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Certified Professional Coder (CPC) Practice Exam 1
Take your exam preparation to the next level with fully simulated online practice tests designed to replicate the real exam experience. These exams feature realistic questions, timed conditions, and detailed explanations to help you assess your knowledge, identify weak areas, and build confidence before test day.
1. A patient is diagnosed with stomach cancer, and the oncologist assigns Stage IIA using the TNM system. What is the most likely TNM classification for this stage?
Correct Answer: B Explanation: In gastric cancer staging, Stage IIA generally corresponds to T2 N1 M0, where T2 indicates tumor invasion into the muscularis propria, N1 represents metastasis to 1–2 regional lymph nodes, and M0 confirms no distant metastasis (B). T1 N0 M0 (A) is incorrect because it represents Stage I. T3 N2 M1 (C) is incorrect because M1 (distant metastasis) moves the staging to Stage IV. T4 N3 M1 (D) is incorrect because T4 tumors invade surrounding organs, and N3 represents extensive nodal involvement, which is more advanced than Stage IIA.
2. A 67-year-old female presents to the emergency department with confusion, fever, and a blood pressure of 85/50 mmHg. The physician immediately recognizes signs of septic shock, initiates aggressive IV fluid resuscitation, and starts broad-spectrum antibiotics. The physician remains at the bedside monitoring the patient’s condition for 40 minutes. What is the most appropriate CPT code for this visit?
Correct Answer: B (99285). The correct code is 99285 (B) because the physician performed a high complexity emergency department visit, which involves comprehensive history, comprehensive examination, and high complexity MDM. The patient is critically ill but does not meet the minimum time requirement (30 minutes) for 99291 critical care coding since the provider's total critical care time must exclude separately reportable services such as procedures. Option A (99291) is incorrect because while the patient is severely ill, critical care coding requires at least 30 minutes of exclusive critical care, which may not be fully documented in this scenario. Option C (99292) is incorrect because it is an add-on code used only when the first hour of critical care (99291) has been reported. Option D (99283) is incorrect because it represents moderate complexity MDM, which is inappropriate given the patient's life-threatening condition.
3. A 50-year-old male is seen in the outpatient clinic for "possible osteoarthritis of the right knee." The provider recommends X-rays and physical therapy but does not confirm the diagnosis. How should this visit be coded?
Correct Answer: D. M25.561 Explanation: The correct ICD-10-CM code for possible osteoarthritis in an outpatient setting is M25.561 (Pain in right knee) (D). ICD-10-CM outpatient coding guidelines state that uncertain diagnoses should NOT be coded as confirmed conditions. Instead, coders should assign symptom-based codes. R26.2 (A) is incorrect because R26.2 (Difficulty walking) does not specifically describe knee pain, which is more appropriate for this encounter. M17.11 (B) is incorrect because M17.11 (Unilateral primary osteoarthritis, right knee) should only be assigned if osteoarthritis is confirmed. M17.9 (C) is incorrect because M17.9 (Unspecified osteoarthritis of knee) represents a confirmed but unspecified type of osteoarthritis, which is not appropriate when the diagnosis is uncertain. Coders must follow outpatient coding guidelines and report the patient’s symptoms rather than uncertain conditions.
4. A psychiatrist evaluates a 52-year-old male patient who has had multiple depressive episodes in the past and is currently experiencing another one, described as severe with psychotic symptoms. What is the appropriate ICD-10-CM code for this diagnosis?
Correct Answer: C. F33.3 is the correct ICD-10-CM code for major depressive disorder, recurrent, severe, with psychotic symptoms. (C) Since the patient has a history of multiple depressive episodes, the provider must use a code from the F33 category (recurrent major depressive disorder). The inclusion of psychotic symptoms means the specific code for severe depression with psychotic features (F33.3) is appropriate. (A) F32.3 is incorrect because it represents major depressive disorder, single episode, severe with psychotic symptoms, which does not match the recurrent nature of the patient’s condition. (B) F31.2 is incorrect as it represents bipolar disorder, which is not indicated in the documentation. (D) F34.8 is incorrect because it refers to other persistent mood disorders, which do not align with the diagnosis of major depressive disorder with psychotic symptoms.
5. A 45-year-old male patient presents with GERD symptoms and undergoes a Bravo pH test, which involves a wireless pH capsule placed via endoscopy. What is the correct CPT code for this procedure?
Correct Answer: B. 91035 Explanation: The correct answer is (B) 91035, which codes for esophageal pH monitoring using the Bravo capsule system, a wireless method of measuring acid reflux over 48 hours. (A) 91034 is incorrect as it represents traditional catheter-based pH monitoring, which is different from the Bravo capsule system. (C) 43235 is incorrect as it represents a diagnostic EGD without pH monitoring. (D) 43239 is incorrect as it codes for an EGD with biopsy, which was not performed in this case.
6. A 50-year-old woman is seen in the clinic for persistent pain in her right shoulder after a previously healed rotator cuff tear. The original tear occurred over a year ago, and she completed physical therapy, but she continues to experience weakness and limited mobility. The coder looks up S46.011- (Strain of right rotator cuff muscle) and finds that a seventh character extension is required. What is the correct ICD-10-CM code assignment?
Correct Answer: C. S46.011S Explanation: The correct ICD-10-CM code for a chronic complication of a previously healed right rotator cuff tear is S46.011S (C). The seventh character "S" is used for sequela, which applies to conditions where a past injury leads to ongoing problems requiring treatment. S46.011A (A) is incorrect because "A" is for initial encounters during active treatment. S46.011D (B) is incorrect because "D" is for subsequent encounters related to ongoing healing, not long-term effects. S46.011X (D) is incorrect because the seventh character is required. Coders must assign "S" when treating conditions that are consequences of prior injuries.
7. A 68-year-old female presents with secondary Parkinsonism due to past cerebrovascular disease. The provider documents "Parkinsonism secondary to prior stroke." The coder reviews "Parkinsonism, post-cerebrovascular disease" in the ICD-10-CM index and finds I69.09 [G21.4], which follows the etiology/manifestation coding rule. What is the correct ICD-10-CM coding sequence?
Correct Answer: B. I69.09, G21.4 Explanation: The correct ICD-10-CM codes for post-stroke secondary Parkinsonism are I69.09, G21.4 (B). I69.09 (Sequela of cerebrovascular disease) is the etiology and must be coded first, while G21.4 (Secondary Parkinsonism) is the manifestation and must be coded second.
8. A 48-year-old male with hepatitis C undergoes FibroScan (transient elastography) to assess liver stiffness and fibrosis stage. What is the correct CPT code for this diagnostic procedure?
Correct Answer: A. 91200 Explanation: The correct answer is (A) 91200, which codes for transient elastography (FibroScan), a non-invasive test used to measure liver stiffness and assess fibrosis. (B) 76705 is incorrect because it represents a limited abdominal ultrasound, which does not provide fibrosis staging. (C) 76700 is incorrect because it codes a complete abdominal ultrasound, but FibroScan specifically measures liver stiffness rather than performing a general ultrasound. (D) 47011 is incorrect as it represents a liver biopsy performed via laparoscopy, which is an invasive procedure and not the same as transient elastography.
9. A 65-year-old woman presents to the clinic after tripping on a rug and falling onto her outstretched hand. Imaging confirms a Colles' fracture of the left distal radius. What is the correct ICD-10-CM code?
Correct Answer: C. S52.531A Explanation: The correct code is S52.531A (Colles' fracture of left radius, initial encounter for closed fracture) because a Colles' fracture refers to a distal radius fracture with dorsal displacement. (C) is correct as it accurately describes the injury. (A) S52.532A (Colles' fracture of right radius, initial encounter for closed fracture) is incorrect because the injury is to the left radius, not the right. (B) S52.501A (Unspecified fracture of lower end of left radius, initial encounter for closed fracture) is incorrect because a Colles' fracture is a specific type of fracture, requiring a more precise code. (D) S52.592A (Other specified fracture of left radius, initial encounter for closed fracture) is incorrect because a Colles' fracture has its own specific code and should not be coded under "other specified fracture."
10. A 29-year-old woman presents at 14 weeks gestation with continuous vaginal bleeding for the past three weeks. The physician diagnoses her with an inevitable abortion and admits her for observation. What is the appropriate ICD-10-CM code?
Correct Answer: A. O03.1 Explanation: The correct ICD-10-CM code for an inevitable abortion is O03.1 (Spontaneous abortion, incomplete, with hemorrhage) (A). An inevitable abortion refers to pregnancy loss that is in progress, characterized by vaginal bleeding, cervical dilation, and an impending miscarriage. O20.0 (Threatened abortion) (B) is incorrect because a threatened abortion describes vaginal bleeding without cervical dilation, whereas an inevitable abortion is a step further, where miscarriage is certain. O03.4 (Incomplete spontaneous abortion with other complications) (C) is incorrect because the case does not mention additional complications beyond bleeding. O03.2 (Incomplete spontaneous abortion without complication) (D) is incorrect because hemorrhage is present, and ICD-10-CM requires specification of complications when they exist. Correct coding ensures proper documentation of the patient’s condition and supports appropriate clinical management.
11. A 52-year-old male presents to the emergency department with severe abdominal pain and vomiting. After evaluation, the provider diagnoses acute pancreatitis due to chronic alcohol use. The patient also has a history of alcoholic cirrhosis of the liver. The provider documents "Acute alcohol-induced pancreatitis with alcoholic cirrhosis of the liver." What is the correct ICD-10-CM coding sequence for this encounter?
Correct Answer: A. K85.20, K70.30 Explanation: The correct ICD-10-CM codes for acute pancreatitis due to chronic alcohol use with alcoholic cirrhosis of the liver are K85.20, K70.30 (A). K85.20 (Acute pancreatitis, alcohol-induced, without necrosis or infection) is the principal diagnosis because it is the acute condition requiring immediate treatment. K70.30 (Alcoholic cirrhosis of the liver without ascites) is listed as a secondary diagnosis since it is a pre-existing chronic condition. K70.30, K85.20 (B) is incorrect because the acute condition (pancreatitis) should be coded as the principal diagnosis, not the chronic condition. K85.20, K70.31 (C) is incorrect because K70.31 represents alcoholic cirrhosis with ascites, which was not documented. K85.21, K70.30 (D) is incorrect because K85.21 represents acute pancreatitis with necrosis, which was not specified in the provider's documentation. When an acute condition and a chronic condition are both present, the acute condition is coded first if it is the primary reason for treatment.
12. A 78-year-old male with chronic kidney disease stage 4 presents with fever, cough, and severe fatigue. He tests positive for COVID-19 and is diagnosed with acute kidney injury due to COVID-19. What is the correct ICD-10-CM code assignment?
Correct Answer: A Explanation: The correct codes are (A) U07.1, which represents "COVID-19," N17.9, which represents "Acute kidney failure, unspecified," and N18.4, which represents "Chronic kidney disease stage 4." Since the provider documented acute kidney injury (AKI) due to COVID-19 in a patient with preexisting CKD stage 4, both conditions must be coded, with U07.1 sequenced first. (B) N17.9, U07.1 is incorrect because U07.1 should always be sequenced first in cases where COVID-19 is the confirmed underlying cause of another condition. (C) U09.9, N17.9, N18.4 is incorrect because U09.9 is for post-COVID conditions, but this is an active COVID-19 infection. (D) B97.21, N17.9 is incorrect because B97.21 represents "SARS-associated coronavirus as the cause of diseases classified elsewhere," which is not used for COVID-19 cases.
13. A patient visits the clinic for a headache, but the physician does not specify whether it is tension-type, migraine, or due to another cause. What is the most appropriate ICD-10-CM code?
Correct Answer: A. R51.9 Explanation: The correct ICD-10-CM code for an unspecified headache is R51.9 (A), which is classified as "headache, unspecified." The NOS convention applies because the provider documented a headache without specifying whether it was a migraine, tension-type, or another form. G44.209 (B) is incorrect because it represents tension-type headache, unspecified, which should only be used when the provider specifically documents tension headaches. G43.909 (C) is incorrect because it refers to unspecified migraine without status migrainosus, which is inappropriate unless the provider states the headache is a migraine. R51.0 (D) is incorrect because it refers to headache with orthostatic component, which was not mentioned in the provider's notes. The NOS designation ensures that coders apply the correct general code when documentation lacks specificity.
14. A 14-year-old boy presents with mild social difficulties and repetitive behaviors but is high-functioning and does not require significant support. The provider diagnoses him with pervasive developmental disorder, unspecified. What is the correct ICD-10-CM code?
Correct Answer: B. F84.9 is the correct ICD-10-CM code for pervasive developmental disorder, unspecified. (B) This code is used when a patient exhibits some characteristics of autism spectrum disorder or other neurodevelopmental conditions but does not meet full criteria for a specific diagnosis. (A) F84.0 is incorrect because it represents autism spectrum disorder, which typically requires clear diagnostic criteria regarding communication deficits and behavioral restrictions. (C) F84.5 is incorrect as it codes for Asperger’s syndrome, which is a more specific diagnosis than the provider has documented. (D) F90.9 is incorrect because it codes for unspecified ADHD, which is unrelated to the patient’s diagnosis of a neurodevelopmental disorder.
15. A 40-year-old patient is diagnosed with pneumocystis pneumonia (PCP) and tests positive for HIV for the first time. The provider confirms "AIDS with PCP." What is the correct ICD-10-CM code assignment?
Correct Answer: A Explanation: The correct codes are (A) B20, which represents "HIV disease," and B59, which represents "Pneumocystis pneumonia." Since the patient is newly diagnosed with HIV and has an AIDS-defining illness (PCP), the appropriate coding guideline states that B20 must be assigned, followed by the specific AIDS-related condition. (B) B97.35, B59 is incorrect because B97.35 is used as a secondary code when HIV causes another disease but does not replace B20. (C) Z21, B59 is incorrect because Z21 is used only for asymptomatic HIV patients, and this patient has AIDS. (D) R75, B59 is incorrect because R75 is used for inconclusive HIV test results, but this patient has a confirmed diagnosis.
16. A 58-year-old female with a recent hip replacement presents with calf pain and swelling. A venous ultrasound confirms an acute DVT of the left peroneal vein. What is the correct ICD-10-CM code assignment?
Correct Answer: D. I82.412 Explanation: Acute embolism and thrombosis of the peroneal vein is correctly coded as I82.412. This code is specific to an acute event in the peroneal vein of the lower extremity. (A) I82.501 is incorrect because it represents chronic thrombosis rather than an acute DVT. (B) I82.432 is incorrect because it represents thrombosis of the popliteal vein, which is not documented in this scenario. (C) I82.452 is incorrect because it represents thrombosis of the iliac vein, rather than the peroneal vein. The correct answer is (D) I82.412, as it accurately describes an acute DVT of the peroneal vein.
17. A pediatric patient is diagnosed with a rare congenital abnormality that does not have a specific ICD-10-CM code available. The provider has documented the abnormality, but the coder cannot find an exact match in the classification system. Which code should be assigned?
Correct Answer: C. Q89.8 Explanation: The correct ICD-10-CM code for a specified congenital abnormality without a precise classification is Q89.8 (C), which represents "other specified congenital malformations, NEC." This is an NEC code used when the provider specifies a congenital anomaly but no exact ICD-10-CM code exists. Q89.9 (A) is incorrect as it refers to an unspecified congenital malformation, which would only be used if the provider did not document the nature of the anomaly. Q79.8 (B) pertains to other congenital malformations of the musculoskeletal system, which is incorrect unless the anomaly specifically affects that system. Q99.8 (D) is for other specified chromosome abnormalities, which is unrelated to the case. NEC conventions allow coders to select the most appropriate category when no direct match is available.
18. A 68-year-old patient with end-stage renal disease undergoes an arteriovenous (AV) fistula creation in the forearm for hemodialysis access. What is the correct CPT code for this procedure?
Answer: C. 36821 Explanation: The correct CPT code for the surgical creation of an arteriovenous fistula in the forearm without a graft is 36821. This code is used when an AV fistula is made by directly connecting an artery to a vein, allowing for dialysis access. Option (A) is incorrect because 36830 refers to thrombectomy of an AV fistula, not creation. Option (B) is incorrect because 36825 refers to an AV fistula with a graft, which is not specified in this scenario. Option (D) is incorrect because 36901 is for a percutaneous AV fistula procedure, not a surgical one.
19. A 70-year-old patient with macular degeneration presents with visual acuity of 20/500 in both eyes, despite best correction. The physician confirms that the patient meets the criteria for statutory blindness. What is the correct ICD-10-CM code?
Correct Answer: C. H54.52 Explanation: H54.52 is the correct ICD-10-CM code for severe visual impairment in both eyes, which is defined as best-corrected visual acuity worse than 20/400. (C) is correct because the patient’s 20/500 visual acuity qualifies as statutory blindness. (A) is incorrect because H54.8 is a non-specific code that does not define the severity of impairment. (B) is incorrect because H54.03 is used for total blindness, whereas the patient retains some vision. (D) is incorrect because H54.10 represents blindness determined by visual field restriction, whereas this case is based on visual acuity measurements.
20. A 29-year-old pregnant woman is diagnosed with a urinary tract infection (UTI) during the third trimester. The coder looks up O23.43- (Infections of the urinary tract in pregnancy, third trimester) and notes that a seventh character is required. What is the correct ICD-10-CM code assignment?
Correct Answer: B. O23.439A Explanation: The correct ICD-10-CM code for a UTI in pregnancy during the third trimester is O23.439A (B). The seventh character is required to indicate the pregnancy episode (A for the initial encounter, D for subsequent, etc.). The "9" serves as a necessary additional digit to maintain proper ICD-10-CM structure before the seventh character "A". O23.43XA (A) is incorrect because "X" is not used in this specific category. O23.43X1A (C) is incorrect because "X1" is not a valid coding format. O23.43A (D) is incorrect because the code must be six characters before applying a seventh character. Proper understanding of placeholder usage ensures correct pregnancy-related coding and prevents denials.
21. A 68-year-old female presents with frequent episodes of syncope. The ECG confirms tachy-brady syndrome. The provider diagnoses "bradycardia-tachycardia syndrome secondary to sick sinus syndrome." What is the correct ICD-10-CM code assignment?
Correct Answer: A. I49.5 Explanation: Bradycardia-tachycardia syndrome, also known as tachy-brady syndrome, is a variant of sick sinus syndrome and is correctly coded as I49.5. This condition involves alternating episodes of bradycardia and tachycardia due to sinoatrial node dysfunction. (B) I49.8 is incorrect because it represents other specified arrhythmias and does not specifically include sick sinus syndrome. (C) I45.4 is incorrect because it represents a different conduction disorder, namely, incomplete left bundle branch block. (D) I44.2 is incorrect because it represents complete heart block, which is unrelated to sick sinus syndrome. The correct answer is (A) I49.5, as it fully captures the diagnosis of tachy-brady syndrome associated with sick sinus syndrome.
22. A 40-year-old male presents with red, swollen, and painful lesions in both armpits, diagnosed as hidradenitis suppurativa. The provider prescribes antibiotics and plans for possible surgical intervention if symptoms do not improve. What is the correct ICD-10-CM code for this condition?
Correct Answer: A. L73.2 Explanation: The correct answer is L73.2 (Hidradenitis suppurativa), which is a chronic inflammatory condition affecting apocrine sweat glands, commonly in the axillae and groin, characterized by painful nodules, abscesses, and sinus tract formation. (B) L03.113 (Cellulitis of right lower limb) is incorrect because hidradenitis suppurativa is distinct from cellulitis, which is an acute bacterial skin infection. (C) L02.419 (Cutaneous abscess of unspecified site) is incorrect because hidradenitis suppurativa is a chronic, recurring condition and not a simple abscess. (D) L98.3 (Eosinophilic cellulitis) is incorrect because this is a different inflammatory skin disorder unrelated to hidradenitis suppurativa.
23. A 67-year-old male is seen for follow-up of a healing diabetic foot ulcer on his left heel. The provider documents that the ulcer is due to type 2 diabetes with peripheral angiopathy, and the ulcer is now in the healing stage without necrosis. What is the correct ICD-10-CM coding?
Correct Answer: C Explanation: ICD-10-CM guidelines require that diabetic complications be coded as combination codes when available. E11.51 (C) correctly captures type 2 diabetes with peripheral angiopathy, and L97.421 (C) is assigned for a non-pressure ulcer of the left heel limited to breakdown of skin. Option A is incorrect because the diabetes should be coded first as the underlying condition, not the ulcer. Option B is incorrect as E11.621 is for diabetic foot ulcers with necrosis, which was not documented. Option D is incorrect as E11.9 represents diabetes without complications, which does not reflect the provider's documentation of peripheral angiopathy and ulcer.
24. A 40-year-old male presents to the emergency department with confusion and tachycardia after consuming a large amount of alcohol along with his prescribed opioid pain medication. The physician diagnoses opioid toxicity due to accidental combination with alcohol. What is the correct ICD-10-CM code for the opioid toxicity?
Correct Answer: A. T40.2X1A Explanation: The patient experienced opioid toxicity due to the accidental interaction of alcohol and prescribed opioids. The correct classification is an unintentional (accidental) poisoning. Looking up "Opioids" in the Table of Drugs and Chemicals, T40.2X- is used for other opioids. The "1" in T40.2X1- denotes accidental poisoning. (A) is correct because T40.2X1A correctly classifies opioid poisoning due to accidental ingestion. (B) is incorrect because T40.2X3A is used for intentional self-harm. (C) is incorrect because T40.2X5A represents an adverse effect rather than poisoning. (D) is incorrect because T40.2X2A is used for poisoning due to assault, which is not applicable.
25. A patient presents with a second-degree burn covering 8% of the left forearm and a first-degree burn covering 3% of the right thigh. According to ICD-10-CM laterality and site-specific coding guidelines, how should this be reported?
Correct Answer: C Explanation: ICD-10-CM guidelines require reporting burns by degree, site, and laterality, along with a total body surface area code when appropriate. T22.212A (C) is assigned for a second-degree burn of the left forearm, T24.111A (C) for a first-degree burn of the right thigh, and T31.10 (C) for burns covering 10-19% of the total body surface area. Option A is incorrect because T31.11 is used for burns covering 20-29% of the body, which is not the case here. Option B is incorrect because T22.211A is for a first-degree burn, while the left forearm burn is second-degree. Option D is incorrect because T24.112A is for a second-degree burn of the right thigh, but the documentation states it is a first-degree burn.
26. A 29-year-old woman has been experiencing persistent delusions for the past year without prominent hallucinations or disorganized speech. Her provider diagnoses her with delusional disorder. What is the correct ICD-10-CM code?
Correct Answer: A. F22 is the correct ICD-10-CM code for delusional disorder. (A) Delusional disorder is characterized by the presence of one or more persistent delusions without the other core symptoms of schizophrenia, such as disorganized speech or behavior. (B) F20.9 is incorrect because it represents schizophrenia, unspecified, which requires a broader range of psychotic symptoms beyond delusions. (C) F25.1 is incorrect as it codes for schizoaffective disorder, depressive type, which includes mood disturbances not mentioned in the patient’s presentation. (D) F20.0 is incorrect because it represents paranoid schizophrenia, which typically includes hallucinations and disorganized thought, not just persistent delusions.
27. A 38-year-old male is newly diagnosed with primary lateral sclerosis (PLS), a rare form of motor neuron disease that causes progressive muscle weakness without lower motor neuron involvement. What is the correct ICD-10-CM code assignment for this diagnosis?
Correct Answer: A Explanation: The correct ICD-10-CM code for primary lateral sclerosis (PLS) is G12.23 (A), which specifically classifies this form of motor neuron disease that affects only the upper motor neurons without causing lower motor neuron degeneration. G12.21 (B) is incorrect because it represents amyotrophic lateral sclerosis (ALS), which affects both upper and lower motor neurons. G10 (C) is incorrect as it codes for Huntington’s disease, which is unrelated to motor neuron diseases. G35 (D) is incorrect because it represents multiple sclerosis, which is an autoimmune demyelinating disorder rather than a motor neuron disease.
28. A 50-year-old female with uncontrolled hypertension is diagnosed with hypertensive heart and chronic kidney disease stage 4. No signs of heart failure are documented. What is the correct ICD-10-CM code assignment?
Correct Answer: C. I13.10, N18.4 Explanation: Hypertensive heart and chronic kidney disease without heart failure requires the use of combination code I13.10, along with a secondary code to indicate the stage of CKD, which is N18.4 in this case. (A) I11.0 is incorrect because it represents hypertensive heart disease with heart failure, which is not documented here. (B) I10 is incorrect because it represents essential hypertension without associated heart or kidney disease. (D) I12.0 is incorrect as it represents hypertensive CKD without heart disease, whereas the provider specifically documents both conditions. The correct answer is (C) I13.10 and N18.4 to fully capture the patient's diagnosis.
29. A patient is diagnosed with "cervical radiculopathy." While searching for "Radiculopathy," the coder finds "Radiculopathy (cervical) (thoracic) (lumbosacral)" listed in the index. What does this indicate, and what is the correct ICD-10-CM code?
Correct Answer: B. M54.12 Explanation: The correct ICD-10-CM code for cervical radiculopathy is M54.12 (B). The parentheses around "(cervical) (thoracic) (lumbosacral)" in the index mean that these words do not change the meaning of the term "radiculopathy," but instead indicate that the coder must look further to select the most specific code. M54.17 (A) is incorrect because it represents lumbosacral radiculopathy, which does not match the documented cervical region. M54.10 (C) is incorrect because it represents radiculopathy, unspecified site, which should only be used when the provider does not document the affected area. M54.16 (D) is incorrect because it represents thoracic radiculopathy, which is not applicable in this scenario. Coders must apply the proper level of specificity while recognizing that terms in parentheses serve as supplementary indicators rather than exclusions.
30. A physician prescribes sterile saline irrigation solution for wound care management in a home setting. The patient receives a 500 mL bottle of sterile normal saline solution for external use. What is the appropriate HCPCS Level II code for this supply?
Correct Answer: D. A4218 Explanation: The correct answer is (D) A4218, which represents sterile saline or sterile water for irrigation, 500 mL. This code is appropriate for wound care irrigation solutions provided for home or outpatient use. (A) A4217 is incorrect because it represents sterile water, not sterile saline. (B) A4216 is incorrect as it codes for sterile saline in smaller volumes, typically used for injection rather than irrigation. (C) J7030 is incorrect because it represents intravenous normal saline infusions, which is distinct from external irrigation solutions. Accurate selection of HCPCS codes for supplies ensures compliance with billing regulations and prevents denials due to incorrect classification.
31. A 45-year-old male presents with symptoms of a UTI and is treated with a suprapubic catheterization due to urinary retention. What is the correct CPT code for this procedure?
Answer: A. 51020 Explanation: The correct CPT code for suprapubic catheterization is 51020, which is used when a catheter is placed directly into the bladder through the abdominal wall. Option (B) is incorrect because 51701 refers to a simple urethral catheterization, not a suprapubic approach. Option (C) is incorrect because 51702 is for insertion of an indwelling urethral catheter, which is not specified in the scenario. Option (D) is incorrect because 51703 represents complicated urethral catheterization, which is not relevant to a suprapubic approach.
32. A 62-year-old patient with ulcerative colitis undergoes a total proctocolectomy with ileal pouch-anal anastomosis (IPAA). What is the correct CPT code for this procedure?
Correct Answer: A. 44150 Explanation: The correct answer is (A) 44150, which represents a total proctocolectomy with ileal pouch-anal anastomosis (IPAA), a common surgical procedure for ulcerative colitis. (B) 44155 is incorrect because it represents a total abdominal colectomy without proctectomy, whereas this procedure removes both the colon and rectum. (C) 44211 is incorrect because it represents a laparoscopic version of this procedure, but the scenario does not specify a laparoscopic approach. (D) 45110 is incorrect because it represents a proctectomy without total colectomy, which is not the procedure performed in this case.
33. A 55-year-old female with breast cancer undergoes a left-sided mastectomy with axillary lymph node dissection. What is the correct CPT code for this procedure?
Correct Answer: B Explanation: The correct CPT code for total mastectomy with axillary lymph node dissection is 19307 (Mastectomy, modified radical, including axillary lymph nodes, with or without pectoralis minor muscle) (B). 19303 (Mastectomy, simple, complete) (A) is incorrect because it does not include axillary lymph node dissection. 19305 (Mastectomy, radical, including pectoral muscles and axillary lymph nodes) (C) is incorrect because it describes a more extensive radical mastectomy. 38525 (Axillary lymph node dissection) (D) is incorrect because it only codes for the lymph node dissection and does not include the mastectomy.
34. A physician performs a total abdominal hysterectomy. Within the global period, the patient returns with a suspected urinary tract infection. The physician evaluates the patient and prescribes antibiotics. How should the evaluation and management service be reported?
Correct Answer: A Explanation: The correct answer is (A) because modifier -24 is used when an unrelated evaluation and management service is performed during the global period of a surgical procedure. The urinary tract infection is unrelated to the hysterectomy, making the office visit separately billable. (B) is incorrect because only visits related to the original procedure are included in the global package, and this condition is unrelated. (C) is incorrect because modifier -57 is for an evaluation and management service leading to the decision for major surgery, which is not applicable. (D) is incorrect because modifier -25 is used for an E/M service provided on the same day as a procedure, which does not apply in this case.
35. A 70-year-old man was admitted to the hospital for third-degree burns after his clothing caught fire while cooking on a gas stove at home. What is the appropriate external cause coding?
Correct Answer: C. X04.0XXA, Y92.013, Y93.89 Explanation: The correct external cause code for clothing catching fire from a controlled fire in a stove is X04.0XXA (Exposure to flames from other specified source, initial encounter) (C). Y92.013 (Kitchen in a private residence as the place of occurrence) accurately describes where the injury occurred. Y93.89 (Activity, other specified) is used when the specific activity is not classified elsewhere. Option A (X08.8XXA) is incorrect because X08 is for burns from other specified sources of fire, but not controlled flames from a stove. Option B (X00.0XXA) is incorrect because X00 is for exposure to uncontrolled fires in buildings, which does not apply here. Option
36. A 19-year-old male presents with multiple burns sustained in a house fire. The provider documents a second-degree burn on the right upper arm, a third-degree burn on the left forearm, and a first-degree burn on the chest. What is the appropriate ICD-10-CM coding for this encounter?
Correct Answer: A. T22.211A, T22.321A, T21.10XA Explanation: The correct answer is T22.211A (Burn of second degree of right upper arm, initial encounter), T22.321A (Burn of third degree of left forearm, initial encounter), and T21.10XA (Burn of unspecified degree of chest, initial encounter), which correctly captures the multiple burn sites and degrees. (B) T22.221A (Burn of second degree of unspecified upper arm, initial encounter) is incorrect because the laterality (right) is known and should be coded accordingly. (C) T22.322A (Burn of third degree of unspecified forearm, initial encounter) is incorrect because the left forearm is documented and must be coded specifically. (D) T21.11XA (Burn of first degree of chest, initial encounter) is incorrect because the degree of the chest burn is unspecified in the coding selection.
37. A 50-year-old male with a history of dyslipidemia presents for routine blood work. His lab results indicate a total cholesterol of 265 mg/dL and an LDL of 175 mg/dL. The provider confirms the diagnosis of pure hypercholesterolemia. What is the correct ICD-10-CM code for this condition?
Correct Answer: B. E78.0 Explanation: The correct ICD-10-CM code for pure hypercholesterolemia is E78.0 (B), which includes elevated LDL and total cholesterol without elevated triglycerides. (A) E78.2 is incorrect because it represents "Mixed hyperlipidemia," which includes both high cholesterol and high triglycerides, whereas this case involves only high cholesterol. (C) E78.4 is incorrect because it represents "Other hyperlipidemia," which does not specifically identify pure hypercholesterolemia. (D) E78.5 is incorrect because it represents "Hyperlipidemia, unspecified," which lacks the specificity required for this diagnosis.
38. A 60-year-old female with long-standing rheumatoid arthritis presents with deformities in her fingers, significant pain, and joint erosion. The provider documents “rheumatoid arthritis with rheumatoid factor, multiple sites, with rheumatoid arthritis mutilans.” Which ICD-10-CM code should be assigned?
Correct Answer: C. M05.20 Explanation: The correct code is M05.20 (Rheumatoid arthritis with rheumatoid factor, multiple sites, with rheumatoid arthritis mutilans) because the provider specifies rheumatoid arthritis mutilans, a severe form of joint destruction. (C) is correct as it accurately captures the diagnosis of seropositive rheumatoid arthritis with joint mutilans. (A) M05.89 (Other rheumatoid arthritis with rheumatoid factor, multiple sites) is incorrect because it does not specifically account for rheumatoid arthritis mutilans. (B) M05.79 (Rheumatoid arthritis with rheumatoid factor, multiple sites, without organ or systems involvement) is incorrect because it lacks the specification of mutilans. (D) M06.09 (Rheumatoid arthritis without rheumatoid factor, multiple sites) is incorrect as the provider documents rheumatoid factor, meaning this is seropositive rather than seronegative rheumatoid arthritis.
39. A 70-year-old male presents with left-sided weakness following a prior nontraumatic intracerebral hemorrhage. The provider documents "post-stroke left hemiparesis." The coder reviews I69.954 (Hemiplegia and hemiparesis following nontraumatic intracerebral hemorrhage, affecting left non-dominant side). What is the correct ICD-10-CM code assignment?
Correct Answer: A. I69.954 Explanation: The correct ICD-10-CM code for left-sided hemiparesis following a prior intracerebral hemorrhage is I69.954 (A). This is a sequela code that correctly captures both the cause (prior hemorrhagic stroke) and the residual condition (left-sided weakness). G81.94, I69.954 (B) is incorrect because G81.94 (hemiplegia, unspecified side) is unnecessary when the more specific sequela code I69.954 is available. I69.951 (C) is incorrect because it represents hemiplegia on the right side, not the left. G81.90 (D) is incorrect because it does not specify that the hemiparesis is due to a prior stroke. Coders must select the correct sequela code to fully describe both the prior event and its long-term effects.
40. A 60-year-old male is admitted to the hospital after being struck by another vehicle while riding his bicycle on a public road. He sustains multiple injuries, including a fractured clavicle. What is the correct external cause code for this event?
Correct Answer: B. V20.2XXA Explanation: The ICD-10-CM Alphabetic Index to External Causes classifies transportation-related injuries based on the type of vehicle involved and the nature of the incident. The patient was riding a bicycle and was struck by a motor vehicle on a public road, which is indexed under "Accident, transport, bicycle rider, collision with motor vehicle, traffic," leading to V20.2-. The 7th character "A" indicates an initial encounter. (B) is correct because V20.2XXA correctly describes a bicycle rider involved in a collision with a motor vehicle in a traffic accident. (A) is incorrect because V19.9XXA refers to unspecified pedal cycle accidents, not a specific collision with a vehicle. (C) is incorrect because V17.2XXA is used for motorcyclists, not bicycle riders. (D) is incorrect because V21.1XXA applies to occupants of three-wheeled motor vehicles, which is unrelated to this case.
41. A patient presents with "septicemia due to E. coli." The index entry for "Septicemia, E. coli" includes brackets showing "A41.51 [B96.20]." How should this be coded?
Correct Answer: C. A41.51, B96.20 Explanation: The correct ICD-10-CM coding for septicemia due to E. coli is A41.51, B96.20 (C). The brackets indicate that both codes must be assigned to fully describe the condition. A41.51 (A) alone is incorrect because it only specifies the primary septicemia without identifying the causative organism. B96.20 (B) alone is incorrect because it represents E. coli as an infectious agent without specifying that the patient has septicemia. A41.9 (D) is incorrect because it refers to septicemia of unspecified organism, which does not accurately capture the documented E. coli infection. Bracketed codes in the index must always be assigned together to ensure full diagnostic accuracy.
42. A 72-year-old male is admitted to the hospital for an intracranial hemorrhage. He has a history of chronic immune thrombocytopenic purpura (ITP) and is currently on long-term corticosteroid therapy. His platelet count is critically low at 12,000/mm鲁. The physician confirms "chronic ITP with spontaneous hemorrhage." What is the correct ICD-10-CM code assignment?
Correct Answer: B. D69.41 Explanation: The correct ICD-10-CM code for chronic ITP with spontaneous hemorrhage is D69.41 (Chronic immune thrombocytopenic purpura with bleeding) (B), as it specifies chronic ITP in conjunction with significant bleeding episodes. D69.49 (Other primary thrombocytopenia) (A) is incorrect because it does not specify immune-mediated thrombocytopenia or the presence of bleeding. D69.6 (Thrombocytopenia, unspecified) (C) is incorrect because it is too vague and does not indicate the chronic immune-mediated nature of the condition. D68.8 (Other specified coagulation defects) (D) is incorrect because it does not address thrombocytopenia, which is a platelet disorder rather than a coagulation defect.
43. A 34-year-old woman in labor at 40 weeks gestation is unable to deliver vaginally due to cephalopelvic disproportion (CPD). The physician proceeds with a cesarean section to ensure a safe delivery. What is the correct ICD-10-CM code for this complication?
Correct Answer: C. O65.4 Explanation: The correct ICD-10-CM code for labor complicated by cephalopelvic disproportion (CPD) is O65.4 (Maternal disproportion, unspecified) (C). CPD occurs when the fetal head is too large or the maternal pelvis is too small for a safe vaginal delivery. O66.2 (Obstructed labor due to unusually large fetus) (A) is incorrect because it is used when macrosomia is the primary issue, rather than CPD. O66.4 (Obstructed labor due to other maternal pelvic abnormality) (B) is incorrect because it does not specifically address CPD. O64.0XX0 (Obstructed labor due to breech presentation) (D) is incorrect because the scenario does not describe a breech presentation. Accurate ICD-10-CM coding of labor complications supports appropriate clinical care and hospital reimbursement.
44. A 45-year-old woman presents with chronic cough, hemoptysis, and weight loss. She has a history of untreated tuberculosis from 10 years ago. A CT scan reveals fibrotic changes and calcifications in the upper lobes of her lungs. The physician documents "old, healed tuberculosis." What is the correct ICD-10-CM code?
Correct Answer: B Explanation: The correct code is (B) B90.9, which represents "Sequelae of tuberculosis, unspecified." Since the physician documented "old, healed tuberculosis," and the patient presents with radiographic evidence of prior TB without active disease, this sequela code is appropriate. (A) A16.9 is incorrect because it represents "Tuberculosis of lung, without bacteriological or histological confirmation," which applies to active TB, not a past healed infection. (C) A19.2 is incorrect because it represents "Miliary tuberculosis, unspecified," which refers to widespread active TB, not residual effects from a past infection. (D) A15.5 is incorrect because it represents "Tuberculosis of larynx, trachea, and bronchus, confirmed bacteriologically," which is unrelated to this patient’s current condition.
45. A 67-year-old male presents to the clinic with complaints of memory loss and difficulty concentrating over the past several months. The physician conducts a cognitive assessment and orders an MRI to rule out neurodegenerative disorders but does not diagnose dementia or any other cognitive disorder at this visit. What is the most appropriate ICD-10-CM code to report?
Correct Answer: A. R41.3 Explanation: The appropriate ICD-10-CM code for this scenario is (A) R41.3, which represents memory loss without a definitive diagnosis. (B) G30.9, Alzheimer's disease, is incorrect because the physician has not made a diagnosis of Alzheimer's. (C) F03.90, unspecified dementia, is incorrect because there is no confirmed diagnosis of dementia. (D) R41.840, attention and concentration deficit, is incorrect because the primary symptom documented is memory loss rather than attention deficit. In ICD-10-CM coding, reporting symptoms when no definitive diagnosis is established ensures appropriate medical coding and billing compliance.
46. A 67-year-old patient with a history of glaucoma presents with persistent elevated intraocular pressure despite maximum medical therapy. The ophthalmologist recommends a placement of an aqueous shunt in the left eye to reduce pressure. What is the correct CPT code for this procedure?
Correct Answer: A. 66180 Explanation: 66180 is the correct CPT code for placement of an aqueous shunt to manage intraocular pressure in patients with glaucoma. (A) is correct because it accurately describes a surgical procedure to place an aqueous drainage device. (B) is incorrect because 66185 is used for a revision of an existing shunt, not a new placement. (C) is incorrect because 66179 is for implantation of a posterior segment drainage device, which differs from an anterior segment aqueous shunt. (D) is incorrect because 66170 describes a trabeculectomy, which is a different surgical technique used for glaucoma management.
47. A 68-year-old female presents to the emergency department with a worsening cough, shortness of breath, and fever. The physician diagnoses acute bronchitis and underlying COPD but does not mention an acute exacerbation. What is the correct ICD-10-CM code assignment?
Correct Answer: B. J44.0, J20.9 Explanation: The correct codes are J44.0 (Chronic obstructive pulmonary disease with acute lower respiratory infection) and J20.9 (Acute bronchitis, unspecified). COPD with acute bronchitis is coded with J44.0, and the specific acute bronchitis code J20.9 must be added to specify the infection. (A) J20.9 with J44.1 is incorrect because J44.1 is used for acute exacerbations, not infections. (C) J44.9 is incorrect because it does not specify that an infection is present. (D) J44.1 is incorrect because there is no mention of an exacerbation, only an infection.
48. A 28-year-old female is diagnosed with iron deficiency anemia secondary to chronic blood loss due to heavy menstrual bleeding. What is the correct ICD-10-CM code assignment?
Correct Answer: B. D50.0 Explanation: The correct ICD-10-CM code for iron deficiency anemia due to chronic blood loss is D50.0 (B). This code is used when the anemia is directly related to chronic blood loss, as explicitly documented in this case. D50.9 (A) is for unspecified iron deficiency anemia, which does not capture the underlying cause and is therefore incorrect. N92.0 (C) is for excessive and frequent menstruation with regular cycles, which describes the menstrual condition but does not address the anemia. N92.6 (D) is for irregular menstrual bleeding, which is incorrect because the scenario specifies heavy menstrual bleeding rather than irregular cycles. When coding anemia, coders must determine whether the condition is due to chronic blood loss and select the appropriate code accordingly.
49. A patient is undergoing a complex cardiac procedure under general anesthesia. The anesthesiologist documents an anesthesia start time of 15:25 and an end time of 18:00. What is the total anesthesia time to be reported?
Correct Answer: A. 150 minutes Explanation: Anesthesia time begins when the anesthesiologist starts continuous care and ends when the patient no longer requires monitoring. The correct total anesthesia time is 150 minutes (18:00 – 15:25). (B) 155 minutes is incorrect as it miscalculates the time. (C) 160 minutes is incorrect as it overestimates the time. (D) 165 minutes is incorrect because it adds unnecessary extra minutes beyond what is documented. Proper time documentation ensures accurate billing and compliance with anesthesia coding regulations.
50. A 52-year-old female presents with complaints of fever, fatigue, and multiple swollen lymph nodes. Blood tests reveal the presence of Epstein-Barr virus (EBV), and the physician documents "Infectious mononucleosis with splenic rupture." What is the correct ICD-10-CM code?
Correct Answer: D Explanation: The correct code is (D) B27.89, which represents "Other infectious mononucleosis." Since the patient has infectious mononucleosis complicated by splenic rupture, this is the most appropriate code. (A) B27.0 is incorrect because it represents "Gammaherpesviral mononucleosis," which does not capture the complication of splenic rupture. (B) B27.81 is incorrect because it represents "Other infectious mononucleosis with neurologic complication," and splenic rupture is not a neurologic complication. (C) B27.9 is incorrect because it represents "Infectious mononucleosis, unspecified," which does not specify any complications, making B27.89 the best choice.
51. A 35-year-old female presents with painful vesicular lesions on the labia and perianal region. The physician performs a PCR test, which confirms herpes simplex virus type 2 (HSV-2). The provider documents "Genital herpes simplex with ulceration." What is the correct ICD-10-CM code?
Correct Answer: A Explanation: The correct code is (A) A60.04, which represents "Herpetic ulcer of the perianal skin and rectum." Since the patient has HSV-2 with ulceration in the genital and perianal region, this is the most specific ICD-10-CM code. (B) A63.0 is incorrect because it represents "Anogenital warts," which are caused by HPV, not herpes simplex virus. (C) B00.1 is incorrect because it represents "Herpesviral vesicular dermatitis," which is a general code for herpes-related skin infections but does not specify the anogenital region. (D) A57 is incorrect because it represents "Chancroid," a bacterial STI caused by Haemophilus ducreyi, which is unrelated to herpes simplex virus.
52. A 50-year-old male is diagnosed with a deep laceration of the right thigh after being struck by a falling piece of metal. The wound is 6 cm long and requires layered closure. What is the correct ICD-10-CM code for this injury?
Correct Answer: A. S71.111A Explanation: The correct ICD-10-CM code for a deep laceration of the right thigh is S71.111A (A). The S71 category covers open wounds of the thigh, with S71.111A specifically indicating a deep laceration of the right thigh. (B) S71.112A is incorrect as it represents a deep laceration of the left thigh instead of the right. (C) S71.114A is incorrect because it represents a puncture wound rather than a laceration. (D) S71.121A is incorrect because it describes an unspecified open wound rather than a specified deep laceration. Selecting the most specific code based on wound type, location, laterality, and encounter type is essential for proper documentation.
53. A patient presents with a stage 3 pressure ulcer of the right heel. The coder looks up L89.613 (Pressure ulcer of right heel, stage 3) and sees a "Code Also" note stating, "Code also any associated gangrene (I96)." If gangrene is present, how should the coding be completed?
Correct Answer: B. L89.613, I96 Explanation: The correct ICD-10-CM codes for a stage 3 pressure ulcer of the right heel with gangrene are L89.613, I96 (B). The "Code Also" instruction under L89.613 directs the coder to report I96 (Gangrene, unspecified) if present. L89.613 (A) alone is incorrect because it does not capture the gangrene, which is clinically significant. I96, L89.613 (C) is incorrect because L89.613 should be listed first, as it is the primary diagnosis. L89.619 (D) is incorrect because it represents a stage 3 pressure ulcer of an unspecified site, while the right heel was documented. Coders must apply "Code Also" notes to fully report related conditions.
54. A 72-year-old male with a history of abdominal aortic aneurysm (AAA) undergoes an ultrasound of the abdomen for aneurysm screening. The physician performs and interprets the study. What is the correct CPT code for this procedure?
Correct Answer: B Explanation: The correct CPT code for an abdominal ultrasound for AAA screening is 76705 (B). This code is specifically used for a limited ultrasound of the abdomen, which is typically performed for screening purposes, such as for an abdominal aortic aneurysm. 76700 (A) is incorrect because it represents a complete abdominal ultrasound, which includes imaging of multiple abdominal organs and is not necessary for AAA screening. 76881 (C) is incorrect because it represents a complete ultrasound of extremities, which does not apply to this case. 76981 (D) is incorrect because it is used for ultrasound elastography, a specialized ultrasound technique not related to abdominal aortic aneurysm screening. Proper selection of ultrasound codes depends on whether the study is complete or limited and the specific anatomical area being examined.
55. A 43-year-old male undergoes a radical orchiectomy due to a confirmed diagnosis of testicular cancer. What is the correct CPT code for this procedure?
Answer: B. 54530 Explanation: The correct CPT code for a radical orchiectomy for testicular cancer is 54530, which includes removal of the testis, spermatic cord, and surrounding structures. Option (A) is incorrect because 54520 refers to a simple orchiectomy, which does not include removal of the spermatic cord. Option (C) is incorrect because 54522 is for a bilateral procedure, whereas the scenario does not specify both testicles. Option (D) is incorrect because 54640 refers to orchiopexy (surgical correction of an undescended testicle), which is unrelated to this case.
56. A 55-year-old male presents with persistent speech difficulties and right-sided weakness following a stroke that occurred six months ago. The physician documents that these deficits are sequelae of the previous cerebrovascular accident. What is the correct ICD-10-CM code assignment?
Correct Answer: B Explanation: The correct ICD-10-CM codes for this patient’s condition are I69.391 (B), which represents right-sided weakness (hemiparesis) as a sequela of a stroke, and I69.320, which represents dysphasia (speech difficulties) as a sequela of a cerebrovascular accident. I69.351 (A) is incorrect because it specifies hemiparesis affecting the dominant side, but the documentation does not specify dominance. I63.9, R29.81 (C) is incorrect because I63.9 represents an acute infarction rather than a sequela, and R29.81 is a general code for neurological symptoms that lacks specificity. I69.959, I69.398 (D) is incorrect as both are non-specific codes that do not provide adequate documentation of hemiparesis or dysphasia.
57. A 65-year-old male with a history of recurrent bacterial infections is found to have a persistently low absolute neutrophil count (ANC) below 500 cells/碌L. The physician documents the diagnosis as agranulocytosis. What is the correct ICD-10-CM code for this condition?
Correct Answer: A. D72.810 Explanation: The correct ICD-10-CM code for agranulocytosis is D72.810 (Agranulocytosis, unspecified) (A), which refers to a severe decrease in neutrophils, significantly increasing the risk of infections. D70.9 (Neutropenia, unspecified) (B) is incorrect because agranulocytosis is a severe form of neutropenia requiring a more specific code. D70.0 (Congenital agranulocytosis) (C) is incorrect because this scenario describes an acquired condition, not a congenital disorder. D72.829 (Elevated white blood cell count, unspecified) (D) is incorrect because it refers to an increased rather than decreased white blood cell count.
58. A patient is undergoing a thyroid function panel to assess thyroid health due to symptoms of hypothyroidism. The test includes T3, T4 (total), and TSH levels. Which of the following CPT codes correctly reports this panel?
Correct Answer: C Explanation: The correct answer is (C) 80090, which represents a thyroid panel including thyroid-stimulating hormone (TSH), total thyroxine (T4), and triiodothyronine (T3). (A) 80091 is incorrect because it represents a different panel that includes additional thyroid tests beyond the standard T3, T4, and TSH. (B) 84436 is incorrect because it represents a single test for free thyroxine (T4) rather than the full thyroid panel. (D) 84443 is incorrect because it represents a single thyroid-stimulating hormone (TSH) test rather than the complete thyroid panel.
59. A 34-year-old female undergoes a vaginal delivery with an episiotomy and subsequent repair. The physician provides global obstetric care, including prenatal and postpartum management. What is the correct CPT code for this service?
Correct Answer: D Explanation: The correct CPT code for global obstetric care, including prenatal care, vaginal delivery, and postpartum care, is 59400 (D). 59409 (A) represents a vaginal delivery only, excluding prenatal and postpartum care, which does not fully describe the service provided. 59410 (B) includes vaginal delivery and postpartum care only, but not prenatal care, making it incorrect in this case. 59510 (C) represents a cesarean delivery with global care, which does not apply to this vaginal delivery scenario. The correct choice is 59400 (D) as it encompasses all aspects of care provided.
60. A 12-year-old child presents with dry, scaly patches on their face, arms, and legs. The parent states the child has a history of seasonal allergies and asthma. The provider diagnoses atopic dermatitis. Which ICD-10-CM code should be assigned?
Correct Answer: B. L20.9 Explanation: The correct answer is L20.9 (Atopic dermatitis, unspecified), as the child’s symptoms and history of allergic conditions (seasonal allergies and asthma) strongly suggest atopic dermatitis, which is a chronic inflammatory skin disorder. (A) L30.9 (Dermatitis, unspecified) is incorrect because atopic dermatitis has a specific classification. (C) L24.0 (Irritant contact dermatitis due to detergents) is incorrect because there is no mention of an irritant trigger. (D) L23.5 (Allergic contact dermatitis due to other chemical products) is incorrect because allergic contact dermatitis is a delayed hypersensitivity reaction to an external allergen, whereas atopic dermatitis is typically genetic and associated with other allergic conditions.
61. A 42-year-old patient is seen in the physician's office for evaluation of chest pain. The provider orders an EKG and cardiac enzymes and documents "chest pain, likely due to gastroesophageal reflux disease (GERD)." How should this visit be coded?
Correct Answer: A Explanation: In the outpatient setting, ICD-10-CM Official Guidelines require coders to report symptoms rather than a suspected or probable diagnosis. Since the provider documented "chest pain, likely due to GERD," the coder must report the symptom, which is chest pain, making R07.9 (A) the correct choice. K21.9 (B) is incorrect because GERD has not been definitively diagnosed in this visit. I20.9 (C) is incorrect because there is no mention of angina pectoris. R07.89 (D) is incorrect because "other chest pain" should only be used if the documentation specifies a different type of chest pain, which is not the case here.
62. A 55-year-old female presents with symptoms of hoarseness and difficulty swallowing. A thyroid ultrasound reveals multiple nodules, and a fine-needle aspiration confirms the presence of a multinodular toxic goiter. What is the correct ICD-10-CM code for this condition?
Correct Answer: A. E05.21 Explanation: The correct ICD-10-CM code for a toxic multinodular goiter is E05.21 (A), which is used when multiple nodules are causing hyperthyroidism. (B) E04.2 is incorrect because it represents "Nontoxic multinodular goiter," which means the goiter does not cause thyrotoxicosis. (C) E06.5 is incorrect because it represents "Chronic thyroiditis with transient thyrotoxicosis (Hashitoxicosis)," which is a separate autoimmune condition. (D) E07.9 is incorrect because it is a nonspecific code for "Disorder of thyroid, unspecified," which lacks the specificity needed to describe the documented multinodular toxic goiter.
63. A coding professional working in a physician’s office overhears a coworker discussing a patient’s diagnosis in a public area where others can hear. What action should the coder take in accordance with HIPAA compliance?
Correct Answer: C Explanation: The coder should remind the coworker about the importance of patient confidentiality and report to the office’s compliance officer if necessary (C). HIPAA requires that discussions about patient information be conducted privately to protect confidentiality. Reporting directly to OCR (A) is incorrect because internal reporting and corrective actions should occur before escalating to federal authorities. Ignoring the conversation unless a patient complains (B) is incorrect because failure to address the violation could result in continued noncompliance. Confronting the coworker aggressively (D) is incorrect because a professional and policy-driven approach is necessary to handle HIPAA violations.
64. A 40-year-old male undergoes a tympanoplasty due to chronic perforation of the tympanic membrane caused by repeated infections. What is the appropriate CPT code for this procedure?
Correct Answer: B. 69631 Explanation: The correct CPT code for tympanoplasty without ossicular reconstruction is (B) 69631, which covers "Tympanoplasty, without mastoidectomy (including canalplasty, atticotomy, and/or middle ear surgery), without ossicular chain reconstruction." (A) 69641 is incorrect because it includes ossicular chain reconstruction, which is not performed in this case. (C) 69611 refers to "Tympanoplasty with mastoidectomy," which is incorrect as no mastoidectomy was performed. (D) 69646 is incorrect as it refers to "Revision tympanoplasty, with mastoidectomy," which does not match the primary tympanoplasty described. Accurate CPT coding ensures appropriate reimbursement and procedural documentation.
65. A 40-year-old male with a history of myelodysplastic syndrome develops severe aplastic anemia requiring a bone marrow transplant. The physician documents "aplastic anemia due to myelodysplastic syndrome." What is the correct ICD-10-CM code?
Correct Answer: B. D61.818 Explanation: The correct ICD-10-CM code for aplastic anemia due to myelodysplastic syndrome is D61.818 (Other pancytopenia) (B), as myelodysplastic syndromes can lead to pancytopenia, including aplastic anemia. D46.9 (Myelodysplastic syndrome, unspecified) (A) is incorrect because it does not code for the resulting aplastic anemia. D61.1 (Drug-induced aplastic anemia) (C) is incorrect because the cause is myelodysplastic syndrome, not medication. D61.82 (Myelophthisic anemia) (D) is incorrect because myelophthisic anemia is caused by bone marrow infiltration rather than myelodysplastic syndromes.
66. A patient is diagnosed with myasthenia gravis, an autoimmune neuromuscular disorder causing muscle weakness, and has also developed a thymoma. What is the correct ICD-10-CM code for this condition?
Correct Answer: A. G70.01 Explanation: The correct code, G70.01 (Myasthenia gravis with (acute) exacerbation), is used for myasthenia gravis, a chronic autoimmune disorder affecting neuromuscular transmission and causing muscle weakness (A). Option B (C37 - Malignant neoplasm of thymus) is incorrect as it refers specifically to a malignant thymoma, whereas the condition may not necessarily be malignant. Option C (G35 - Multiple sclerosis) is incorrect as multiple sclerosis is a different autoimmune disorder affecting the central nervous system rather than neuromuscular function. Option D (D89.2 - Hypergammaglobulinemia, unspecified) is incorrect because it refers to an excess of immunoglobulins rather than an autoimmune neuromuscular disease.
67. A 26-year-old male has a history of methamphetamine use and presents with extreme aggression, hyperactivity, and severe insomnia. His provider diagnoses stimulant dependence with intoxication and perceptual disturbances. What is the correct ICD-10-CM code?
Correct Answer: B. F15.229 is the correct ICD-10-CM code for stimulant dependence with intoxication and perceptual disturbances. (B) The patient's aggression, hyperactivity, and insomnia indicate stimulant intoxication, while perceptual disturbances suggest hallucinations or paranoia, making F15.229 the correct selection. (A) F15.20 is incorrect because it represents stimulant dependence without complications, failing to capture the intoxication and perceptual symptoms. (C) F15.21 is incorrect because it represents stimulant dependence with intoxication but without perceptual disturbances. (D) F15.23 is incorrect as it codes for stimulant dependence with withdrawal, which is not part of the patient’s symptoms.
68. A 40-year-old woman has a breast biopsy, which reveals ductal carcinoma in situ (DCIS) of the right breast. What is the correct ICD-10-CM code based on the Table of Neoplasms?
Correct Answer: D Explanation: The correct ICD-10-CM code for ductal carcinoma in situ (DCIS) of the right breast is D05.01 (Lobular carcinoma in situ of right breast) (D). The Table of Neoplasms directs to D05 for carcinoma in situ of the breast, with further specificity to D05.01 for the right breast. C50.911 (Malignant neoplasm of unspecified site of right breast) (A) is incorrect because DCIS is classified as in situ, not an invasive malignancy. D05.10 (Carcinoma in situ of unspecified breast) (B) is incorrect because the laterality is documented, and a more specific code should be used. D49.3 (Neoplasm of unspecified behavior of breast) (C) is incorrect because DCIS has a known behavior as an in situ carcinoma, not unspecified.
69. A premature newborn at 28 weeks’ gestation develops apnea of prematurity on the second day of life. The physician documents recurrent episodes of cessation of breathing lasting longer than 20 seconds, requiring continuous monitoring. What is the correct ICD-10-CM code?
Correct Answer: A. P28.3 Explanation: The correct code is (A) P28.3, which designates primary apnea of newborn, commonly known as apnea of prematurity. This occurs frequently in preterm infants due to immaturity of the respiratory control centers in the brain. Since the case explicitly describes apnea in a premature newborn, this is the correct coding choice. Option (B) P22.8 is incorrect as it represents other respiratory distress of newborns, which is not specific to apnea. Option (C) P28.5 is incorrect as it codes for respiratory failure of newborns, which is a more severe condition than apnea. Option (D) P22.0 is incorrect because it refers to respiratory distress syndrome, a surfactant-deficiency condition distinct from apnea of prematurity.
70. A psychiatrist evaluates a 40-year-old patient who experiences intense anxiety, heart palpitations, sweating, and a feeling of impending doom several times a week, without any identifiable trigger. The physician diagnoses the patient with panic disorder. What is the correct ICD-10-CM code?
Correct Answer: A. F41.0 is the correct ICD-10-CM code for panic disorder. (A) Panic disorder is characterized by sudden, recurrent panic attacks that occur unexpectedly and without an obvious trigger. This matches the patient’s symptoms of frequent panic episodes. (B) F42.3 is incorrect as it represents hoarding disorder, which involves difficulty discarding possessions rather than panic attacks. (C) F41.9 is incorrect as it represents an unspecified anxiety disorder, which lacks the specificity required to properly document panic disorder. (D) F43.23 is incorrect because it codes for an adjustment disorder with mixed anxiety and depressed mood, which does not fit the sudden and unprovoked nature of panic attacks.
71. A 9-year-old female is diagnosed with selective IgA deficiency after recurrent respiratory tract infections and low serum IgA levels, while IgG and IgM remain normal. What is the appropriate ICD-10-CM code for this condition?
Correct Answer: B. D81.2 Explanation: The correct code, D81.2 (Severe combined immunodeficiency [SCID] with low T- and B-cell numbers), is used when an immunodeficiency results in defects in both major lymphocyte types (B). However, if selective IgA deficiency was specifically documented, D80.6 (Selective deficiency of immunoglobulin A [IgA]) should be assigned instead. Option A (D80.6 - Selective deficiency of immunoglobulin A [IgA]) is incorrect because while it is a valid code for IgA deficiency, the scenario's focus on broader immunodeficiency classification makes D81.2 a better choice. Option C (D89.0 - Hypogammaglobulinemia, unspecified) is incorrect because it lacks specificity regarding IgA deficiency. Option D (D80.2 - Selective deficiency of immunoglobulin G [IgG] subclasses) is incorrect because IgG, not IgA, is affected in this condition.
72. A 50-year-old female presents with a persistent cough, chest discomfort, and fever. The provider diagnoses "viral pneumonia due to Influenza A." What is the correct ICD-10-CM code assignment?
Correct Answer: B. J10.00 Explanation: The correct ICD-10-CM code for viral pneumonia due to Influenza A is J10.00 (Influenza due to other identified influenza virus with unspecified pneumonia). This code is appropriate when pneumonia is linked to a specific influenza virus other than avian or novel H1N1 influenza. (A) J09.X1 is incorrect because it represents influenza due to novel influenza A virus with pneumonia, which is not specified in this case. (C) J11.00 is incorrect because it represents influenza with pneumonia, unspecified, when the type of influenza is not known, whereas the provider has specified Influenza A. (D) J12.9 is incorrect because it represents unspecified viral pneumonia, but the cause of pneumonia was identified as influenza, which requires a more specific code.
73. A physician prescribes a nebulizer for a pediatric asthma patient to administer albuterol treatments at home. The supplier must submit the correct HCPCS Level II code for this device. Which code is appropriate?
Correct Answer: A. E0570 Explanation: The correct answer is (A) E0570, which represents a durable medical equipment nebulizer, commonly used for respiratory treatments at home. (B) A7003 is incorrect as it describes a nebulizer administration set rather than the nebulizer device itself. (C) E0605 is incorrect because it refers to a vaporizer or humidifier, which differs in function from a nebulizer. (D) A7015 is incorrect as it represents nebulizer filters, which are accessory components rather than the primary device. Correct coding ensures compliance with DME reimbursement requirements and accurate claim processing.
74. A 52-year-old male is diagnosed with Parkinson’s disease with associated dementia. According to ICD-10-CM guidelines, what is the correct code assignment?
Correct Answer: C Explanation: ICD-10-CM Official Guidelines instruct coders to report both Parkinson’s disease and associated dementia when both are documented. G20 (C) is assigned for Parkinson’s disease, and F02.80 (C) is used for dementia in diseases classified elsewhere, without behavioral disturbances. Option A is incorrect because G20 alone does not capture the presence of dementia. Option B is incorrect because G31.83 refers to mild cognitive impairment rather than dementia. Option D is incorrect because F03.90 is used for unspecified dementia rather than dementia associated with another condition such as Parkinson’s.
75. A 29-year-old female presents with severe eye pain, photophobia, and corneal clouding. She has a history of herpes simplex virus (HSV) infections. Slit lamp examination reveals a dendritic ulcer in her right eye, confirming a diagnosis of herpetic keratitis. What is the correct ICD-10-CM code for this condition?
Correct Answer: B. B00.51 Explanation: B00.51 is the correct ICD-10-CM code for herpes simplex keratitis with dendritic ulcer, which is a hallmark feature of HSV-related corneal infections. (B) is correct because it identifies the viral etiology and the presence of a dendritic ulcer, which is a common manifestation of HSV keratitis. (A) is incorrect because H16.241 is used for interstitial keratitis, a non-ulcerative condition typically linked to syphilis rather than HSV. (C) is incorrect because H16.221 refers to exposure keratoconjunctivitis, which is related to incomplete eyelid closure rather than an infectious cause. (D) is incorrect because B00.52 represents herpetic keratoconjunctivitis without ulceration, whereas the patient’s diagnosis specifically includes a dendritic ulcer.
76. A 65-year-old male patient with a history of heart failure presents with weight loss, muscle wasting, and a BMI of 17.2 kg/m簡. The provider diagnoses him with cachexia due to chronic disease. What is the appropriate ICD-10-CM code for this condition?
Correct Answer: B. R64 Explanation: The correct ICD-10-CM code for cachexia due to chronic disease is R64 (B). This code is used when the patient has wasting syndrome or severe weight loss due to an underlying chronic illness. (A) E41 is incorrect because it represents "Nutritional marasmus," which is a form of severe protein-energy malnutrition often seen in children, not in a patient with chronic disease. (C) E44.1 is incorrect because it represents "Moderate protein-energy malnutrition," which does not fully describe cachexia. (D) E43 is incorrect because it represents "Severe protein-energy malnutrition," which does not specifically indicate cachexia or chronic disease-related wasting.
77. A 70-year-old female presents with severe fever, chills, jaundice, and hemolytic anemia. She recently returned from a safari in Africa and reports multiple mosquito bites. A blood smear confirms Plasmodium falciparum infection. The provider diagnoses "Severe falciparum malaria with cerebral complications." What is the correct ICD-10-CM code selection?
Correct Answer: C Explanation: The correct code is (C) B50.0, which represents "Plasmodium falciparum malaria with cerebral complications." Since the patient has confirmed falciparum malaria with cerebral involvement, this is the most specific ICD-10-CM code. (A) B50.8 is incorrect because it represents "Other severe malaria due to Plasmodium falciparum," but the case specifically involves cerebral complications. (B) B50.9 is incorrect because it represents "Plasmodium falciparum malaria, unspecified," but the provider documented severe complications, which should be coded separately. (D) A98.5 is incorrect because it represents "Hemorrhagic fever with renal syndrome," which is caused by hantaviruses, not Plasmodium falciparum.
78. A patient receives a series of three trigger point injections in two muscle groups. What is the correct CPT code assignment?
Correct Answer: A Explanation: CPT 20552 (A) is the correct code because it represents an injection of one or two muscle groups for trigger point injections. The CPT guidelines specify that 20553 (B) is used when injections are administered to three or more muscle groups, which is not the case here. CPT 20550 (C) is used for injections of tendons or tendon sheaths, not muscles. CPT 20551 (D) is incorrect as it describes an injection into a tendon origin, which is different from a trigger point injection.
79. A 58-year-old male patient presents with an "uncertain behavior" neoplasm of the bladder. The biopsy indicates that it is not definitively benign or malignant. What is the appropriate ICD-10-CM code?
Correct Answer: B. D41.4 Explanation: The term "uncertain behavior" refers to a neoplasm that is not definitively classified as benign or malignant, usually due to atypical features seen in pathology but lacking invasive characteristics. In the ICD-10-CM Table of Neoplasms, we look under "Neoplasm, bladder, uncertain behavior," which leads to D41.4. (B) is correct because D41.4 is the correct code for a neoplasm of uncertain behavior of the bladder. (A) is incorrect because D49.4 refers to a neoplasm of unspecified behavior of the bladder, which is different from uncertain behavior. (C) is incorrect because C67.9 refers to a malignant neoplasm of the bladder, but the scenario specifies "uncertain behavior," not malignancy. (D) is incorrect because D30.3 is used for a benign neoplasm of the bladder, but the scenario indicates the behavior is uncertain, not definitively benign.
80. A 33-year-old male patient with a known allergy to penicillin presents with a diffuse rash, wheezing, and hypotension 30 minutes after receiving an antibiotic injection. The provider diagnoses an anaphylactic reaction due to penicillin. What is the appropriate ICD-10-CM code?
Correct Answer: B. T88.7XXA Explanation: The correct code, T88.7XXA (Unspecified adverse effect of drug or medicament, initial encounter), is used for cases where a medication has caused an anaphylactic reaction (B). If the medication was specified as penicillin, an additional external cause code from the T36-T50 range may be necessary. Option A (T78.0XXA - Anaphylactic reaction due to food, initial encounter) is incorrect because the reaction was caused by a drug, not food. Option C (L50.0 - Allergic urticaria) is incorrect because the patient experienced anaphylaxis, not just hives. Option D (T78.2XXA - Anaphylactic shock, unspecified) is incorrect because the reaction was specifically caused by a drug, making T88.7XXA more precise.
81. A patient is seen in the emergency department for a displaced left distal radius fracture and is discharged home with a short-arm cast. The physician performs closed reduction and immobilization. How should the physician report the procedure?
Correct Answer: A Explanation: In a physician setting, CPT codes are used for procedures, and appropriate modifiers should be applied for laterality when applicable. 25605-LT (A) correctly describes closed treatment of a distal radius fracture with manipulation, and "LT" indicates the left side. Option B is incorrect because 25545 describes an open reduction procedure, but the documentation specifies closed reduction. Option C is incorrect because 25607 is for an open treatment of an intra-articular fracture, which was not performed. Option D is incorrect because 25600 is for a closed reduction without manipulation, whereas the provider performed manipulation.
82. A 47-year-old female with a history of asthma presents with severe wheezing and respiratory distress unresponsive to initial treatment. The provider documents "status asthmaticus." What is the correct ICD-10-CM code assignment?
orrect Answer: C. J45.902 Explanation: The correct ICD-10-CM code is J45.902 (Unspecified asthma with status asthmaticus). Status asthmaticus is a severe, prolonged asthma attack that does not respond to usual treatment, requiring urgent medical intervention. (A) J45.909 is incorrect because it represents unspecified asthma without any mention of exacerbation or status asthmaticus. (B) J45.901 is incorrect because it represents unspecified asthma with an acute exacerbation, but the provider documented status asthmaticus, which requires a different code. (D) J45.998 is incorrect because it refers to other specified asthma, which is not applicable when status asthmaticus is clearly documented.
83. A patient presents with alcohol dependence and alcoholic gastritis. The coder reviews K29.20 (Alcoholic gastritis without bleeding) and sees an Excludes1 note stating "Excludes1: alcohol dependence (F10.2-)." How should this be coded?
Correct Answer: A. F10.20, K29.20 Explanation: The correct coding for alcohol dependence with alcoholic gastritis is F10.20, K29.20 (A). The Excludes1 note usually means the conditions should not be coded together, but ICD-10-CM guidelines allow both to be reported when they coexist. K29.20 (B) alone is incorrect because it omits the alcohol dependence diagnosis. F10.20 (C) alone is incorrect because it does not capture the gastritis. K29.21 (D) is incorrect because it represents alcoholic gastritis with bleeding, which was not documented. Understanding Excludes1 notes prevents incorrect omissions or duplications.
84. A 60-year-old female presents with a suspicious skin lesion on her arm. A biopsy confirms melanoma in situ. What is the appropriate ICD-10-CM code for this diagnosis?
Correct Answer: A Explanation: Melanoma in situ is a non-invasive form of melanoma confined to the epidermis, meaning it has not spread deeper into the skin. The correct ICD-10-CM code is D03.60 (Melanoma in situ of unspecified upper limb, including shoulder) (A). C43.60 (Malignant melanoma of unspecified upper limb, including shoulder) (B) is incorrect because the lesion is documented as in situ, meaning it has not invaded deeper layers. L81.5 (Leukoderma, not elsewhere classified) (C) is incorrect as it describes a pigmentation disorder, not melanoma. D49.2 (Neoplasm of unspecified behavior of skin) (D) is incorrect because melanoma in situ has a defined behavior, not an unspecified one.
85. A 64-year-old male with a history of hyperlipidemia presents with gangrene of his right toes due to severe peripheral arterial disease. The provider documents "critical limb ischemia with atherosclerosis of the right lower extremity and gangrene." What is the correct ICD-10-CM code assignment?
Correct Answer: C. I70.262 Explanation: Atherosclerosis of native arteries of the right leg with gangrene is correctly coded as I70.262. This code captures both the presence of peripheral arterial disease and the severity indicated by the development of gangrene. (A) I70.263 is incorrect because it represents atherosclerosis with ulceration, whereas the scenario specifies gangrene. (B) I70.261 is incorrect because it represents atherosclerosis with ulceration rather than gangrene. (D) I73.9 is incorrect because it represents unspecified peripheral vascular disease, whereas the scenario provides a clear diagnosis of atherosclerosis. The correct answer is (C) I70.262, as it fully captures the severity of the patient's condition.
86. A 60-year-old female with focal epilepsy is seen for evaluation. The patient has experienced focal aware seizures (simple partial seizures) for several years, and they are not intractable. The physician confirms a diagnosis of localization-related epilepsy without status epilepticus. What is the correct ICD-10-CM code assignment?
Correct Answer: A Explanation: The correct ICD-10-CM code for localization-related epilepsy with focal aware seizures (simple partial seizures) without intractability and without status epilepticus is G40.009 (A). This code classifies localization-related (focal) epilepsy and epileptic syndromes without intractability. G40.219 (B) is incorrect because it refers to intractable epilepsy, which is not documented in this case. G40.109 (C) is incorrect because it describes generalized idiopathic epilepsy, whereas the patient has focal epilepsy. G40.001 (D) is incorrect because it refers to generalized epilepsy with absence seizures rather than focal epilepsy.
87. A physician performs a robotic-assisted percutaneous coronary intervention using a new device that has not yet been widely adopted but has been given temporary CPT coding for tracking and data collection. How should this procedure be coded?
Correct Answer: C Explanation: The correct answer is (C) because Category III codes are used for tracking new and emerging medical technologies, including robotic-assisted interventions. Since this procedure involves a new device that has not been widely adopted, it falls into the Category III classification for data collection and future evaluation. (A) is incorrect because Category I codes are assigned to established procedures with widespread use and proven efficacy, which does not apply to this case. (B) is incorrect because Category II codes track performance measures rather than procedures. (D) is incorrect because HCPCS Level II codes are typically used for supplies, medications, and non-physician services rather than new surgical techniques.
88. A patient is diagnosed with deep vein thrombosis (DVT) of the left lower extremity with a pulmonary embolism. The coder looks up I82.409 (Acute embolism and thrombosis of unspecified deep veins of lower extremity) and finds a "Use Additional Code" instruction to specify the presence of a pulmonary embolism. How should this case be coded?
Correct Answer: C. I82.409, I26.99 Explanation: The correct ICD-10-CM codes for DVT with pulmonary embolism are I82.409, I26.99 (C). The "Use Additional Code" instruction under I82.409 directs the coder to assign a code for pulmonary embolism (I26.99) when present. I82.409 (A) alone is incorrect because it does not capture the pulmonary embolism. I26.99 (B) alone is incorrect because it documents a pulmonary embolism but omits the primary DVT diagnosis. I26.99, I82.40 (D) is incorrect because I82.40 represents unspecified DVT but lacks laterality. Coders must always adhere to "Use Additional Code" instructions to ensure full documentation of related conditions.
89. A 25-year-old female presents with persistent cough, chest tightness, and shortness of breath. She reports using THC-containing vaping products regularly. The provider diagnoses her with EVALI. What is the correct coding for this encounter?
Correct Answer: A. U07.0 Explanation: The correct ICD-10-CM code for a confirmed diagnosis of EVALI is U07.0 (A), which should be assigned when the provider documents the vaping-associated lung injury. Option B (J44.9, T40.7X1A) is incorrect because J44.9 refers to unspecified chronic obstructive pulmonary disease, which is not the condition in question. Option C (J80, T65.92XA) is incorrect as J80 represents ARDS, which may be a complication but does not replace the EVALI diagnosis. Option D (T40.7X1A, J68.9) is incorrect because T40.7X1A represents poisoning from cannabis or derivatives, which does not fully capture the lung injury caused by vaping THC products.
90. A 70-year-old female is diagnosed with conductive hearing loss in her left ear due to chronic otosclerosis. She has no history of head trauma or infection. What is the correct ICD-10-CM code for this condition?
Correct Answer: C. H80.71 Explanation: The correct ICD-10-CM code for otosclerosis involving the left ear is (C) H80.71, which specifies "Otosclerosis involving oval window, nonobliterative, left ear," reflecting the chronic conductive hearing loss due to this condition. (A) H90.22 refers to "Conductive hearing loss, unilateral, left ear, with unrestricted hearing on the contralateral side," but it does not specify otosclerosis as the cause. (B) H80.72 refers to "Otosclerosis involving oval window, nonobliterative, bilateral," which is incorrect as the patient has unilateral involvement. (D) H90.21 refers to "Conductive hearing loss, unilateral, right ear," which is incorrect as the patient’s condition affects the left ear. Coding otosclerosis accurately is essential for proper documentation, particularly if surgical interventions such as stapedectomy are being considered.
91. A patient undergoes a screening colonoscopy at an outpatient surgical center. During the procedure, a single polyp is found and removed using cold biopsy forceps. The physician correctly reports the procedure with CPT coding, but which HCPCS Level II modifier should be appended to indicate that the procedure was initially scheduled as a screening but turned into a therapeutic procedure?
Correct Answer: B. -PT Explanation: The correct answer is (B) -PT, which is the HCPCS Level II modifier used when a screening colonoscopy is converted into a therapeutic procedure due to the discovery of a polyp. This modifier is required by Medicare and other payers to indicate that the procedure started as preventive but resulted in treatment. (A) -59 is incorrect because it is a CPT modifier used to indicate a distinct procedural service, not for screening-to-therapeutic conversion. (C) -33 is incorrect as it is used to indicate preventive services under the Affordable Care Act but does not specifically apply to screening colonoscopies that turn therapeutic. (D) -GA is incorrect because it is used to indicate that a waiver of liability (ABN) is on file, which does not apply to this scenario.
92. A hospital’s compliance officer identifies a pattern where physicians refer patients for laboratory tests at a facility they own, and the facility bills Medicare for these services. Which federal law is most relevant in evaluating this arrangement for compliance?
Correct Answer: A Explanation: The Stark Law is most relevant because it prohibits self-referrals involving designated health services (A). The Stark Law restricts physicians from referring Medicare patients to entities in which they have a financial interest unless an exception applies. The Anti-Kickback Statute (B) is related but focuses on remuneration for referrals rather than self-referrals to owned entities. The False Claims Act (C) primarily addresses billing fraud, but the core issue here is physician ownership and referral conflicts. The HITECH Act (D) deals with electronic health record security, which is unrelated to self-referral violations.
93. A 62-year-old male presents with hematuria and is found to have a malignant bladder tumor. He also has a secondary metastasis in the lung. What are the appropriate ICD-10-CM codes?
Correct Answer: B Explanation: The primary malignancy in this case is bladder cancer, which is correctly coded as C67.9 (Malignant neoplasm of bladder, unspecified) (B). The secondary malignancy is in the lung, which should be coded as C78.01 (Secondary malignant neoplasm of right lung) (B). C78.00 (Secondary malignant neoplasm of unspecified lung) (A, D) is incorrect because the laterality is documented as right lung, and a more specific code should be used. Z85.51 (Personal history of malignant neoplasm of bladder) (D) is incorrect because the bladder cancer is still active, not in history.
94. A 55-year-old female patient with long-standing Type 2 diabetes mellitus presents to the clinic with a non-healing foot ulcer on the plantar surface of her right foot. The provider diagnoses "Type 2 diabetes mellitus with a non-pressure chronic ulcer of the right foot, limited to the skin breakdown." What is the correct ICD-10-CM code for this condition?
Correct Answer: C. E11.621, L97.411 Explanation: The correct coding for Type 2 diabetes mellitus with a non-healing diabetic foot ulcer is E11.621 (C) for "Type 2 diabetes mellitus with foot ulcer," and L97.411 for "Non-pressure chronic ulcer of right foot, limited to skin breakdown." ICD-10-CM requires an additional code to specify the ulcer’s location and severity. (A) E11.621, L97.419 is incorrect because L97.419 represents an ulcer with unspecified severity, while the documentation specifies skin breakdown. (B) E11.622, L97.412 is incorrect because E11.622 is used for foot ulcers with deeper tissue involvement, which is not documented. (D) E11.69, L97.412 is incorrect because E11.69 is a general code for "Other specified diabetes mellitus complications," and it does not specifically indicate an ulcer.
95. A newborn is diagnosed with "congenital hydrocephalus due to aqueductal stenosis." The coder searches "Hydrocephalus, congenital" and finds "Hydrocephalus, congenital: aqueductal Q03.0." What does this indicate, and what is the correct ICD-10-CM code?
Correct Answer: C. Q03.0 Explanation: The correct ICD-10-CM code for congenital hydrocephalus due to aqueductal stenosis is Q03.0 (C). The colon in "Hydrocephalus, congenital:" means the term is incomplete and must be followed by a specified type, such as "aqueductal," leading to Q03.0. Q03.9 (A) is incorrect because it represents unspecified congenital hydrocephalus, but the provider specified aqueductal stenosis. Q03.1 (B) is incorrect because it refers to other types of obstructive congenital hydrocephalus. G91.9 (D) is incorrect because it represents unspecified hydrocephalus, which is used when no congenital or acquired distinction is made. Coders must be aware that colons in the index indicate that additional terms must be used for a complete selection.
96. A patient undergoes cataract surgery on the left eye. Two weeks later, the same physician performs cataract surgery on the right eye. How should the second procedure be reported?
Correct Answer: C Explanation: Modifier 79 (C) is used when an unrelated procedure is performed by the same physician during the postoperative period of a previous surgery. Since the second cataract surgery is performed on the opposite eye and is not related to complications from the first surgery, modifier 79 is appropriate. Modifier 58 (A) is incorrect because it is used for staged or planned procedures that are related to the initial procedure, which does not apply here. Modifier 78 (B) is incorrect because it is used when a related procedure requires a return to the operating room due to complications. Modifier 50 (D) is incorrect because it is used to indicate bilateral procedures performed in the same session, but in this case, the procedures were done on separate days.
97. A 55-year-old male presents with complaints of chest pain and shortness of breath. He has a history of coronary artery bypass graft (CABG) and is diagnosed with atherosclerosis of bypass graft with unstable angina. What is the correct ICD-10-CM code assignment?
Correct Answer: A. I25.710 Explanation: The provider documents atherosclerosis of a coronary artery bypass graft with unstable angina, which is appropriately coded as I25.710 in ICD-10-CM. (B) I25.701 is incorrect because it represents atherosclerosis of a bypass graft without angina. (C) I20.0 and I25.9 is incorrect because I25.9 is unspecified ischemic heart disease, which does not accurately capture the atherosclerosis of the bypass graft. (D) I25.798 is incorrect because it represents atherosclerosis of other bypass grafts without specific mention of unstable angina. The correct answer is (A) I25.710, as it accurately captures the documented condition.
98. A 45-year-old male presents to the emergency department with an intense, stabbing headache centered around his right eye. He describes these headaches as occurring at least 10 times per day in short bursts of excruciating pain. The physician diagnoses him with paroxysmal hemicrania. What is the correct ICD-10-CM code for this condition?
Correct Answer: A Explanation: The correct ICD-10-CM code for paroxysmal hemicrania is G44.041 (A), which describes a severe, short-lasting, unilateral headache occurring multiple times per day and typically responsive to indomethacin. G44.011 (B) is incorrect because it represents episodic cluster headaches, which have longer durations and may not respond to indomethacin. G44.009 (C) is incorrect because it represents an unspecified tension-type headache, which is not consistent with the severe nature of paroxysmal hemicrania. G43.909 (D) is incorrect because it is a nonspecific code for migraines, which do not typically present in short, frequent bursts of pain as seen with paroxysmal hemicrania.
99. A 65-year-old male presents with angina pectoris due to atherosclerosis of native coronary arteries. The provider documents "Coronary artery disease with angina pectoris." The coder reviews I25.119 (Atherosclerotic heart disease of native coronary artery with unspecified angina pectoris) and finds that a single combination code exists. What is the correct ICD-10-CM code assignment?
Correct Answer: A. I25.119 Explanation: The correct ICD-10-CM code for atherosclerotic heart disease with angina is I25.119 (A), which is a combination code that fully captures both coronary artery disease and angina pectoris, eliminating the need for separate codes.
100. A 30-year-old female with a history of lupus presents with increasing muscle weakness and elevated muscle enzyme levels. The provider diagnoses “lupus myositis.” What is the correct ICD-10-CM code assignment?
Correct Answer: D. M32.11 Explanation: The correct code is M32.11 (Lupus myositis) because the provider specifically diagnoses myositis associated with systemic lupus erythematosus (SLE). (D) is correct because M32.11 accurately captures myositis as a complication of lupus. (A) M33.00 (Juvenile dermatomyositis, organ involvement unspecified) is incorrect because the patient has lupus myositis, not dermatomyositis. (B) M60.9 (Myositis, unspecified) is incorrect because the provider has identified a specific type of myositis linked to lupus. (C) M35.03 (Inflammatory myopathy in diseases classified elsewhere) is incorrect because lupus myositis has a unique ICD-10-CM code and does not require coding under the "diseases classified elsewhere" category.
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