AAPC CPC - Certified Professional Coder (CPC) Exam

1. Procedure and CPT® Code Selection:

The patient underwent a lymphangiography of both arms in an outpatient radiology setting to evaluate suspected lymphangitis.

CPT® Code 75803 is for bilateral lymphangiography of an extremity. This code covers lymphangiography procedures where multiple images are obtained in the study of lymphatic channels and nodes in an extremity.

2. Modifier for Bilateral Procedure:

Modifier 50 is applied to indicate that the procedure was performed bilaterally (on both arms). This modifier appropriately reflects the bilateral nature of the lymphangiography.

3. Rationale for Excluding Other Options:

Code 75801 is for lymphangiography of a single extremity and does not apply to bilateral procedures.

Code 75801-50 (option B) would indicate bilateral use of a code meant for a single extremity, which is not appropriate when a specific bilateral code, 75803, is available.

Option C, without the bilateral modifier, would not indicate that both arms were examined.

4. AAPC and CPT® Coding Guidelines:

AAPC guidelines specify using 75803 for bilateral lymphangiography procedures of extremities, and Modifier 50 is applied for clarity on bilateral involvement.

Therefore, the correct answer is D. 75803-50.

1. E/M Code Category Selection:

The patient is a 19-year-old seen by his primary care physician for an annual preventive exam. His last exam was four years ago, and he has no complaints, indicating a preventive rather than problem-focused visit.

CPT® Code 99385 is for a new patient preventive visit for ages 18-39. Since the patient’s last visit was four years ago, this qualifies him as a new patient by CPT® standards (a patient is considered new if they have not received any professional services from the physician within the past three years).

2. Rationale for Excluding Other Options:

Code 99395 is for an established patient preventive visit for ages 18-39, which does not apply here since the patient is considered new after four years.

Code 99394 is for a preventive visit for an established patient aged 12-17, which does not match the patient’s age.

Code 99384 is for a new patient preventive visit for ages 12-17, which also does not apply given the patient’s age of 19.

3. AAPC and CPT® Coding Guidelines:

According to CPT® guidelines, 99385 is appropriate for a new patient in the 18-39 age range for a preventive visit, especially when they have not seen the provider in over three years.

Therefore, the correct answer is A. 99385.

The patient with malignant lymphoma is administered Rituximab (800 mg) and Benadryl (100 mg) intravenously.

Procedure Description:

Administration of Rituximab (800 mg) intravenously.

Administration of Benadryl (100 mg) intravenously.

HCPCS Level II Coding:

J9312: Injection, Rituximab, 10 mg.

For 800 mg, report 80 units of J9312.

J1200: Injection, Diphenhydramine HCl, up to 50 mg.

For 100 mg, report 2 units of J1200.

References:

HCPCS Level II Code Book (current year).

HCPCS Level II coding guidelines for intravenous drug administration.

The emergent endovascular repair of an infrarenal abdominal aortic aneurysm with an aorto-aortic tube endograft is coded with CPT 34702. This code includes the deployment of the endograft and the necessary balloon angioplasty for sealing the proximal and distal attachment zones.

References:

AMA's CPT® Professional Edition (current year)

The correct CPT® code for a therapeutic drug test to monitor the total level of carbamazepine is 80156. The ICD-10-CM code G40.909 is used for epileptic seizures, not otherwise specified, which aligns with the patient's condition being treated for seizures.

References:

AMA's CPT® Professional Edition (current year)

ICD-10-CM (current year)

The procedure involves the aspiration of fluid from an ovarian follicle to retrieve the egg under radiologic guidance.

Procedure Description:

Aspiration needle insertion.

Puncture of the ovary and preovulatory follicle.

Withdrawal of fluid containing the egg.

Radiologic guidance was used.

CPT® Coding:

58976: Aspiration of ovarian follicle(s) with ultrasound guidance.

References:

AMA's CPT® Professional Edition (current year).

CPT® Assistant for detailed coding guidelines on reproductive procedures.

According to ICD-10-CM Guidelines, I11A.0 (Resistant hypertension) is used to indicate hypertension that remains uncontrolled despite the use of multiple antihypertensive medications. Resistant hypertension is coded to highlight the severity of the patient’s condition and the difficulty in managing their blood pressure. This code is added as a secondary code to reflect the persistent elevation of blood pressure despite medication.

A. I10 (Essential hypertension) is a general code for primary hypertension but does not specify resistance to treatment.

B. A code from category I27 is related to pulmonary heart diseases, not directly related to hypertension management issues.

D. A code from category I16 (Hypertensive crisis) is used for hypertensive emergencies or urgencies, which are acute episodes, not persistent uncontrolled hypertension despite treatment.

Thus, the correct answer is C. I11A.0, Resistant hypertension.

In medical billing, Place of Service (POS) code 31 is used to indicate that a service was performed in a skilled nursing facility (SNF). POS codes are standardized by the Centers for Medicare & Medicaid Services (CMS) to specify the location where services are provided.

A. 32 refers to a nursing facility (NF), which is different from a skilled nursing facility in terms of the level of care provided.

B. 20 indicates urgent care facility.

C. 22 is used for outpatient hospital services.

Thus, the correct answer is D. 31 for a skilled nursing facility.

End-Stage Renal Disease (ESRD) is a condition in which the kidneys fail to work effectively to remove waste products and excess fluids from the blood. This primarily affects the genitourinary system, which includes the kidneys, ureters, bladder, and urethra. Patients with ESRD often require dialysis or a kidney transplant.References: ICD-10-CM (current year), Chapter 14: Diseases of the Genitourinary System (N00-N99).

1. Procedure and CPT® Code Selection:

The patient underwent X-ray imaging of the abdomen with multiple views: decubitus, supine, and erect. This is a comprehensive study that includes different positioning to evaluate the abdomen.

CPT® Code 74022 is appropriate for an abdominal X-ray with a minimum of three views. This code accurately reflects the multiple views taken in this scenario.

2. Modifier 26:

Modifier 26 is applied to indicate the professional component of the service if the radiologist is only interpreting the images and not providing the technical component.

3. Rationale for Excluding Other Options:

Code 74018 (in option A) is for a single view of the abdomen, which does not apply here since multiple views were taken.

Code 74019 (in option C) covers two views of the abdomen, which is insufficient for this three-view study.

Code 74021 (in option D) represents an abdominal X-ray with more limited or focused views and does not align with the comprehensive three-view study described.

4. AAPC and CPT® Coding Guidelines:

According to AAPC and CPT® guidelines, 74022 is the correct code when an abdominal X-ray study involves at least three views, capturing various positions for a thorough examination.

Therefore, the correct answer is B. 74022-26.