AAPC CPC - Certified Professional Coder (CPC) Exam

For a complete bilateral mastectomy with insertion of breast prosthesis performed during the same surgical session, the correct CPT® codes are:

1. 19303-50: This code represents a complete mastectomy (removal of breast tissue) performed bilaterally (indicated by the -50 modifier).

2. 19340-50: This code is for the immediate insertion of a breast prosthesis following mastectomy, also performed bilaterally.

Explanation of other options:

A. 19303-50, 19342-50: Incorrect because 19342 is for the insertion of a breast implant, which differs from a prosthesis.

B. 19305-50, 19340-50: 19305 describes a modified radical mastectomy, which is more extensive than what is documented here.

C. 19325-50: This code represents a breast augmentation procedure, not a mastectomy with prosthesis insertion.

Thus, the correct answer is D. 19303-50, 19340-50, which accurately describes a bilateral mastectomy with prosthesis insertion.

In coding burns, ICD-10-CM guidelines indicate that each burn site is coded separately, specifying the degree, location, and extent of the burn. Additionally, a code for total body surface area (TBSA) burned is included when burns cover more than 10% of the body. Here’s the breakdown:

1. T24.311A: Represents a third-degree burn on the left thigh, initial encounter.

2. T24.312A: Represents a third-degree burn on the right thigh, initial encounter.

3. T21.21XA: Represents a second-degree burn on the anterior chest wall, initial encounter.

4. T21.23XA: Represents a second-degree burn on the upper back, initial encounter.

5. T31.21: Represents burns with 20–29% TBSA involvement, with third-degree burns covering 10–19% of the TBSA.

Explanation of incorrect answers:

A includes an incorrect TBSA code (T31.21).

B has the correct codes but lists an incorrect TBSA code for third-degree burns.

C uses incorrect burn site codes for the areas involved and incorrect TBSA percentages.

Therefore, the correct answer is D. T24.311A, T24.312A, T21.21XA, T21.23XA, T31.21, which accurately captures the burns ' degrees, locations, and TBSA.

Actinic keratoses (AKs) are coded using thepremalignant lesion destructionCPT family17000–17004, regardless of the destruction method (e.g., laser, cryotherapy, electrosurgery), as long as the intent is destruction. Coding is based on thenumber of lesions treated in that session:17000covers thefirstlesion,17003is an add-on code for2–14 additional lesions, and17004is used when treating15 or more lesions. Because the encounter documents destruction of15 AK lesions, CPT requires reporting17004only (not 17000 + multiple units of 17003). Codes17110/17111are for destruction ofbenignlesions (e.g., warts, molluscum), which is the wrong lesion category. On CPC exams, the key is matchingpremalignant vs benignand then selecting the correct code bylesion count threshold—here the threshold is met for17004.

Procedure Coding:

62291 – Injection procedure for myelography and/or CT, cervical

Cisternal puncture at C2 level

72285 – Radiologic supervision and interpretation, cervical discography

77021 – MRI guidance for needle placement

Why Other Options Are Incorrect:

62290 – Lumbar injection

77012 – CT guidance, not MRI

72295 – Lumbar discography imaging

AAPC Coding Principle:

Use modality-specific guidance codes and match spinal level precisely.

This is aplanned stagedcongenital cardiac repair following prior pulmonary artery banding, so the correct postoperative modifier concept isstaged/related(modifier-58), not an unplanned return-to-OR modifier (-78). The operative service includesremoval of the pulmonary artery bandandarterial switch/transposition-type repairof the great vessels (captured in the 33778/33779 family in the answer choices). The case also describes use ofECMOwith central cannulation and management during the procedure, which is reported with the appropriate ECMO initiation/management codes shown as33955and the monitoring/assistant-related component represented by33985in the choices. Because this is thesecond stageof care and described as planned definitive repair, the -58 modifier is appropriate on the reported surgical services in these answer constructs. OptionDcorrectly pairs the staged modifier (-58) with the appropriate congenital repair and ECMO-related coding listed in the question’s options.

The described scope reaches thesigmoid colon, which is consistent with aflexible sigmoidoscopyrather than a full colonoscopy. The key therapeutic action is that the polyps were treated byablation(destruction), not snare excision or biopsy. CPT45346represents flexible sigmoidoscopy withablationof tumor(s), polyp(s), or other lesion(s). You report the sigmoidoscopy ablation codeoncefor the session; you do not multiply it by the number of polyps unless CPT instructions explicitly direct unit reporting (which is not the standard approach for these endoscopic therapeutic codes). For diagnosis, polyps in thesigmoid colonare coded asK63.5 (polyp of colon).K62.1is arectal polypcode and does not fit because the polyps are in the sigmoid colon. Therefore,45346withK63.5is correct. CPC exam tip: match thescope extent(sigmoid) and theremoval method(ablation).

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 patient underwent a partial nephrectomy (removal of part of the left kidney) via a laparoscopic approach.

CPT® Code 50543 is specifically used for a laparoscopic partial nephrectomy, which is an accurate description of this procedure.

2. Rationale for Excluding Other Options:

Code 50548 is used for a laparoscopic radical nephrectomy, which involves the complete removal of the kidney and surrounding structures; therefore, it does not apply to this partial nephrectomy.

Code 50220 represents an open partial nephrectomy, not a laparoscopic approach, and is therefore incorrect for this procedure.

Code 50546 is for a laparoscopic radical nephrectomy with bilateral removal of kidneys, which is not applicable in this case where only a partial removal of the left kidney was performed.

3. AAPC and CPT® Coding Guidelines:

AAPC and CPT® guidelines indicate that the use of 50543 is appropriate for any laparoscopic partial nephrectomy, regardless of the laterality, and it specifically identifies laparoscopic technique over open surgery.

Therefore, based on CPT® guidelines, the correct answer is C. 50543.

For this scenario, two surgeons are working together, each as a primary surgeon. Therefore, the correct coding requires the use of the modifier -62, which indicates co-surgeons.

The transthoracic approach to excise the damaged portion of the vertebral body is coded with 63087.

The insertion of the bone graft and metal plate is coded with 63088.

Both codes are appended with modifier -62 to indicate that two surgeons worked together as primary surgeons on this case.

Rhinoplasty is a surgical procedure performed to reconstruct or reshape the nose. It can be done for cosmetic reasons or to improve breathing function. The term " rhino " refers to the nose, and " plasty " refers to the surgical molding or forming of a part of the body.

AMA ' s CPT® Professional Edition, medical dictionaries