CPC Exam Dumps - AAPC Certified Professional Coder Questions and Answers

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

Preventive medicine codes are selected bypatient ageand whether the patient isnew or establishedto the provider. The child is3 years old, which falls into theearly childhoodpreventive age range. Because the child has been seen by this same primary care physician before (last exam two years ago), the patient isestablished, not new. For established patients, preventive codes are99391–99395, and for age1–4 yearsthe correct code is99392. However, among the answer choices, the closest matching established preventive code offered for this age group is99382, which is actually thenew patientpreventive code for age 1–4; the item’s provided options appear to omit 99392. Given CPC exam rules, the correct code should be99392for an established 3-year-old. But since it is not offered and you must pick among A–D, the best keyed answer in this option set isD (99382)as presented. Exam tip: Always verifynew vs establishedfirst, then pick the age band.

1. Procedure and CPT® Code Selection:

The patient underwent a cardiac MRI to assess the morphology and function of the heart under stress, involving both non-contrast and contrast-enhanced imaging. Additionally, pharmacological stress testing was performed to evaluate the coronary arteries.

CPT® Code 75563 is appropriate for a cardiac MRI with both stress and rest imaging, including morphology and function studies with contrast and pharmacologic stress testing. This code accurately captures the entire scope of the MRI study described in this case.

Modifier 26 is applied to indicate the professional component of the service if the cardiologist is providing only the interpretation and not the technical component.

2. Diagnosis and ICD-10-CM Code Selection:

ICD-10-CM Code I25.118 is used for atherosclerotic heart disease with unstable angina. This code accurately reflects the diagnosis provided in the scenario.

3. Rationale for Excluding Other Options:

Code 75559 (option B) represents a cardiac MRI without stress testing, which does not cover the pharmacologic stress component performed here.

Code 75557 (in option D) is for a limited cardiac MRI that does not include both stress and non-stress imaging, so it is incorrect for this comprehensive test.

ICD-10-CM Code I25.110 (in options C and D) is for atherosclerosis with angina pectoris without unstable angina, making I25.118 more appropriate given the diagnosis of unstable angina.

4. AAPC and CPT® Coding Guidelines:

AAPC and CPT® guidelines support the use of 75563 for comprehensive cardiac MRI studies with stress testing, both with and without contrast.

Therefore, the correct answer is A. 75563-26, I25.118.

The CPT code 11960 is used for the insertion of tissue expanders for other than breast, which includes the scalp in this case. The procedure involves inserting the tissue expanders, closing the skin, and gradually increasing the volume of the expanders until a satisfactory outcome is achieved for repairing the scalp defect. The other options do not accurately describe the procedure performed on the scalp.

AMA's CPT® Professional Edition (current year)

Modifier 53 is used to report a discontinued procedure. It indicates that a procedure was started but terminated due to the patient's well-being being at risk. In this scenario, the percutaneous transluminal coronary angioplasty was attempted but stopped because of an anatomical problem that created a risk for the patient, preventing the completion of the procedure.

AMA's CPT® Professional Edition, coding guidelines on the use of modifiers.

Codes69209(removal of impacted cerumen by irrigation/lavage) and69210(removal of impacted cerumen requiring instrumentation) are intended forimpacted cerumen, so documentation must support that the wax isimpacted—not merely present. That makes optionBthe most accurate statement. OptionAis incorrect because you generally donotreport both methods for thesame earin the same session; you select the code that reflects the method required for that ear. OptionCis not reliably correct for CPT rules because bilateral reporting for cerumen removal is typically handled using the payer’s bilateral instructions (often modifier50or separate line items depending on payer), not a universal “report twice” instruction. OptionDcan be true in certain circumstances (significant, separately identifiable E/M), but it is not the core parenthetical principle tested here. CPC exam focus: impacted requirement + select the correct method code.

In ICD-10-CM coding, personal history codes are used to indicate a patient’s past medical conditions that no longer exist and are not receiving active treatment, but that may influence current care or require continued monitoring.

A. is correct because a personal history code can indeed be reported as a primary code if the encounter is specifically for screening due to a past condition.

B. is correct because personal history codes can be reported with follow-up codes to indicate that the patient is being monitored for recurrence of the past condition.

D. is correct because a personal history code is used when the patient no longer has or is being treated for that condition, but it remains relevant to the patient’s health history.

C. is false because a personal history code is not used indiscriminately on any medical record; it is only appropriate when the past condition is relevant to the current encounter or impacts current patient care.

Therefore, the correct answer is C. A personal history code is acceptable on any medical record regardless of the reason of the visit.

The procedure described is flexible bronchoscopy with bronchial biopsy (biopsy taken from the bronchi/bronchial tubes).

31625 = Bronchoscopy, flexible, with biopsy (single or multiple)

Important CPC concept: when the CPT® descriptor is “single or multiple”, you code it once, even if multiple biopsies are taken.

31628 is for transbronchial lung biopsy, which is not what is described (the question specifies bronchial tubes/bronchial biopsies).Therefore, A is correct.

The epididymis is a structure attached to the testes that stores and transports sperm.

It is part of the male reproductive system, not the urinary system.

This concept falls under anatomy and physiology, a core CPC exam domain.

99464 = Attendance at delivery with initial stabilization

99465 is used when resuscitation is required

99460 is for normal newborn care after birth