[Sep-2025] AAPC-CPC Dumps Full Questions - Medical Certification Exam Study Guide
Exam Questions and Answers for AAPC-CPC Study Guide
NEW QUESTION # 44
In which scenario would the modifier 53 be appended?
- A. The surgeon decides to terminate a routine colonoscopy when the patient becomeshypertensive before receiving anesthesia in the outpatient procedure room.
- B. An IUD removal is not completed because the patient reports severe pain when thespeculum is inserted.
- C. A patient receives an x-ray of one femur when the doctor ordered bilateral views.
- D. A surgeon decides to stop a gallbladder removal procedure in the hospital operating roomafter the patient has extensive bleeding at the incision site.
Answer: D
Explanation:
Modifier 53 is used to indicate that a procedure was terminated by the provider after anesthesia was given due to extenuating circumstances that affected the health of the patient.
Although option B is similar, the procedure that was discontinued was done so prior to anesthesia in the outpatient setting, in which case modifier 73 would be appended.
NEW QUESTION # 45
A physician inserts a chest tube through the right chest wall and into the pleural cavity to release trapped air in a 19-year-old patient with recurring pneumothorax. A second physician assists in providing moderate sedation. In total, the procedure took 8 minutes. What ICD-IO-CM and CPT codes should the provider report?
- A. 32550, 193.9
- B. 32551, 99156-59, 193.9
- C. 32550-62, 99156, 193.83
- D. 32551, 193.83
Answer: D
Explanation:
The code description "tube thoracostomy" is not clearly stated in the documentation, but CPT crosswalk for a 'tube placement" followed by "chest" leads the coder to CPT 32551. CPT 32550 describes the insertion of a catheter that allows the patient to drain pleural fluid in an outpatient setting. Moderate sedation can be separately billed but only by the provider administering the medication. The 193 series is circumstantial (e.g., spontaneous, acute). Even though the term
"recurrent" is not used, it does describe the background of the patient's condition and so would fall into the other specified diagnosis rather than unspecified.
NEW QUESTION # 46
A 72 -year-old patient is admitted due to atrial fibrillation. A comprehensive electrophysiology study is completed with fluoroscopic guidance, followed by a cardiac catheter ablation during the same procedure. The procedure took 22 minutes, and the patient was moderately sedated. Which CPT codes should the cardiologist report?
- A. 93650, 93619-26-59, 99152
- B. 93656, 77001, 99152, 99153
- C. 93656, 99152
- D. 93650, 93619-26-59, 77001, 99152, 99153
Answer: C
Explanation:
It is common practice to perform both an electrophysiology (EP) study and a cardiac ablation procedure in the same session. These procedures have been bundled in the CPC manual, and the coding of such is dependent on the type of arrhythmia being treated. The EP study and cardiac ablation are not to be reported separately. In this scenario, the patient has atrial fibrillation, which is reported with CPT 93656. When fluoroscopy is used for guidance rather than for diagnostic imaging, it is usually not reported separately from the primary procedure. Moderate sedation can be reported when used, and selection is based on time. CPT 99152 and 99153 are counted in 15-minute intervals. lvVhen the procedure does not fall on a 15-minute interval, it must at least meet the halfway point of the time stated to be reported.
NEW QUESTION # 47
A patient who is experiencing rectal bleeding has a colonoscopy. Prior to the procedure, the provider administers general anesthesi a. What CPT code(s) should be reported?
- A. 45378, 0081147
- B. 45378-47
- C. 0
- D. 45382, 00811
Answer: B
Explanation:
The patient is having the colonoscopy done because they have been experiencing symptoms.
Therefore, the colonoscopy would be considered diagnostic versus screening. CPT crosswalk for a diagnostic colonoscopy is 45378. The documentation gives no indication that any bleeding was identified and controlled. When the surgeon performing the primary procedure is simultaneously administering anesthesia services, modifier 47 is appended rather than billing an additional anesthesia delivery code.
NEW QUESTION # 48
Which option would best fall under a level II HCPC code?
- A. Advanced life support
- B. Diagnostic colonoscopy
- C. A malignant neoplasm
- D. Radiation treatment management
Answer: A
Explanation:
A level II HCPC code describes medical devices, supplies, medication, and/or other services that a provider and/or entity used during a service provided to a patient. Advanced life support (ALS) fits this description because it is a set of life-saving protocols administered in transit.
Radiation treatment management and a diagnostic colonoscopy describe a level I HCPC code, otherwise known as a CPT code. If the patient was asymptomatic and the colonoscopy was for screening purposes only, a level II HCPC code could be assigned. However, a diagnostic procedure implies a past medical/family history that puts the patient at risk and/or symptoms that warrant the procedure. A malignant neoplasm describes an ICD-IO-CM code because it is a diagnosis.
NEW QUESTION # 49
A patient tests positive for coronavirus (SARS-CoV-2) and bronchitis after presenting with a cough. What diagnosis code(s) should be reported?
- A. U07.1,J40, Z20.828
- B. 140, 897.29, R05.9
- C. U07.1,J40
- D. J40,B97.29, Z20.828
Answer: C
Explanation:
The underlying condition should always be first listed, which in this case would be the SARS- COV-2 infection (U07.1). The description of the code then prompts the biller to list the manifestations, which would be the unspecified bronchitis 040). In answer A. cough would not be coded as a symptom because the patients illness is confirmed. Answers C and D, which include a suspected exposure code, can also be eliminated because this code is used only when the existence ofthe illness in the patient is unknown or negative.
NEW QUESTION # 50
A 74-year-old male patient recently had a bone marrow transplant due to aplastic anemi a. At his follow-up visit with the doctor, his blood is drawn and sent to the laboratory to determine if the engraftment was successful. The laboratory evaluates the immature reticulocyte fraction (IRF) using an automated cell counter and total reticulocyte by way of a manual count. What codes should the laboratory report?
- A. 85046, D61.9
- B. 85046, 85044, D61.9, Z94.81
- C. 85046, D61.9, Z79.89
- D. 85046, 85044, D61.9
Answer: A
Explanation:
When a hematologr procedure that could be billed alone is encompassed in another code, only the most complex of the tvo should be reported. Because CPT 85046 includes the reticulocyte count billing CPT 85044 as secondary despite using a different method would be considered an unbundling of services. Per ICD-IO-CM guidelines, an organ or tissue transplant status code is for use "only if there are no complications or malfunctions of the organ or tissue replaced." As the testing is to determine whether the engraftment was successful, a bone marrow transplant status code would not be appropriate until deemed by the provider.
NEW QUESTION # 51
A patient presents to urgent care with complaints of a sore throat, a temperature of 100.2, and pain while urinating. The provider examines the patient and collects a throat swab and urine sample. The following codes are then entered on the patient's claim: R30.9, R07.O, R50.9, N39.O, J03.8, and B95.3. What code(s) should be removed?
- A. R30.9, 102.9 and R50.9
- B. R30.9, J02.9
- C. N39.O, 103.00
- D. 395.3
Answer: A
Explanation:
Pain while urinating 830.9) is a symptom of a urinary tract infection (N39.O), and a sore throat (R07.0) and fever 850.9) are symptoms of acute tonsillitis caused by Streptococcus (103.00).
Neither ofthese three codes should be reported because ICD-IO-CM guidelines stipulate that when a definitive diagnosis is present, signs and/or symptoms should not be additionally listed on the claim.
NEW QUESTION # 52
Modifier 50 is not an appropriate modifier to append on CPT code 52000.
- A. True
- B. False
Answer: A
Explanation:
The statement is true. In general, modifier 50 is not appended on cystourethroscopies because human anatomy has only one bladder. However, if the descriptor includes "with ureteral catherization," the procedure can be performed tvvice and billed once with modifier 50 because there are two ureters. CPT 52000 does not include this descriptor.
NEW QUESTION # 53
A 74-year-old patient presents with a fever. She is admitted into observational care after her labs confirm a diagnosis of pneumoni a. She has a medical history of being HIV positive. How should this be reported?
- A. 99236, 118.9, B20
- B. 99222, B20, 118.9
- C. 99223, 118.9, B20
- D. 99235, B20, 118.9
Answer: B
Explanation:
Hospital inpatient and observation care services (99221-99236) are selected based on the level of medical decision-making. In this scenario, reporting a code from the initial hospital inpatient and observation care services would be most appropriate (99221-99223), as the documentation indicates the patient is being admitted. When leveling this service, consider that the patient has an acute illness with systemic symptoms (pneumonia) and a stable, chronic illness (HIV). Labs were reviewed to confirm the diagnosis, and a decision was made to admit the patient into observation. Therefore, the final level of medical decision-making is moderate, making the E/M code 99222. Even though pneumonia is the reason for admission, ICD-IO-CM guidelines stipulate that a confirmed HIV diagnosis takes precedence in sequencing when the reason for admission is HIV related.
NEW QUESTION # 54
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. R07.9
- B. R07.9, Ell.9, J45.909, 110
- C. Z03.89
- D. Z03.89
Answer: B
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 # 55
Which healthcare professional may NOT report medical nutrition therapy?
- A. Nutritionist
- B. Endocrinologist
- C. Dietician
- D. Registered nurse
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 # 56
A 79-year-old female patient is admitted to a skilled nursing facility for continued monitoring as she completes her course of antibiotics for bronchitis. Upon admission, a nurse practitioner spends 20 minutes with the patient, performing an evaluation of recovery and rebuilding of stamin a. On day 3, the patient's physician completes an initial comprehensive assessment and determines the patient is recovering well on her current dosage of antibiotics. What CPT code should be reported on day 3?
- A. 0
- B. 1
- C. 2
- D. 3
Answer: B
Explanation:
CPT defines an initial nursing facility service (NFS) as "the first encounter with the patient by the admitting physician to nursing facilities." Although the patient can be evaluated and treated by other medical staff in the meantime, only the physician responsible for the admission may report the initial comprehensive visit (99304-99306). If other medical personnel do provide treatment, those visits would be reported using the subsequent nursing facility care encounter codes (99307-
99310). Nursing facility care services require a medically appropriate history and/or examination, and a review of medical decision making. In this scenario, the number and complexity of problems addressed at the encounter is low (one stable, acute illness), the amount and/or complexity of data reviewed or analyzed is straightforward (minimal or none), and the risk of complications and/or morbidity or mortality of patient management is moderate (prescription drug management). After considering that the patient is established, the level of complexity for the visit is considered low and the encounter should be reported with CPT code 99304.
NEW QUESTION # 57
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. 38100, 38999-59
- B. 38120, 49000-51
- C. 49000, 38102
- D. 0
Answer: A
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 # 58
Which of the four chambers in the heart receives deoxygenated blood from the body through the vena cava?
- A. Left ventricle
- B. Left atrium
- C. Right atrium
- D. Right ventricle
Answer: C
Explanation:
After receiving deoxygenated blood from the body through the vena cava, the right atrium pumps blood into the right ventricle. The right ventricle sends the blood to the lungs to be oxygenated. The left atrium receives blood from the lungs through the pulmonary veins and pumps it into the left ventricle via the mitral valve. The left ventricle then distributes oxygenated blood to tissues throughout the body.
NEW QUESTION # 59
What is the difference between presumptive and definitive testing?
- A. Presumptive testing confirms the presence of a drug class; definitive testing identifies thequantity or presence of a drug.
- B. Presumptive testing requires additional observation time; definitive testing requires ablood draw.
- C. Presumptive testing assumes a diagnosis; definitive testing confirms a diagnosis.
- D. Presumptive testing is based on exhibited signs and/or symptoms; definitive testing isbased on lab results.
Answer: A
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 # 60
What describes a surgical procedure that removes a portion of the vertebral body to relieve pressure on the spinal cord and nerves?
- A. Laminectomy
- B. Insertion of interspinous process stabilization device
- C. Spinal fusion
- D. Corpectomy
Answer: D
Explanation:
The insertion of an interspinous process stabilization device is done to increase the space within the neural foramen, release nerve pressure that causes physical pain, and create spinal stabilization. A spinal fusion is a surgical procedure that permanently joins Nto or more vertebrae into one solid bone so that no space exists between them. A laminectomy is a surgical procedure that removes the lamina to enlarge the spinal canal and relieve pressure on the spinal cord and/or nerves.
NEW QUESTION # 61
When seen next to a diagnosis code, the term "Excludes 20 indicates that the condition excluded is not part of the condition represented by the code and that the patient may have both conditions simultaneously.
- A. True
- B. b False
Answer: A
Explanation:
The statement is true. The term "Excludes 2" shows that two seemingly related conditions can be billed in the same encounter. See Section I of the Coding Guidelines in the ICD-IO-CM 2020 edition for reference.
NEW QUESTION # 62
An 88-year-old patient with Medicare comes in for her yearly flu shot. After receiving a 0.5 mL single shot dose of preservative-free Alfuria intramuscularly, the provider observes the patient for 15 minutes to monitor any adverse reactions. How should the provider code for this encounter?
- A. 96372, 90686 Z23
- B. G0008, 90656, Z23
- C. 90471, 90656, Z23
- D. 99211-25, 90471, 90656, Z23, Z03.89
Answer: B
Explanation:
The patient has Medicare insurance and therefore requires the use of an HCPC code (G0008) in place of a CPT intramuscular injection code. The use of an E/M code in answer B is not warranted because the provider only administered services related to the vaccination. The appropriate diagnosis code for any vaccination would be Z23.
NEW QUESTION # 63
A sternal closure using sutures is considered inclusive to CPT 33255 and should not be reported separately.
- A. True
- B. False
Answer: A
Explanation:
The statement is true. Regardless of how a sternal closure is performed, it would be considered integral to this, and any other open cardiac procedure, when a sternal approach is used as the method of exposure. If a sternal closure were performed as the only procedure to repair an injury, the closure would then be reported.
NEW QUESTION # 64
A patient is admitted for chemical burns caused by a leaky car battery. The physician diagnoses the patient with second- and third-degree burns on the right hand and second- degree burns on the left hand. The physician follows up with the patient 3 days later and performs a detailed examination. His findings include an infection that has developed on the right hand as a result of the burn. The patient is started on antibiotics. Code this encounter.
- A. 99231, T23.201A, T23.361A T23.301A, T23.202A T54.2X4A L08.9
- B. 99231, L08.9, T23.701S, T23.662A T54.2XIS
- C. 99232, L08.9, T23.201S, T23.361S, T23.301S, T23.202A T54.2X4A
- D. 99232, T23.701A, T23.662A T54.2XIA, L08.9
Answer: D
Explanation:
The physician's level of medical decision-making was moderate in complexity due to the acute, complicated injury/ illness, the minimal amount and complexity of data reviewed, and the issuance of a prescription drug. Because the patient has already been receiving care in a hospital setting for 3 days, the visit would be considered subsequent hospital care, making the level of inpatient service a 99232 and eliminating answers B and D. A burn caused by a chemical would be considered a corrosion because it is not caused by heat, electricity, and/or radiation, thus eliminating the remaining choice of A. Additionally, when multiple burns on the same anatomic location and laterality are being treated, identify and code only the highest degree of burn recorded in the diagnosis. In this case, only the third-degree burns on the right hand and the second-degree burns on the left hand would be reported. Although the skin infection is a sequela, the seventh character in the corrosion code would remain "A" and sequenced first to indicate that the patient is still receiving active treatment for the reason of admission.
NEW QUESTION # 65
What is NOT a condition related to the thyroid gland?
- A. Hashimoto,s disease
- B. Graves, disease
- C. Acosta disease
- D. Toxic adenoma
Answer: C
Explanation:
Toxic adenoma E05.2- is a thyroid nodule that may secrete hormones into the body that results in an overactive thyroid. Graves' disease E05.0- is an autoimmune disorder that attacks the thyroid, resulting in overactivity. Hashimoto's disease E06.3 is also an autoimmune disorder:
however, it usually results in an underactive thyroid. Acosta disease T 70.29- is altitude sickness.
Even if a coder is unfamiliar with these terms, by locating the ICD-IO-CM code that correlates to the condition, a coder can infer which body system a diagnosis relates to.
NEW QUESTION # 66
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