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AAPC CPC Exam Syllabus Topics:

SectionWeightObjectives
Topic 1: ICD-10-CM Coding15-17%- Diagnosis coding guidelines
- Code selection & sequencing
Topic 2: Compliance & Regulations8-10%- Reimbursement rules
- HIPAA, fraud & abuse
Topic 3: Modifiers5-7%
Topic 4: Reimbursement & Revenue Cycle5-7%
Topic 5: CPT® Coding45-50%- Evaluation & Management (E/M)
- Surgery (10000–69999)
- Radiology, Pathology/Laboratory, Medicine
Topic 6: HCPCS Level II Coding5-7%
Topic 7: Medical Terminology & Anatomy8-10%

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AAPC Certified Professional Coder (CPC) Exam Sample Questions (Q409-Q414):

NEW QUESTION # 409
A 67-year-old male presents with DJD and spondylolisthesis at L4-L5 The patient is placed prone on the operating table and, after induction of general anesthesia, the lower back is sterilely prepped and draped. One incision was made over L1-L5. This was confirmed with a probe under fluoroscopy. Laminectomies are done at vertebral segments L4 and L5 with facetectomies to relieve pressure to the nerve roots. Allograft was packed in the gutters from L1-L5 for a posterior arthrodesis. Pedicle screws were placed at L2, L3, and L4.
The construct was copiously irrigated and muscle; fascia and skin were closed in layers.
Select the procedure codes for this scenario.

Answer: A

Explanation:
Laminectomy and Facetectomy (63047 and 63048): The laminectomies at L4 and L5 with facetectomies fall under CPT codes 63047 (for the initial segment) and 63048 (for each additional segment).
Posterior Arthrodesis (22612 and 22614 x 3): The posterior arthrodesis from L1-L5 is coded with 22612 for the primary segment (L4-L5) and 22614 for each additional segment (L1-L4).
Placement of Pedicle Screws (22842): The placement of pedicle screws at L2, L3, and L4 is captured under CPT code 22842 for segmental instrumentation.
References:
AMA's CPT Professional Edition (current year)
ICD-10-CM (current year)
HCPCS Level II (current year)


NEW QUESTION # 410
A 20-year-old female is being seen for the first time by a primary care physician to have a yearly physical.
During the examination for the physical, the provider discovers non-inflammed lesions on her legs and arms.
The physician performs a complete physical and additional separate documentation for the treatment of the lesions on the bilateral upper and lower extremities. The provider has the patient buy an over-the-counter ointment and will continue to watch them.
What CPT coding is reported for this visit?

Answer: C

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


NEW QUESTION # 411
A patient undergoes coronary angiography for chest pain. Coronary arteries are normal, and CAD is ruled out.
What CPT and ICD-10-CM codes are reported?

Answer: B

Explanation:
93454 = Coronary angiography
R07.9 = Chest pain, unspecified
CAD code is not reported when ruled out


NEW QUESTION # 412
Refer to the supplemental information when answering this question:
View MR 000281
What anesthesia and diagnosis codes are reported for this case?

Answer: B

Explanation:
CPT Code 00811: Anesthesia for lower intestinal endoscopic procedures, endoscope introduced distal to the splenic flexure; diagnostic, with or without collection of specimen(s) by brushing or washing This code is reported for anesthesia services provided during a colonoscopy that is diagnostic in nature.
ICD-10-CM Code D62: Acute posthemorrhagic anemia
This is the most accurate postoperative diagnosis. The operative report states "Anemia due to acute blood loss." ICD-10-CM Code N18.6: End stage renal disease This code captures the patient's documented history of ESRD.
ICD-10-CM Code Z99.2: Dependence on renal dialysis
This code is necessary to report the patient's dialysis status, as it affects the overall risk of the procedure.
Why other options are incorrect:
00812: This code is for therapeutic colonoscopies, not diagnostic.
D64.9: This code is for anemia, unspecified. D62 is more specific to the patient's condition.
K62.5: This code is for lower gastrointestinal bleeding, but the anemia is the primary diagnosis in this case.
References:
CPT Code 00811: Anesthesia for lower intestinal endoscopic procedures, endoscope introduced distal to the splenic flexure; diagnostic, with or without collection of specimen(s) by brushing or washing ICD-10-CM Code D62: Acute posthemorrhagic anemia ICD-10-CM Code N18.6: End stage renal disease ICD-10-CM Code Z99.2: Dependence on renal dialysis AAPC Coder's Desk Reference: This resource provides detailed information on coding guidelines and procedures.


NEW QUESTION # 413
Which circumstance supports medical necessity for a payment by the insurance company?

Answer: C

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 # 414
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