Pass the AAPC Certified Professional Coder CPC Questions and answers with CertsForce

CPT® code 69644 refers to a tympanoplasty with mastoidectomy, which includes canalplasty, middle ear surgery, and tympanic membrane repair. The specific procedure described by this code is performed with an intact or reconstructed canal wall and includes ossicular chain reconstruction. The use of a semicolon in the CPT® description helps distinguish between different variations of the procedure.

AMA ' s CPT® Professional Edition, specific code descriptions and guidelines.

The scenario describes an emergency basic life support (BLS) ambulance service. The appropriate HCPCS Level II code for BLS emergency transport is A0429.

Modifier QN indicates that the service was provided by an ambulance supplier, and SH indicates the services were provided in an emergency situation.

HCPCS Level II, current year

For a patient diagnosed with sepsis and associated acute respiratory failure, the ICD-10-CM codes are:

A41.9: Sepsis, unspecified organism.

R65.21: Severe sepsis with septic shock.

J96.00: Acute respiratory failure, unspecified whether with hypoxia or hypercapnia.

These codes appropriately capture the severity of the sepsis and the presence of acute respiratory failure.

ICD-10-CM guidelines

AMA ' s CPT® Professional Edition (current year)

The scenario involves a secondary repair of two flexor tendons in the forearm. CPT® code 25272 describes the repair of a secondary flexor tendon injury, including a graft, in the forearm and/or wrist, which fits the description provided. This code should be reported once, as the procedure encompasses the repair of multiple tendons.

The correct answer is B. Modifier 32. Modifier 32 identifies a mandated service, meaning the service was required by a third-party payer, governmental body, legal authority, employer, or other regulatory entity rather than being performed solely at the physician’s independent clinical discretion. In professional coding, this modifier communicates the reason the service was rendered and helps distinguish required examinations or evaluations from routine medically indicated services. Typical examples include services requested for insurance review, workers’ compensation requirements, legal determinations, disability evaluation, or other administrative mandates.

The other modifiers do not match the scenario. Modifier 23 is used for unusual anesthesia circumstances. Modifier 76 reports a repeat procedure or service performed by the same physician or other qualified health care professional. Modifier 24 is appended to an unrelated evaluation and management service performed during a postoperative global period. None of these indicate that the service was required by an external payer or regulatory authority.

Reference topics: CPC Modifiers; CPT Appendix A Modifiers; Mandated Services; Regulatory and Third-Party Payer Reporting Requirements.

Diabetes mellitus is achronic illness. In the MDM framework, the “number and complexity of problems addressed” considers whether a chronic condition isstable, whether it isexacerbated, and whether it requires significant management changes. The vignette says this is afollow-upfor diabetes with blood sugarsat goaland continuing current medications—this describes astable chronic illnessbeing managed. It is not an acute illness or injury, and it is not “minimal problem,” because diabetes generally requires ongoing monitoring and management and is not considered trivial. “Stable, acute illness” is internally inconsistent; “acute uncomplicated illness/injury” is also incorrect because diabetes is not acute in this context. CPC exam tip: “stable on meds” + chronic disease follow-up →stable chronic illness(often supporting at least a low-to-moderate problem complexity depending on other MDM elements). Therefore, the correct selection isStable, chronic illness.

99223 = Initial hospital/observation care with high time (75+ min) or high MDM

Prolonged service 99418 is bundled into observation services

In this scenario, the procedure involved the excision of a large sacral pressure ulcer with deep tissue damage that required muscle and bone removal and was followed by a layered flap closure. The coding reflects both the extent of the ulcer and the procedure performed:

1. CPT® Code 15937: This code describes excision of a pressure ulcer with muscle and bone removal followed by flap closure, which matches the detailed procedure performed on the sacral ulcer.

2. ICD-10-CM Code L89.156: This code is used for a stage 4 sacral pressure ulcer, indicating the presence of deep tissue damage down to muscle and possibly bone, which aligns with the clinical findings.

Explanation of other options:

A. 15933, L89.153 and B. 15931, L89.153: These codes do not adequately describe the excision with muscle and bone removal nor the stage 4 severity of the ulcer.

C. 15935, L89.156: Although L89.156 is correct for a stage 4 ulcer, 15935 does not account for both muscle and bone excision with flap closure.

Therefore, the correct answer is D. 15937, L89.156, accurately capturing the procedure performed and the severity of the ulcer.

1. Procedure and CPT® Code Selection:

The patient underwent a pulmonary function test that included spirometry, vital capacity, breathing capacity, and flow volume measurements before and after bronchodilator administration.

CPT® Code 94060 is for spirometry, including the bronchodilator responsiveness testing, which involves capturing pre- and post-bronchodilator measurements. This code accurately reflects the testing performed.

CPT® Code 94010 is for spirometry testing without bronchodilator, which might be considered redundant in this case since 94060 encompasses spirometry testing with and without bronchodilator. However, some practices may code both, but generally, 94060 alone should suffice.

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

ICD-10-CM Code J45.901 is used for unspecified asthma with acute exacerbation. This code is appropriate given that the diagnosis indicates intermittent asthma with exacerbation.

J45.21 represents mild intermittent asthma without the specification of exacerbation, making it less accurate than J45.901 in this context.

3. Rationale for Excluding Other Options:

Code 94070 (options B and C) is for bronchospasm provocation testing, which does not apply to standard pulmonary function testing with bronchodilator responsiveness.

Option D includes J45.21, which does not capture the exacerbation aspect and is therefore incorrect.

4. AAPC and CPT® Coding Guidelines:

According to AAPC guidelines, 94060 should be used when pre- and post-bronchodilator spirometry is performed, and J45.901 is appropriate for asthma with exacerbation.

Therefore, the correct answer is A. 94060, 94010, J45.901.

The documentation describes making a skin incision off the tip of the twelfth rib and extending medially along the banger’s lines of the skin. The use of electrocautery to gain access through multiple layers of musculature and fascia indicates an open surgical approach. Open surgery involves making a large incision to expose and directly view the surgical site. This is distinct from percutaneous (which involves needles or catheters), laparoscopic (which uses small incisions and a camera), and other minimally invasive techniques.

AMA ' s CPT® Professional Edition, ICD-10-CM, and HCPCS Level II (current year)