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AAPC CPC Exam Syllabus Topics:

TopicDetails
Topic 1
  • Musculoskeletal System: This section of the exam measures the skills of coding specialists and focuses on coding procedures involving bones, joints, muscles, and tendons. It covers surgeries, reductions, arthroscopies, and fracture treatments, emphasizing accurate mapping of procedures to anatomical areas.
Topic 2
  • Pathology & Laboratory: This section of the exam measures the skills of medical coders and includes lab tests, specimen analysis, and pathological examination procedures. It ensures that coders understand how to apply codes for chemistry panels, cultures, and histopathological diagnostics.
Topic 3
  • Review of Anatomy: This section of the exam measures the skills of coding specialists and covers a high-level understanding of human anatomy. It includes organs, systems, directional terminology, and anatomical locations, enabling coders to link procedures and diagnoses to the correct bodily structures with accuracy and consistency.
Topic 4
  • Special Senses (Ocular and Auditory): This section of the exam measures the skills of coding specialists and covers the coding of procedures related to the eyes and ears. Topics include surgeries on the cornea, retina, and middle
  • inner ear, as well as related diagnostic procedures.
Topic 5
  • Overview of ICD-10-CM: This section of the exam measures the skills of medical coders and introduces the structure, format, and usage of the ICD-10-CM coding system. It reviews the purpose of ICD-10-CM in diagnosis reporting and prepares candidates to interpret chapters, code ranges, and conventions embedded in the system.
Topic 6
  • Female Reproductive System and Maternity Care & Delivery: This section of the exam measures the skills of coding specialists and evaluates coding accuracy for gynecological and obstetric procedures. It includes deliveries, antepartum care, cesarean sections, and surgical procedures involving female reproductive anatomy.
Topic 7
  • Radiology: This section of the exam measures the skills of coding specialists and focuses on diagnostic imaging procedures including X-rays, CT scans, MRIs, ultrasounds, and nuclear medicine. It emphasizes proper selection of codes based on anatomical site and modality used.
Topic 8
  • Integumentary System: This section of the exam measures the skills of medical coders and covers procedures related to the skin and related structures. Topics include excisions, biopsies, repairs, and destruction services, focusing on accurate code selection and modifier usage for integumentary interventions.
Topic 9
  • Digestive System: This section of the exam measures the skills of coding specialists and evaluates the coding of surgeries and procedures involving the oral cavity, pharynx, esophagus, stomach, intestines, liver, pancreas, and related organs. Understanding endoscopic procedures is particularly critical here.
Topic 10
  • Applying the ICD-10-CM Guidelines: This section of the exam measures the skills of coding specialists and covers how to apply official ICD-10-CM guidelines to real-world coding scenarios. It emphasizes the hierarchy of instructional notes, general and chapter-specific rules, and how to make judgment calls within compliant coding frameworks.
Topic 11
  • Evaluation & Management Services: This section of the exam measures the skills of coding specialists and covers office visits, hospital care, consultations, and other E
  • M services. It tests the understanding of time-based coding, medical decision-making, and history
  • exam components per current CMS guidelines.
Topic 12
  • Introduction to CPT®, HCPCS Level II, and Modifiers: This section of the exam measures the skills of coding specialists and introduces candidates to CPT® coding for procedures, HCPCS Level II for supplies and services, and the correct use of modifiers. It helps learners distinguish between different code sets and understand their place in medical billing.
Topic 13
  • Cardiovascular System: This section of the exam measures the skills of coding specialists and addresses services related to the heart, arteries, and veins. It involves the coding of diagnostic and therapeutic procedures, including catheterizations, bypasses, and repairs.:
Topic 14
  • Hemic & Lymphatic Systems, Mediastinum, Diaphragm: This section of the exam measures the skills of medical coders and includes procedures related to the spleen, lymph nodes, bone marrow, as well as surgical interventions in the mediastinum and diaphragm. Coders must differentiate procedures by region and system accurately.
Topic 15
  • Endocrine System and Nervous System: This section of the exam measures the skills of medical coders and assesses the ability to assign codes for surgeries involving glands, the brain, spinal cord, and peripheral nerves. Procedures like resections and electrical stimulation are part of the evaluated content.
Topic 16
  • Anesthesia: This section of the exam measures the skills of medical coders and involves coding anesthesia services based on surgical site, complexity, and time. It tests the understanding of anesthesia modifiers and the importance of linking anesthesia codes with the correct primary procedures.
Topic 17
  • The Business of Medicine: This section of the exam measures the skills of medical coders and covers foundational knowledge regarding the healthcare system, reimbursement models, insurance payers, HIPAA compliance, and the ethical responsibilities coders hold within clinical and billing environments. It establishes the context in which coding decisions directly affect healthcare operations and financial outcomes.
Topic 18
  • Urinary System and Male Genital System: This section of the exam measures the skills of medical coders and assesses understanding of procedures on kidneys, bladder, ureters, prostate, and male reproductive organs. Proper use of CPT codes for surgical and diagnostic interventions is tested.
Topic 19
  • Accurate ICD-10-CM Coding: This section of the exam measures the skills of medical coders and focuses on the precise assignment of diagnosis codes using the ICD-10-CM system. The goal is to ensure accurate representation of patient conditions, proper sequencing, and a clear linkage between diagnoses and services.

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AAPC Certified Professional Coder (CPC) Exam Sample Questions (Q39-Q44):

NEW QUESTION # 39
Adenoids, tonsils, appendix, and spleen belong to which organ system?

Answer: A

Explanation:
The adenoids, tonsils, appendix, and spleen are all part of the lymphatic system, which plays a crucial role in immune function and the filtration of pathogens. These organs contribute to the body's defense by trapping and eliminating bacteria and other pathogens.
Adenoids and tonsils are lymphatic tissues located in the throat and help prevent infection by filtering pathogens from inhaled or ingested particles.
The appendix contains lymphoid tissue and is thought to play a role in gut immunity.
The spleen filters blood, removing old or damaged blood cells and producing lymphocytes for immune response.
The other options are unrelated:
B: Gastrointestinal: Involved in digestion, but not specifically immune response.
C: Cardiovascular: Involved in blood circulation, not immune response.
D: Nervous: Coordinates sensory and motor functions, unrelated to lymphatic tissue.
Therefore, the correct answer is A. Lymphatic.


NEW QUESTION # 40
Which circumstance supports medical necessity for a payment by the insurance company?

Answer: D

Explanation:
Medical necessity is determined by whether a procedure or treatment is necessary to treat or manage a health condition. Removing excess skin after significant weight loss from a gastric bypass often meets medical necessity criteria because excess skin can lead to physical complications, such as infections, rashes, and mobility issues. Insurance companies are more likely to cover this procedure when it's needed to alleviate health issues rather than for cosmetic purposes.
A: Speech therapy for a lisp: Typically, therapy for minor speech impediments like a lisp may not be deemed medically necessary unless it severely affects communication or daily functioning.
B: Tummy tuck after a pregnancy: This procedure is generally classified as cosmetic and not medically necessary, as it is often done to improve appearance rather than address a health condition.
C: Second rhinoplasty for a smaller nose: This would likely be considered elective and cosmetic, especially if it is solely for aesthetic preference without any health-related issues.
Thus, the correct answer is D. Removing excess skin in losing weight from a gastric bypass, as it can be essential for physical health and quality of life.


NEW QUESTION # 41
Ten-year-old boy has a painful felon abscess of the deep tissues of the palmar surface of his right thumb. The provider makes an incision on one side of the nail and then across the fingertip parallel to the end of the nail. He identifies the area of abscess and drains it. A drainage tube is inserted.
What CPT and ICD-10-CM is reported?

Answer: D

Explanation:
1. Procedure and CPT Code Selection:
The procedure involves an incision and drainage (I&D) of a deep abscess (felon) on the palmar surface of the right thumb. A felon is an abscess in the pulp of the fingertip, often involving deep tissue.
Code 26010 is specific for incision and drainage of a finger abscess, which includes the thumb. This code applies to cases where the abscess is drained from a deep tissue level.
Code 26011 is similar but involves the use of extensive drainage or debridement, which is not indicated in this case. Therefore, 26011 is not appropriate here.
Code 10061 refers to incision and drainage of abscesses at different locations on the body but not for specific areas such as the thumb, making it inappropriate in this context.
Code 10140 pertains to the evacuation of hematoma, seroma, or fluid but does not apply to abscesses, so it is not suitable for this scenario.
2. Modifier:
Modifier F5 is added to specify that the procedure was performed on the right thumb.
3. Diagnosis and ICD-10-CM Code Selection:
ICD-10-CM Code L02.511 is appropriate for cutaneous abscess of the right finger, as it accurately describes the diagnosis of a felon on the thumb.
L03.011 would represent cellulitis but does not specify an abscess, making it less precise for this case.
4. AAPC and CPT Coding Guidelines:
The AAPC guidelines for coding finger abscess drainage emphasize the selection of specific codes for deep tissue drainage procedures in extremities. Additionally, correct laterality should be included with the use of modifiers and specific ICD-10-CM codes for an accurate representation of the site and nature of the condition.
Thus, based on the coding standards and guidelines, the verified answer is B. 26010-F5, L02.511.


NEW QUESTION # 42
A 16-year-old female just moved to the area and is living in a campground with her parents. She has several medical conditions and the parents are unable to take her to a physician's office. A physician sees the patient in the campground and documents a medical decision making of moderate complexity. After the visit, the physician spends an additional 25 minutes in a prolonged discussion with the patient's parents; he reviews complex and detailed medical records from her previous physicians and completes a comprehensive treatment plan. A care plan with the local hearth agency and a dietician is initiated.
What E/M coding is reported for this visit?

Answer: A

Explanation:
Service location = campground → domiciliary/home visit
Patient is new
99344 = New patient domiciliary visit, moderate MDM
Prolonged Services:
Additional 25 minutes beyond base time
99417 is used for prolonged services with office/home E/M codes
Why others are incorrect:
99349 - Established patient
99204 - Office visit (wrong location)


NEW QUESTION # 43
The CPTcode book provides full descriptions of medical procedures, with some descriptions requiring the use of a semicolon (;) to distinguish among closely related procedures.
What is the full description of CPTcode 35860?

Answer: C

Explanation:
In the CPTcode book, code 35860 describes an "Exploration for postoperative hemorrhage, thrombosis or infection" in multiple areas, specifically including the neck, chest, abdomen, and/or extremity. This code is used when a surgeon explores these areas postoperatively to locate and address complications such as bleeding, clots, or infections.
B, C, and D are incorrect as they do not fully encompass all the areas listed in the actual description of CPT code 35860, which includes all four regions (neck, chest, abdomen, and extremity).
Thus, the correct answer is A. Exploration for postoperative hemorrhage, thrombosis or infection; neck, chest, abdomen, and/or extremity.


NEW QUESTION # 44
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