AAPC-CPC Dumps 2026 - New Medical Tests AAPC-CPC Exam Questions
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NEW QUESTION # 43
A physician performs a thyroidectomy on a 26-year-old female patient with thyroid cancer. A radical neck dissection with a partial parathyroidectomy and autotransplantation of two parathyroid glands is also completed in the same session. W'hat CPT code(s) should the physician report?
- A. 0
- B. 60254, 60512-52
- C. 60254, 60500-51, 60512
- D. 60254, 60500-51, 60512-51
Answer: B
Explanation:
The CPT code for a thyroidectomy with a radical neck dissection is 60254 and sequenced first because it is the primary procedure with the highest RVU. CPT 60500, which describes a parathyroidectomy, is bundled into a thyroidectomy. Therefore, the two procedures should never be reported together. Parathyroid autotransplantation (CPT 60512) involves the removal of all four parathyroid glands. If not all four glands are removed, report the code with modifier 52 to indicate reduced services. As this is an add-on code, do not append modifier 51.
NEW QUESTION # 44
A mammogram is done on a patient who has a lump on her right breast at 4 0'clock and a lump in her left breast at 6 0'clock. What CPT and ICD-IO-CM code(s) should be reported?
- A. 77067, D49.3
- B. 77067, D48.61, D48.62
- C. 77065-50, N63.13, N63.20
- D. 77066, N63.14, N63.25
Answer: D
Explanation:
CPT code 77067 is a screening mammogram. In this case, the mammogram would be diagnostic because the purpose is to rule out and/or make a diagnosis based on physical exam findings. Code 77065-50 is an inappropriate use of the modifier because there exists a bilateral procedure code. A breast lump should only be coded to "mass" and not as a neoplasm unless specifically stated in the diagnosis. When deciphering the location of the mass, 12 0'clock is at the top of each breast, and the point of movement is clockwise. Therefore, 4 0'clock in the right breast is equivalent to the lower-inner quadrant, and 6 0'clock in the left breast is in the middle ofthe t".vo lower quadrants.
NEW QUESTION # 45
A 92-year old female with Medicare part A coverage receives ongoing hospice care due to dementi a. She goes to a physician's office to receive closed treatment of a hip dislocation following a fall. No anesthesia was used. How should the provider submit this claim?
- A. 27250-GW, S73.003A, W19XXXA
- B. 27250, S73.003A, W19XXXA
- C. 27250, 99213-25, S73.003A
- D. 27250-GW, 99202-25, S73.003A W19XXYuA
Answer: A
Explanation:
When a patient is receiving hospice care, Medicare will not reimburse the physician for services rendered that are unrelated to the terminal illness unless submitted with modifier GW. In Answers C and D, a separate, identifiable E/M is not to be billed because the procedure is considered minor (1- to 10-day global period) and includes an inherent E/M component.
NEW QUESTION # 46
An orthopedic surgeon performs a meniscectomy for a right radial tear using an arthroscope. During the procedure, the surgeon removes a piece of the damaged meniscus from the lateral compartment of the knee and shaves the articular cartilage of the same compartment. A separate incision was made to remove a 6 mm loose body in the medial compartment. The surgery was completed without any complications. What procedure and diagnosis code(s) should be reported?
- A. 29881, 29874-59,S83.281A
- B. 29881, 29874-51, S83.203A
- C. 29882, 29877-51, 29874-51, S83.203A
- D. 29887, 29874-59,S83.281A
Answer: A
Explanation:
The procedures performed on this encounter were the meniscectomy (removal of damaged meniscus from the lateral compartment) with a chondroplasty (shaving of articular cartilage,
29881) and loose body removal by means of an arthroscopy (29874). Because the removal of loose bodies is considered inclusive to the primary procedure, modifier 59 is appended as opposed to modifier 51 to indicate that it was a distinct procedural service due to the separate incision.
Answers A and D can be eliminated based on the diagnosis chosen. S83.203A indicates the location of meniscus is unspecified: however, the surgeon removed the damaged meniscus from the lateral compartment, leading the biller to S83.281A.
NEW QUESTION # 47
The appendix is removed through an abdominal incision due to metastatic colon malignancy. How should this be reported?
- A. 44950, C78.5, C18.9
- B. 44970, C18.9, C78.5
- C. 44950, C78.5
- D. 44970, C78.5
Answer: A
Explanation:
An open appendectomy procedure is reported with CPT 44950. A metastatic colon malignancy is a cancer that began in the colon but has spread to other areas. In this scenario, that means that the primary malignancy is the colon, and the secondary malignancy is the appendix.
Additionally, ICD-IO-CM guidelines state that when "treatment is directed toward the metastatic site only, the metastatic site is designated as the principal/first-listed diagnosis. The primary malignancy is coded as an additional code." The malignancy codes do not specifically state
"appendix," but the ICD-IO-CM coding crosswalk in the neoplasm table assigns this diagnosis as C78.5 secondary malignant neoplasm of large intestine and rectum.
NEW QUESTION # 48
Which healthcare professional may NOT report medical nutrition therapy?
- A. Dietician
- B. Endocrinologist
- C. Registered nurse
- D. Nutritionist
Answer: B
Explanation:
Medical nutrition therapy describes nutritional assessments and interventions in a face-to- face or group patient setting and is reported with CPT codes 97802-97804. These codes are used by nonphysician healthcare professionals only. When a physician provides nutritional advice, a preventative service or evaluation and management code should be reported.
NEW QUESTION # 49
A low-risk obstetrical patient is told to come in for weekly ultrasounds in her first trimester. This is an example of what?
- A. Misuse
- B. Waste
- C. Fraud
- D. Abuse
Answer: B
Explanation:
In this case, the patient is not at risk, and most organs either are not developed and/or cannot be visualized in the first trimester. Thus, this would constitute as waste due to the provider overutilizing services that result in unnecessary cost. AAPC defines fraud as purposely billing "for services that were never given or to bill for a service that has a higher reimbursement than the service provided." Abuse is payment for services "that are billed by mistake by providers."
NEW QUESTION # 50
A 39-year-old female patient has developed a diaphragmatic hernia after an episode of domestic violence. The surgeon repairs the hernia through an incision into the abdomen. The patient is later discharged with no complications. How should this encounter be reported?
- A. 39541, K44.O, T74.11YA Y07.9
- B. 39540, K44.9, T74.11XA Y07.9
- C. 39540,K44.9, T 76.1 IXA
- D. 39541, K44.O, T76.1 IXA
Answer: B
Explanation:
Acute trauma results from a single incident, whereas chronic trauma is repeated, usually over the course of months or years. In this scenario, the documentation does not specify, so the coder should assume acute trauma. There is no mention of obstruction, so ICD-IO-CM code selection is K44.9, followed by the cause of the hernia. Vvhen an exam shows evidence of abuse, the abuse is no longer considered suspected but confirmed.
NEW QUESTION # 51
Dr. Black orders a hepatitis panel for a patient who has recently returned from traveling abroad and is now experiencing lower abdominal pain. The laboratory completed a hepatitis A antibody test, hepatitis B core antibody test, and a hepatitis C antibody test. Select the CPT and the ICD-IO-CM codes that the laboratory will report.
- A. 86709, 86705, 86803, RIO.30
- B. 80074, RIO.30
- C. 86709, 86705, 86803, RIO.31, RIO.32
- D. 80074-52, RIO.30
Answer: A
Explanation:
The hepatitis B surface antigen test was not performed, so the actual panel code in answer A was not completed, leaving each test to be reported separately. It would not be appropriate to add modifier 52 to 80074 in answer B. Because the provider did not specify which side the lower abdominal pain was on, it would be reported as unspecified with RIO.30, eliminating answer C.
NEW QUESTION # 52
Which service would NOT be covered under Medicare part A?
- A. Observation hospital care
- B. Home health care
- C. Inpatient hospital care
- D. Hospice care
Answer: A
Explanation:
Observation hospital care is provided to patients who are not sick enough to be admitted.
Therefore, it is considered an outpatient service and is covered under Medicare part B.
NEW QUESTION # 53
What is the difference between presumptive and definitive testing?
- A. Presumptive testing assumes a diagnosis; definitive testing confirms a diagnosis.
- B. Presumptive testing confirms the presence of a drug class; definitive testing identifies thequantity or presence of a drug.
- C. Presumptive testing is based on exhibited signs and/or symptoms; definitive testing isbased on lab results.
- D. Presumptive testing requires additional observation time; definitive testing requires ablood draw.
Answer: B
Explanation:
A presumptive test reports whether the patient is positive or negative for a specific drug. A definitive test would analyze which specific agent and/or how much of that agent is in the patients' system.
NEW QUESTION # 54
A patient relocates after receiving treatment for an arm fracture. The patient schedules an appointment with a new orthopedist to remove the cast. The orthopedic office should report the fracture diagnosis code with the seventh character A to indicate active treatment.
- A. True
- B. False
Answer: B
Explanation:
The statement is false. When a patient is in the healing and/or recovery phase of an injury, the seventh character would be D to indicate that the care is subsequent-whether the provider has treated the patient in the past or not.
NEW QUESTION # 55
Which type of anesthesia is NOT separately reportable?
- A. Regional anesthesia
- B. Monitored anesthesia care
- C. Metacarpal blocks
- D. Spinal anesthesia
Answer: C
Explanation:
CPT surgery guidelines uphold that local infiltration, metacarpal/metatarsal/digital block, or topical anesthesia is always included in the surgical package. Under monitored anesthesia care (MAC), a patient is sedated but typically still aware, and the presence of qualified anesthesia personnel is required. Spinal and regional anesthesia is used for a variety of different procedures and is also separately reportable.
NEW QUESTION # 56
A physician performs an esophagogastroduodenoscopy on a patient who has GERD. A single tissue sample is obtained from the upper gastrointestinal tract using biopsy forceps. A reflux test was also done and a bravo capsule temporarily attached to the esophageal wall to monitor pH levels. What procedures should the physician report?
- A. 43239, 91034
- B. 43239, 91035
- C. 43235, 91035
- D. 43235, 91034
Answer: B
Explanation:
To report an esophagogastroduodenoscopy, see CPT code range 43233-43259. In this scenario, the procedure is not considered diagnostic (43235) because the physician is stating the patient has GERD. Additionally, the tissue sample was obtained by means of biopsy forceps and not by brushing or washing. The secondary procedure is a reflux test and an esophageal pH test by means of a bravo capsule, which evaluates the level of acid refluxing into the esophagus. Although CPT 91035 doesn't specifically state a capsule in the description of the code, it would fall under a
"mucosal attached" placement. A nasal catheter was not used, so reporting CPT 91034 would be incorrect.
NEW QUESTION # 57
Which service is NOT bundled into pediatric critical care CPT 99475?
- A. The doctor suspects meningitis on a 4-year-old patient and performs a lumbar puncture totest the fluid around the spinal cord.
- B. A suprapubic aspiration is performed on a 3-year-old patient who has blood in her urine.
- C. A central line is inserted to stabilize a 5-year-old patient in respiratory arrest.
- D. A blood transfusion is given to a 2-year-old patient with sickle cell disease.
Answer: C
Explanation:
A blood transfusion (CPT 36430, 36440), lumbar puncture (CPT (62270), and suprapubic aspiration (CPT 51100) are all considered inclusive to pediatric critical care services rendered on patients betvv'een the age of 2 and 5 years old. A complete list of all additional services can be found in the CPT Section Guidelines for Newborn and Pediatric Services. A central line insertion (CPT
36556) is not bundled into critical care services and may be reported separately.
NEW QUESTION # 58
A patient with preexisting hypertension presents to the office at 23-weeks' gestation for prenatal care. Her blood pressure is slightly elevated, and a transabdominal ultrasound shows the fetus is small for dates. The provider advises rest and to follow up as normal. How would the provider code the visit if the patient has an insurance that accepts the global obstetrical package?
- A. 0502F, 76815, 010.012, 036.5920, Z3A 23
- B. 0502F, 76816, 010.012, Z3A. 23
- C. 99213-25, 76815, 010.012, 036.5920, Z3A. 23
- D. 99213-25, 76816, 010.012, Z3A. 23
Answer: B
Explanation:
The global obstetrical package includes routine prenatal care visits and blood pressure checks, so a placeholder code (0500F-0503F) is used to report that a visit occurred instead of an E/M code. CPT 76816 is reported when biometric measurements are taken ofthe fetus, whereas CPT 76815 is limited to one element of the fetus, such as the position or heartbeat. Per ICD-IO-CM, codes beginning with 035- and 036- are reported only "when the fetal condition is actually responsible for modifying the management of the mother."
NEW QUESTION # 59
A physician performs a 6 cm midline celiotomy to remove a patient's enlarged spleen by means of cautery. Abdominal exploration was performed, and the lymph nodes surrounding the inferior mesenteric artery that were noted to be abnormal were also removed. What CPT code(s) describes the surgery performed by the physician?
- A. 49000, 38102
- B. 0
- C. 38120, 49000-51
- D. 38100, 38999-59
Answer: D
Explanation:
CPT 38120 is the removal of the spleen by means of a laparoscope. The physician performed a midline celiotomy (an abdominal incision), which is an open procedure, eliminating this option. CPT 43631 describes the removal of certain portions of the stomach and was not the procedure performed. An exploratory laparotomy (or abdominal exploration) is inclusive to a splenectomy procedure and should not be reported separately. Additionally, CPT 38102 is reported when the spleen is involved in an extensive disease such as malignancy. On the other hand, CPT
38100 fully describes the open splenectomy, and CPT 38999 is used for the removal of mesenteric lymph nodes because there is no specific code for this procedure.
NEW QUESTION # 60
A diaphragm resection and repair are done using a biologic mesh to reduce the formation of adhesions. Which procedure code should be reported?
- A. 0
- B. 1
- C. 2
- D. 3
Answer: B
Explanation:
A diaphragm resection is reported with CPT codes 39560-39561. The use ofa biologic mesh makes the repair complex, whereas a simple repair would implement only internal sutures.
NEW QUESTION # 61
A female patient with type II diabetes, asthma, and hypertension is admitted with complaints of chest pain. Testing rules out heart attack and other underlying conditions as the cause. Which diagnosis codes should be listed on the discharge note?
- A. Z03.89
- B. Z03.89
- C. R07.9, Ell.9, J45.909, 110
- D. R07.9
Answer: C
Explanation:
The primary diagnosis on an inpatient record would be the primary reason the patient was admitted. In this case, because a definitive diagnosis could not be confirmed, the symptom of chest pain would be selected instead. The previously confirmed chronic conditions would also be coded because they affect the management of inpatient care. Diabetes would be coded to an unspecified code because the term "with" implies a causal relationship between the conditions that is not implicitly documented. Per ICD-IO-CM guidelines, a rule-out code is not assigned when "any signs or symptoms related to the suspected condition are present."
NEW QUESTION # 62
A patient is seen in the emergency room with a thermal burn to the left thigh because of a fire. The patient denies feelings of hypothermi a. Vitals are obtained, and a physical examination reveals that approximately 4% of the body is affected by second-degree burns, and nonviable tissue needs to be removed to avoid the risk of infection. After consent is obtained, the physician debrides the wound, cleanses the area, and applies a gauze. The patient is discharged and told to follow up with their primary care physician in 2 days. What CPT code(s) should be reported for this encounter?
- A. 0
- B. 99283-25, 16020
- C. 99282-25, 16020
- D. 16020, 99282
Answer: B
Explanation:
When billing for physician services in the emergency room, it is appropriate to report a standalone E/M when the documentation supports its necessity in determining the need for appropriate treatment. Modifier 25 is necessary to the E/M code when being billed alongside a procedure and/or surgery to indicate a separately billable service. In this case, the documentation supports decision-making of moderate complexity. CPT code 99283 meets these criteria, whereas CPT code 99282 reflects a medical decision-making of low complexity and does not accurately portray the services rendered. The emergency room visit is always the first listed code, followed by the procedure and/or surgery performed.
NEW QUESTION # 63
A patient with a history of colon cancer was treated with radiation therapy. CT scans and blood tests show the malignancy has been eradicated. The patient is directed to take 81 mg of aspirin daily over the course of the next year to help prevent reoccurrence of the malignancy. What ICD-IO-CM code(s) should be reported by the provider on subsequent visits related to this patient's condition?
- A. Z48.3, C18.9
- B. C18.9
- C. Z08, Z85.038
- D. Z85.038
Answer: C
Explanation:
Regarding Z08, ICD-IO-CM guidelines state: "The follow-up codes are used to explain continuing surveillance following completed treatment of a disease. They imply that the condition has been fully treated and no longer exists." When using a follow-up code as the primary reason for an encounter, a history code indicating what condition the patient originally had should be assigned as secondary. Aftercare codes are used to describe the continued treatment of a disease. In this case, the malignancy has been eradicated, the disease no longer exists, and aspirin is being used merely as a preventative measure. History codes can never be reported as first listed; rather, a follow-up code or other current disease and/or condition should precede it.
NEW QUESTION # 64
A 69-year-old patient with a medical history of diabetes is evaluated in the emergency room for a urinary tract infection. After performing a medically appropriate history and exam, the physician prescribes 100 mg of Macrobid every 12 hours and admits the patient to observation status to monitor for sepsis. After seeing an improvement in symptoms, the physician discharges the patient the following day. What CPT and ICD-IO-CM code(s) should be reported for the entirety of the patient's stay?
- A. 99284, 99238, Ell.69, N39.O
- B. 99234, N39.O, 397.89
- C. 99222, 99238, N39.O
- D. 99221, 99238, N39.O, Ell.9
Answer: D
Explanation:
When a patient is admitted into observation status from the emergency room, only the observation code is reported for that day. When observation extends past the initial date of service, the initial treatment would be reported with CPT codes 99221-99223. In this scenario, the appropriate level of service would be 99221, based on the moderate level of decision-making.
which can be ascertained by the number and complexity of problems addressed and the risk of complications and/or morbidity or mortality of patient management. Discharge from observation on a separate date is reported with CPT codes 99238-99239.
Because the diabetes is documented and is a coexisting chronic condition during the time of the encounter, it should follow the reason for admission. Due to a lack of specificity in the diabetes diagnosis, a causal relationship with a UTI is not presumed, and Ell.69 should not be coded.
NEW QUESTION # 65
Diagnostic endoscopy is always inclusive to a surgical endoscopy.
- A. True
- B. False
Answer: A
Explanation:
The statement is true. When multiple endoscopic procedures are performed in the same session, only the most extensive service should be reported. In this case, it would be the surgical endoscopy because it has a higher revenue value.
NEW QUESTION # 66
CPT code 11102 is a column 2 code that has an NCCI edit of 1 when paired with CPT code 11402. How would this be interpreted?
- A. The two codes are exclusive of each other and can never be billed together.
- B. The two codes are inclusive of each other and can never be billed together.
- C. The two codes can be billed together with an appropriate modifier.
- D. If being billed together, only report one unit of each.
Answer: C
Explanation:
NCCI stands for National Correct Coding Initiative and was created by CMS to prevent unbundling and prevent incorrect payments. Column one represents a correct code when listed next to column two. There are three edits listed with the combination of the two columns: 0, 1, and
9. Edit 0 means that the two codes should never, under any circumstance, be reported together. Edit
1 means that the procedures may be coded together with the use of a modifier. Edit 9 means that the edit does nota I .
NEW QUESTION # 67
A patient opts to replace his semi-rigid penile prosthesis with a multicomponent, inflatable penile prosthesis. What CPT code(s) should the urologist report if this was completed in one encounter?
- A. 0
- B. 54415, 54405-51
- C. 54405, 54415-51
- D. 1
Answer: A
Explanation:
Penile prosthesis procedure codes are based on the type of prosthesis being used. In this scenario, a semi-rigid prosthesis is being replaced by a multicomponent inflatable one. Currently, there are no CPT codes that encompass the removal of one type of prosthesis and insertion of another type. The most common course of action might be to code the removal and insertion separately and amend a multi-procedural modifier on the secondary code. However, CPT 54415 indicates that the prosthesis removed was not replaced by another, which is an inaccurate description of services rendered. In this case, only the insertion (CPT 54405) should be reported because it has the highest RVU value.
NEW QUESTION # 68
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