CPC Exam Dumps - AAPC Certified Professional Coder Questions and Answers

CPT code 99385 is used for initial comprehensive preventive medicine evaluation and management of an individual, including a detailed history and examination, and anticipatory guidance. Since additional documentation and treatment for non-inflamed lesions are provided, an additional E/M service code 99203 with modifier -25 (significant, separately identifiable evaluation and management service by the same physician on the same day) is appropriate to indicate both services were rendered. References: CPT® Professional Edition (current year), AMA.

The key phrase is “remove the sequestered section of dead infected fragment bone”, which is a sequestrectomy performed for osteomyelitis.

23172 describes sequestrectomy of the scapula (shoulder blade).Therefore, C is correct.

1. Procedure and CPT® Code Selection:

The patient had a cochlear implant placed in the left ear and is now seeing the audiologist for initialization and programming of the implant.

CPT® Code 92603 is specific for initial programming of a cochlear implant for patients younger than 12 years old. This includes the setup and initial adjustments required for the cochlear implant, making it the correct code.

2. Rationale for Excluding Other Options:

Code 92626 is used for evaluating auditory function with the cochlear implant, focusing on assessment rather than programming, and is therefore incorrect for this programming session.

Code 92630 is for aural rehabilitation following cochlear implant, which does not apply to the programming/initiation stage.

Code 92604 is for subsequent programming sessions after the initial programming and is therefore not applicable for the first-time programming.

3. AAPC and CPT® Coding Guidelines:

According to AAPC guidelines, 92603 is the appropriate code for initial programming of a cochlear implant in children under 12 years of age.

Therefore, the correct answer is D. 92603.

1. Procedure and CPT® Code Selection:

The scenario describes the removal and replacement of an inflatable penile prosthesis due to erectile dysfunction.

CPT® Code 54416 is specifically used for the removal and replacement of a multi-component inflatable penile prosthesis. This code accurately describes the procedure performed.

2. Rationale for Excluding Other Options:

Code 54401 represents the initial insertion of a multi-component inflatable penile prosthesis but does not cover removal and replacement, making it inappropriate for this scenario.

Code 54400 is for the insertion of a non-inflatable (malleable) penile prosthesis, which does not apply here as the prosthesis is inflatable.

Code 4417 does not exist in the CPT® coding system and is likely a typo or incorrect option.

3. AAPC and CPT® Coding Guidelines:

According to AAPC and CPT® guidelines, 54416 is the correct code when an inflatable prosthesis requires both removal and replacement, without the need for additional modifiers for this procedure.

Therefore, the correct answer based on CPT® guidelines is D. 54416.

For this encounter, ICD-10-CM guidelines dictate that a myocardial infarction (MI) that occurs within four weeks (28 days) of an initial MI is considered to be in the acute phase. Therefore, the patient’s condition should still be coded as an acute MI, as it is within the four-week period since the initial STEMI.

B. I21.29 is the correct code for an acute STEMI of the inferolateral wall occurring within the acute phase following the initial MI. The code I21.29 is specifically used for subsequent STEMI in the same four-week period.

Explanation of incorrect options:

A. I22.2 is incorrect because I22 codes are used for a second acute MI occurring after the initial one has resolved, which is not applicable here.

C. I21.19 and D. I21.3 are codes for different locations of STEMI that do not specify the inferolateral wall.

Therefore, the correct answer is B. I21.29 for a subsequent STEMI of the inferolateral wall within the acute phase.

According to ICD-10-CM burn guidelines:

When burns of different degrees occur at the same site, only the highest degree is coded, not separate codes.

The other statements are true:

Necrosis is coded as a non-healed burn

Burn codes include electrical and radiation burns

The highest degree burn is sequenced first

Under HIPAA (Health Insurance Portability and Accountability Act), PHI stands for Protected Health Information. It includes any individually identifiable health information related to a patient’s health status, provision of healthcare, or payment for healthcare. Protection of PHI is a key compliance topic on the CPC exam.

55970 = Female-to-male sex transformation

55980 is for male-to-female transformation

Unlisted codes (58999, 55899) are not used when a specific CPT® code exists

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

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

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

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

Thus, the correct answer is D. Removing excess skin in losing weight from a gastric bypass, as it can be essential for physical health and quality of life.

1. Procedure and CPT® Code Selection:

The procedure involves an incision and drainage (I & D) of a deep abscess (felon) on the palmar surface of the right thumb. A felon is an abscess in the pulp of the fingertip, often involving deep tissue.

Code 26010 is specific for incision and drainage of a finger abscess, which includes the thumb. This code applies to cases where the abscess is drained from a deep tissue level.

Code 26011 is similar but involves the use of extensive drainage or debridement, which is not indicated in this case. Therefore, 26011 is not appropriate here.

Code 10061 refers to incision and drainage of abscesses at different locations on the body but not for specific areas such as the thumb, making it inappropriate in this context.

Code 10140 pertains to the evacuation of hematoma, seroma, or fluid but does not apply to abscesses, so it is not suitable for this scenario.

2. Modifier:

Modifier F5 is added to specify that the procedure was performed on the right thumb.

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

ICD-10-CM Code L02.511 is appropriate for cutaneous abscess of the right finger, as it accurately describes the diagnosis of a felon on the thumb.

L03.011 would represent cellulitis but does not specify an abscess, making it less precise for this case.

4. AAPC and CPT® Coding Guidelines:

The AAPC guidelines for coding finger abscess drainage emphasize the selection of specific codes for deep tissue drainage procedures in extremities. Additionally, correct laterality should be included with the use of modifiers and specific ICD-10-CM codes for an accurate representation of the site and nature of the condition.

Thus, based on the coding standards and guidelines, the verified answer is B. 26010-F5, L02.511.