AAPC CPC - Certified Professional Coder (CPC) Exam

Medicare provides specific codes for screening colonoscopy based on the patient's risk factors. For a Medicare patient scheduled for a screening colonoscopy who is at high risk (such as those with a history of intestinal polyps), the appropriate code is G0105.

G0105 is used for colorectal cancer screening; colonoscopy on individuals at high risk.

HCPCS Level II, current year

Medicare Guidelines for Colorectal Cancer Screening

1. Procedure and CPT® Code Selection:

The patient required surgical intervention for severe ocular trauma involving removal of a foreign body from the posterior segment of the eye, suturing of the corneal laceration, and a pars plana lensectomy.

CPT® Code 65265 is for removal of a foreign body from the posterior segment of the eye without the use of a magnet. This code is appropriate for the removal of the metallic foreign body using retinal forceps.

CPT® Code 66852 covers the pars plana lensectomy, which was performed as part of the surgical treatment.

CPT® Code 65280 is used for repairing a corneal laceration with multiple perforations, which applies to the corneal suturing.

2. Modifiers:

Modifier RT is used to indicate that the procedures were performed on the right eye.

Modifier 51 is added to indicate multiple procedures performed during the same surgical session.

3. Diagnosis and ICD-10-CM Code Selection:

ICD-10-CM Code S05.51XA is appropriate for penetrating wound of the right eyeball with a foreign body in the posterior segment.

ICD-10-CM Code W31.1XXA is used to indicate that the injury was caused by contact with a metalworking and woodworking machine.

4. Rationale for Excluding Other Options:

Codes 65235 and 65275 in options B, C, and D refer to foreign body removal from the anterior chamber and the anterior segment, respectively, which are not appropriate since the foreign body was located in the posterior segment.

Codes S05.31XA and W31.0XXA in options C and D represent different eye injuries and types of machines, which do not match the scenario described.

5. AAPC and CPT® Coding Guidelines:

According to AAPC guidelines, codes should be selected based on the specific location (posterior segment) and the type of foreign body removal. Each procedure, including the corneal repair, should be coded to capture the full extent of the treatment.

Therefore, the correct answer is A. 65265-RT, 66852-51-RT, 65280-51-RT, S05.51XA, W31.1XXA.

CPT code 99385 is used for initial comprehensive preventive medicine evaluation and management of an individual, including a detailed history and examination, and anticipatory guidance. Since additional documentation and treatment for non-inflamed lesions are provided, an additional E/M service code 99203 with modifier -25 (significant, separately identifiable evaluation and management service by the same physician on the same day) is appropriate to indicate both services were rendered. References: CPT® Professional Edition (current year), AMA.

44010 = Biopsy of small intestine, single or multiple

Reported once only, regardless of number

99393 = Preventive visit, established patient, age 5–11

Preventive codes are based on age and patient status, not time since last visit

This is arepeatdecompression at apreviously operatedlumbar level, described as “repeat exploration laminotomy,” which aligns with there-explorationcode family rather than a primary discectomy code. The procedure includesbilateral foraminotomyat a single lumbar interspace (L1–L2), meaning it is performed onboth sidesat the same level. In the answer choices,63042represents re-exploration/decompression (repeat procedure) and is appropriately markedbilateralwith-50. The foraminotomy component at the lumbar level is represented by63044, also performed bilaterally, so63044-50is appropriate when the code is unilateral by descriptor and the work was done on both sides. Options C and D reference63030/63035, which are associated with lumbar discectomy/decompression primary coding patterns, not the “repeat exploration laminotomy” scenario presented. Option A incorrectly lists 63044 twice rather than using bilateral reporting. Therefore,63042-50, 63044-50is the best match within the provided options.

88299 = Unlisted cytogenetic study

Other unlisted codes are for chemistry, immunology, or pathology

For the excision of an 11 cm lesion with a rotation flap repair, the appropriate CPT codes are 14001 for the adjacent tissue transfer or rearrangement (12 sq cm flap) and 11606-51 for the excision of a malignant lesion including margins, face, ears, eyelids, nose, lips; excised diameter over 4.0 cm. Modifier 51 indicates multiple procedures. The detailed operative report specifies the lesion size and the technique used, justifying these codes.

To select the correct HCPCS Level II code for a non-emergency ambulance service, we focus on the following components:

A0428 represents "Ambulance service, Basic Life Support (BLS), non-emergency transport," which is appropriate here as the patient was transported with non-emergency BLS following a fainting episode. This eliminates options B and D, which indicate "emergency" (A0429).

QM Modifier indicates "Ambulance service provided under arrangement by a provider of services," relevant when a physician arranges the ambulance transport.

PH Modifier specifies "Physician’s office to hospital" transport, matching the scenario where the patient was taken from the physician’s office to the hospital.

Thus, A0428-QM-PH accurately describes a non-emergency BLS transport arranged by a provider from a physician's office to the hospital, aligning with choice A.

For a physician who owns the equipment and interprets the chest X-rays (both frontal and lateral views), code 71046 is used. This code includes both the technical and professional components, as the equipment is owned by the physician group and the physician also provides the interpretation.