AAPC CPC - Certified Professional Coder (CPC) Exam

1. Procedure and CPT® Code Selection:

The scenario describes the fabrication of an ocular prosthesis due to a severe injury to the left eye. A prosthesis made from silicon materials was created and customized to restore cosmetic appearance.

Code 21088 is the correct CPT® code for facial prosthesis involving materials, such as silicone, specifically designed to address anatomical loss in the eye region. This code accurately reflects the custom fabrication of a prosthesis to replace or augment damaged eye structures for aesthetic purposes.

2. Ruling Out Other Options:

Code 21077 applies to the prosthetic augmentation or replacement of mandibular or maxillary bone, not ocular prostheses, so it does not apply here.

Code 21080 covers the fabrication of facial prosthetics but is not specific to the ocular area and is more generalized. Given the focused nature of the eye, 21088 is more appropriate.

Code 21086 pertains to the creation of orbital prostheses (used for areas surrounding the eye) but not specifically for an ocular prosthesis. Since this scenario involves an intraocular replacement, 21088 is the most precise choice.

3. AAPC and CPT® Guidelines:

According to AAPC guidelines, using codes for facial prosthetics requires matching the specific anatomical site and purpose of the prosthesis. CPT® 21088 is directly applicable to prosthetic replacements within the ocular region, making it the best fit.

Thus, based on the CPT® guidelines and coding standards, the verified answer is C. 21088.

The documented service is an upper GI endoscopy (EGD) withesophageal dilationperformed using aguidewireand a passed dilator (“dilation performed over the guidewire”). In CPT, when a therapeutic endoscopic service is performed, you report thetherapeutic EGD code, not the separate diagnostic EGD code, because diagnostic visualization is inherent in performing the therapeutic procedure. Therefore,43235(diagnostic EGD) is not additionally reported. The key distinction between the dilation codes offered is the method:43248describes EGD withesophageal dilation using a guidewire technique(bougie/dilator passed over a guidewire), which matches the narrative: guidewire placed in the antrum, scope removed, and a dilator passedover the guidewireinto the stomach area. Code43249generally reflects balloon dilation of the esophagus performed endoscopically; the note does not describe balloon inflation, diameter, or balloon equipment. The hiatal hernia findings and dysphagia indication support medical necessity but do not change code selection. Thus, the correct CPT code is43248alone.

Procedure: The physician performed a liver biopsy using ultrasonic guidance.

CPT® Codes:

47000: This code is for the liver biopsy.

76942-26: This code is for ultrasonic guidance for needle placement, with modifier -26 indicating the professional component.

Code Selection Justification: The CPT® code 47000 specifically captures the liver biopsy, and 76942-26 accurately represents the ultrasonic guidance utilized during the procedure.

AMA CPT® Professional Edition (current year)

ICD-10-CM (current year)

HCPCS Level II (current year)

00537 = Anesthesia for EP procedures

P1 = Normal healthy patient

The procedure involved the placement of an intra-aortic balloon pump (IABP) through the right common femoral artery for a patient with acute MI and severe left main arteriosclerotic coronary artery disease.

Procedure Description:

Placement of an intra-aortic balloon pump (IABP).

Right common femoral artery approach.

Confirmation of good waveform and securement of the catheter.

CPT® Coding:

33975: Insertion of intra-aortic balloon assist device, percutaneous.

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

CPT® Assistant for detailed coding guidelines on cardiac procedures.

73562 = Knee X-ray, 3 views

-26 = Professional component only

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.

Break the term into parts:“oophor-”refers to theovary, and“-ectomy”meanssurgical removal/excision. The modifier“bilateral”meansboth sides(right and left). Put together,bilateral oophorectomymeanssurgical removal of both ovaries. This is commonly confused withsalpingectomy(removal of fallopian tube[s]) andhysterectomy(removal of uterus). CPC terminology questions often use these closely related female-reproductive terms as distractors, so the safest approach is to anchor on the root: “oophor” = ovary, “salping” = fallopian tube, “hyster/uter” = uterus. If it were removal of both tubes, it would bebilateral salpingectomy; removal of uterus (open or laparoscopic) is still a hysterectomy, not an oophorectomy. The “bilateral” part is critical—without it, an oophorectomy could be unilateral (one ovary).

The prefix “sub-” means below or under.

Common examples include subcutaneous (below the skin) and sublingual (under the tongue).

This is a core concept tested under medical terminology on the CPC exam.

For a mastectomy that involves removing the breast tissue, skin, pectoral muscles, and surrounding tissue, including the axillary and internal mammary lymph nodes, the appropriate CPT® code is:

19306: Mastectomy, radical, including pectoral muscles, axillary lymph nodes.

This code captures the extent of the surgery, including the removal of the breast tissue, skin, pectoral muscles, and lymph nodes.

CPT® Professional Edition (current year)

Surgery guidelines for mastectomy procedures