CPC Practice Exam

1. What is the primary function of the National Correct Coding Initiative (NCCI) edits in procedural coding?

• A. To prevent unbundling by identifying codes that should not be reported together on the same claim
• B. To set the maximum allowable reimbursement for each procedure listed in the Medicare physician fee schedule
• C. To determine whether the diagnosis on the claim establishes medical necessity for each surgical procedure
• D. To map CPT procedure codes to their HCPCS Level II equivalents for supplies billed on the same claim

2. A coder identifies that a patient's chart lacks documentation of a known drug allergy that is referenced elsewhere in the patient's history, creating a risk that incomplete information could affect future clinical decisions. What is the coder's most appropriate compliance-oriented action?

• A. Add the allergy information to the chart directly, because a documented patient safety concern permits a coder to update clinical content
• B. Ignore the discrepancy, since allergy status does not affect code selection and lies outside the coder's scope
• C. Flag the discrepancy through the organization's established query or documentation improvement process for provider resolution
• D. Change the existing entry to match the referenced allergy without notifying the provider, and note the change in the coder's log

3. Which element is essential in every medical record entry supporting a billed service?

• A. The coder's initials in place of the provider's signature when the provider is unavailable
• B. Legible, dated documentation authenticated by the rendering provider
• C. The patient's insurance identification number and group number on each page
• D. The expected reimbursement amount for each service listed in the entry

4. When is an Advance Beneficiary Notice appropriately issued to a Medicare beneficiary?

• A. Before providing a service the provider believes Medicare will likely not cover, so the patient can decide whether to accept financial responsibility
• B. Only for services that are statutorily excluded from Medicare coverage, such as routine dental care or cosmetic surgery
• C. For every service provided to every Medicare beneficiary, as a routine intake form that protects the practice against any future denial
• D. After the claim has been denied by Medicare, so that the patient understands why the unpaid balance is being transferred to personal financial responsibility

5. A coder reviews a claim where the physician documented 'right knee pain' in the chief complaint but ordered an MRI of the right ankle. The coder coded for both knee and ankle pain. Which documentation principle has the coder violated?

• A. The coder should code only what is clearly documented and supported by test orders or findings, not infer additional diagnoses
• B. The coder should code both joints whenever imaging of more than one anatomic site is documented in the same encounter
• C. The coder should code the site of the imaging study, because the test order overrides the chief complaint whenever the two conflict
• D. The coder should query the physician only when the documentation is incomplete, and otherwise code every site that is mentioned

6. What is the purpose of the National Correct Coding Initiative?

• A. To license and credential the coding professionals who submit claims to Medicare Administrative Contractors
• B. To set the physician fee schedule payment amounts by assigning relative value units to each procedure code
• C. To prevent improper payment through edits that identify code pairs that should not be reported together
• D. To assign ICD-10-CM diagnosis codes to the procedures on a claim so that medical necessity is established

7. A practice discovers it has been overpaid by a federal health care program due to a coding error. What is the general obligation?

• A. Offset the amount against future claims for the same patient without notifying the payer
• B. Take no action if the error was unintentional, because liability requires intent to deceive
• C. Report and return the overpayment within the statutory deadline after identification
• D. Retain the funds unless the payer identifies the error and formally requests a refund

8. When the alphabetic index and the tabular list appear to conflict in ICD-10-CM, which governs?

• A. The tabular list, though both must always be consulted
• B. The payer's internal policy, which supersedes both references
• C. The alphabetic index, because every code search begins there
• D. Whichever of the two produces the more specific code

9. A patient is seen for a condition and the record documents both an acute and a chronic form of the same condition, with separate entries in the index. How are they sequenced?

• A. The acute or subacute code is sequenced first
• B. The chronic code is sequenced first as the underlying condition
• C. Only the chronic code is reported, since it includes the acute form
• D. Only the acute code is reported, since it reflects the current visit

10. A coder reviewing documentation for a patient with diabetes must determine whether the record supports type 1 or type 2 classification before assigning a code, since long-term management differs significantly between the two forms. Which documentation element most directly resolves this distinction for coding purposes?

• A. The patient's stated preference for a particular insulin brand
• B. The physician's specific documentation of the diabetes type
• C. The patient's age alone, since age always determines the type
• D. The billing department's default assignment

11. In the ICD-10-CM Alphabetic Index, a main term is followed by a code with no additional qualifying subterms matching the documented condition. What does this code represent when no more specific information is documented?

• A. The default code, appropriate when the record does not specify a more detailed variant
• B. A code reserved for inpatient use, because outpatient claims must always carry the full detail
• C. A code that can never be reported without first querying the physician for the missing detail
• D. A placeholder that must be replaced with a more specific code before the claim can be submitted

12. A patient returns for a scheduled follow-up during the healing phase of a fracture treated at the initial encounter. Which seventh character generally applies?

• A. S, for sequela
• B. No seventh character is used for follow-up visits
• C. D, for subsequent encounter
• D. A, for initial encounter

13. A patient's record documents type 2 diabetes mellitus with a specified diabetic complication, and ICD-10-CM classifies this relationship using a single code capturing both the underlying disease and the complication. What coding principle does this represent?

• A. An Excludes1 conflict that requires the coder to report the diabetes code and omit the complication
• B. A default code assigned when the documentation does not specify which complication the patient has
• C. A dual coding requirement that mandates two separate codes, one for the disease and one for the complication
• D. A combination code that classifies the underlying disease together with its associated complication

14. When abstracting a diagnosis from a physician's documentation, a coder encounters a condition described only as 'possible' or 'probable' in the outpatient record. In outpatient coding, how should such an uncertain diagnosis generally be handled?

• A. Code the condition as if it were confirmed, to capture the highest level of specificity available
• B. Code the documented signs, symptoms, or findings rather than the unconfirmed condition
• C. Omit the encounter from coding entirely until the physician confirms or rules out the condition
• D. Query the payer for permission to report the possible diagnosis as an established condition

15. A coder abstracting a procedure notes that the documentation describes services beyond what a single base code captures. Which action best supports accurate reporting when the documented work exceeds the base procedure description?

• A. Split the encounter across two separate dates of service to justify reporting the additional codes
• B. Report only the base code and ignore the additional documented work, since it is included in the global package
• C. Report the additional documented service using the appropriate add-on or supplemental code when supported
• D. Round up to a more expensive code in an unrelated family that better reflects the total work performed

16. A coder is assigning a code for a surgical procedure performed through an endoscope. Which principle applies?

• A. The endoscopic code is reported in addition to the open code, with modifier 51 on the lesser of the two
• B. Approach is irrelevant to CPT selection, because relative values are assigned to the procedure, not the technique
• C. The approach documented determines code selection, so an endoscopic approach requires the endoscopic code
• D. Open and endoscopic approaches use interchangeable codes, because the anatomic result of the procedure is the same

17. A CPT code is designated as an add-on code with a plus symbol. How must it be reported?

• A. Always in addition to a primary procedure code, and never alone
• B. Alone, as a standalone service
• C. With modifier 51 appended to reduce payment
• D. Only when the primary procedure is performed on a different date

18. Modifier 59 is used to identify a distinct procedural service. What is the primary compliance concern with this modifier?

• A. It may only be appended to evaluation and management codes, so reporting it on a surgical procedure triggers an automatic denial of the entire claim
• B. It always reduces the reimbursement for the second procedure, so it should be replaced with modifier 51 whenever two procedures are performed during the same operative session
• C. It is required on every claim that lists more than one procedure, so omitting it causes the secondary procedures to be denied as duplicates
• D. It can be misused to bypass edits that correctly bundle services, so it must be supported by documentation of a genuinely separate encounter, site or session

19. A CPT code description is preceded by a bullet symbol in the codebook. What does this indicate?

• A. The code is exempt from modifier 51 reporting
• B. The code includes moderate (conscious) sedation
• C. The code's descriptor has been revised this edition
• D. The code is new for the current edition

20. A medical coder is reviewing an operative report and must select the code that most precisely reflects the documented procedure. When two codes could apply but one describes the service to a greater level of specificity, which principle should guide the selection?

• A. Assign both codes and append modifier 59 to the second so the payer can decide which one to reimburse
• B. Assign whichever code carries the higher reimbursement, since both are supported by the operative report
• C. Assign the more general code to avoid over-reporting, because a specific code invites closer payer scrutiny in audits
• D. Assign the code that describes the service to the highest level of specificity supported by the documentation

21. A coder selects a CPT code for a procedure with multiple components (e.g., evaluation, preparation, and execution). The CPT descriptor for the code states 'includes.' What does this convention tell the coder?

• A. The components listed are optional and may be reported separately with modifier 51 when each is performed
• B. The components listed are add-on services that increase the total reimbursement when they are documented
• C. The provider may choose to report the components separately or bundled, depending on the payer's policy
• D. The components listed are included in the code value and should not be separately reported

22. A physician evaluates a patient at the request of another physician seeking a specialist's opinion on a specific problem, and sends a written report of findings back to the requesting physician. Which three elements must generally be present to support reporting this encounter as a consultation?

• A. Request, refusal of the opinion, and re-evaluation by the requesting provider
• B. Referral for transfer of care, treatment, and a discharge summary sent to the primary provider
• C. Registration, review of the outside records, and reimbursement by the requesting provider
• D. Request, render (an opinion or service), and report back to the requesting provider

23. A patient is within the global postoperative period of a prior unrelated surgery performed by the same physician and presents with a new, unrelated problem that the physician evaluates and manages during an office visit. Which modifier is appended to the E/M code to indicate the visit is unrelated to the prior surgery's global period?

• A. Modifier 24
• B. Modifier 79
• C. Modifier 58
• D. Modifier 78

24. A patient is seen for a preventive medicine visit, and during the same encounter the physician also evaluates and treats a new significant problem. How is this reported?

• A. Report the preventive medicine code with modifier 22 to reflect the additional work of the problem evaluation
• B. Report the preventive medicine code plus the appropriate problem-oriented E/M code with modifier 25
• C. Report only the preventive medicine code, because any problem addressed during a wellness visit is included
• D. Report only the problem-oriented E/M code at a higher level to account for the preventive counseling

25. Modifier 25 is appended to an evaluation and management code. What does it signify?

• A. An E/M service reduced in scope because part of the visit time was devoted to performing the procedure
• B. A preventive rather than problem-oriented E/M service provided on the same day as a minor procedure
• C. A significant, separately identifiable E/M service by the same physician on the same day as another procedure
• D. An E/M service performed by a physician of a different specialty in the same group on the same day as the procedure

26. For evaluation and management purposes, how is a new patient defined?

• A. One who has never been seen at the current practice location, even if the same physician treated the patient at a previous office location within the past three years
• B. One whose insurance coverage has changed since the last visit, because the new payer has no claims history for the patient with the physician
• C. One who has not been seen by any physician in the group within the past twelve months, regardless of that physician's specialty or subspecialty
• D. One who has not received a professional service from the physician or another physician of the same specialty in the same group within the past three years

27. Under current evaluation and management guidelines for office visits, what determines the level of service?

• A. The patient's insurance plan type and the place of service reported
• B. Medical decision making or total time on the date of the encounter
• C. The number of history and examination bullet elements documented
• D. The number of diagnoses listed on the claim, weighted by their severity

28. Which three elements comprise medical decision making for evaluation and management leveling?

• A. Total time, place of service and the number of prescriptions written on the date of the encounter
• B. Chief complaint, review of systems and past history, weighted by the number of systems addressed
• C. Number and complexity of problems, amount and complexity of data, and risk of complications
• D. History, examination and counseling, each scored against the 1995 or 1997 documentation guidelines

29. When coding multiple wound repairs of the same classification and anatomic group, how are the lengths handled?

• A. Average the lengths and report the code for the mean length with modifier 22 for the extra work
• B. Report each wound with its own code, appending modifier 59 to every repair after the first
• C. Add the lengths together and report a single code for the combined length
• D. Report only the longest wound, because the smaller repairs are included in the larger one

30. During one office visit a dermatologist performs a punch biopsy of a suspicious lesion on the back and a tangential (shave) biopsy of a different lesion on the left arm; both specimens are sent to pathology. What is reported for the biopsies?

• A. 11104 for the punch biopsy and 11102 for the tangential biopsy, each as a primary code with modifier 59 on the second
• B. 11102 for the tangential biopsy plus add-on 11105 for the punch biopsy of the second lesion
• C. 11104 with two units, because both lesions were sampled with a full-thickness biopsy technique
• D. 11104 for the punch biopsy plus add-on 11103 for the tangential biopsy of the second lesion

31. A dermatologist excises a biopsy-proven basal cell carcinoma from the left forearm. The lesion measures 1.5 cm at its widest point, the surgeon takes 0.3 cm margins on each side, and the defect is closed with a single-layer closure. Which CPT reporting is correct?

• A. 11603 plus 12002, reporting the single-layer closure of the 2.1 cm excision site as a separate simple repair
• B. 11602, because the lesion itself measures 1.5 cm and falls in the 1.1 to 2.0 cm tier of the malignant series
• C. 11403, because the excised diameter of 2.1 cm is reported from the benign series for the trunk, arms or legs
• D. 11603, because the excised diameter is 2.1 cm (1.5 cm lesion plus 0.3 cm margins on each side) in the malignant series

32. A wound repair is documented as requiring layered closure of deeper subcutaneous tissue and superficial fascia. How is this classified for CPT purposes?

• A. Adjacent tissue transfer
• B. Intermediate repair
• C. Simple repair
• D. Complex repair

33. A wound-care physician documents sharp surgical debridement of necrotic subcutaneous tissue from a sacral pressure ulcer measuring 6 cm by 8 cm (48 sq cm). Muscle, fascia and bone are not involved. Which codes are reported?

• A. 97597 plus 97598, selective debridement of an open wound, first 20 sq cm and each additional 20 sq cm
• B. 11042 for the first 20 sq cm plus 11045 with two units for the remaining 28 sq cm of subcutaneous debridement
• C. 11042 with three units, one unit for each 20 sq cm segment of the 48 sq cm wound surface
• D. 11043 plus 11046, because a pressure ulcer of this size is assumed to extend into the muscle layer

34. In the emergency department a physician performs single-layer closures of a 2.5 cm laceration of the scalp and a 4.0 cm laceration of the right forearm. No debridement, undermining or layered closure is documented. How is the repair reported?

• A. 12004, because two wounds closed in one session are reported at the next higher length tier
• B. 12001 for the 2.5 cm scalp wound plus 12002 for the 4.0 cm forearm wound, listed as two repairs
• C. 12002 for the forearm plus 12011 for the scalp, because the scalp is a separate anatomic site
• D. 12002, one code for the summed 6.5 cm of simple repair in the same anatomic grouping

35. A patient has seven actinic keratoses on the face and the dorsum of both hands destroyed with liquid nitrogen cryosurgery during a single office visit. Which CPT codes and units are reported?

• A. 17110 with one unit, because destruction of up to 14 lesions by any method is reported by lesion count
• B. 17000 with seven units, one unit for each premalignant lesion that was destroyed
• C. 17004, the code for destruction of premalignant lesions when more than five lesions are treated
• D. 17000 for the first lesion plus 17003 with six units for the second through seventh lesions

36. At 20 weeks of gestation a twin pregnancy has a complete transabdominal obstetric ultrasound with full fetal anatomic survey and maternal evaluation of both fetuses. Which codes are reported?

• A. 76805 with two units, one complete after-first-trimester study for each fetus that was examined
• B. 76801 plus 76802, first-trimester study for the first gestation plus each additional gestation
• C. 76811 plus 76812, detailed fetal anatomic examination for the first gestation plus each additional gestation
• D. 76805 for the first gestation plus add-on 76810 for the additional gestation

37. A patient undergoes a diagnostic imaging study interpreted by one radiologist, and later the same day a covering radiologist from a different practice repeats the same study and provides a new interpretation. Which modifier does the covering radiologist append to indicate the service was repeated by a different physician?

• A. Modifier 76
• B. Modifier 59
• C. Modifier 25
• D. Modifier 77

38. A hospital performs a two-view chest X-ray with its own equipment and technologist; a radiologist in private practice interprets the images and signs the report. How does the radiologist report the service?

• A. 71046 with modifier 26, the professional component of a two-view chest radiograph
• B. 71046 without a modifier, the global service, because a single report covers the entire study
• C. 71047 with modifier 26, the professional component reported at the three-view level
• D. 71046 with modifier TC, because the radiologist did not own the equipment used for the study

39. An interventional radiologist performs a percutaneous needle core biopsy of the liver using CT guidance for needle placement and documents the guidance in the report. Which codes are reported?

• A. 47000 plus 77012, percutaneous needle biopsy of the liver plus CT guidance for needle placement
• B. 47000 plus 76942, percutaneous needle biopsy of the liver plus ultrasonic guidance for needle placement
• C. 47000 plus 77002, percutaneous needle biopsy of the liver plus fluoroscopic guidance for needle placement
• D. 47000 alone, because imaging guidance is included in every percutaneous organ biopsy code in CPT

40. A 52-year-old asymptomatic woman has her annual screening mammogram: two digital views of each breast with computer-aided detection, plus screening digital breast tomosynthesis of both breasts. What is reported?

• A. 77067 plus 77062, screening mammography, bilateral, plus diagnostic digital breast tomosynthesis, bilateral
• B. 77066 plus 77063, diagnostic mammography, bilateral, including computer-aided detection when performed, plus screening digital breast tomosynthesis
• C. 77067 with two units, one screening mammogram per breast, plus 77063 for the tomosynthesis
• D. 77067 plus add-on 77063, screening mammography, bilateral, including CAD, plus screening digital breast tomosynthesis, bilateral

41. Which pair of modifiers distinguishes the professional component from the technical component of a diagnostic service?

• A. Modifier 91 for the professional component and modifier 76 for the technical component
• B. Modifier 51 for the professional component and modifier 50 for the technical component
• C. Modifier 26 for the professional component and modifier TC for the technical component
• D. Modifier TC for the professional component and modifier 26 for the technical component

42. A CT of the abdomen and pelvis is performed first without contrast and then repeated after intravenous contrast administration in the same session. Which code is reported for the study?

• A. 74160 plus 72193, CT abdomen with contrast plus CT pelvis with contrast, reported per body region
• B. 74178, CT abdomen and pelvis without contrast in one or both regions followed by contrast material(s) and further sections
• C. 74176 plus 74177, CT abdomen and pelvis without contrast plus CT abdomen and pelvis with contrast
• D. 74177, CT abdomen and pelvis with contrast material(s), because the diagnostic portion was the contrast phase

43. During right knee arthroscopy the surgeon performs a partial medial meniscectomy and also shaves fibrillated articular cartilage (chondroplasty) in the lateral compartment of the same knee. No loose body is removed. What is reported?

• A. 29881 plus G0289, the Medicare code for chondroplasty in a different compartment of the same knee
• B. 29880, because surgical work was performed in both the medial and the lateral compartments
• C. 29881 plus 29877 with modifier 59, because the chondroplasty was performed in a separate compartment
• D. 29881 alone; the code includes chondroplasty in the same or a separate compartment when performed

44. An orthopedist performs a closed reduction of a displaced distal radius fracture under sedation, confirms alignment with fluoroscopy, and applies a short arm cast. The same surgeon will provide all follow-up care. What is reported?

• A. 25600 plus 29075, closed treatment without manipulation plus application of the short arm cast
• B. 25605 alone; the initial cast application is included in the fracture treatment code
• C. 25605 plus 29075, closed treatment with manipulation plus the short arm cast applied at the same session
• D. 25607, because a displaced fracture that requires reduction is reported with the open treatment code

45. An operative report describes correction of a right hallux valgus deformity by a distal chevron osteotomy of the first metatarsal with medial capsulorrhaphy and resection of the medial eminence. Which CPT code applies?

• A. 28292, correction of hallux valgus with resection of the proximal phalanx base, when performed, any method
• B. 28296, correction of hallux valgus with distal metatarsal osteotomy, any method
• C. 28295, correction of hallux valgus with proximal metatarsal osteotomy, any method
• D. 28297, correction of hallux valgus with first metatarsal and medial cuneiform joint arthrodesis, any method

46. An arthroscopic repair of a full-thickness rotator cuff tear of the right shoulder is performed together with arthroscopic subacromial decompression with partial acromioplasty and release of the coracoacromial ligament. Which codes are reported?

• A. 29827 alone, because decompression of the subacromial space is integral to any arthroscopic rotator cuff repair
• B. 29827 for the arthroscopic rotator cuff repair plus add-on 29826 for the subacromial decompression
• C. 23412 plus 29826, open repair of a chronic rotator cuff tear plus the arthroscopic subacromial decompression
• D. 29826 alone, since the decompression with acromioplasty is the more extensive of the two procedures

47. A physician injects 40 mg of triamcinolone acetonide into the right knee joint using real-time ultrasound guidance; the guidance image is permanently recorded and a report is documented. Which codes are reported for the service?

• A. 20610 for the major joint injection plus 76942 for the ultrasound guidance plus J3301 with four units
• B. 20606 for the intermediate joint injection with ultrasound guidance plus J3301 with one unit for the 40 mg dose
• C. 20611 plus 76942, because the permanent recording of the guidance image is a separately reportable service
• D. 20611 for the injection with ultrasound guidance plus J3301 with four units for the drug

48. An emergency physician evaluates a patient with a nondisplaced distal radius fracture, applies a static short arm splint, and refers the patient to an orthopedist who will assume all definitive fracture care. Which reporting is correct for the emergency physician?

• A. 25600 for closed treatment without manipulation, because the initial immobilization of the fracture was applied
• B. 25600 with modifier 54 for surgical care only, plus 29125 for the application of the short arm splint
• C. The E/M service alone, because splint application is never separately reportable in the emergency department
• D. The E/M service with modifier 25 plus 29125 for the splint application; the fracture care code is not reported

49. A cardiothoracic surgeon performs coronary artery bypass grafting using the left internal mammary artery to the left anterior descending artery and one saphenous vein graft to the right coronary artery. Which codes are reported?

• A. 33510 alone with modifier 22, venous grafting single with increased procedural services for the arterial graft
• B. 33510 plus 33533, venous grafting single plus arterial grafting single, each reported as a stand-alone code
• C. 33533 for the single arterial graft plus add-on 33517 for the single venous graft of the combined procedure
• D. 33533 alone, because the arterial graft is the primary bypass and the vein is only a secondary conduit

50. A pulmonologist performs flexible bronchoscopy with bronchoalveolar lavage of the right lower lobe and endobronchial biopsies of two separate sites in the left mainstem bronchus. Which codes are reported?

• A. 31628 plus 31624, transbronchial lung biopsy of a single lobe plus the bronchoalveolar lavage
• B. 31624 for the lavage plus 31625 for the endobronchial biopsies, with only one unit of 31625
• C. 31622 plus 31624 plus 31625, the diagnostic bronchoscopy plus each additional service performed
• D. 31624 plus 31625 with two units, one unit for each endobronchial site that was biopsied

51. A cardiologist implants a new dual-chamber permanent pacemaker: a pulse generator with transvenous leads positioned in the right atrium and the right ventricle. Which code reports the insertion?

• A. 33249, insertion or replacement of a permanent implantable defibrillator system with transvenous lead(s)
• B. 33207, insertion of a new or replacement permanent pacemaker with transvenous electrode(s); ventricular
• C. 33208, insertion of a new or replacement permanent pacemaker with transvenous electrode(s); atrial and ventricular
• D. 33207 plus 33206, ventricular insertion plus atrial insertion reported as two separate procedures

52. An otolaryngologist performs bilateral endoscopic maxillary antrostomies and removes polypoid tissue from both maxillary sinuses; a diagnostic nasal endoscopy is documented at the start of the case. What is reported?

• A. 31267 with modifier 50; the diagnostic endoscopy is included in the surgical sinus endoscopy
• B. 31237 with modifier 50, nasal/sinus endoscopy, surgical, with biopsy, polypectomy or debridement
• C. 31267 for the right side plus 31256 for the left side, because tissue removal is reported per sinus
• D. 31256 with modifier 50 plus 31231, bilateral maxillary antrostomy plus the diagnostic nasal endoscopy

53. For a patient with breast cancer the surgeon injects isosulfan blue dye intraoperatively, identifies two deep axillary sentinel nodes, and excises them through an open incision for frozen section. Which codes does the surgeon report?

• A. 38525 plus 38792, open biopsy or excision of deep axillary node(s) plus injection of radioactive tracer for sentinel node identification
• B. 38525 plus add-on 38900, open biopsy or excision of deep axillary node(s) plus intraoperative identification of sentinel node(s) with dye injection
• C. 38500 plus 38900, open biopsy or excision of superficial lymph node(s) plus intraoperative sentinel node mapping
• D. 38745, axillary lymphadenectomy, complete, because more than one lymph node was removed from the axilla

54. A patient with a large right pleural effusion undergoes ultrasound-guided needle thoracentesis; 1.2 liters of fluid are aspirated and no catheter is left in place. Which code is reported?

• A. 32551, tube thoracostomy, including connection to a drainage system (water seal) when performed
• B. 32555, thoracentesis, needle or catheter, aspiration of the pleural space; with imaging guidance
• C. 32554 plus 76942, thoracentesis without imaging guidance plus ultrasonic guidance for needle placement
• D. 32557, pleural drainage, percutaneous, with insertion of an indwelling catheter; with imaging guidance

55. A general surgeon performs an open repair of an initial, reducible umbilical hernia in a 45-year-old; the fascial defect measures 2 cm and a polypropylene mesh is placed. Which CPT code is reported?

• A. 49591, anterior abdominal hernia repair, initial, total defect length less than 3 cm, reducible; mesh included
• B. 49593, anterior abdominal hernia repair, initial, total defect length 3 cm to 10 cm, reducible, with mesh
• C. 49592, anterior abdominal hernia repair, initial, total defect length less than 3 cm, incarcerated or strangulated
• D. 49613, anterior abdominal hernia repair, recurrent, total defect length less than 3 cm, reducible

56. During a colonoscopy on a commercially insured patient the gastroenterologist removes a 1 cm sigmoid polyp with a snare and takes cold-forceps biopsies of a separate flat lesion in the ascending colon. How is this reported?

• A. 45385 plus 45380 without a modifier, because the two lesions are documented in different colon segments
• B. 45385 for the snare polypectomy plus 45380 with modifier 59 (or XS) for the biopsy of the separate lesion
• C. 45378 plus 45385 plus 45380, the diagnostic colonoscopy plus each therapeutic technique that was performed
• D. 45385 alone, because a biopsy taken during the same colonoscopy is always bundled into the polypectomy

57. A laparoscopic cholecystectomy with intraoperative cholangiography is begun, but dense adhesions force conversion to an open approach and the cholecystectomy with cholangiography is completed open. How does the surgeon report the case?

• A. 47605 only, open cholecystectomy with cholangiography; the abandoned laparoscopic approach is not reported
• B. 47563 with modifier 53 plus 47605, the discontinued laparoscopic procedure plus the completed open procedure
• C. 47563 plus 47605 with modifier 51, both approaches reported with the multiple-procedure modifier
• D. 47600 plus 47563, open cholecystectomy plus the laparoscopic cholecystectomy with cholangiography

58. A 24-year-old undergoes laparoscopic appendectomy for acute appendicitis with perforation and generalized peritonitis; no abscess is found. Which CPT and ICD-10-CM codes are reported?

• A. 44970 with K35.80, laparoscopic appendectomy with acute appendicitis, unspecified
• B. 44970 with K35.201, laparoscopic appendectomy with acute appendicitis with generalized peritonitis, with perforation, without abscess
• C. 44970 plus 44955 with K35.32, laparoscopic appendectomy plus the add-on for an incidental appendectomy
• D. 44960 with K35.201, open appendectomy for ruptured appendix with abscess or generalized peritonitis, with perforation, without abscess

59. An esophagogastroduodenoscopy is performed with cold-forceps biopsies of the gastric antrum and of the second portion of the duodenum; a brushing of the distal esophagus is also obtained. What is reported for the physician?

• A. 43239 plus 43235 with modifier 59, because the esophageal brushing is a distinct specimen collection
• B. 43239 with one unit; the code describes biopsy, single or multiple, and brushing is included in every EGD code
• C. 43239 with two units, one unit for each organ from which biopsy specimens were taken
• D. 43235 plus 43239, the diagnostic EGD with brushing plus the EGD with biopsy, with modifier 51

60. A patient presents with a painful thrombosed external hemorrhoid. In the office the surgeon excises the hemorrhoid together with the overlying skin under local anesthesia. Which code is reported?

• A. 46083, incision of thrombosed hemorrhoid, external, with evacuation of the clot
• B. 46221, hemorrhoidectomy, internal, by rubber band ligation(s), single or multiple
• C. 46255, hemorrhoidectomy, internal and external, single column or group
• D. 46320, excision of thrombosed hemorrhoid, external

61. In a physician office a urine specimen is tested with a 12-class immunoassay cup that is read by direct visual observation of the color lines; the result is negative for every class. What is reported?

• A. 80306, presumptive drug test read by instrument-assisted direct optical observation, one unit per date
• B. 80305 with 12 units, one unit for each drug class that was screened on the cup
• C. 80307, presumptive drug test by instrumented chemistry analyzers, because the cup uses immunoassay chemistry
• D. 80305 with one unit, presumptive drug test(s), any number of drug classes, read by direct optical observation

62. A child with pharyngitis has a rapid group A streptococcus antigen test performed on a throat swab using a visually read lateral-flow cartridge; the result is negative and a backup throat culture for group A strep is set up in the office laboratory. Which codes are reported?

• A. 87880 plus 87070, the rapid antigen test plus culture, bacterial, any other source except urine, blood or stool, aerobic, with isolation and presumptive identification of isolates
• B. 87430 plus 87081, strep A antigen by enzyme immunoassay technique plus culture, presumptive, pathogenic organisms, screening only
• C. 87880 plus 87081, strep A antigen by immunoassay with direct optical observation plus culture, presumptive, pathogenic organisms, screening only
• D. 87651 plus 87081, strep A by nucleic acid amplified probe technique plus culture, presumptive, pathogenic organisms, screening only

63. A laboratory test is repeated on the same day to obtain subsequent results. Which modifier reports this?

• A. Modifier 59
• B. Modifier 77
• C. Modifier 91
• D. Modifier 76

64. A dermatologist submits three separately identified skin excision specimens from three different lesions in three labeled containers. The pathologist grosses and examines each microscopically and issues one report. What does the pathologist report?

• A. 88305 with three units, one unit for each separately identified specimen requiring individual examination
• B. 88304 with three units, level III surgical pathology, gross and microscopic, for skin specimens
• C. 88307 with one unit, level V surgical pathology for a multi-specimen skin case
• D. 88305 with one unit, because a single pathology report was issued for the encounter

65. An office laboratory performs a complete blood count on an automated hematology analyzer that also generates an automated white blood cell differential. Which code is reported?

• A. 85027 plus 85004, complete CBC, automated, plus automated differential WBC count
• B. 85027 plus 85007, complete CBC, automated, plus a manual differential WBC count on a blood smear
• C. 85025, complete CBC, automated (Hgb, Hct, RBC, WBC and platelet count) and automated differential WBC count
• D. 85027 alone, complete CBC, automated, with the differential included in the base count

66. A physician orders a basic metabolic panel together with albumin, total bilirubin, alkaline phosphatase, total protein, ALT and AST on one venous specimen; the same laboratory performs every test. How is the laboratory work reported?

• A. 80048 plus 82040, 82247, 84075, 84155, 84460 and 84450, the basic metabolic panel plus each additional test
• B. 80053 plus 80048, the comprehensive metabolic panel plus the basic metabolic panel because both were ordered
• C. 80053, the comprehensive metabolic panel, because every component test of that panel was performed
• D. 80048 plus 80076, the basic metabolic panel plus the hepatic function panel, since both groups were ordered

67. Ureteroscopy is performed for a 7 mm left distal ureteral stone; the stone is fragmented with a holmium laser and an indwelling double-J ureteral stent is left in place at the end of the case. Which code(s) are reported?

• A. 52353 plus 52332, ureteroscopy with lithotripsy plus insertion of the indwelling ureteral stent
• B. 52353 with modifier 22, ureteroscopic lithotripsy with increased procedural services for placing the stent
• C. 52356 plus 52332 with modifier 51, lithotripsy including the stent plus cystourethroscopy with insertion of indwelling ureteral stent as a second procedure
• D. 52356, cystourethroscopy with ureteroscopy and/or pyeloscopy; with lithotripsy including insertion of indwelling ureteral stent

68. A pediatrician performs a Gomco clamp circumcision on a 5-day-old newborn after administering a dorsal penile nerve block with lidocaine. Which code is reported?

• A. 54160, circumcision, surgical excision other than clamp, device or dorsal slit; neonate (28 days of age or less)
• B. 54150 plus 64450, circumcision using a clamp plus injection of an anesthetic agent into a peripheral nerve
• C. 54150 with modifier 52, reduced services, because the procedure was performed on a neonate
• D. 54150, circumcision using clamp or other device with regional dorsal penile or ring block

69. A surgeon removes the entire thyroid gland for a nontoxic multinodular goiter; no lymph node dissection is performed and the final pathology is benign. Which CPT and ICD-10-CM codes are reported?

• A. 60220 with modifier 50 and E04.2, total thyroid lobectomy, unilateral, reported bilaterally with modifier 50
• B. 60252 and E04.2, thyroidectomy, total or subtotal for malignancy; with limited neck dissection
• C. 60240 and E04.2, thyroidectomy, total or complete, with nontoxic multinodular goiter
• D. 60225 and E04.9, total thyroid lobectomy with contralateral subtotal lobectomy, nontoxic goiter, unspecified

70. An obstetrician who provided none of the antepartum care performs a cesarean delivery and then provides all of the routine postpartum care, including the six-week office visit. Which code is reported?

• A. 59515, cesarean delivery only; including postpartum care
• B. 59510, routine obstetric care including antepartum care, cesarean delivery and postpartum care
• C. 59514 plus 59430, cesarean delivery only plus postpartum care only (separate procedure)
• D. 59514 alone, because postpartum visits are included in the global surgical package of any delivery

71. A urologist performs cystourethroscopy and transurethral resection of a 3.0 cm bladder tumor; the tumor base is fulgurated after the resection. Which CPT code is reported?

• A. 52234, cystourethroscopy with fulguration and/or resection of small bladder tumor(s), 0.5 cm up to 2.0 cm
• B. 52235, cystourethroscopy with fulguration and/or resection of medium bladder tumor(s), 2.0 cm to 5.0 cm
• C. 52240, cystourethroscopy with fulguration and/or resection of large bladder tumor(s), greater than 5.0 cm
• D. 52224 plus 52204, fulguration of a minor lesion plus cystourethroscopy with biopsy of the tumor base

72. A gynecologist performs a total laparoscopic hysterectomy with bilateral salpingo-oophorectomy for symptomatic leiomyomata; the pathology report documents a uterine weight of 310 g. Which code is reported?

• A. 58573, laparoscopy, surgical, with total hysterectomy, for uterus greater than 250 g; with removal of tube(s) and/or ovary(s)
• B. 58571, laparoscopy, surgical, with total hysterectomy, for uterus 250 g or less; with removal of tube(s) and/or ovary(s)
• C. 58150, total abdominal hysterectomy (corpus and cervix), with or without removal of tube(s), with or without removal of ovary(s)
• D. 58572, laparoscopy, surgical, with total hysterectomy, for uterus greater than 250 g, tubes and ovaries retained

73. An anesthesiologist medically directs one CRNA during a single hip replacement case and meets all of the medical direction requirements. Which anesthesia modifiers are reported on the anesthesiologist's claim and on the CRNA's claim, respectively?

• A. QY on the anesthesiologist's claim and QZ on the CRNA's claim
• B. QY on the anesthesiologist's claim and QX on the CRNA's claim
• C. QK on the anesthesiologist's claim and QX on the CRNA's claim
• D. AA on the anesthesiologist's claim and QZ on the CRNA's claim

74. An anesthesiologist personally performs general anesthesia. The record shows anesthesia start (patient preparation in the operating room) at 08:02, incision at 08:20, end of the procedure at 09:15, and transfer of the patient to the PACU nurse with the anesthesiologist released at 09:32. How many minutes of anesthesia time are reported?

• A. 73 minutes, counted from the documented anesthesia start at 08:02 to the end of the surgical procedure at 09:15
• B. 55 minutes, counted from the surgical incision at 08:20 to the end of the procedure at 09:15
• C. 90 minutes, counted from the anesthesia start at 08:02 to the transfer to postoperative care at 09:32
• D. 72 minutes, counted from the surgical incision at 08:20 to the handoff to the PACU nurse at 09:32

75. A 74-year-old patient requires an emergency open appendectomy at 2 a.m.; the anesthesia code for the procedure is 00840. Which qualifying circumstances add-on codes may be reported with the anesthesia service?

• A. 99140 only, anesthesia complicated by emergency conditions, because the emergency supersedes the age factor
• B. 99116 plus 99140, anesthesia complicated by utilization of total body hypothermia plus emergency conditions
• C. 99100 plus 99140, extreme age (older than 70) plus emergency conditions, both reported in addition to 00840
• D. 99100 only, anesthesia for a patient of extreme age, older than 70, because only one qualifying circumstance may be reported

76. The pre-anesthesia evaluation describes a patient with poorly controlled type 2 diabetes and COPD requiring home oxygen as having severe systemic disease that is not a constant threat to life. Which physical status modifier is appended to the anesthesia code?

• A. P4, a patient with severe systemic disease that is a constant threat to life
• B. P3, a patient with severe systemic disease
• C. P5, a moribund patient who is not expected to survive without the operation
• D. P2, a patient with mild systemic disease

77. A laboring patient receives a neuraxial (epidural) catheter for a planned vaginal delivery. After several hours labor fails to progress and a cesarean delivery is performed under the same epidural. Which anesthesia codes are reported?

• A. 01967 plus add-on 01968, neuraxial labor analgesia for planned vaginal delivery plus cesarean delivery following neuraxial labor analgesia
• B. 01960 plus 01961, anesthesia for vaginal delivery only plus anesthesia for cesarean delivery only, reported as two primary codes
• C. 01961 only, anesthesia for cesarean delivery only, because the cesarean is the definitive procedure and absorbs the labor epidural time
• D. 01967 plus 01961, neuraxial labor analgesia for planned vaginal delivery plus a stand-alone code for the cesarean delivery

78. A 4-year-old receives MMR (measles, mumps and rubella) and varicella vaccines by subcutaneous injection; the pediatrician documents face-to-face counseling with the parent for each vaccine. Which administration codes are reported?

• A. 90460 with two units only, one first-component administration per vaccine, together with 90707 and 90716
• B. 90460 with one unit plus 90461 with three units, counting four components across the two vaccines
• C. 90471 plus 90472, immunization administration for the first vaccine plus each additional vaccine
• D. 90460 with two units plus 90461 with two units, together with product codes 90707 and 90716

79. In a physician office an IV antibiotic is infused over 100 minutes through a peripheral IV; afterward 45 minutes of normal saline hydration is infused through the same line for dehydration. Which codes are reported?

• A. 96365 plus 96366 plus 96361, therapeutic infusion initial and each additional hour plus hydration as the subsequent service
• B. 96360 plus 96361 plus 96365 with modifier 59, hydration initial and additional hour plus the antibiotic as a distinct initial service
• C. 96365 plus 96366 plus 96360, therapeutic infusion initial and additional hour plus hydration initial
• D. 96365 plus 96361, therapeutic infusion initial plus hydration each additional hour, omitting the second hour of the antibiotic

80. In an oncology office a patient receives two chemotherapy drugs by intravenous infusion: the first drug runs for two hours, then a second, different drug is infused sequentially for 45 minutes through the same IV line. Which codes are reported?

• A. 96413 plus 96415 plus 96413 with modifier 59, reporting the second drug as a distinct initial chemotherapy infusion
• B. 96413 plus 96417 with two units, the initial infusion plus the second hour and the second drug each as a sequential infusion
• C. 96413 with two units plus 96415, one initial infusion for each drug plus the additional hour of the first drug
• D. 96413 plus 96415 plus 96417, initial infusion up to one hour, each additional hour, and each additional sequential infusion of a different drug

81. An osteopathic physician performs osteopathic manipulative treatment of the cervical, thoracic, lumbar and sacral regions during a visit for chronic back pain. Which OMT code is reported?

• A. 98927, osteopathic manipulative treatment, 5-6 body regions involved, because the pelvis is treated with the sacrum
• B. 98925 plus 98926, OMT of 1-2 body regions plus OMT of 3-4 body regions, together covering four regions
• C. 98926, osteopathic manipulative treatment, 3-4 body regions involved
• D. 98925 with two units, osteopathic manipulative treatment, 1-2 body regions, reported twice for four regions

82. A cardiologist performs a left heart catheterization with selective coronary angiography and left ventriculography, including imaging supervision, interpretation and report; no right heart catheterization is performed. Which code is reported?

• A. 93452 plus 93454, left heart catheterization with ventriculography plus coronary angiography reported as two separate procedures
• B. 93458, catheter placement in coronary artery(s) for coronary angiography with left heart catheterization, including intraprocedural injection(s) for left ventriculography when performed
• C. 93454, catheter placement in coronary artery(s) for coronary angiography, including intraprocedural injection(s) for coronary angiography, imaging supervision and interpretation, without left heart catheterization
• D. 93460, catheter placement in coronary artery(s) for coronary angiography with right and left heart catheterization, including ventriculography when performed

83. An open carpal tunnel release is performed on the right wrist: the transverse carpal ligament is divided under direct vision and the median nerve is decompressed. Which code is reported?

• A. 64719, neuroplasty and/or transposition; ulnar nerve at wrist, including Guyon's canal release
• B. 29848, endoscopic release of transverse carpal ligament, which also describes the open technique
• C. 64721, neuroplasty and/or transposition; median nerve at carpal tunnel
• D. 64718, neuroplasty and/or transposition; ulnar nerve at elbow, with anterior transposition

84. After a fall a patient has an acute subdural hematoma over the right frontal lobe with midline shift. A craniotomy is performed and the supratentorial hematoma is evacuated. Which CPT code is reported?

• A. 61313, craniectomy or craniotomy for evacuation of hematoma, supratentorial; intracerebral
• B. 61314, craniectomy or craniotomy for evacuation of hematoma, infratentorial; extradural or subdural
• C. 61510, craniectomy, trephination, bone flap craniotomy; for excision of brain tumor, supratentorial
• D. 61312, craniectomy or craniotomy for evacuation of hematoma, supratentorial; extradural or subdural

85. A pain physician performs a lumbar interlaminar epidural steroid injection at L4-L5 using fluoroscopic guidance to confirm needle placement, and contrast confirms epidural spread. What is reported?

• A. 62323 alone, interlaminar epidural injection, lumbar or sacral, with imaging guidance (fluoroscopy or CT)
• B. 64483, transforaminal epidural injection with imaging guidance, lumbar or sacral, single level
• C. 62321, interlaminar epidural injection, cervical or thoracic, with imaging guidance (fluoroscopy or CT)
• D. 62322 plus 77003, interlaminar epidural injection without imaging guidance plus fluoroscopic guidance for the spinal injection

86. Bilateral lumbar facet joint injections with fluoroscopic guidance are performed at the L3-L4 and L4-L5 levels for diagnostic purposes. Which codes are reported?

• A. 64493 with modifier 50 plus 64494 with modifier 50, first and second levels each reported bilaterally
• B. 64493 with four units, one unit for each facet joint that received an injection
• C. 64493 plus 64494, single level plus second level, with laterality shown by modifiers RT and LT on each line
• D. 64493 with modifier 50 plus 64494 plus 64495, first level bilateral, second level and third level

87. A neurosurgeon performs a lumbar hemilaminotomy with decompression of the nerve roots and excision of herniated disc material at both L4-L5 and L5-S1 through a single incision. Which codes are reported?

• A. 63030 with two units, one unit for each lumbar interspace treated
• B. 63047 plus 63048, laminectomy with facetectomy and foraminotomy, single segment plus each additional segment
• C. 63030 for the first interspace plus add-on 63035 for the additional interspace
• D. 63030 plus 63042, laminotomy at one interspace plus the re-exploration code for the second interspace

88. A coder is assigning a code for a piece of durable medical equipment supplied to a patient at home. Which characteristic identifies a valid HCPCS Level II code for this item?

• A. Three alphabetic characters followed by two numeric digits
• B. A three-to-seven character code with a decimal point
• C. One alphabetic character followed by four numeric digits
• D. Five numeric digits, the same format used by CPT codes

89. A HCPCS J code is defined as "injection, drug X, 10 mg." The provider documents administration of 30 mg. How many units are reported?

• A. 3 units
• B. 1 unit
• C. 30 units
• D. 10 units

90. Which HCPCS Level II code category reports drugs administered other than by the oral method?

• A. The A codes
• B. The L codes
• C. The J codes
• D. The E codes

91. A coder is selecting a code for a supply item not found in the CPT codebook. Where should the coder look for the appropriate code?

• A. ICD-10-CM, whose Chapter 21 Z codes describe the equipment and supplies furnished to the patient
• B. HCPCS Level II, which is designed to identify supplies, equipment, and services not included in CPT
• C. CPT code 99070 (supplies and materials), which reports any supply item that has no specific CPT code
• D. The payer's local coverage policy, which assigns a proprietary item number for each supply dispensed

92. Which prefix means "around" or "surrounding"?

• A. Endo-
• B. Epi-
• C. Hypo-
• D. Peri-

93. A procedure note documents a 'nephrectomy.' Based on the medical terminology root, which organ was removed?

• A. The bladder
• B. The spleen
• C. The kidney
• D. The liver

94. The suffix "-ectomy" in a procedure description indicates what?

• A. Creation of an artificial opening
• B. Surgical repair or reconstruction
• C. Surgical removal or excision
• D. Visual examination with a scope

95. A diagnosis is documented using a medical term ending in the suffix '-itis,' such as appendicitis or bronchitis. What does this suffix indicate about the condition?

• A. Surgical removal
• B. Inflammation
• C. Abnormal narrowing
• D. Formation of a new opening

96. A hospital inpatient coder needs to report a surgical procedure performed during an inpatient admission. Which code set is used to report inpatient procedures instead of CPT?

• A. HCPCS Level II
• B. ICD-10-CM
• C. ICD-10-PCS
• D. CPT Category I

97. Which code set is maintained by the American Medical Association and reports physician and outpatient procedures and services?

• A. HCPCS Level II
• B. ICD-10-CM
• C. ICD-10-PCS
• D. CPT

98. When a clinical documentation specifies that a procedure was performed, which coding system should the coder select to describe the specific procedure and its technical components?

• A. CPT, which describes specific procedures, services, and technical components
• B. ICD-10-PCS, which reports procedures performed during inpatient hospital admissions
• C. ICD-10-CM, which classifies the diagnoses, symptoms and reasons for the encounter
• D. HCPCS Level II, which reports supplies, drugs and equipment not described in CPT

99. Which term refers to the layer of skin containing blood vessels, nerves and hair follicles, lying beneath the epidermis?

• A. The subcutaneous layer
• B. The stratum corneum
• C. The fascia
• D. The dermis

100. Which body system includes the pancreas in its endocrine function?

• A. The lymphatic system only, because the pancreas drains into the thoracic duct
• B. The endocrine system, through the islet cells producing insulin and glucagon
• C. The integumentary system, through the sweat glands that respond to insulin
• D. The urinary system, because pancreatic enzymes are cleared through the kidneys