code R18 the includes note indicates: Fluid in peritoneal cavity. A person who has nephritis has inflammation in what location? A. Gallbladder B. Nerve C. Uterus D. Kidney D. Kidney The term breaks down as: Nephr/o refers to kidney and the suffix -itis refers to inflammation. Nephritis is inflammation of the kidney. In the ICD-10-CM Alphabetic Index look for Inflammation/kidney-see Nephritis. CKD is a disease of which system? A. Circulatory B. Genitourinary C. Digestive D. Musculoskeletal B. Genitourinary CKD is the abbreviation for Chronic Kidney Disease. The abbreviation is found in the ICD-10-CM Tabular List for category code N18 which falls under the Genitourinary System. [Show Less]
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CPC Exam 2022 question and correct answers
medicare part A The part of the Medicare program that pays for hospitalization, care in a skilled nursing facility, home health care, and hospice care. ... [Show More] Medicare Part B the part of medicare that helps cover madically necessary physician services outpatient care and other medical services full services not covered under medicare part a part B is an optional benefit for which the patient must pay a premium in which generally requires a yearly deductible and co insurance 01:31 01:38 Medicare Part C (Medicare Advantage) combines benefits of part A and B, sometimes D. Medicare—Part D Prescription drug coverage medical coding The process of translating this written or dictated medical record into a series of numeric and alpha numeric codes 2 primary types of insurers commercial insurance plans and government insurance plans Medicare provides coverage for people over the age of 65, bling or disabled individuals, and people with permanent kidney failure or end stage renal disease (ESRD) Medicaid a health insurance assistance program for low income people Advanced Beneficiary Notice (ABN) Document that informs covered patients that Medicare may not cover a certain service and the patient will be responsible for the bill required before billing the patient if coverage is denied HITECH Health Information Technology for Economic and Clinical Health Act - allows patients to request an audit trail of their disclosures of their health info made through the electronic health record - requires that an individual be notified if their is an unauthorized disclosure of their health info compliance plan A written set of instructions outlining the process for coding and submitting accurate claims, and what to do if mistakes are found. The AAPC was founded in what year? 1988 00:02 01:38 can a word have more than one root? yes blephar/o eyelid bucc/o cheek cholecyst/o gallbladder colp/o vagina cyst/o A fluid sac or pouch, urinary bladder derm/o skin encephal/o brain enter/o intestine hem/o, hemat/o blood my/o muscle myel/o spinal cord, bone marrow onych/o nail oste/o bone phleb/o vein pulm/o, pulmon/o lungs synov/i synovial fluid, joint, or membrane ab- away from [Show Less]
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AAPC CPC exam prep Compliance and Regulatory latest update 2022/2023
What document is referenced to when looking for potentialproblem areas identified by the government indicatingscrutiny of the services within the coming ye... [Show More] ar?: A) OIG Compliance Plan Guidance B) OIG Security Summary C) OIG Work Plan D) OIG Investigation Plan C (Rationale: Twice a year, the OIG releases a Work Plan outlining its priorities for the fiscal year ahead. Within the Work Plan, potential problem areas with claims submissions are listed and will be targeted with special scrutiny.) What form is provided to a patient to indicate a servicemay not be covered by Medicare and the patient may be responsible for the charges?: A) LCD B) CMS-1500 C) UB-04 D) ABN D (Rationale: An Advanced Beneficiary Notice (ABN) is used when a Medicare beneficiary requests or agrees to receive a procedure or service that Medicare may not cover. This form notifies the patient of potential out of pocket costs for the patient.) Under HIPAA, what would be a policy requirement for "minimum necessary"? " A) Only individuals whose job requires it may have access to protected health information. B) Only the patient has access to his or her own protected health information. C) Only the treating provider has access to protected health information. D) Anyone within the provider's office can have access to protected health information. A (Rationale: It is the responsibility of a covered entity to develop and implement policies, best suited to its particular circumstances to meet HIPAA requirements. As a policy requirement, only those individuals whose job requires it may have access to protected health information.) Which statement describes a medically necessary service? : A) Performing a procedure/service based on cost to eliminate wasteful services. B) Using the least radical service/procedure that allows for effective treatment of the patient's complaint or condition. C) Using the closest facility to perform a service or procedure. D) Using the appropriate course of treatment to fit within the patient's lifestyle. B (Rationale: Medical necessity is using the least radical services/procedure that allows for effective treatment of the patient's complaint or condition.) According to the example LCD from Novitas Solutions, which of the following conditions is considered a systemic condition that may result in the need for routine foot care? : A) arthritis B) chronic venous insufficiency C) hypertension D) muscle weakness B (Rationale: According to the LCD, Chronic venous insufficiency is a systemic condition that may result in the need for routine foot care.) When presenting a cost estimate on an ABN for a potentially noncovered service, the cost estimate should be within what range of the actual cost? A) $25 or 10 percent B) $100 or 10 percent C) $100 or 25 percent D) An exact amount C (Rationale: CMS instructions stipulate, "Notifiers must make a good faith effort to insert a reasonable estimate...the estimate should be within $100 or 25 percent of the actual costs, whichever is greater.") Which act was enacted as part of the American Recovery and Reinvestment Act of 2009 (ARRA) and affected privacy and security? : A) HIPAA B) HITECH C) SSA D) PPACA B What document assists provider offices with the development of Compliance Manuals? A) OIG Compliance Plan Guidance B) OIG Work Plan C) OIG Suggested Rules and Regulations D) OIG Internal Compliance Plan A (Rationale: The OIG has offered compliance program guidance to form the basis of a voluntary compliance program for physician offices. Although this was released in October 2000, it is still considered as active compliance guidance today.) Select the TRUE statement regarding ABNs. A) ABNs may not be recognized by non-Medicare payers. B) ABNs must be signed for emergency or urgent care. C) ABNs are not required to include an estimate cost for the service. D) ABNs should be routinely signed by Medicare Beneficiaries in case Medicare doesn't cover a service. A (Rationale: ABNs may not be recognized by non-Medicare payers. Providers should review their contracts to determine which payers will accept an ABN for services not covered.) Who would NOT be considered a covered entity under HIPAA? A) Doctors C) HMOs D) Clearinghouses E) Patients E (Rationale: Covered entities in relation to HIPAA include Health Care Providers, Health Plans, and Health Care Clearinghouses. The patient is not considered a covered entity although it is the patient's data that is protected.) What type of profession, other than coding, might skilled coders enter?: A) Physicians, insurance carriers, nurses B) Front desk personnel, HR dept C) Consultants, educators, medical auditors D) None of the above C What is the difference between outpatient and inpatient coding?: A) Outpatient coders use ICD-10-CM and ICD-10-PCS. B) Outpatient coders only focuse on hospital services and Inpatient coders focuse on physician services. C) Inpatient coders have more interaction than Outpatient coders. D) Inpatient coders use ICD-10-CM and ICD-10-PCS. D What is a mid-level provider? A) Non-licensed PAs B) Physician withholder C) Mid-level providers include physician assistants (PA) and nurse practitioners (NP). D) NPs with Bachelor's Degree C What are the different parts of Medicare? A) Part A, B, D B) Part A, B, C, D C) Part E, F, G, H D) Part A and B B Evaluation and management (E/M) services are often provided and documented in a standard format. One such format is SOAP notes. What does SOAP represent? A) Subjective, Objective, Assessment, Plan B) Statement, Observation, Action, Prepare C) Symptoms, Objective, Auscultation, Percussion D) Subjective, Observation, Action, Plan A What are five tips for coding operative (op) reports? A) Look for key words, Ignore unfamiliar words, Skip the body, Ignore pathology reports, Only code procedures from the header B) Diagnosis code reporting, Start with the procedures listed, Look for key words, Highlight unfamiliar words, Read the body C) Highlight familiar words, Look for key words, Read the body, Only code what you have highlighted, Code procedure only D) Read the headers only, Look for key words, Highlight familiar words, Ignore pathology report, Code diagnosis only B What is medical necessity?: A) Services to a Medicare beneficiary that are billed for unreasonable and unnecessary treatment. B) The most radical service/procedure that allows for effective treatment of the patient's complaint or condition. C) Something insurance plans do not care about. D) Relates to whether a procedure or service is considered appropriate in a given circumstance. D What is not a common reason Medicare may deny a procedure or service?: A) Patient's condition B) Frequently proposed C) Covered service D) Experimental C Under the Privacy Rule, the minimum necessary standard does NOT apply to what type of disclosures?: A) Uses or disclosures to drug companies. B) Disclosures to or requests by family members. C) Disclosures to the individual who is the subject of the information. D) Uses or disclosures to insurance companies. C Which is not one of the seven key components of an internal compliance plan?: A) Develop open lines of communication. B) Conduct training but not perform education on practice standards and procedures. C) Enforce disciplinary standards through well-publicized guidelines. D) Conduct internal monitoring and auditing through the performance of periodic audits. B The ____describes whether specific medical items, services, treatment procedures or technologies are considered medically necessary under Medicare: A) National Coverage Determinations Manual B) Internet Only Manual C) Medicare Severity-Diagnosis Related Groups (MS-DRG) D) Medicare Physician Fee Schedule A According to the AAPC Code of Ethics, which term is NOT listed as an ethical principle of professional conduct?: A) Integrity B) Efficiency C) Responsibility D) Commitment B According to AAPC's Code of Ethics, an AAPC member shall use only ____ and ____ means in all professional dealings: A) private and professional B) legal and ethical C) legal and profitable D) efficient and inexpensive B What is the definition of medical coding?: A) Translating documentation into numerical/alphanumerical codes used to obtain reimbursement. B) Deciphering explanation of benefits provided by an insurance carrier. C) Translating documentation into software compatible notes. D) Translating the services a provider performs into documentation. A If an NCD does not exist for a particular service/procedure performed on a Medicare patient, who determines coverage?: A) Medicare Administrative Contractor (MAC) B) The physician providing the service C) Current Procedural Terminology (CPT®) guidelines D) Centers for Medicare & Medicaid Services (CMS) A Many coding professionals go on to find work as: A) Accountants B) Medical Assistants C) Financial Planners D) Consultants D LCDs only have jurisdiction in their ____: A) Locality B) Region C) District D) State B A covered entity does NOT include: A) Health plans B) Patients C) Healthcare providers D) Clearinghouses B [Show Less]
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CPC Practice Exam 1 correctly answered 2022
46 year-old female had a previous biopsy that indicated positive malignant margins anteriorly on the right side of her neck. A 0.5 cm margin was drawn out ... [Show More] and a 15 blade scalpel was used for full excision of an 8 cm lesion. Layered closure was performed after the removal. The specimen was sent for permanent histopathologic examination. What are the CPT® code(s) for this procedure? A. 11626 B. 11626, 12004-51 C. 11626, 12044-51 D. 11626, 13132-51, 13133 According to CPT® guidelines "Repair of an excision of a malignant lesion requiring intermediate or complex closure should be reported separately". The intermediate repair code is reported because it was a layered closure. Answer C 30 year-old female is having 15 sq cm debridement performed on an infected ulcer with eschar on the right foot. Using sharp dissection, the ulcer was debrided all the way to down to the bone of the foot. The bone had to be minimally trimmed because of a sharp point at the end of the metatarsal. After debriding the area, there was minimal bleeding because of very poor circulation of the foot. It seems that the toes next to the ulcer may have some involvement and cultures were taken. The area was dressed with sterile saline and dressings and then wrapped. What CPT® code should be reported? A. 11043 B. 11012 C. 11044 D. 11042 Debridement is not being performed on an open fracture/open dislocation eliminating multiple choice answer B. The ulcer was debrided all the way to the bone of the foot, making multiple choice answer C, the correct procedure. Answer C 00:15 01:38 64 year-old female who has multiple sclerosis fell from her walker and landed on a glass table. She lacerated her forehead, cheek and chin and the total length of these lacerations was 6 cm. Her right arm and left leg had deep cuts measuring 5 cm on each extremity. Her right hand and right foot had a total of 3 cm lacerations. The ED physician repaired the lacerations as follows: The forehead, cheek, and chin had debridement and cleaning of glass debris with the lacerations being closed with one layer closure, 6-0 Prolene sutures. The arm and leg were repaired by layered closure, 6-0 Vicryl subcutaneous sutures and Prolene sutures on the skin. The hand and foot were closed with adhesive strips. Select the appropriate procedure codes for this visit. A. 99283-25, 12014, 12034-59, 12002-59, 11042-51 B. 99283-25, 12053, 12034-59, 12002-59 C. 99283-25, 12014, 12034-59, 11042-51 D. 99283-25, 12053, 12034-59 To start narrowing your choices down, the hand and foot were closed with adhesive strips. The Section Guidelines in the CPT® manual for Repair (Closure) states: "Wound closure utilizing adhesive strips as the sole repair material should be coded using the appropriate E/M code." Eliminating multiple choice answers A and B. The lacerations on the face are intermediate repairs, because debridement and glass debris was removed. The guidelines in the CPT® codebook for Repair (Closure) states: "Single-layer closure of heavily contaminated wounds that have required extensive cleaning or removal of particulate matter also constitutes intermediate repair." Eliminating multiple choice answer C. The intermediate repair of the lacerations to the face totaled 6 cm (12053). The right arm and left leg had cuts measuring 5 cm each which totaled 10 cm requiring intermediate repair (12034). Answer D 52 year-old female has a mass growing on her right flank for several years. It has finally gotten significantly larger and is beginning to bother her. She is brought to the Operating Room for definitive excision. An incision was made directly overlying the mass. The mass was down into the subcutaneous tissue and the surgeon encountered a well encapsulated lipoma approximately 4 centimeters. This was excised primarily bluntly with a few attachments divided with electrocautery. What CPT® and ICD-10-CM codes are reported? A. 21932, D17.39 B. 21935, D17.1 C. 21931, D17.1 D. 21925, D17.9 The mass growing turned out to be a lipoma found in the subcutaneous tissue of the flank. In the ICD-10-CM Alphabetic Index, look for Lipoma/subcutaneous/trunk. You are referred to code D17.1, eliminating multiple choice answers A and D. Because the 4 cm tumor was found in the subcutaneous tissue code 21931 is the correct CPT® code to report. Answer C PREOPERATIVE DIAGNOSIS: Right scaphoid fracture. TYPE OF PROCEDURE: Open reduction and internal fixation of right scaphoid fracture. DESCRIPTION OF PROCEDURE: The patient was brought to the operating room; anesthesia having been administered. The right upper extremity was prepped and draped in a sterile manner. The limb was elevated, exsanguinated, and a pneumatic arm tourniquet was elevated. An incision was made over the dorsal radial aspect of the right wrist. Skin flaps were elevated. Cutaneous nerve branches were identified and very gently retracted. The interval between the second and third dorsal compartment tendons was identified and entered. The respective tendons were retracted. A dorsal capsulotomy incision was made, and the fracture was visualized. There did not appear to be any type of significant defect at the fracture site. A 0.045 Kirschner wire was then used as a guidewire, extending from the proximal pole of the scaphoid distal ward. The guidewire was positioned appropriately and then measured. A 25-mm Acutrak® drill bit was drilled to 25 mm. A 22.5-mm screw was selected and inserted and rigid internal fixation was accomplished in this fashion. This was visualized under the OEC imaging device in multiple projections. The wound was irrigated and closed in layers. Sterile dressings were then applied. The patient tolerated the procedure well and left the operating room in stable condition. What CPT® code is reported for this procedure? A. 25628-RT B. 25624-RT C. 25645-RT D. 25651-RT Patient had an open reduction, meaning an incision was made to get to the fracture, eliminating multiple choice answer B. The fracture site was the scaphoid of the wrist (carpal), eliminating multiple choices C and D. Answer A An infant with genu valgum is brought to the operating room to have a bilateral medial distal femur hemiepiphysiodesis done. On each knee, the C-arm was used to localize the growth plate. With the growth plate localized, an incision was made medially on both sides. This was taken down to the fascia, which was opened. The periosteum was not opened. The Orthofix® figure-of-eight plate was placed and checked with X-ray. We then irrigated and closed the medial fascia with 0 Vicryl suture. The skin was closed with 2-0 Vicryl and 3-0 Monocryl®. What procedure code is reported? A. 27470-50 B. 27475-50 C. 27477-50 D. 27485-50 Your keywords in the scenario to narrow your choices down to code 27485 are: "distal femur,""genu valgum," and "hemiepiphysiodesis." Answer D The patient is a 67 year-old gentleman with metastatic colon cancer recently operated on for a brain metastasis, now for placement of an Infuse-A-Port for continued chemotherapy. The left subclavian vein was located with a needle and a guide wire placed. This was confirmed to be in the proper position fluoroscopically. A transverse incision was made just inferior to this and a subcutaneous pocket created just inferior to this. After tunneling, the introducer was placed over the guide wire and the power port line was placed with the introducer and the introducer was peeled away. The tip was placed in the appropriate position under fluoroscopic guidance and the catheter trimmed to the appropriate length and secured to the power port device. The locking mechanism was fully engaged. The port was placed in the subcutaneous pocket and everything sat very nicely fluoroscopically. It was secured to the underlying soft tissue with 2-0 silk stitch. What CPT® code(s) is (are) reported for this procedure? A. 36556, 77001-26 B. 36558 C. 36561, 77001-26 D. 36571 Patient is having an Infuse-A-Port put in his chest to receive chemotherapy. The subclavian vein (central venous) is being tunneled for the access device, eliminating multiple choices A and D. The patient had a subcutaneous pocket created to insert the power port, eliminating multiple choice answer B. Code 77001 reports fluoroscopic guidance for a central venous access device. Modifier 26 denotes the professional service. Answer C A CT scan identified moderate-sized right pleural effusion in a 50 year-old male. This was estimated to be 800 cc in size and had an appearance of fluid on the CT Scan. A needle is used to puncture through the chest tissues and enter the pleural cavity to insert a guidewire under ultrasound guidance. A pigtail catheter is then inserted at the length of the guidewire and secured by stitches. The catheter will remain in the chest and is connected to drainage system to drain the accumulated fluid. The CPT® code is: A. 32557 B. 32555 C. 32556 D. 32550 The drainage of fluid from the pleural cavity was performed via needle (percutaneous) with insertion of an indwelling catheter to drain the fluid, eliminating multiple choice answers B and D. The procedure was performed under ultrasound guidance, eliminating multiple choice answer C. Answer A [Show Less]
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AAPC CPC Practice Exam A correctly answered 2022
Which statement is TRUE for reporting external cause codes of morbidity (V00-Y99)? A. All external cause codes do not require a seventh character. B. O... [Show More] nly report one external cause code to fully explain each cause. C. Report code Y92.9 if the place of occurrence is not stated. D. External cause codes should never be sequenced as a first-listed or primary code D. External cause codes should never be sequenced as a first-listed or primary code Multiple choice D is the correct answer. The ICD-10-CM guidelines for the External Causes Of Morbidity (V00-Y99) is in Section I.C.20. Which statement is TRUE about reporting codes for diabetes mellitus? A. If the type of diabetes mellitus is not documented in the medical record the default type is E11.- Type 2 diabetes mellitus. B. When a patient uses insulin, Type 1 is always reported. C. The age of the patient is a sole determining factor to report Type 1. D. When assigning codes for diabetes and its associated condition(s), the code(s) from category E08-E13 are not reported as a primary code. A. If the type of diabetes mellitus is not documented in the medical record the default type is E11.- Type 2 diabetes mellitus. The ICD-10-CM coding guidelines for diabetes mellitus are found in Section I.C.4. Multiple choice A is the correct answer, this guideline is in Section I.C.4.a.2. What is NOT included in CPT® surgical package? A. Typical postoperative follow-up care B. One related Evaluation and Management service on the same date of the procedure C. Returning to the operating room the next day for a complication resulting from the initial procedure D. Evaluating the patient in the post-anesthesia recovery area C. Returning to the operating room the next day for a complication resulting from the initial procedure The CPT® surgical package definition is in the Surgery Guidelines found in the CPT® code book (right after the Anesthesia section of codes). Multiple choice C is the correct answer, because modifier 78 is reported on a procedure code to indicate a patient's return to the OR for a complication (unplanned return) that has occurred during the postoperative period of the initial procedure. What is PHI? A. Physician-health care interchange B. Private health insurance C. Protected health information D. Provider identified incident-to C. Protected health information Protected health information under the Health Information Portability and Accountability Act (HIPAA) is any information, whether oral or recorded, in any form or medium that is created or received by a health care provider, health plan, public health authority, employer, life insurer, school or university, or health care clearinghouse relating to the past, present, or future physical or mental health or condition of an individual, the provision of health services to that individual, or payment around those services. Only health information at the individual level is covered; health information of groups is not. Which statement is TRUE when reporting pregnancy codes (O00-O9A): A. These codes can be used on the maternal and baby records. B. These codes have sequencing priority over codes from other chapters. C. Code Z33.1 should always be reported with these codes. D. The seventh character assigned to these codes only indicate a complication during the pregnancy. B. These codes have sequencing priority over codes from other chapters. According to ICD-10-CM guidelines (Section I.C.15.a.1): Chapter 15 codes have sequencing priority over codes from other chapters. Additional codes from other chapters may be used in conjunction with chapter 15 codes to further specify conditions. When a patient is having a tenotomy performed on the abductor hallucis muscle, where is this muscle located? A. Foot B. Upper Arm C. Upper Leg D. Hand A. Foot The abductor hallucis is a muscle of the foot that abducts the big toe. In the CPT® Index look for Tenotomy. There are many anatomical areas to choose from, but you will find this muscle located in the description of code 28240. All the codes in that section deal with the foot. Fracturing the acetabulum involves what area? A. Skull B. Shoulder C. Pelvis D. Leg C. Pelvis The acetabulum is the cup-shaped socket of the hip joint which is part of the pelvis. You can locate this answer in the ICD-10-CM codebook. In the ICD-10-CM Alphabetic Index look for Fracture, traumatic/pelvis and you will see acetabulum listed under pelvis. Ventral, umbilical, spigelian and incisional are types of: A. Surgical approaches B. Hernias C. Organs found in the digestive system D. Cardiac catheterizations B. Hernias These are types of hernias. CPT® codes 49491-49657 are categorized by the type of hernias to be repaired. An arteriovenous anastomosis is used to increase blood flow in hemodialysis. Which one of the following describes a direct arteriovenous anastomosis? A. Insertion of a cannula B. A section of artery and a neighboring vein are joined C. A donor's vein is used to connect an artery and a vein D. Radical hysterectomy not otherwise specified B. A section of artery and a neighboring vein are joined CPT® Professional code book, an illustration given under code 36821, "In a direct arteriovenous anastomosis, a section of artery and a neighboring vein are joined, allowing blood flow down the artery and into the vein for the purpose of increasing blood flow, usually in hemodialysis." What is the difference between entropion and ectropion? A. Entropion is the inward turning of the eyelid and ectropion is the outward turning of the eyelid. B. Entropion is facial droop and ectropion is a facial spasm. C. Entropion is the outward turning of the hands and ectropion is the inward turning of the hands. D. Entropion inward turning of the feet and ectropion is the outward turning of the feet due to muscle disorder. A. Entropion is the inward turning of the eyelid and ectropion is the outward turning of the eyelid. Multiple choice A is the correct answer. In the ICD-10-CM Alphabetic Index look for Entropion (eyelid), H02.009. Ectropion is H02.109. In the Tabular List category H02 is for Other disorders of the eyelid. [Show Less]
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