AAPC CPC - Certified Professional Coder (CPC) Exam

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.

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

Place of Service (POS) codes are two-digit numeric codes used on professional claims to identify where a service was performed (e.g., office, inpatient hospital, outpatient hospital).

Reporting an incorrect POS can affect reimbursement and may result in claim denial ✔

POS codes are not alphanumeric

They describe many locations, not just ICU

POS codes are maintained by CMS, not found in the ICD-10-CM code book

1. E/M Service Code Selection:

On day two, the urologist provided an evaluation and management (E/M) service for a hospitalized patient with a low level for the number and complexity of problems addressed, minimal complexity for data reviewed, and moderate risk of complications.

CPT® Code 99232 is for a subsequent hospital care E/M service with a level of "Expanded Problem Focused" history and examination, with Medical Decision Making (MDM) of Moderate complexity. This matches the description provided, as the MDM includes a low number of problems, minimal data, and moderate risk.

2. Rationale for Excluding Other Options:

Code 99233 is for a subsequent hospital care visit with high complexity MDM (e.g., addressing a high number of problems or higher levels of data review), which does not align with the moderate risk described here.

Code 99221 is for initial hospital care, not a subsequent visit.

Code 99231 represents a lower level of subsequent hospital care with straightforward or low complexity MDM, which does not meet the moderate risk criteria in this scenario.

3. AAPC and CPT® Coding Guidelines:

AAPC and CPT® guidelines indicate 99232 as appropriate for subsequent hospital visits with moderate MDM, such as this visit with moderate risk but minimal data complexity.

Therefore, the correct answer is B. 99232.

In CPT® fracture and dislocation care, manipulation refers to the application of force or traction to restore a bone or joint to its normal anatomic position.

This is a key distinction between with manipulation and without manipulation, which directly affects CPT code selection (e.g., 23505 vs. 23500).

Manipulation may be performed closed (no incision) or open (with incision).

Lesion excision codes in the CPT® codebook include the removal of the lesion along with the necessary margins and a simple (nonlayered) closure when performed. These codes do not cover intermediate or complex closures, which are reported separately if performed. The measurement for selecting the appropriate lesion excision code includes the lesion and the margins required for complete excision.

AMA's CPT® Professional Edition, lesion excision guidelines.

“Three-view imaging of both hips and the pelvis” corresponds toCPT 73523(bilateral hips with pelvis, 3–4 views). Because the same study is repeated laterthe same daydue to a new event (fall from bed) and is interpreted by thesame radiologist, the correct repeat modifier concept is-76(repeat procedure by thesamephysician/qualified health professional). The most accurate reporting is73523for the first study and73523-76for the repeat study. Among the provided options,Dis the only choice that includes both73523and the correct repeat-by-same modifier-76. The inclusion of-51in option D reflects a multiple-procedure concept that is not the primary modifier logic for a true repeat of the same radiologic service; however, the CPC exam intent here is to recognize73523and that the repeat isby the same radiologist, requiring-76(not -77). Key learning point: select the correctstudy code by views, then apply-76for same-provider repeat interpretation.

This encounter includes two reportable endoscopic services:esophagoscopy with dilationand asubmucosal injectionperformed via the endoscope. Balloon dilation of an esophageal stricture/stenosis performed transendoscopically is captured by43220(esophagoscopy, flexible, transoral; with transendoscopic balloon dilation of esophagus). The scenario also documents aninjection of Kenalogdelivered endoscopically to the stenotic area; endoscopic injection is reported with43201(esophagoscopy with directed submucosal injection[s]). These services are not mutually exclusive when both are performed and documented, and no separate diagnostic-only esophagoscopy code is reported because the therapeutic codes include the scope. Option D is incorrect because43200is the base diagnostic esophagoscopy and should not be reported in addition to the therapeutic dilation; modifier -59 does not fix that bundling. Options A and B include codes that do not match the described esophagoscopy balloon dilation plus injection combination. Therefore,43220 and 43201is correct.

Procedure Coding:

49186 – Excision or destruction of intra-abdominal tumors, 1–4 tumors

Four tumors excised → correct code selection

Size does not alter code selection once tumor count is determined

Diagnosis Coding:

C48.2 – Malignant neoplasm of peritoneum, unspecified

Pathology confirms malignancy

C76.2 is used for ill-defined sites, not appropriate when peritoneum is specified

Why Other Options Are Incorrect:

B – 49187 is for 5 or more tumors

D – K66.8 = non-malignant peritoneal disorder

Escharotomy is reported using CPT codes16035(escharotomy; initial incision) and16036(each additional incision). Because the operative note statestwo incisionswere made, you report16035 for the first incisionand16036 for the second incision. Reporting 16035 twice is not correct because CPT distinguishes the first incision from each additional incision. “-51” is not the appropriate mechanism here because 16036 is inherently an add-on style “each additional incision” service within the family; you code the correct units rather than applying a multiple-procedure modifier. For diagnosis coding, a third-degree burn of the chest wall is captured withT21.31XA(third-degree burn of chest wall, initial encounter). TBSA is10%, and because all burns are third-degree totaling10%, the TBSA code should reflect10–19% TBSA with 10–19% third-degree, which isT31.11. Option B is the only choice that correctly pairs the CPT structure (initial + additional incision) with the appropriate burn location and TBSA/third-degree severity reporting.