CPC Practice Test

100 questions · 240 answering minutes.

Original practice booklet. Record your answers, then open explanations after your attempt. Responses stay in this browser when storage is available. This booklet does not predict an official score.

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CPC original practice form — calendar-year 2026 preparation Answer all 100 four-choice questions. Choose one answer for each question and allow 240 minutes for answering and review. The last 10 questions use original medical records, one question per case. Keep answers and explanations closed until you finish your attempt. Use 2026 AMA CPT Professional Edition, ICD-10-CM and HCPCS Level II references for this form. Clinical records explicitly dated September 2026 use FY2026 ICD-10-CM. The October 1 clinical-year transition differs from AAPC's calendar-year exam edition. Actual AAPC examinations allow one copy each of approved current-year or preceding-year books, or eBooks supplied through the exam platform. Consult AAPC's current policy before your examination. The actual examination supplies an online calculator and prohibits physical calculators. Use an electronic calculator for the arithmetic in this practice attempt. This booklet supplies the questions and response workspace; it does not reproduce AAPC's proctoring system or licensed reference-book search interface. The real CPC examination requires at least 70 correct answers out of 100. Your raw result here is study feedback from an original, uncalibrated form and does not predict certification. Domain counts follow the published blueprint. Difficulty labels and the order of the first 90 questions are editorial choices; secure exam ordering and difficulty proportions are not publicly established. Medicare-specific questions identify that payer in their stems. Apply those rules only to the stated setting. No official examination questions or licensed code-book pages are reproduced here.
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Question 1

An operative note calls a procedure an arthrotomy. What does that term describe?
  • ☐ A. Visual examination of a joint
  • ☐ B. Removal of a joint
  • ☐ C. Surgical fusion of a joint
  • ☐ D. An incision into a joint
Show answer and explanation

Response: D

Final answer: An incision into a joint

Arthro- identifies the joint, and -tomy identifies an incision. Removal, fusion and scope examination use different suffixes, so arthrotomy does not describe those procedures. Check the operative details before selecting a code.

Question 2

A procedure record states nephrectomy. Which basic action and organ are named?
  • ☐ A. Removal of the urinary bladder
  • ☐ B. Removal of a kidney
  • ☐ C. Incision into a kidney
  • ☐ D. Surgical fixation of a kidney
Show answer and explanation

Response: B

Final answer: Removal of a kidney

Nephr- identifies the kidney. The -ectomy ending indicates removal, separating this term from an incision or fixation procedure and from an operation on the bladder. The term alone does not settle side, extent or surgical approach.

Question 3

A clinician documents hematemesis. Which symptom does this term identify?
  • ☐ A. Vomiting bile
  • ☐ B. Blood in urine
  • ☐ C. Coughing blood
  • ☐ D. Vomiting blood
Show answer and explanation

Response: D

Final answer: Vomiting blood

Hemat- refers to blood and -emesis to vomiting, so hematemesis identifies blood brought up by vomiting. The symptom wording matters. It does not state a confirmed cause of the bleeding or describe blood passed in urine.

Question 4

A record describes tachypnea. Which observation is consistent with that term?
  • ☐ A. An unusually slow heart rate
  • ☐ B. Complete absence of breathing
  • ☐ C. Abnormally slow breathing
  • ☐ D. Abnormally rapid breathing
Show answer and explanation

Response: D

Final answer: Abnormally rapid breathing

Tachy- means fast and -pnea refers to breathing. Together they describe rapid breathing, while a slow rate uses brady- and a cardiac term refers to the heart. Do not infer a specific disease from this rate description alone.

Question 5

An imaging report describes a vertical section dividing a patient's body into front and back portions. Which plane does this describe?
  • ☐ A. Median
  • ☐ B. Transverse
  • ☐ C. Coronal
  • ☐ D. Sagittal
Show answer and explanation

Response: C

Final answer: Coronal

The section is coronal, or frontal. Dividing anterior from posterior portions distinguishes it from a transverse section, which separates upper and lower portions, and a sagittal section, which separates right from left. Median specifically means a sagittal section through the midline.

Question 6

A procedure note identifies the narrow tube carrying urine from the renal pelvis toward the bladder. Which structure is being described?
  • ☐ A. Collecting duct
  • ☐ B. Renal vein
  • ☐ C. Ureter
  • ☐ D. Urethra
Show answer and explanation

Response: C

Final answer: Ureter

The ureter connects the renal pelvis with the urinary bladder, matching the endpoints in the note. Follow those endpoints. This is neither the urethral route out of the bladder nor a blood vessel, and it lies beyond the kidney's internal collecting structures.

Question 7

A surgeon describes a valve between the left atrium and left ventricle. Which valve is it?
  • ☐ A. Tricuspid
  • ☐ B. Pulmonary
  • ☐ C. Mitral
  • ☐ D. Aortic
Show answer and explanation

Response: C

Final answer: Mitral

The left atrioventricular valve is mitral, also called bicuspid. Tricuspid separates the right atrium and right ventricle. Aortic and pulmonary valves instead sit at the ventricular outlets, so their locations do not match the chamber pair documented here.

Question 8

A forearm note locates one finding near the elbow and another near the wrist. Relative to the elbow finding, how is the wrist finding described?
  • ☐ A. Distal
  • ☐ B. Medial
  • ☐ C. Proximal
  • ☐ D. Cranial
Show answer and explanation

Response: A

Final answer: Distal

Distal points away from the origin. The wrist finding is distal to the elbow finding because it lies farther from the upper limb's attachment at the trunk, while proximal describes a position closer to that attachment. Neither term specifies severity or laterality.

Question 9

A coder knowingly selects a higher-level service than the performed and documented service to increase a Medicare payment. Which practice is illustrated?
  • ☐ A. Upcoding
  • ☐ B. Downcoding
  • ☐ C. A supported code correction
  • ☐ D. Unbundling
Show answer and explanation

Response: A

Final answer: Upcoding

The selected code overstates the service. Knowingly seeking payment for a higher level than the record supports is upcoding, rather than a correction to reflect actual care. A higher reimbursement amount does not justify selecting an unsupported code.

Question 10

A covered office prepares a non-routine disclosure to an insurer for ordinary payment review. No patient authorization, legal mandate or other minimum-necessary exception applies. What should its disclosure review address?
  • ☐ A. The information reasonably needed for the payment-review purpose
  • ☐ B. Only whether the insurer has paid a prior claim
  • ☐ C. Whether the treatment exception automatically covers payment requests
  • ☐ D. Every available record solely because the insurer is the payer
Show answer and explanation

Response: A

Final answer: The information reasonably needed for the payment-review purpose

Apply the payment-review purpose. The office should use its criteria to limit this non-routine disclosure to the information reasonably necessary, while the treatment exception does not automatically extend to ordinary payment review. Whole-record disclosure requires an appropriate need rather than an assumption.

Question 11

A Medicare postoperative visit consists solely of care already included in the surgery’s global payment. No distinct service or exception exists. The practice nevertheless separately bills an E/M service for that included care. What is the compliance problem?
  • ☐ A. Correctly reporting an unrelated postoperative problem
  • ☐ B. Seeking separate payment for a component already included in the global fee
  • ☐ C. Applying an appropriate separate-service exception
  • ☐ D. Treating a new patient encounter as established
Show answer and explanation

Response: B

Final answer: Seeking separate payment for a component already included in the global fee

The postoperative care is already paid through the global service, and the facts supply no distinct service or applicable exception. Billing it again seeks duplicate payment for an included component. A separate E/M code cannot create separateness that the actual care lacks.

Question 12

The Alphabetic Index points a coder to a diagnosis code with a trailing dash. Which action is needed before reporting the code?
  • ☐ A. Verify the complete code and its instructions in the Tabular List.
  • ☐ B. Add zeros until the entry contains seven characters.
  • ☐ C. Report the Index entry without adding characters.
  • ☐ D. Replace the dash with the first character of the diagnosis.
Show answer and explanation

Response: A

Final answer: Verify the complete code and its instructions in the Tabular List.

The Index starts the search. The Tabular List supplies the full code, including required laterality, seventh characters and instructional notes, so an incomplete Index entry cannot be submitted as the diagnosis code.

Question 13

A diagnosis-code category requires a seventh character, but its base code contains only five characters. What fills the sixth position before the required seventh character is added?
  • ☐ A. A zero as a universal placeholder
  • ☐ B. Counting the decimal point as the sixth character
  • ☐ C. The placeholder X
  • ☐ D. Repeating the fifth character
Show answer and explanation

Response: C

Final answer: The placeholder X

Use X in the empty position. The required encounter character must occupy position seven in the code, and the decimal does not supply a code character.

Question 14

Two current diagnoses are both documented and affect an outpatient encounter. One has an Excludes2 note referencing the other. What does that note permit when both conditions otherwise meet reporting requirements?
  • ☐ A. Reporting the second diagnosis only at a later encounter
  • ☐ B. Reporting only the diagnosis listed above the note
  • ☐ C. Reporting both diagnosis codes
  • ☐ D. Replacing both diagnoses with a symptom code
Show answer and explanation

Response: C

Final answer: Reporting both diagnosis codes

Both codes may be reported. An Excludes2 note separates the excluded condition from the content of that code but allows a patient to have both conditions at the same time.

Question 15

A confirmed underlying disease and its manifestation are documented. The Tabular List gives the manifestation a code-first instruction naming the underlying disease. Which sequence follows that instruction?
  • ☐ A. Manifestation alone because it explains the symptoms
  • ☐ B. Either sequence, determined only by code length
  • ☐ C. Manifestation first, then underlying disease
  • ☐ D. Underlying disease first, then manifestation
Show answer and explanation

Response: D

Final answer: Underlying disease first, then manifestation

Follow the code-first instruction. The underlying disease precedes its manifestation when the etiology/manifestation convention applies, including when the manifestation is the immediate reason for care.

Question 16

A provider documents the same condition as both acute and chronic. The Alphabetic Index has separate acute and chronic subentries at the same indentation level, with no applicable combination code. Which coding approach applies?
  • ☐ A. Report both codes, always sequencing the chronic code first.
  • ☐ B. Report only the acute code in every such case.
  • ☐ C. Report both codes, with the acute code first.
  • ☐ D. Report only the chronic code because it predates the acute episode.
Show answer and explanation

Response: C

Final answer: Report both codes, with the acute code first.

Code both forms and sequence acute first. This rule depends on separate acute and chronic Index entries at the same indentation level, rather than simply on how long the patient has had symptoms.

Question 17

An injured patient received an initial assessment elsewhere and now sees a different physician for definitive active treatment. The injury category uses A for initial encounter and D for subsequent encounter. Which seventh character applies to the current active-treatment encounter?
  • ☐ A. D
  • ☐ B. S
  • ☐ C. X
  • ☐ D. A
Show answer and explanation

Response: D

Final answer: A

Active treatment governs the choice. Character A applies while the patient receives active treatment, even after an earlier assessment or when a different physician provides the definitive treatment.

Question 18

A provider documents a specific diagnosis, but the classification has no separate code for that specific form. The Index directs the coder to an NEC entry. What does NEC indicate?
  • ☐ A. An encounter requiring a seventh character
  • ☐ B. Unspecified because documentation is missing
  • ☐ C. A diagnosis that may be coded only in an inpatient setting
  • ☐ D. Other specified
Show answer and explanation

Response: D

Final answer: Other specified

NEC identifies other specified coding. The documentation contains the detail, but the classification places that specified condition in a broader code because an individual code is unavailable.

Question 19

At a September 2026 office visit, a physician documents type 2 diabetes without complications, treated by diet alone. Hyperglycemia, remission and drug use are not documented. Which diagnosis code fits this record?
  • ☐ A. E10.9
  • ☐ B. E11.65
  • ☐ C. E11.9
  • ☐ D. E11.8
Show answer and explanation

Response: C

Final answer: E11.9

E11.9 matches the documented type 2 disease without complications. The record does not support type 1 diabetes, an unspecified complication or hyperglycemia, and diet alone supplies no long-term drug-use code. Verify the Index lead in the Tabular List before reporting.

Question 20

An outpatient office note from September 2026 documents epigastric pain and an assessment of possible gastritis. No definitive cause is established after the evaluation. Which first-listed diagnosis code is supported?
  • ☐ A. R10.9
  • ☐ B. K29.70
  • ☐ C. R10.10
  • ☐ D. R10.13
Show answer and explanation

Response: D

Final answer: R10.13

Outpatient possible diagnoses are not coded as established conditions. R10.13 identifies the documented epigastric pain location, and the office record supports that symptom while the clinician's possible gastritis assessment remains unconfirmed.

Question 21

A September 2026 office encounter evaluates pain in the right shoulder. No injury or underlying disorder is established, and the note does not describe a chronic pain-management visit. Which diagnosis code represents the documented symptom?
  • ☐ A. M25.50
  • ☐ B. M25.511
  • ☐ C. M25.519
  • ☐ D. M25.512
Show answer and explanation

Response: B

Final answer: M25.511

The record identifies the right shoulder. M25.511 preserves both the joint and laterality, while the other choices either reverse the side or discard documented specificity. With no established cause in this outpatient record, coding the evaluated symptom is appropriate.

Question 22

In September 2026, a patient is transferred from urgent care to a physician who actively treats a right-hand laceration by definitive suturing. No foreign body, fracture, infection or tendon damage is present. Which injury code fits this encounter?
  • ☐ A. S61.412A
  • ☐ B. S61.411A
  • ☐ C. S61.411D
  • ☐ D. S61.421A
Show answer and explanation

Response: B

Final answer: S61.411A

Definitive suturing is active treatment. S61.411 identifies a right-hand laceration without a foreign body, and the category requires A during active treatment even when another clinician saw the patient earlier. Routine healing care would use D, while the remaining alternatives change the documented hand or add a foreign body.

Question 23

At a September 2026 office visit, the physician documents type 2 diabetes with diabetic chronic kidney disease, stage 3a. The patient is treated by diet alone, has no hypertension and has no transplant. Which diagnosis-code sequence is supported?
  • ☐ A. E11.22, N18.31
  • ☐ B. E11.22, N18.32
  • ☐ C. E11.9, N18.31
  • ☐ D. N18.31, E11.22
Show answer and explanation

Response: A

Final answer: E11.22, N18.31

Report E11.22 before N18.31. The diabetes code includes the documented kidney complication and instructs the coder to add its stage, while N18 also directs associated diabetic kidney disease to be coded first. Stage 3a is N18.31, not the stage 3b code.

Question 24

A September 2026 record documents 30 units of injected insulin administered in the office, not through an insulin pump. Assume the drug is separately reportable, with no wastage. Which HCPCS drug-code and unit combination represents this amount?
  • ☐ A. J1815, 6 units
  • ☐ B. J1815, 30 units
  • ☐ C. J1815, 1 unit
  • ☐ D. J1817, 6 units
Show answer and explanation

Response: A

Final answer: J1815, 6 units

J1815 represents five insulin units per billing unit. Divide the documented 30 by five to report six units, while J1817 describes insulin delivered through DME such as a pump and does not match this office injection. This calculation addresses the drug, not its administration service.

Question 25

A supplier dispenses a standard-weight walker with a folding frame and wheels. The equipment is not a rigid-frame walker, a pickup walker without wheels or a heavy-duty model. Which HCPCS Level II code identifies the equipment supplied?
  • ☐ A. E0143
  • ☐ B. E0141
  • ☐ C. E0135
  • ☐ D. E0149
Show answer and explanation

Response: A

Final answer: E0143

Match both the frame and wheels. E0143 identifies the folding wheeled walker supplied here, while E0135 describes a folding pickup walker, E0141 a rigid wheeled walker and E0149 a heavy-duty model, so each alternative changes a documented equipment feature.

Question 26

An office administers exactly 1,000 mcg of cyanocobalamin from a supplied drug, with no wastage. Assume the drug is separately reportable. Which HCPCS code and number of drug billing units represents this dose?
  • ☐ A. J3420, 10 units
  • ☐ B. J1815, 1 unit
  • ☐ C. J3420, 1,000 units
  • ☐ D. J3420, 1 unit
Show answer and explanation

Response: D

Final answer: J3420, 1 unit

One J3420 unit covers up to 1,000 mcg of cyanocobalamin, so the exact documented dose requires one drug billing unit. Micrograms are the medication quantity. They are not the number of claim units, and an insulin code would identify the wrong medication.

Question 27

Operative record: A surgeon completely excises a small pilonidal cyst and its short sinus tract. The operative report identifies the excision as simple, without extensive dissection or a complicated repair. This is excision rather than incision and drainage alone. Which CPT procedure code describes the completed operation?
  • ☐ A. 11770
  • ☐ B. 11772
  • ☐ C. 11771
  • ☐ D. 10080
Show answer and explanation

Response: A

Final answer: 11770

The completed excision is simple. Code 11770 fits the documented pilonidal cyst-and-sinus removal, while extensive and complicated excisions have different codes. Incision and drainage alone would not describe the complete removal performed here.

Question 28

Operative record: A physician removes one confirmed benign skin lesion from the upper arm by full-thickness excision. The lesion measures 1.4 cm, and the narrowest planned margin is 0.2 cm on each side, all measured before removal. Simple nonlayered sutures close the defect. Which reporting choice describes the excision and its closure?
  • ☐ A. 11402 only
  • ☐ B. 11402 and a separate simple-repair code
  • ☐ C. 11403 only
  • ☐ D. 11401 only
Show answer and explanation

Response: A

Final answer: 11402 only

Include both margins in the diameter. Adding 1.4 cm and two 0.2 cm margins gives 1.8 cm, placing this benign arm lesion in the 1.1–2.0 cm range for 11402. Simple closure is included, so it does not add a separate repair code.

Question 29

Procedure record: A dermatologist takes a tangential sample from one suspicious skin lesion with a flexible blade solely for diagnostic histopathology. The lesion is not completely removed or destroyed, and no punch or incisional biopsy is performed. Which CPT biopsy code reports this single lesion?
  • ☐ A. 11104
  • ☐ B. 11106
  • ☐ C. 11103
  • ☐ D. 11102
Show answer and explanation

Response: D

Final answer: 11102

This is one tangential biopsy. Code 11102 identifies that diagnostic sampling method, whereas 11103 is an additional-lesion tangential code and the other choices describe punch or incisional sampling. No second lesion or different biopsy technique appears in the record.

Question 30

A Medicare physician excises a single benign trunk lesion with an excised diameter of 0.4 cm, properly represented by 11400. A medically necessary complex repair closes that same defect. What is the reporting result for the excision and repair under the stated Medicare rule?
  • ☐ A. Report 11400 and a separate complex-repair code for that defect.
  • ☐ B. Report 11400 twice, once for excision and once for repair.
  • ☐ C. Omit 11400 and report the complex repair alone.
  • ☐ D. 11400 includes the repair for this small lesion.
Show answer and explanation

Response: D

Final answer: 11400 includes the repair for this small lesion.

For this lesion, the repair is included. CMS specifies that benign-lesion excision codes for an excised diameter of 0.5 cm or less include simple, intermediate and complex repair, so the small-lesion exception controls this case.

Question 31

Procedure record: A dermatologist destroys eight separately documented actinic keratoses with cryotherapy at one visit. No biopsy, excision or other lesion treatment is performed. Which CPT procedure-and-unit combination represents destruction of these eight premalignant lesions?
  • ☐ A. 17004, one unit
  • ☐ B. 17000, one unit, and 17003, eight units
  • ☐ C. 17000, one unit, and 17003, seven units
  • ☐ D. 17000, eight units
Show answer and explanation

Response: C

Final answer: 17000, one unit, and 17003, seven units

Use one first-lesion unit and seven additional units. Report 17000 once for the first actinic keratosis and 17003 seven times for the remaining lesions. The fifteen-or-more-lesion code does not apply to this visit's eight treated lesions.

Question 32

For a Medicare patient, one physician performs Mohs surgery and the pathologic examination included in that Mohs procedure. No separate diagnostic biopsy or unrelated specimen is involved. Which reporting approach applies to the included pathology work?
  • ☐ A. Omit the Mohs code and report pathology alone.
  • ☐ B. Report the Mohs service without separately adding its included pathology service.
  • ☐ C. Add a skin-biopsy code for every Mohs stage.
  • ☐ D. Add a surgical-pathology code solely because slides were examined.
Show answer and explanation

Response: B

Final answer: Report the Mohs service without separately adding its included pathology service.

Mohs includes this pathology work. The same physician performs both the excision and its defining pathologic examination, so an extra pathology code would duplicate a component already captured by the Mohs service.

Question 33

Operative record: Through an arthroscope, the surgeon removes the torn portion of the medial meniscus of the right knee. The lateral meniscus is intact and untreated. Cartilage is shaved in the patellofemoral compartment; no loose body is removed. For this Medicare case, which CPT reporting choice captures the described knee work? Do not include laterality modifiers in your answer.
  • ☐ A. 29870 and 29877
  • ☐ B. 29881 and 29877
  • ☐ C. 29880
  • ☐ D. 29881
Show answer and explanation

Response: D

Final answer: 29881

Only the medial meniscus was treated. Code 29881 includes its meniscectomy and the cartilage work even in another compartment, so adding 29877 for patellofemoral shaving would unbundle the operation and choosing 29880 would incorrectly imply treatment of both menisci.

Question 34

A surgeon begins a planned therapeutic shoulder arthroscopy for a Medicare patient. Inadequate visualization prevents completion of the repair, so the surgeon converts the same operation to an open repair and completes it. No separate diagnostic encounter is involved. Which services should be reported for this converted operation?
  • ☐ A. The attempted therapeutic arthroscopy and the completed open repair
  • ☐ B. The attempted therapeutic arthroscopy only
  • ☐ C. The completed open repair only
  • ☐ D. The diagnostic arthroscopy and the completed open repair
Show answer and explanation

Response: C

Final answer: The completed open repair only

Report the completed open procedure. The arthroscopic attempt was converted rather than completed as a separate service, so neither a surgical nor a diagnostic arthroscopy code should be added for that same operation.

Question 35

Operative record: Using a lateral extracavitary approach through one incision, the surgeon performs arthrodesis at two contiguous thoracic vertebral segments, T10 and T11. Both segments receive the same technique. Which CPT combination reports the two arthrodesis segments? Ignore separately reportable graft or instrumentation work.
  • ☐ A. 22532 twice
  • ☐ B. 22533 and 22534
  • ☐ C. 22532 and 22533
  • ☐ D. 22532 and 22534
Show answer and explanation

Response: D

Final answer: 22532 and 22534

Start with the thoracic primary code. Use 22532 for the first segment and the add-on 22534 for the second contiguous segment, rather than another primary code. The lumbar primary code 22533 would change the documented spinal region.

Question 36

In one treatment session, a physician injects five documented trigger points across three distinct muscles. The record identifies each muscle and the medication used; this is injection therapy, not dry needling. Assuming the service meets applicable coverage requirements, which CPT procedure reporting choice applies? Exclude the drug supply code.
  • ☐ A. 20552, one unit
  • ☐ B. 20553, five units
  • ☐ C. 20553, one unit
  • ☐ D. 20552, three units
Show answer and explanation

Response: C

Final answer: 20553, one unit

The muscle count controls this selection. Five trigger points across three distinct muscles place the treatment under 20553, reported once for the session rather than five times for the needle placements. Code 20552 applies to one or two muscles.

Question 37

A physician aspirates a Medicare patient's shoulder joint and injects one surrounding bursa of that same shoulder during the encounter. No ultrasound guidance is used. Assuming the services are otherwise reportable, which CPT procedure code and unit count describe this joint-and-bursa work? Exclude medication and laterality modifiers.
  • ☐ A. 20611, one unit
  • ☐ B. 20605, two units
  • ☐ C. 20610, one unit
  • ☐ D. 20610, two units
Show answer and explanation

Response: C

Final answer: 20610, one unit

The joint and surrounding bursa share one unit. Report 20610 once for this shoulder treatment without ultrasound, because treating its bursa as well does not establish an additional unit under the stated Medicare rule. Ultrasound-guided treatment would use 20611.

Question 38

Operative record: For degenerative disease, the surgeon performs a primary total replacement of the left hip, inserting both an acetabular component and a femoral prosthesis. This is neither a revision nor treatment of an acute fracture. Which CPT procedure code fits the described operation? Ignore laterality modifiers.
  • ☐ A. 27236
  • ☐ B. 27130
  • ☐ C. 27447
  • ☐ D. 27125
Show answer and explanation

Response: B

Final answer: 27130

Both hip components were replaced. The documented acetabular and femoral components support primary total hip code 27130, while the alternatives would change the operation to a partial replacement, fracture treatment or total knee surgery despite those features being absent from the record.

Question 39

Operative record: A flexible bronchoscope identifies a small aspirated plastic fragment in the right lower-lobe bronchus. The surgeon grasps and completely removes it through the scope. No tissue biopsy or separate therapeutic aspiration is performed. Which CPT reporting choice captures this Medicare bronchoscopic service?
  • ☐ A. 31622 and 31635
  • ☐ B. 31625
  • ☐ C. 31645
  • ☐ D. 31635
Show answer and explanation

Response: D

Final answer: 31635

The foreign body was removed. Code 31635 captures that removal with the diagnostic bronchoscopic examination included, so adding 31622 would duplicate part of the service and selecting a biopsy or therapeutic-aspiration code would substitute work not documented here.

Question 40

A rapidly deteriorating patient requires emergency endotracheal intubation. The physician uses laryngoscopy solely to visualize the airway for placing the tube, with no separate laryngeal disorder examined. Under the Medicare coding rules, which CPT procedure reporting choice fits the encounter?
  • ☐ A. 31500 and 31575
  • ☐ B. 31500 only
  • ☐ C. 31622 only
  • ☐ D. 31575 only
Show answer and explanation

Response: B

Final answer: 31500 only

This was an emergency intubation. Report 31500 for tube placement with the laryngoscopy used only to accomplish it, because that visualization does not establish a separate diagnostic service. The record contains neither an independent laryngeal examination nor a bronchoscopy.

Question 41

During the postoperative period after nasal surgery, the same surgeon returns a Medicare patient to the operating room for treatment of a related hemorrhage. The distinct return procedure is correctly represented by 30903. Which modifier should be appended to that procedure code to show the related, unplanned operating-room return?
  • ☐ A. 79
  • ☐ B. 58
  • ☐ C. 78
  • ☐ D. 25
Show answer and explanation

Response: C

Final answer: 78

The surgeon returned to treat a complication. Modifier 78 identifies this related, unplanned operating-room procedure during the postoperative period, whereas 58 concerns staged or planned work and 79 concerns an unrelated procedure. Modifier 25 applies to an E/M service.

Question 42

Operative record: The surgeon bypasses three obstructed coronary targets using three separate saphenous-vein grafts. No arterial graft is used. Harvest is performed through an open incision. Which single CPT bypass code reports the graft count? Exclude anesthesia and other unrelated services.
  • ☐ A. 33510
  • ☐ B. 33511
  • ☐ C. 33512
  • ☐ D. 33513
Show answer and explanation

Response: C

Final answer: 33512

There are three venous coronary grafts. Their count selects 33512 rather than the neighboring one-, two- or four-graft codes. The open vein procurement belongs to this bypass work and does not change how many coronary grafts were placed.

Question 43

Operative record: One internal-mammary arterial graft supplies a coronary target, and two saphenous-vein grafts supply two other targets. No additional coronary grafts are placed. Which CPT bypass-code combination represents this mix? Exclude harvesting and other services from your answer.
  • ☐ A. 33534 and 33517
  • ☐ B. 33533 and 33511
  • ☐ C. 33535 only
  • ☐ D. 33533 and 33518
Show answer and explanation

Response: D

Final answer: 33533 and 33518

Count the graft types separately. One arterial graft uses 33533 together with two-vein add-on 33518 for this combined operation, because choosing the venous-only 33511 would omit the arterial component and a higher arterial-count code would overstate the single arterial graft.

Question 44

During an open cardiac operation on a Medicare patient, the surgeon inserts a temporary single-chamber transvenous pacing electrode to support that same operation. No separate encounter is involved. The coder proposes adding 33210 to the open cardiac procedure. Which reporting choice follows the NCCI rule?
  • ☐ A. Add 33210 with modifier 59 solely because pacing uses a separate catheter.
  • ☐ B. Report the open cardiac procedure without an additional 33210 for this pacing placement.
  • ☐ C. Report only 33210 and omit the completed open cardiac procedure.
  • ☐ D. Report 33210 twice, once for placement and once for operative monitoring.
Show answer and explanation

Response: B

Final answer: Report the open cardiac procedure without an additional 33210 for this pacing placement.

The pacing supports the open operation. NCCI does not permit an additional 33210 for this placement at the same encounter, and using a separate catheter does not make that included work a distinct service.

Question 45

Procedure record: An upper GI endoscope passes through the esophagus and stomach into the duodenum. The physician takes forceps biopsies from an abnormal gastric area and from the duodenal mucosa, without dilation or another therapeutic procedure. Which CPT reporting choice captures this endoscopic service?
  • ☐ A. 43239, one unit
  • ☐ B. 43239, two units
  • ☐ C. 43249, one unit
  • ☐ D. 43235 and 43239
Show answer and explanation

Response: A

Final answer: 43239, one unit

The biopsies belong to one upper endoscopy. Code 43239 covers single or multiple samples, so sampling both gastric and duodenal tissue does not double its units. The diagnostic examination is included, and no dilation supports 43249.

Question 46

Procedure record: During one complete flexible colonoscopy, the physician removes a sigmoid polyp and a transverse-colon polyp with a snare. No forceps biopsy, submucosal injection or other lesion treatment is performed. Which CPT procedure reporting choice describes the removals?
  • ☐ A. 45385, two units
  • ☐ B. 45380, one unit
  • ☐ C. 45385, one unit
  • ☐ D. 45381 and 45385
Show answer and explanation

Response: C

Final answer: 45385, one unit

Both polyps were removed by snare. Report 45385 once for this colonoscopy despite the two treated lesions, because the procedure captures that removal technique without multiplying units by polyp count or adding biopsy and submucosal-injection services that were not performed.

Question 47

A Medicare colonoscopy record clearly identifies two distinct lesions: a cecal lesion sampled with forceps and a sigmoid polyp completely removed by snare. The biopsy was not taken from the snared polyp. Which reporting choice appropriately distinguishes these procedures? Use modifier 59 when a permitted distinct-service modifier is needed.
  • ☐ A. 45378, 45380 and 45385
  • ☐ B. 45380 and 45385-25
  • ☐ C. 45385 and 45380-59
  • ☐ D. 45385 only, because any biopsy is always included in every snare removal
Show answer and explanation

Response: C

Final answer: 45385 and 45380-59

The lesions are documented separately. The snare work uses 45385, while 45380-59 identifies the distinct cecal biopsy and can bypass this NCCI edit when the record supports separate lesions. No diagnostic-colonoscopy code is added, and modifier 25 concerns E/M.

Question 48

Operative record: The surgeon removes the gallbladder laparoscopically and performs intraoperative cholangiography through the cystic duct. There is no common-duct exploration and no conversion to an open operation. Which single CPT surgical code describes this combination? Do not include a separately reportable professional radiology component in your answer.
  • ☐ A. 47562
  • ☐ B. 47563
  • ☐ C. 47600
  • ☐ D. 47564
Show answer and explanation

Response: B

Final answer: 47563

Cholangiography selects 47563 for this laparoscopic operation. Code 47562 omits that feature, while 47564 requires common-duct exploration and 47600 describes an open procedure. Only the surgical code is requested.

Question 49

Operative record: The surgeon removes an inflamed appendix laparoscopically. The procedure is completed through the ports without conversion, and no other abdominal operation is performed. Which CPT code reports the appendectomy?
  • ☐ A. 44950
  • ☐ B. 44960
  • ☐ C. 44979
  • ☐ D. 44970
Show answer and explanation

Response: D

Final answer: 44970

The appendix was removed laparoscopically. The completed procedure has a specific code, 44970, so an open appendectomy code or the unlisted laparoscopic appendix code is unnecessary. This is treatment of a diseased appendix, rather than incidental removal of a normal one.

Question 50

During a Medicare open colectomy, the surgeon spends substantial additional time freeing dense intestinal adhesions to carry out the operation. The operative note documents the unusual work in detail; the enterolysis is not a separate procedure at a separate site. Which approach may appropriately represent the increased work?
  • ☐ A. Report the colectomy with modifier 22 and supporting documentation.
  • ☐ B. Report 44005 alone and omit the colectomy.
  • ☐ C. Add modifier 25 to the colectomy code to indicate increased surgical work.
  • ☐ D. Add 44005-59 solely because the adhesiolysis took extra time.
Show answer and explanation

Response: A

Final answer: Report the colectomy with modifier 22 and supporting documentation.

The unusual work must be documented. NCCI includes this enterolysis in the colectomy but permits consideration of modifier 22 for extensive, time-consuming work on the primary operation. Additional payment depends on the contractor's review rather than following automatically from that modifier.

Question 51

Procedure record: During one session, a urologist passes a ureteroscope into the left ureter and fragments two stones using a laser. No indwelling stent is left in place, and the right ureter is untreated. Which CPT procedure reporting choice represents this Medicare lithotripsy? Ignore laterality modifiers.
  • ☐ A. 52353, one unit
  • ☐ B. 52351, one unit
  • ☐ C. 52352, two units
  • ☐ D. 52353, two units
Show answer and explanation

Response: A

Final answer: 52353, one unit

One ureter was treated. Report one unit of 52353 for its lithotripsy despite the two fragmented stones, because the unit follows the ureter rather than each stone. Diagnostic 52351 and removal-or-manipulation 52352 would describe different work, and no indwelling stent supports a combination code.

Question 52

Procedure record: Using a cystoscope, a urologist places a self-retaining double-J stent in the right ureter for continued drainage after the encounter. There is no ureteroscopy, lithotripsy or separate stone removal. Which CPT procedure code best describes this placement? Ignore laterality modifiers.
  • ☐ A. 52000
  • ☐ B. 52332
  • ☐ C. 52005
  • ☐ D. 52351
Show answer and explanation

Response: B

Final answer: 52332

The double-J stent remains in place. Code 52332 identifies that self-retaining indwelling device, rather than a temporary catheter, diagnostic cystoscopy or diagnostic ureteroscopy. There is no other definitive stone procedure to alter this selection.

Question 53

Procedure record: A gynecologist visualizes the uterine cavity through a hysteroscope and removes an endometrial polyp. No fibroid resection or endometrial ablation is performed. Which CPT procedure code describes the hysteroscopic polyp-removal service?
  • ☐ A. 58555
  • ☐ B. 58563
  • ☐ C. 58561
  • ☐ D. 58558
Show answer and explanation

Response: D

Final answer: 58558

The polyp was removed hysteroscopically. Code 58558 captures that treatment with the diagnostic inspection included, while 58555 alone would miss the removal and the fibroid resection of 58561 or ablation of 58563 would add a different procedure absent from the record.

Question 54

Operative record: A surgeon repairs a rectocele by posterior colporrhaphy and performs associated perineorrhaphy. There is no anterior repair, hysterectomy or vaginal suspension. Which CPT procedure code describes this repair?
  • ☐ A. 57240
  • ☐ B. 57282
  • ☐ C. 57250
  • ☐ D. 57260
Show answer and explanation

Response: C

Final answer: 57250

Only the posterior compartment was repaired. Code 57250 includes the rectocele repair and associated perineorrhaphy, whereas the other choices would describe an anterior repair, a combined anterior-and-posterior repair or a suspension despite none of that additional work being documented.

Question 55

Operative record: Through a vaginal approach, the surgeon repairs both a cystocele and a rectocele during one operation, completing anterior and posterior colporrhaphies. No hysterectomy is performed. Which single CPT code represents the combined repair?
  • ☐ A. 57282
  • ☐ B. 57240
  • ☐ C. 57250
  • ☐ D. 57260
Show answer and explanation

Response: D

Final answer: 57260

Both compartments were repaired. The combined anterior-and-posterior colporrhaphy code is 57260, rather than a code for only one compartment or a vaginal suspension.

Question 56

Operative record: For elective sterilization, a urologist divides and removes a short segment of each vas deferens and secures the ends. Neither testis is removed, and no hydrocele or varicocele is treated. Which CPT procedure code identifies the vasectomy?
  • ☐ A. 55530
  • ☐ B. 55250
  • ☐ C. 54520
  • ☐ D. 55040
Show answer and explanation

Response: B

Final answer: 55250

The target is the vas deferens. Code 55250 identifies the vasectomy, including unilateral or bilateral performance, while the other choices would describe surgery on a testis, hydrocele or varicocele rather than the documented division and removal of a vas segment.

Question 57

Procedure record: A physician performs a lumbar spinal puncture to collect cerebrospinal fluid for diagnostic laboratory testing. Needle placement uses surface landmarks, without fluoroscopy or CT guidance. The purpose is diagnosis, not therapeutic drainage, and no intrathecal drug is administered. Which CPT procedure code describes this puncture? Exclude the laboratory testing.
  • ☐ A. 62329
  • ☐ B. 62328
  • ☐ C. 62270
  • ☐ D. 62272
Show answer and explanation

Response: C

Final answer: 62270

The fluid is collected for diagnosis. A lumbar diagnostic puncture without imaging guidance is 62270, while therapeutic drainage and a puncture performed with fluoroscopy or CT use the other code families offered here.

Question 58

Operative record: A surgeon begins an endoscopic release of the right carpal tunnel but converts to an open approach because visualization is inadequate. The open median-nerve decompression is completed at the same site. Under Medicare NCCI policy, which reporting choice represents the completed release? Ignore laterality modifiers.
  • ☐ A. 64721 only
  • ☐ B. 64721 and 29848-59
  • ☐ C. 29848 only
  • ☐ D. 29848 and 64721
Show answer and explanation

Response: A

Final answer: 64721 only

The completed release used the open approach. Report 64721 for that median-nerve decompression with the attempted endoscopic approach included at the same site. Modifier 59 cannot make the abandoned approach a second completed service.

Question 59

Procedure record: A physician performs a lumbar interlaminar epidural steroid injection with fluoroscopic guidance and needle localization. No transforaminal injection, catheter infusion or other procedure is performed. Which CPT reporting choice describes this Medicare service?
  • ☐ A. 62323 only
  • ☐ B. 64483 only
  • ☐ C. 62323 and 77003
  • ☐ D. 62321 only
Show answer and explanation

Response: A

Final answer: 62323 only

The injection is lumbar and interlaminar. Code 62323 captures that regional approach with fluoroscopic guidance included, so adding 77003 would duplicate guidance and choosing either 62321 or 64483 would change the documented spinal region or substitute a transforaminal approach.

Question 60

Operative record: During a Medicare patient's craniotomy, the surgeon places a ventricular catheter for pressure monitoring through the same skull opening used for the operation. No separate twist-drill opening or additional cranial site is created. The coder proposes adding CPT 61107 for the catheter placement. Which reporting choice follows Medicare NCCI policy?
  • ☐ A. Omit the craniotomy and report only 61107 for the catheter placement.
  • ☐ B. Report the craniotomy and add 61107 because monitoring has a separate purpose.
  • ☐ C. Report the craniotomy without a separate 61107 for this placement.
  • ☐ D. Report the craniotomy and add 61107 with modifier 59 for the same opening.
Show answer and explanation

Response: C

Final answer: Report the craniotomy without a separate 61107 for this placement.

The surgeon uses the operative opening. NCCI includes the ventricular-catheter placement through that same hole in the craniotomy service, and a separate 61107 would require the distinct placement circumstances described by the policy.

Question 61

Operative record: A dural tear occurs during a Medicare patient's spinal decompression. Before completing that same operation, the surgeon closes the tear and confirms that the cerebrospinal-fluid leak has stopped. No later return to surgery or unrelated repair is performed. The coder proposes adding CPT 63707 for the dural-leak repair. Which reporting approach applies?
  • ☐ A. Report only 63707 and omit the completed spinal decompression.
  • ☐ B. Add 63707 with modifier 59 because the tear was unplanned.
  • ☐ C. Report the spinal operation without separately adding 63707 for the intraoperative leak repair.
  • ☐ D. Add 63707 because the repair required sutures and extra operative time.
Show answer and explanation

Response: C

Final answer: Report the spinal operation without separately adding 63707 for the intraoperative leak repair.

Repair occurs during the spinal operation. The closure of a dural leak arising in that procedure is integral to it, so NCCI directs the coder to report the spinal operation without a separate 63707 or 63709 for this repair.

Question 62

Procedure record: A physician performs a therapeutic block of one sciatic nerve during one Medicare encounter. Three injections of the same anesthetic are made at different locations around that nerve to complete the block. The opposite sciatic nerve is untreated, and no continuous catheter is placed. The appropriate code is established as CPT 64445. How many units of 64445 represent this service?
  • ☐ A. One unit
  • ☐ B. Four units
  • ☐ C. Three units
  • ☐ D. Two units
Show answer and explanation

Response: A

Final answer: One unit

All three injections block one nerve. The injections around that sciatic nerve at the single encounter constitute one unit of 64445, because NCCI counts the described nerve-block service rather than each needle placement.

Question 63

Imaging record: Four medically necessary views of one shoulder are obtained during one radiology encounter. One view is repeated because of positioning, with no change in the patient’s condition. Which CPT reporting choice represents the Medicare radiographic service? Ignore laterality and component modifiers.
  • ☐ A. 73020, five units
  • ☐ B. 73030, one unit
  • ☐ C. 73030, two units
  • ☐ D. 73020 and 73030
Show answer and explanation

Response: B

Final answer: 73030, one unit

The images form one complete shoulder study. Code 73030 covers at least two views, including the additional views obtained here, while the positioning repeat does not establish another study. Report one unit rather than counting individual exposures.

Question 64

Imaging record: For documented urinary tract symptoms, an ultrasound evaluates both native kidneys and the urinary bladder completely. No transplant kidney or other pelvic study is performed. Which CPT choice describes the Medicare ultrasound service?
  • ☐ A. 76775 and 76857
  • ☐ B. 76775 only
  • ☐ C. 76857 only
  • ☐ D. 76770 only
Show answer and explanation

Response: D

Final answer: 76770 only

The urinary-tract examination is complete. Evaluating both native kidneys and the bladder in this clinical context supports 76770, while dividing that complete examination into two limited studies would misrepresent the examination and a kidney-only or pelvic-only selection would omit part of it.

Question 65

Imaging record: At one session, CT images of both the abdomen and pelvis are obtained without contrast, followed by intravenous contrast and further images of both regions. No angiographic study is performed. Which single CPT code describes the CT examination?
  • ☐ A. 74176 and 74177
  • ☐ B. 74177
  • ☐ C. 74176
  • ☐ D. 74178
Show answer and explanation

Response: D

Final answer: 74178

The examination includes both phases. Code 74178 represents the combined abdomen-and-pelvis CT before and after contrast, rather than either phase alone or two codes for the same complete examination. The contrast sequence is part of selecting the combined code.

Question 66

Imaging record: A patient undergoes one conventional MRI examination of the brain, with sequences obtained before intravenous contrast and additional sequences afterward. No MR angiography or functional MRI is performed. Which CPT choice describes the examination?
  • ☐ A. 70551 and 70552
  • ☐ B. 70553 only
  • ☐ C. 70551 only
  • ☐ D. 70552 only
Show answer and explanation

Response: B

Final answer: 70553 only

Both contrast phases form one examination. Code 70553 captures the brain MRI without and then with contrast, whereas 70551 and 70552 each describe only one contrast state and reporting both would replace the available combined code with two phase-specific services.

Question 67

Imaging record: An asymptomatic patient receives bilateral digital screening mammography and bilateral screening digital breast tomosynthesis during the same encounter. No diagnostic mammogram is performed. Which CPT choice represents the two documented screening services?
  • ☐ A. 77063 only
  • ☐ B. 77067 and 77063
  • ☐ C. 77067, two units
  • ☐ D. 77067 only
Show answer and explanation

Response: B

Final answer: 77067 and 77063

Both screening technologies were used. Report 77067 for the bilateral screening mammogram with add-on 77063 for its screening tomosynthesis, because repeating the mammography code would not identify the additional technology and no diagnostic study is documented to select a different family.

Question 68

Imaging record: For a CT examination requiring intravenous contrast, staff establish venous access solely for the scan and administer the contrast. No hydration, medication treatment or separate injection service occurs. Under Medicare NCCI policy, how are the venous access and contrast administration reported?
  • ☐ A. They are included in the CT procedure; do not add separate access or administration codes.
  • ☐ B. Add an IV-access code but omit the administration code.
  • ☐ C. Add an administration code but omit the IV-access code.
  • ☐ D. Add both an IV-access code and an administration code.
Show answer and explanation

Response: A

Final answer: They are included in the CT procedure; do not add separate access or administration codes.

The IV serves the scan alone. Venous access and intravenous contrast administration are integral to this radiologic procedure, so they are not added as separate access or injection services. A separate therapeutic infusion would require different facts and its own coding review.

Question 69

Laboratory record: On one specimen, the laboratory performs total cholesterol, HDL cholesterol and triglyceride testing, with no additional lipid measurement or repeat testing. Which CPT reporting choice represents the completed Medicare lipid panel?
  • ☐ A. 80061 and 82465
  • ☐ B. 80061 only
  • ☐ C. 82465, 83718 and 84478
  • ☐ D. 80061 and 83718
Show answer and explanation

Response: B

Final answer: 80061 only

All three panel components were performed. Report the lipid panel as 80061, rather than its individual components or a panel plus one of those same components. The record contains no separate test that would justify an additional lipid code.

Question 70

Laboratory record: The treating physician orders an automated complete blood count with automated white-cell differential. The laboratory also examines a smear solely to verify a flagged automated result; no separate manual differential is ordered. Which CPT choice represents the Medicare testing?
  • ☐ A. 85025 only
  • ☐ B. 85025 and 85007
  • ☐ C. 85027 only
  • ☐ D. 85025 and 85008
Show answer and explanation

Response: A

Final answer: 85025 only

The smear verifies the ordered automated test. Code 85025 covers the complete count with automated differential, and the laboratory's verification does not support an additional manual-smear code. Reporting 85027 alone would omit the ordered automated differential.

Question 71

Laboratory record: A morning chemistry result is valid. After treatment, the physician orders a medically necessary repeat of that same test in the afternoon to assess the patient’s response. Both specimens and runs are satisfactory. Which modifier identifies the repeat clinical diagnostic laboratory test?
  • ☐ A. 76
  • ☐ B. 77
  • ☐ C. 25
  • ☐ D. 91
Show answer and explanation

Response: D

Final answer: 91

The repeat measures the response to treatment. Modifier 91 identifies the medically necessary repeat clinical laboratory test with a valid first result, rather than a rerun for equipment trouble or simple confirmation. The new clinical need is documented.

Question 72

Laboratory record: A lipid panel is completed, and the laboratory calculates an LDL cholesterol value from its measured components. No direct LDL assay is performed. May CPT code 83721 be added for that calculated value under Medicare NCCI policy?
  • ☐ A. Yes; calculation supports 83721 with modifier 59.
  • ☐ B. No; 83721 requires direct LDL measurement.
  • ☐ C. Yes; calculation supports 83721 with modifier 91.
  • ☐ D. Yes; every LDL result supports 83721.
Show answer and explanation

Response: B

Final answer: No; 83721 requires direct LDL measurement.

The LDL value was calculated. Code 83721 identifies direct measurement, so a calculation from the panel does not support that additional assay code. Neither a repeat-test nor a distinct-service modifier changes the method actually performed.

Question 73

Pathology record: Three forceps fragments from one gastric lesion are submitted together for a single examination and diagnosis. They are processed into two blocks and four slides. The appropriate gross-and-microscopic surgical pathology level is already established as 88305. How many units of 88305 represent this specimen?
  • ☐ A. Three
  • ☐ B. One
  • ☐ C. Two
  • ☐ D. Four
Show answer and explanation

Response: B

Final answer: One

There is one specimen for examination and diagnosis. One unit of the established 88305 represents it, regardless of its three fragments, two blocks or four slides. Those processing counts do not create additional specimens.

Question 74

Laboratory record: The physician orders an automated hemogram without automated differential and a manual white-cell differential. The laboratory performs both ordered services, with no automated differential. Which CPT choice describes the Medicare work?
  • ☐ A. 85025 only
  • ☐ B. 85025 and 85007
  • ☐ C. 85027 only
  • ☐ D. 85027 and 85007
Show answer and explanation

Response: D

Final answer: 85027 and 85007

The differential was performed manually. Report 85027 for the automated hemogram together with 85007 for the separately ordered manual white-cell differential, because selecting 85025 would describe an automated differential absent from the record and omitting 85007 would miss the manual service.

Question 75

Encounter record: A clinician performs an initial psychiatric diagnostic evaluation with history, mental-status assessment and recommendations. No medical evaluation and management service or psychotherapy treatment is performed. Which CPT code represents this diagnostic service?
  • ☐ A. 90834
  • ☐ B. 90791 and 90792
  • ☐ C. 90792
  • ☐ D. 90791
Show answer and explanation

Response: D

Final answer: 90791

The evaluation contains no medical services. Code 90791 fits the documented psychiatric diagnostic evaluation, while 90792 would add medical services and 90834 would change the service to psychotherapy treatment, so neither substitute nor both diagnostic codes together accurately represents this encounter.

Question 76

Encounter record: For a symptomatic patient, an office practice performs a routine 12-lead ECG using its own equipment. Its physician interprets the tracing and signs a separate written report. No other ECG is performed. Which CPT reporting choice represents the complete service?
  • ☐ A. 93000 only
  • ☐ B. 93005 only
  • ☐ C. 93000 and 93010
  • ☐ D. 93010 only
Show answer and explanation

Response: A

Final answer: 93000 only

The practice supplied the complete ECG service. Code 93000 captures its tracing, interpretation and report, so adding 93010 would repeat the interpretation. Either component code alone would omit work the practice performed.

Question 77

Pulmonary record: The physician orders diagnostic spirometry before and after a bronchodilator to assess reversible airflow obstruction. Staff administer the bronchodilator only for that test; no acute airway treatment is provided. Which CPT procedural choice describes the Medicare testing? Ignore the medication supply code.
  • ☐ A. 94060 only
  • ☐ B. 94060 and 94640
  • ☐ C. 94010 and 94640
  • ☐ D. 94010 only
Show answer and explanation

Response: A

Final answer: 94060 only

The bronchodilator serves the diagnostic test. Code 94060 includes its administration and the before-and-after spirometry, while adding 94640 would incorrectly represent acute airway treatment. Drug supply is outside the question's procedural scope.

Question 78

Infusion record: During an ordered medication infusion, a small saline flow is used only to maintain the IV line’s patency. The patient has no separately documented need for hydration therapy, and no other fluid treatment occurs. Under Medicare NCCI policy, should a separate hydration administration code be reported?
  • ☐ A. Yes; every saline flow is a hydration treatment.
  • ☐ B. No; the saline flow is incidental to maintaining IV access.
  • ☐ C. Yes; patency fluid supports an initial hydration code.
  • ☐ D. Yes; report hydration if a different diagnosis is assigned.
Show answer and explanation

Response: B

Final answer: No; the saline flow is incidental to maintaining IV access.

The saline maintains the line. It is incidental rather than a separately documented therapeutic hydration service, so a hydration administration code is not added. Assigning another diagnosis cannot turn this line-maintenance fluid into treatment that did not occur.

Question 79

Testing record: Eight distinct allergen extracts are each tested once by a single percutaneous test, with the interpretation and report completed. No sequential dilution testing is done. The appropriate procedure is established as CPT 95004. How many units represent the eight allergen tests?
  • ☐ A. One
  • ☐ B. Eight
  • ☐ C. Two
  • ☐ D. Sixteen
Show answer and explanation

Response: B

Final answer: Eight

Eight individual allergen tests were performed. Report eight units of the established 95004, because the count follows tests rather than visits. No second set or dilution series supports a larger number.

Question 80

Testing record: A medically necessary comprehensive cardiopulmonary exercise test includes ECG monitoring and spirometric measurements before, during and after exercise. Those measurements serve only the comprehensive test, with no separate encounter or indication. Which CPT choice represents the Medicare procedure?
  • ☐ A. 94621 and a separate ECG-monitoring code
  • ☐ B. 94621 and 94010
  • ☐ C. 94621, 94010 and a separate ECG-monitoring code
  • ☐ D. 94621 only
Show answer and explanation

Response: D

Final answer: 94621 only

The measurements belong to the combined test. Code 94621 includes its ECG monitoring and spirometric components, so they are not added as separate procedures for the same testing encounter. A separate diagnostic need is absent from this record.

Question 81

An established office patient is evaluated for hypertension and type 2 diabetes. Both chronic illnesses are stable and actively addressed. After reviewing treatment response, the physician documents the decision to continue prescription medications for both conditions. No tests or outside records are reviewed, and no independent historian is needed. A medically appropriate history and examination are performed. The clinician selects the service by MDM, not time. Which office E/M code is supported?
  • ☐ A. 99215
  • ☐ B. 99212
  • ☐ C. 99213
  • ☐ D. 99214
Show answer and explanation

Response: D

Final answer: 99214

Count the conditions actually addressed. Two stable chronic illnesses meet the moderate problem level, and the documented prescription-drug management supplies moderate risk, so these two elements support established-patient code 99214 even though the encounter has minimal data. History length does not raise the level.

Question 82

In a hospital emergency department, a physician evaluates an adult with an exacerbation of chronic asthma. The physician documents the exacerbation and manages prescription treatment by starting a short course of an oral corticosteroid and adjusting the prescribed rescue inhaler. No tests, outside records or independent historian are used. The patient has no threat to life or bodily function, is discharged home and receives no critical care. A medically appropriate history and examination are performed. Which E/M code is supported when selection is based on MDM?
  • ☐ A. 99285
  • ☐ B. 99283
  • ☐ C. 99284
  • ☐ D. 99204
Show answer and explanation

Response: C

Final answer: 99284

Use the emergency-department code family. The chronic exacerbation supplies a moderate problem, while prescription-drug management supplies moderate risk, meeting two of the three MDM elements needed for 99284, and neither the record nor the absence of testing supports moving this encounter to a high-MDM service.

Question 83

Office record: For an established patient, the physician documents 20 minutes of direct care, 7 minutes reviewing pertinent records and 5 minutes documenting the visit, all on the encounter date. No separately reported service is included. Staff spend another 12 minutes, and the physician does 8 additional minutes the next day. Using time alone, which office E/M code is supported?
  • ☐ A. 99214
  • ☐ B. 99204
  • ☐ C. 99215
  • ☐ D. 99213
Show answer and explanation

Response: A

Final answer: 99214

Count 32 physician minutes that day. The direct care, record review and documentation support the established-patient 30-minute threshold for 99214, while staff time and work on the next day do not enter that total. The 40-minute threshold and new-patient family do not apply.

Question 84

Office record: During MDM data review, the physician compares three prior hemoglobin A1c results from the same unique test. No other test, independent interpretation or outside discussion is documented. How many unique tests does this serial comparison represent for MDM data counting?
  • ☐ A. One
  • ☐ B. Four
  • ☐ C. Three
  • ☐ D. Two
Show answer and explanation

Response: A

Final answer: One

These are serial results of one test. Comparing three hemoglobin A1c values counts as one unique test, rather than three different tests for the MDM data element. The number of historical results does not change the underlying test's identity.

Question 85

Office record: A physician considers surgery for a patient but documents no high-risk patient factors. A coder proposes high MDM solely because all surgery carries some inherent risk. Which response follows the E/M guidance?
  • ☐ A. Assess the documented patient-specific management risk; ordinary surgical risk alone does not establish high overall MDM.
  • ☐ B. Use the length of the examination to establish high overall MDM.
  • ☐ C. Assign high overall MDM whenever a procedure has a 90-day global period.
  • ☐ D. Assign high overall MDM whenever any surgery is considered.
Show answer and explanation

Response: A

Final answer: Assess the documented patient-specific management risk; ordinary surgical risk alone does not establish high overall MDM.

Risk depends on this patient's circumstances. Ordinary surgical hazards and a global-period label do not automatically establish high management risk or high overall MDM, which still depends on the qualifying elements. Clarification is appropriate when the clinical risk assessment is missing.

Question 86

Encounter record: During the postoperative period of a major operation, the same surgeon performs a separately documented office E/M service for a new, unrelated condition. The condition is neither part of recovery nor a surgical complication. Which modifier identifies this unrelated postoperative E/M service?
  • ☐ A. 57
  • ☐ B. 25
  • ☐ C. 24
  • ☐ D. 78
Show answer and explanation

Response: C

Final answer: 24

The condition is unrelated. Modifier 24 identifies the same surgeon's separately documented postoperative E/M for that new condition, while the alternatives concern same-day procedural separation, an initial major-surgery decision or an operating-room return instead of the office encounter described here.

Question 87

Anesthesia record: Continuous anesthesia care is documented from 09:10 to 09:38. Anesthesia care then stops, and no anesthesia practitioner provides care during a documented 10-minute interruption. Continuous anesthesia care resumes at 09:48 and ends at 10:08 when the patient is safely transferred to postoperative care. What actual anesthesia time should be reported for this Medicare claim?
  • ☐ A. 38 minutes
  • ☐ B. 58 minutes
  • ☐ C. 48 minutes
  • ☐ D. 28 minutes
Show answer and explanation

Response: C

Final answer: 48 minutes

Count the two documented care blocks. The first lasts 28 minutes and the second 20, giving 48 minutes of anesthesia time after the unmonitored 10-minute interruption is excluded. An elapsed-clock total would include care that was not furnished.

Question 88

Anesthesia record: Two surgical procedures are performed during one continuous anesthetic. Their applicable anesthesia codes have verified base values of 5 and 7 units. No add-on anesthesia code applies. For Medicare payment, which base-unit value is used before adding the actual anesthesia time units?
  • ☐ A. 12 base units
  • ☐ B. 6 base units
  • ☐ C. 5 base units
  • ☐ D. 7 base units
Show answer and explanation

Response: D

Final answer: 7 base units

Use the higher applicable base value. For these procedures under one anesthetic, Medicare uses the anesthesia procedure with 7 base units and adds the actual anesthesia time units, rather than summing both base values or averaging them. The supplied values are verified premises, not a new code assignment.

Question 89

Anesthesia record: A physician anesthesiologist personally performs the entire anesthesia service alone. The case involves no resident, CRNA or anesthesiologist assistant, and it is not medical direction or supervision of another practitioner. Which payment modifier identifies this physician’s personally performed anesthesia service?
  • ☐ A. AA
  • ☐ B. QY
  • ☐ C. QK
  • ☐ D. AD
Show answer and explanation

Response: A

Final answer: AA

The anesthesiologist performed the service alone. Modifier AA identifies that personally performed anesthesia service, while AD denotes medical supervision of more than four concurrent procedures and QK or QY identifies specified medical-direction arrangements. None of those other arrangements appears in this record.

Question 90

Anesthesia record: A physician personally performs a Medicare anesthesia service with a verified base value of 6 units and 45 actual minutes of anesthesia time. No other unit adjustment applies. How many base-plus-time units enter the fee-schedule calculation before multiplication by the locality’s anesthesia conversion factor?
  • ☐ A. 3 units
  • ☐ B. 51 units
  • ☐ C. 9 units
  • ☐ D. 6 units
Show answer and explanation

Response: C

Final answer: 9 units

The time contributes 3 units. Dividing 45 minutes by Medicare's 15-minute unit gives 3, which is added to the supplied 6 base units for a total of 9 before the locality's conversion factor is applied. Minutes themselves are not base-plus-time units.

Question 91

Medical record — September 2026. Preoperative diagnosis: Biopsy-confirmed basal cell carcinoma of the upper back. The lesion measures 0.9 cm at its greatest clinical diameter. With the patient awake under local anesthesia, the surgeon marks a 0.4 cm margin on each side before cutting. An elliptical full-thickness excision through the dermis removes the entire marked lesion. The surgeon performs a simple single-layer closure, without layered repair, tissue transfer or a graft. Final pathology confirms basal cell carcinoma of the back. No other lesion is treated. Code only the surgeon’s excision service and its diagnosis, excluding the separately provided pathology service. Which pair is supported?
  • ☐ A. 11402; D23.5
  • ☐ B. 11601; C44.519
  • ☐ C. 11602; C44.519
  • ☐ D. 11602; C44.511
Show answer and explanation

Response: C

Final answer: 11602; C44.519

The excised diameter is 1.7 cm. Adding both 0.4 cm margins to the 0.9 cm malignant lesion places this back excision in 11602, and the confirmed basal cell carcinoma of back skin supports C44.519. Simple closure is included in the excision service.

Question 92

Medical record — September 2026. A patient presents with one fresh laceration on the left forearm after contact with a broken metal edge. The clinician examines sensation, circulation and motion, then explores the wound under local anesthesia. There is no retained foreign body, tendon damage, extensive contamination or devitalized tissue requiring debridement. After routine irrigation, the clinician measures a 6.4 cm superficial wound and closes it with a single layer of interrupted skin sutures. No deep layer is repaired, and no extensive undermining or tissue rearrangement is performed. The wound does not involve the hand, face or neck. Select the CPT code for the repair alone.
  • ☐ A. 12004
  • ☐ B. 12002
  • ☐ C. 12032
  • ☐ D. 12001
Show answer and explanation

Response: B

Final answer: 12002

The record supports a simple repair. A single-layer 6.4 cm forearm closure falls within the simple extremity-repair range for 12002, rather than the shorter 12001 range or the longer 12004 range. Nothing documented establishes the layered repair represented by 12032.

Question 93

Medical record — September 2026. The surgeon diagnoses nontraumatic right cubital tunnel syndrome after persistent ulnar-distribution numbness and unsuccessful conservative treatment. Through an incision at the medial elbow, the surgeon exposes the ulnar nerve, releases the compressing structures and transposes the nerve anteriorly. No nerve repair, graft or internal neurolysis is performed. The wrist and median nerve are not operated on, and the left arm is not treated. The postoperative diagnosis remains right ulnar nerve compression at the elbow. Disregard procedure laterality modifiers and select the operative CPT code with the most specific supported diagnosis.
  • ☐ A. 64719; G56.21
  • ☐ B. 64718; G56.21
  • ☐ C. 64718; G56.22
  • ☐ D. 64721; G56.01
Show answer and explanation

Response: B

Final answer: 64718; G56.21

Locate the release at the elbow. Ulnar nerve release and transposition at that site support 64718, while G56.21 identifies the documented nontraumatic right ulnar nerve lesion, and the wrist procedure, median-nerve procedure and left-sided diagnosis each change an essential part of the operative record.

Question 94

Medical record — September 2026. A radiologist performs percutaneous core biopsies of two separate masses in the same breast. The first is at the 2 o’clock position and the second at 7 o’clock. Each mass is sampled through its own needle approach under real-time ultrasound guidance, and samples are sent in separately labeled containers. A localization clip is placed at each biopsy site. Ultrasound is the only guidance modality used. No open incision, stereotactic guidance or MRI guidance is used, and neither lesion is excised. Code the radiologist’s two image-guided biopsy procedures only, without separately coding pathology or routine clip placement. Which code combination represents the first lesion and the additional lesion?
  • ☐ A. 19083 and 19084
  • ☐ B. 19083 reported twice
  • ☐ C. 19081 and 19082
  • ☐ D. 19085 and 19086
Show answer and explanation

Response: A

Final answer: 19083 and 19084

Both lesions use ultrasound guidance. Report the first lesion with 19083 and the separate additional lesion with 19084, rather than repeating the first-lesion code or choosing a stereotactic or MRI-guided pair. The code family includes clip placement when it is performed.

Question 95

Medical record — September 2026. This is a diagnostic, non-screening colonoscopy. The endoscopist advances to the cecum and inspects the colon. A small ascending-colon lesion is removed using biopsy forceps and submitted as specimen A. A distinct sigmoid-colon lesion is removed by snare and submitted as specimen B. Neither technique is used on the other lesion. Pathology confirms a tubular adenoma without malignancy at each site. No other therapeutic procedure is performed. For this Medicare claim, use modifier 59 to identify the distinct biopsy lesion when appropriate. Which option supplies the procedure combination and both site-specific adenoma diagnoses?
  • ☐ A. 45385 only; D12.2 and D12.5
  • ☐ B. 45385 and 45380-59; D12.2 and D12.5
  • ☐ C. 45380 only; D12.2 and D12.5
  • ☐ D. 45385 and 45380-59; D12.6 only
Show answer and explanation

Response: B

Final answer: 45385 and 45380-59; D12.2 and D12.5

Two distinct lesions received different treatments. Snare removal and biopsy removal support 45385 with 45380-59 in this documented setting, while the confirmed ascending and sigmoid adenomas require D12.2 and D12.5. One unspecified-site diagnosis would lose information available in the record.

Question 96

Medical record — September 2026. The surgeon documents acute cholecystitis caused by gallbladder stones, without obstruction. The patient undergoes laparoscopic removal of the gallbladder. The cystic duct and artery are identified, clipped and divided, and the gallbladder is dissected from the liver bed and removed. The operation remains laparoscopic throughout. No intraoperative cholangiogram or common-bile-duct exploration is performed. The final diagnosis is calculus of the gallbladder with acute cholecystitis, without obstruction, gangrene or perforation. Select the surgeon’s operative CPT code and the single ICD-10-CM combination code that captures this diagnosis.
  • ☐ A. 47563; K80.00
  • ☐ B. 47562; K80.00
  • ☐ C. 47562; K81.0
  • ☐ D. 47600; K80.01
Show answer and explanation

Response: B

Final answer: 47562; K80.00

Neither imaging nor open conversion is documented. The laparoscopic removal alone supports 47562, and K80.00 combines gallbladder calculus with acute cholecystitis without obstruction. K81.0 would omit the documented stones, while K80.01 would add obstruction that the record excludes.

Question 97

Medical record — September 2026. The urologist performs cystourethroscopy and identifies one 2.8 cm tumor on the posterior bladder wall. The tumor is resected transurethrally, and its base is fulgurated. No other tumor is treated. Tissue is submitted for pathology, which establishes invasive urothelial carcinoma of the posterior bladder wall. The physician’s final diagnosis matches the pathology. No anterior-wall lesion or carcinoma in situ is documented. Select the surgeon’s CPT code for this tumor resection and the site-specific ICD-10-CM diagnosis, excluding anesthesia and the pathologist’s service.
  • ☐ A. 52234; C67.4
  • ☐ B. 52235; C67.4
  • ☐ C. 52240; C67.9
  • ☐ D. 52235; D09.0
Show answer and explanation

Response: B

Final answer: 52235; C67.4

The tumor is 2.8 cm. That measurement falls in the medium bladder-tumor resection category for 52235, and the confirmed posterior-wall malignancy supports C67.4. The smaller or larger resection categories and an in-situ diagnosis do not match the documented findings.

Question 98

Medical record — September 2026. An ophthalmologist documents active proliferative diabetic retinopathy with macular edema in the right eye of a patient with type 2 diabetes. The left eye is not treated. The operative note describes panretinal scatter laser photocoagulation of extensive peripheral retina to treat the proliferative disease. The treatment is not localized focal photocoagulation of a single retinal lesion. No cataract operation, vitrectomy or retinal-detachment repair is performed. The postoperative diagnosis remains the documented right-eye proliferative diabetic retinopathy with macular edema. Select the procedure code and that diagnosis only, omitting procedure laterality modifiers and medication-status codes.
  • ☐ A. 67228; E11.3511
  • ☐ B. 67210; E11.3511
  • ☐ C. 67228; E11.3591
  • ☐ D. 67228; E11.3512
Show answer and explanation

Response: A

Final answer: 67228; E11.3511

Panretinal scatter treatment supports 67228. The diagnosis combines type 2 diabetes, proliferative retinopathy and macular edema in E11.351, with the required seventh character 1 specifying the right eye, while localized retinal treatment, left-eye laterality and absence of edema would each misrepresent this record.

Question 99

Medical record — September 2026. At an outpatient follow-up, the physician documents type 2 diabetes with diabetic chronic kidney disease, hypertensive chronic kidney disease and CKD stage 3a. The patient uses prescribed insulin every day as long-term treatment, with no oral or injectable non-insulin diabetes medicine. The record excludes acute kidney injury, heart disease, heart failure and kidney transplantation. The physician reviews renal function and both chronic conditions, then continues the treatment plan. Select the complete diagnosis-code set for these documented conditions and treatment status. The order shown is not a request to identify the first-listed condition.
  • ☐ A. E11.22, I13.10, N18.31 and Z79.4
  • ☐ B. E11.9, I10, N18.31 and Z79.4
  • ☐ C. E11.22, I12.9, N18.31 and Z79.4
  • ☐ D. E11.22, I12.9 and N18.31
Show answer and explanation

Response: C

Final answer: E11.22, I12.9, N18.31 and Z79.4

Both documented relationships need combination codes. E11.22 captures diabetic CKD, I12.9 captures hypertensive CKD without the documented exclusions being added, and N18.31 supplies stage 3a. Long-term insulin treatment also requires Z79.4, which the shorter code set leaves out.

Question 100

Medical record — September 2026. An established office patient arrives for injection treatment of primary osteoarthritis of the right knee. Beyond the usual assessment for the injection, the physician separately evaluates worsening type 2 diabetes with hyperglycemia: home glucose readings have risen and the current HbA1c is 9.8%. The physician documents the chronic exacerbation, increases the prescribed insulin dose and arranges diabetes follow-up. The separate diabetes service exceeds the work of deciding on or providing the knee injection. The physician then injects the knee without ultrasound guidance using 40 mg of triamcinolone acetonide, not otherwise specified. The office supplies the drug, and all 40 mg are administered with no waste. Assume the drug supply is separately reportable. Select the separate E/M, procedure and drug-supply codes with units, omitting diagnosis codes and procedure laterality modifiers.
  • ☐ A. 99213-25; 20610; J3301, 4 units
  • ☐ B. 99214-25; 20610; J3301, 4 units
  • ☐ C. 99214-25; 20610; J3301, 40 units
  • ☐ D. 99214-25; 20611; J3301, 4 units
Show answer and explanation

Response: B

Final answer: 99214-25; 20610; J3301, 4 units

Convert the drug amount to units. J3301 represents 10 mg, so 40 mg supplies four units, and the chronic diabetes exacerbation and prescription management establish moderate MDM for a separate 99214 service with modifier 25, alongside the knee injection code 20610 without ultrasound guidance. The drug quantity is not its unit count.