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質問 # 35
A patient underwent a cystourethroscopy with a pyeloscopy using lithotripsy to break up the ureteral calculus. An indwelling stent was also inserted during the same operative session on the same side. This service was performed in the outpatient hospital surgery center.
What CPT coding reported?
- A. 52353, 52332-51
- B. 0
- C. 52325, 52332-51
- D. 52352, 52332-51
正解：B
質問 # 36
View MR 099405
MR 099405
CC: Shortness of breath
HPI: 16-year-old female comes into the ED for shortness of breath for the last two days. She is an asthmatic.
Current medications being used to treat symptoms is Advair, which is not working and breathing is getting worse. Does not feel that Advair has been helping. Patient tried Albuterol for persistent coughing, is not helping. Coughing 10-15 minutes at a time. Patient has used the Albuterol 3x in the last 16 hrs. ED physician admits her to observation status.
ROS: No fever, no headache. No purulent discharge from the eyes. No earache. No nasal discharge or sore throat. No swollen glands in the neck. No palpitations. Dyspnea and cough. Some chest pain. No nausea or vomiting. No abdominal pain, diarrhea, or constipation.
PMH: Asthma
SH: Lives with both parents.
FH: Family hx of asthma, paternal side
ALLERGIES: PCN-200 CAPS. Allergies have been reviewed with child's family and no changes reported.
PE: General appearance: normal, alert. Talks in sentences. Pink lips and cheeks. Oriented. Well developed. Well nourished. Well hydrated.
Eyes: normal. External eye: no hyperemia of the conjunctiva. No discharge from the conjunctiva Ears: general/bilateral. TM: normal. Nose: rhinorrhea. Pharynx/Oropharynx: normal. Neck: normal.
Lymph nodes: normal.
Lungs: before Albuterol neb, mode air entry b/l. No rales, rhonchi or wheezes. After Albuterol neb. improvement of air entry b/l. Respiratory movements were normal. No intercostals inspiratory retraction was observed.
Cardiovascular system: normal. Heart rate and rhythm normal. Heart sounds normal. No murmurs were heard.
GI: abdomen normal with no tenderness or masses. Normal bowel sounds. No hepatosplenomegaly Skin: normal warm and dry. Pink well perfused Musculoskeletal system patient indicates lower to mid back pain when she lies down on her back and when she rolls over. No CVA tenderness.
Assessment: Asthma, acute exacerbation
Plan: Will keep her in observation overnight. Will administer oral steroids and breathing treatment. CXR ordered and to be taken in the morning.
What E/M code is reported?
- A. 0
- B. 1
- C. 2
- D. 3
正解：C
質問 # 37
View MR 003396
MR 003396
Operative Report
Preoperative Diagnosis: Acute MI, severe left main arteriosclerotic coronary artery disease Postoperative Diagnosis: Acute MI, severe left main arteriosclerotic coronary artery disease Procedure Performed: Placement of an intra-aortic balloon pump (IABP) right common femoral artery Description of Procedure: Patient's right groin was prepped and draped in the usual sterile fashion. Right common femoral artery is found, and an incision is made over the artery exposing it. The artery is opened transversely, and the tip of the balloon catheter was placed in the right common femoral artery. The balloon pump had good waveform. The balloon pump catheter is secured to his skin after local anesthesia of 2 cc of 1% Xylocaine is used to numb the area. The balloon pump is secured with a 0-silk suture. The patient has sterile dressing placed. The patient tolerated the procedure. There were no complications.
What CPT coding is reported for this case?
- A. 0
- B. 1
- C. 2
- D. 3
正解：C
質問 # 38
The spleen is in what organ system?
- A. Lymphatic
- B. Digestive
- C. Endocrine
- D. Nervous
正解：A
解説：
The spleen is a part of the lymphatic system, which is responsible for filtering blood, removing damaged blood cells, and supporting immune function. The spleen contains lymphocytes that help fight infections and regulate the immune response.
A: Nervous: The nervous system includes the brain, spinal cord, and nerves, unrelated to immune function.
B: Endocrine: The endocrine system regulates hormones through glands like the thyroid and pancreas, not directly involved with blood filtration or immune cell production.
C: Digestive: While the spleen is located near digestive organs, it does not play a role in digestion.
Thus, the correct answer is D. Lymphatic.
質問 # 39
Dr. Burns sees newborn baby James at the birthing center on the same day after the cesarean delivery. Dr.
Burns examined baby James, the maternal and newborn history, ordered appropriate blood test tests and hearing screening. He met with the family at the end of the exam.
How would Dr. Bums report his services?
- A. 0
- B. 1
- C. 2
- D. 3
正解：C
解説：
Dr. Burns is providing initial hospital or birthing center care for the evaluation and management of a normal newborn infant. CPT code 99460 is used to report initial hospital or birthing center care, per day, for evaluation and management of a normal newborn infant. This includes a comprehensive history, examination, and medical decision-making. The description of the service provided fits this CPT code accurately.
References: CPT Professional Edition (current year), AMA.
質問 # 40
A cardiologist performs remote monitoring for a 30-day period via a previously implanted hemodynamic pulmonary artery pressure monitor for a patient with congestive heart failure with resulting pulmonary edema.
The first month of monitoring includes weekly downloads, interpretations, trend analysis, and subsequent reports.
What CPTcode is reported?
- A. 0
- B. 1
- C. 2
- D. 3
正解：A
解説：
1. Procedure and CPTCode Selection:
The cardiologist provided remote monitoring over a 30-day period for a hemodynamic pulmonary artery pressure monitor implanted in a patient with congestive heart failure.
CPTCode 93264 is appropriate for remote monitoring of a hemodynamic system for up to 30 days. This code includes services such as weekly data transmissions, interpretation, trend analysis, and reporting- exactly as described in this case.
2. Rationale for Excluding Other Options:
Code 93286 is for in-person interrogation and programming of pacemakers or defibrillators, not for remote monitoring of a hemodynamic monitor, making it incorrect.
Code 93288 is for interrogation device evaluation (remote), specifically for pacemakers or defibrillators, and does not apply to a pulmonary artery pressure monitor.
Code 93279 is for in-person programming of certain cardiac devices, which does not match the remote monitoring described in this scenario.
3. AAPC and CPTCoding Guidelines:
AAPC and CPTguidelines specify that 93264 is the correct code when reporting remote hemodynamic monitoring for a pulmonary artery pressure device over a period of up to 30 days, including data review and interpretation.
Therefore, the correct answer is B. 93264.
質問 # 41
A 45-year-old male, with no prior history of heart disease, has been diagnosed having atherosclerotic heart disease with unstable angina. He is in the cardiologist's office for a cardiac MRI test to determine the morphology and function of his heart under stress. First images obtained are without contrast and then contrast is administered for the next set of images. Then the physician injects medicine to increase the heart rate and checks the coronary arteries for narrowing or blockage.
Physician interprets the test and the results and images are in the medical record.
What radiology CPTand ICD-10-CM codes are reported?
- A. 75557, 75559, 125.110
- B. 75563-26, 125.118
- C. 75559-26, 125.118
- D. 75563, 125.110
正解：B
解説：
1. Procedure and CPTCode Selection:
The patient underwent a cardiac MRI to assess the morphology and function of the heart under stress, involving both non-contrast and contrast-enhanced imaging. Additionally, pharmacological stress testing was performed to evaluate the coronary arteries.
CPTCode 75563 is appropriate for a cardiac MRI with both stress and rest imaging, including morphology and function studies with contrast and pharmacologic stress testing. This code accurately captures the entire scope of the MRI study described in this case.
Modifier 26 is applied to indicate the professional component of the service if the cardiologist is providing only the interpretation and not the technical component.
2. Diagnosis and ICD-10-CM Code Selection:
ICD-10-CM Code I25.118 is used for atherosclerotic heart disease with unstable angina. This code accurately reflects the diagnosis provided in the scenario.
3. Rationale for Excluding Other Options:
Code 75559 (option B) represents a cardiac MRI without stress testing, which does not cover the pharmacologic stress component performed here.
Code 75557 (in option D) is for a limited cardiac MRI that does not include both stress and non-stress imaging, so it is incorrect for this comprehensive test.
ICD-10-CM Code I25.110 (in options C and D) is for atherosclerosis with angina pectoris without unstable angina, making I25.118 more appropriate given the diagnosis of unstable angina.
4. AAPC and CPTCoding Guidelines:
AAPC and CPTguidelines support the use of 75563 for comprehensive cardiac MRI studies with stress testing, both with and without contrast.
Therefore, the correct answer is A. 75563-26, I25.118.
質問 # 42
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.
- A. 63047, 63048, 22612, 22614 x 3, 22842
- B. 63005 x 2, 22612, 22614 x 3, 22842
- C. 63017, 63048, 22612, 22808, 22842 x 3
- D. 63042, 63043, 22808, 22841 x 3
正解：A
質問 # 43
A patient arrives with stridor and in respiratory distress. The provider performs a micro laryngoscopy using a Parson's laryngoscope and magnifying telescope. A bronchoscopy was also performed using a 2.5 Stortz bronchoscope. The findings include subglottic web and stenosis with laryngeal edema suggestive of reflux. There was also significant collapse of the trachea at the carina and into the main bronchi bilaterally.
What CPTcoding is reported?
- A. 31629, 31526-51
- B. 31622, 31526-51, 69990
- C. 31622, 69990
- D. 31622, 31526-51
正解：D
解説：
1. Procedure and CPTCode Selection:
The provider performed both a bronchoscopy and a microlaryngoscopy to evaluate the patient's airway due to respiratory distress and stridor.
Code 31622 is used for a diagnostic bronchoscopy, which includes the inspection of the trachea, carina, and bronchial structures. Since the bronchoscopy was diagnostic and no additional therapeutic procedures were performed, this is the appropriate code.
Code 31526 is for direct laryngoscopy with the use of an operating microscope or telescope (microlaryngoscopy). This code is appropriate given the use of a Parson's laryngoscope and magnifying telescope to inspect the larynx.
2. Modifier 51:
Modifier 51 is added to 31526 to indicate that it was performed in conjunction with another procedure (31622, bronchoscopy). Modifier 51 denotes multiple procedures without the necessity of a separate incision.
3. Exclusion of Code 69990:
Code 69990 is used for the use of an operating microscope in microsurgery but is not coded separately when the procedure (such as microlaryngoscopy) already includes visualization with a microscope or telescope as part of the CPTdescriptor. Thus, 69990 is not separately reported in this scenario, per CPTguidelines.
4. AAPC and CPTCoding Guidelines:
The guidelines specify that when visualization or microlaryngoscopy is inherently part of the procedure (as in
31526), 69990 should not be billed separately. Also, the use of Modifier 51 for multiple procedures in the same session is appropriate.
Therefore, the verified answer, following the CPTand AAPC coding rules, is A. 31622, 31526-51.
質問 # 44
911 is called by the physician for an ambulance with non-emergency basic life support to pick up a patient from his office that had fainted. The patient was taken to the hospital. What HCPCS Level II coding is reported for the ambulance's service?
- A. A0429-QM-PH
- B. A0428-QM-HP
- C. A0429-QM-HP
- D. A0428-QM-PH
正解：D
解説：
To select the correct HCPCS Level II code for a non-emergency ambulance service, we focus on the following components:
A0428 represents "Ambulance service, Basic Life Support (BLS), non-emergency transport," which is appropriate here as the patient was transported with non-emergency BLS following a fainting episode. This eliminates options B and D, which indicate "emergency" (A0429).
QM Modifier indicates "Ambulance service provided under arrangement by a provider of services," relevant when a physician arranges the ambulance transport.
PH Modifier specifies "Physician's office to hospital" transport, matching the scenario where the patient was taken from the physician's office to the hospital.
Thus, A0428-QM-PH accurately describes a non-emergency BLS transport arranged by a provider from a physician's office to the hospital, aligning with choice A.
質問 # 45
A patient presents for a percutaneous needle biopsy of the liver with ultrasound guidance to assess the severity of his primary biliary cirrhosis.
What CPTand ICD-10-CM codes are reported?
- A. 47000, 10005, 76942, K74.3
- B. 47000, K74.5
- C. 47000, 76942, K74.3
- D. 47100, K74.5
正解：B
解説：
1. Procedure and CPTCode Selection:
The patient underwent a percutaneous needle biopsy of the liver with ultrasound guidance to assess primary biliary cirrhosis.
Code 47000 is the CPTcode for a percutaneous liver biopsy. This code encompasses the biopsy procedure itself.
Ultrasound guidance is commonly inherent to biopsy procedures, and guidance is not separately reported if the main code (47000) includes the technique used.
2. Diagnosis and ICD-10-CM Code Selection:
ICD-10-CM Code K74.5 is the correct code for primary biliary cirrhosis, which is specifically indicated in this case.
K74.3 is the code for other specified cirrhosis of the liver but is less specific than K74.5, making K74.5 the appropriate choice here.
3. Exclusion of Other Codes:
Code 47100 (option A) is for an open liver biopsy, which does not apply to this percutaneous procedure.
Codes 10005 (biopsy with imaging guidance) and 76942 (ultrasound guidance) would be redundant or incorrect since the main procedure code, 47000, sufficiently describes a percutaneous liver biopsy.
4. AAPC and CPTCoding Guidelines:
AAPC guidelines state that guidance is included in certain biopsy codes when performed for the targeted organ, such as in 47000 for a liver biopsy.
Therefore, based on CPTand ICD-10-CM coding rules, the correct answer is C. 47000, K74.5.
質問 # 46
A 55-year-old patient was recently diagnosed with an enlarged goiter. It has been two years since her last visit to the endocrinologist. A new doctor in the exact same specialty group will be examining her. The physician performs a medically appropriate history and exam. The provider reviewed the TSH results and ultrasound.
The provider orders a fine needle aspiration biopsy which is a minor procedure.
What E/M code is reported?
- A. 0
- B. 1
- C. 2
- D. 3
正解：D
解説：
The patient is seeing a new doctor in the same specialty group for an enlarged goiter and is undergoing a medically appropriate history and exam, along with a fine needle aspiration biopsy.
* Procedure Description:
* Medically appropriate history and exam.
* Review of TSH results and ultrasound.
* Ordering of fine needle aspiration biopsy.
* CPT Coding:
* 99202: Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and straightforward medical decision making.
Since it has been two years since the last visit and the patient is being seen by a new doctor in the same specialty group, the encounter is considered a new patient visit.
References:
* AMA's CPT Professional Edition (current year).
* CPT Assistant for detailed coding guidelines on evaluation and management services.
質問 # 47
A Medicare patient that is on dialysis for ESRD is seen by the nurse for a Hep B vaccination. This patient is given a dialysis patient dosage as part of a three-dose schedule. The nurse administers the Hep B vaccine in the right deltoid. The physician reviews the chart and signs off on the nurse's note.
What procedure and diagnosis codes are reported for the scheduled vaccine injection for this Medicare patient?
- A. G0010, 90740, Z23, N18.6, Z99.2
- B. 90471, 90746, Z23, B19.10, N18.6, Z99.2
- C. 99211-25, G0010, 90740, B19.10, N18.6, Z99.2
- D. 90471, 90746, Z23, N18.6, Z99.2
正解：A
質問 # 48
A patient who has colon adenocarcinoma undergoes a laparoscopic partial colectomy. The surgeon removes the proximal colon and terminal ileum and reconnects the cut ends of the distal ileum and remaining colon.
What procedure and diagnosis codes are reported?
- A. 44140, C18.9
- B. 44160, C18.2
- C. 44204, C18.2
- D. 44205, C18.9
正解：C
解説：
The procedure involves a laparoscopic partial colectomy where the surgeon removes the proximal colon and terminal ileum, then reconnects the cut ends of the distal ileum and remaining colon.
* Procedure Description:
* Laparoscopic partial colectomy.
* Removal of the proximal colon and terminal ileum.
* Anastomosis of the distal ileum and remaining colon.
* CPT Coding:
* 44204: Laparoscopy, surgical; colectomy, partial, with anastomosis.
* ICD-10-CM Coding:
* C18.2: Malignant neoplasm of ascending colon.
References:
* AMA's CPT Professional Edition (current year).
* ICD-10-CM for corresponding diagnosis codes.
質問 # 49
A patient with Parkinson's has sialorrhea. The physician administers an injection of atropine bilaterally into a total of four submandibular salivary glands.
What CPT coding is reported?
- A. 64611 x 4
- B. 64611-50
- C. 0
- D. 64611-52
正解：C
解説：
* Injection of atropine: Atropine is administered to reduce sialorrhea.
* Bilateral submandibular salivary glands: The physician administers the injections into the salivary glands.
* Total of four glands: Indicates that multiple glands are treated in the same session.
CPT code 64611 accurately represents chemodenervation of the salivary glands, bilateral. The use of -50, -52, or x4 modifiers is not appropriate since CPT guidelines include bilateral procedures in this code without needing additional modifiers or codes.
References: AMA's CPT Professional Edition (current year)
質問 # 50
The CPT code book provides full descriptions of medical procedures, although some descriptions require the use of a semicolon (;) to distinguish among closely related procedures.
What is the full description of CPT code 69644?
- A. Tympanoplasty with mastoidectomy (including canalplasty. middle ear surgery, tympanic membrane repair); without ossicular chain reconstruction with intact or reconstructed canal wall, with ossicular chain reconstruction
- B. With intact or reconstructed canal wall with ossicular chain reconstruction
- C. Tympanoplasty with mastoidectomy (including canalplasty. middle ear surgery, tympanic membrane repair); with intact or reconstructed canal wall, with ossicular chain reconstruction
- D. Without ossicular chain reconstruction with intact or reconstructed canal wall, with ossicular chain reconstruction
正解：C
質問 # 51
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AAPC CPC 認定試験の出題範囲：
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AAPC CPCリアルな問題と知能問題集：https://www.passtest.jp/AAPC/CPC-shiken.html
CPC問題集でCertified Professional Coder高確率練習問題集：https://drive.google.com/open?id=1ti0qdH3EYRfNPFIMHTOb4g495UQTG-BM