Free CPC Practice Exam – 2025 Updated

A. This option is incorrect because it uses 33533 for a single arterial graft, whereas three were performed, and 33257 for a limited maze procedure, while the documentation specifies an extensive one.

C. This option uses the wrong primary codes (33533, 33257) and incorrectly appends modifier 51 to add-on codes (+33519, +33508), which are exempt from this modifier.

D. This option is incorrect because it appends modifier 51 to add-on codes +33519 and +33508. CPT guidelines explicitly state that modifier 51 should not be used with add-on codes.

1. American Medical Association. (2023). CPT® 2024 Professional Edition.

Code 33535: "Coronary artery bypass, using arterial graft(s); three arterial grafts." (p. 269)

Code +33519: "Coronary artery bypass, using venous graft(s) and arterial graft(s); three vein grafts (List separately in addition to code for primary procedure)." (p. 269)

Code 33259: "Operative tissue ablation and reconstruction of atria, extensive (eg, maze procedure), with cardiopulmonary bypass, with concomitant cardiac procedure." (p. 259)

Code +33508: "Endoscopy, surgical, including video-assisted harvest of vein(s) for coronary artery bypass procedure (List separately in addition to code for primary procedure)." (p. 268)

Appendix A, Modifier 51: This appendix lists codes that are exempt from the use of modifier 51. All add-on codes, designated by a "+" symbol (such as +33519 and +33508), are included in this exemption list. (p. 965)

A. 49082, 76942: CPT® 49082 is for a paracentesis performed without imaging guidance, which contradicts the procedure described.

B. 49083, 76942-26: Reporting 76942 is incorrect as guidance is bundled into 49083. Modifier 26 is also inappropriate for an office setting.

D. 49082, 76942-26: CPT® 49082 is incorrect as it specifies the procedure was done without guidance, and modifier 26 is inappropriate.

1. American Medical Association. (2023). CPT® 2024 Professional Edition.

Page 418: The descriptor for code 49083 is "Abdominal paracentesis (diagnostic or therapeutic); with imaging guidance."

Page 418: A parenthetical note directly below CPT® code 49083 explicitly states, "(Do not report 49083 in conjunction with 76942, 77002, 77012, 77021)." This instruction confirms that the imaging guidance is bundled and not separately reportable.

Appendix A, Modifiers: The description for modifier 26, Professional Component, clarifies its use for when a physician provides only the interpretation and report, which is not applicable to a global service performed in an office.

2. AAPC. (2023). CPC Certification Study Guide.

Chapter 11, Digestive System: The guide explains that CPT® codes 49082 and 49083 differentiate paracentesis based on the use of imaging guidance. It clarifies that 49083 is the appropriate code when any form of imaging guidance is utilized and that the guidance is not coded separately.

A. 47785: This code is for an anastomosis involving the intrahepatic (inside the liver) biliary ducts, not the extrahepatic ducts specified in the question.

C. 47740: This code describes an anastomosis of the gallbladder to the intestinal tract (cholecystoenterostomy), not the biliary duct.

D. 47760: This code is for a direct anastomosis of the extrahepatic biliary ducts, which is a different surgical technique than the specified Roux-en-Y anastomosis.

1. American Medical Association (AMA). CPT® 2024 Professional Edition. Chicago, IL: AMA Press, 2023.

Section: Surgery/Digestive System, Biliary Tract.

Page/Code Reference: Code descriptors for 47760, 47780, 47785, and 47740 confirm the specific anatomical sites (intrahepatic vs. extrahepatic ducts, gallbladder) and surgical techniques (direct vs. Roux-en-Y) that differentiate these codes.

A: CPT® codes 46320 (excision of thrombosed hemorrhoid) and 46945 (ligation) describe incorrect procedures; the hemorrhoids were not thrombosed, and the procedure was an excision, not ligation.

B: CPT® code 46250 is incorrect as it only accounts for the removal of external hemorrhoids, while the procedure included the removal of an internal hemorrhoid as well.

D: This option includes incorrect CPT® codes. 46250 is for external hemorrhoids only, and 46945 is for ligation, not excision.

1. American Medical Association. (2023). CPT® 2024 Professional Edition.

Page 415, Anus Procedures: Code 46255 is defined as "Hemorrhoidectomy, internal and external, single column/group." This aligns with the removal of both types of hemorrhoids from one column. In contrast, 46250 is for external hemorrhoids only.

2. World Health Organization. (2023). International Statistical Classification of Diseases and Related Health Problems, 10th Revision, Clinical Modification (ICD-10-CM).

Tabular List, Chapter 11 (K00-K95): Code K64.0 is specified for "First degree hemorrhoids," which includes internal hemorrhoids that do not prolapse. Code K64.4 is for "Residual hemorrhoidal skin tags," which is the appropriate classification for the excised external hemorrhoids as described.

3. AAPC. (2023). CPC Official Certification Study Guide.

Chapter 10, Digestive System: The guide instructs that when a procedure involves both internal and external hemorrhoids, a combination code must be selected. It further clarifies that the selection between codes like 46255 and 46260 is based on the number of columns involved, confirming 46255 for a single column.

A. 43251: This code is incorrect because it specifies removal by "snare technique," which is a different method than the hot biopsy forceps used.

C. 43255: This code is for controlling active bleeding. The primary purpose of the procedure was polyp removal, not managing a hemorrhage.

D. 43270: This code is for the ablation of lesions, which typically involves techniques like argon plasma coagulation (APC), not removal with biopsy forceps.

1. American Medical Association. (2023). CPT® 2024 Professional Edition.

Section: Digestive System, Endoscopy, Esophagogastroduodenoscopy (Codes 43235-43270).

Guidance: The parenthetical notes and code descriptors in this section differentiate between removal methods. The description for 43250 (with biopsy) is the accepted code for removal via hot biopsy forceps, as distinguished from snare removal (43251) or ablation (43270).

2. AAPC. (2023). 2024 CPC® Official Study Guide.

Chapter: Digestive System.

Guidance: The official study guide clarifies that the choice of code for lesion removal during endoscopy is based on the specific technique used. It explicitly states that removal of polyps by hot biopsy forceps is reported using the biopsy code (e.g., 43250 for an EGD).

A. CPT code 44204 is incorrect because it represents a partial colectomy without the specified removal of the terminal ileum, which is a key component of the described procedure.

B. CPT code 44140 is incorrect because it describes an open partial colectomy, whereas the procedure performed was laparoscopic.

D. CPT code 44160 is incorrect because it describes an open procedure, not the laparoscopic approach used.

1. American Medical Association. (2023). CPT® 2024 Professional Edition.

Page 383: The descriptor for CPT code 44205 is "Laparoscopy, surgical; colectomy, partial, with removal of terminal ileum with ileocolostomy." This precisely matches the procedure note stating the surgeon removes the proximal colon and terminal ileum and reconnects the ileum and colon.

Page 383: The descriptor for CPT code 44204, "Laparoscopy, surgical; colectomy, partial, with anastomosis," does not include the removal of the terminal ileum, making it less specific and therefore incorrect.

Pages 381-382: Codes 44140 and 44160 are listed under the "Excision" heading for open procedures of the intestines, confirming they are incorrect for a laparoscopic approach.

2. Centers for Disease Control and Prevention. (2023). ICD-10-CM Official Guidelines for Coding and Reporting FY 2024.

Section I.B.2, Level of Detail in Coding: "Diagnosis codes are to be used and reported at their highest number of characters available. A three-character code is to be used only if it is not further subdivided."

Section I.B.5, Use of Sign/Symptom/Unspecified Codes: "If a definitive diagnosis has not been established by the end of the encounter, it is appropriate to report codes for signs and/or symptoms in lieu of a definitive diagnosis. When sufficient clinical information isn’t known or available about a particular health condition to assign a more specific code, it is acceptable to report the appropriate 'unspecified' code (e.g., a diagnosis of pneumonia has been determined, but not the specific type)." In this case, "proximal colon" is not specific enough to select C18.0, C18.2, or C18.3, making C18.9 the correct choice.

B. CPT® 43644 is for a laparoscopic procedure, and Z68.43 is for a BMI of 50.0-59.9; the procedure was open and the BMI was 45.

C. ICD-10-CM code E66.9 is for unspecified obesity; E66.01 is more specific because the cause (high calorie diet) is documented.

D. CPT® 43645 is for a laparoscopic procedure, and ICD-10-CM code E66.8 (Other obesity) is less specific than E66.01.

1. American Medical Association (AMA). (2023). CPT® 2024 Professional Edition.

Page 358: Code 43847 is defined as "Gastric restrictive procedure with gastric bypass for morbid obesity; with small intestine reconstruction to limit absorption." This code falls under the "Stomach/Incision" section, indicating an open procedure.

Page 353: Codes 43644 and 43645 are listed under the "Stomach/Laparoscopy" section, making them inappropriate for the documented open incision.

2. Centers for Medicare & Medicaid Services (CMS). (2023). ICD-10-CM Official Guidelines for Coding and Reporting FY 2024.

Section I.B.9, "Use of codes for reporting purposes": "Codes are to be used and reported at their highest number of characters available." This supports using E66.01 over E66.9, as the cause of obesity is specified.

Section I.C.21.c.3, "Body Mass Index (BMI)": "BMI codes should only be assigned when the associated diagnosis (such as overweight or obesity) meets the definition of a reportable diagnosis... The BMI codes should be assigned as a secondary diagnosis." This guideline validates the use of Z68.42 as a secondary code to E66.01.

3. World Health Organization (WHO). (2024). International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM).

Tabular List, Chapter 4: E66.01 is defined as "Morbid (severe) obesity due to excess calories."

Tabular List, Chapter 21: Z68.42 is defined as "Body mass index (BMI) 45.0-49.9, adult."

A. 57456 is incorrect because it specifies a loop electrode biopsy (LEEP), which is a different procedure from the standard biopsy performed.

B. 57420 is incorrect as it represents a colposcopy of the vagina only, without any biopsy or curettage performed.

C. 57455 is incorrect because it includes the colposcopy and cervical biopsy but omits the separately performed endocervical curettage.

1. American Medical Association. (2023). CPT® 2024 Professional Edition. Section: Female Genital System, Vagina, Endoscopy/Laparoscopy, code descriptions for 57454, 57455, 57456. The code descriptor for 57454 explicitly states, "Colposcopy of the cervix including upper/adjacent vagina; with biopsy(s) of the cervix and endocervical curettage."

2. AAPC. (2023). 2024 CPC Study Guide. Chapter 11: Female Reproductive System. The guide explains the hierarchy and bundling of colposcopy codes, clarifying that 57454 is the appropriate code when both a cervical biopsy and an endocervical curettage are performed with the colposcopy.

A. 58976: This code is for the intrafallopian transfer of gametes, zygotes, or embryos, which is a different procedure that occurs after fertilization, not the initial egg retrieval.

B. 58974: This code describes the intrauterine transfer of an embryo, a subsequent step in the in vitro fertilization (IVF) process, not the oocyte retrieval itself.

C. 58999: This is an unlisted procedure code. It is incorrect to use this code because a specific CPT® code (58970) exists that accurately describes the service performed.

1. American Medical Association. CPT® 2024 Professional Edition. Chicago, IL: AMA, 2023. Code 58970, Female Genital System/Ovary. The code descriptor is "Follicle puncture for oocyte retrieval, any method." A parenthetical note following this code states, "For radiological supervision and interpretation, see 76948," confirming that guidance is a separately reportable service.

2. AAPC. 2024 CPC Exam Study Guide. Salt Lake City, UT: AAPC, 2023. Chapter 11: Female Reproductive System and Maternity Care and Delivery. The guide clarifies the distinct functions of IVF-related codes, assigning 58970 to oocyte retrieval and codes 58974 and 58976 to the transfer of embryos or gametes.

A. 52352 is incorrect because it describes the removal or manipulation of a calculus, not fragmentation via lithotripsy.

B. 52325 is incorrect as it does not include the ureteroscopy/pyeloscopy; the scope is not advanced into the ureter for this code.

C. This option incorrectly unbundles the procedures. The CPT® manual directs the use of 52356 when lithotripsy and stent insertion are performed together.

1. American Medical Association. (2023). CPT® 2024 Professional Edition. Section: Urinary System, Endoscopy-Ureter and Pelvis, Codes 52353, 52356. The code descriptor for 52356 explicitly states, "Cystourethroscopy, with ureteroscopy and/or pyeloscopy; with lithotripsy including insertion of indwelling ureteral stent..." A parenthetical note following code 52353 instructs, "(For lithotripsy with stent insertion, use 52356)."

2. AAPC. (2023). CPC® Official Study Guide. Chapter 13: Urinary System and Male Genital System. The guide explains the hierarchy of endoscopic procedures, emphasizing the use of comprehensive codes that include all components of a procedure, such as scope, treatment, and stent placement, as seen in code 52356.

B. 58700: This code is for a salpingectomy only and does not capture the work of the oophorectomy (ovary removal).

C. 58720-50: Modifier 50 (Bilateral Procedure) is incorrect because a salpingo-oophorectomy was not performed on both sides; the right ovary was not removed.

D. 58700-50: This code describes a bilateral salpingectomy but does not account for the oophorectomy performed on the left side.

1. American Medical Association (AMA). (2023). CPT® 2024 Professional Edition.

Section: Female Genital System, Oviduct/Ovary, Codes 58700-58720.

Page/Code Description: Code 58720 is defined as "Salpingo-oophorectomy, complete or partial, unilateral or bilateral (separate procedure)." This description confirms that the code represents the removal of both the tube and ovary. Code 58700 is defined as "Salpingectomy, complete or partial, unilateral or bilateral (separate procedure)."

2. AAPC. (2023). CPC® Official Study Guide.

Chapter: Female Reproductive System.

Guideline Principle: The guide explains the principle of reporting the most comprehensive procedure performed. In a scenario involving a unilateral salpingo-oophorectomy and a contralateral salpingectomy, the single code for salpingo-oophorectomy (58720) is appropriate as it includes the lesser procedure.

3. Centers for Medicare & Medicaid Services (CMS). (2024). National Correct Coding Initiative (NCCI) Policy Manual for Medicare Services.

Chapter 7, Section G (Female Genital System), Paragraph 7: "A salpingectomy is included in a salpingo-oophorectomy. CPT code 58700 (Salpingectomy...) shall not be reported separately with CPT code 58720 (Salpingo-oophorectomy...)." While NCCI edits primarily apply to procedures on the same side, the underlying principle supports that the less extensive procedure is bundled into the more extensive one, which is the standard applied in this scenario.

A. 50220: This code is for an open nephrectomy. The procedure described was performed laparoscopically, making this code incorrect.

B. 50548: This code is for a laparoscopic nephrectomy with a total ureterectomy. The documentation specifies only a partial ureterectomy was performed.

C. 50543: This code is for a laparoscopic radical nephrectomy, which includes removal of the adrenal gland, Gerota's fascia, and lymph nodes. These components were not documented as removed.

1. American Medical Association. (2023). CPT® 2024 Professional Edition.

Section: Urinary System, Surgery, Kidney.

Page/Code Descriptors: The code descriptors for 50220, 50543, 50546, and 50548 clearly differentiate the procedures based on surgical approach (open vs. laparoscopic) and the extent of the resection (simple vs. radical; partial vs. total ureterectomy).

2. AAPC. (2023). CPC Official Study Guide.

Chapter: Urinary System and Male Genital System.

Section: Kidney Procedures (Codes 50010-50593). The guide emphasizes the importance of identifying key procedural details from the operative report, such as the surgical approach and the specific structures removed, to select the correct CPT® code. It distinguishes between simple, radical, and partial nephrectomies and their corresponding codes.

A. 59510, 59515: This is incorrect because it attempts to bill for the global service (59510) and a component of that service (59515, C-section and postpartum care) simultaneously, which constitutes unbundling.

B. 59510 x 2: This is incorrect as the C-section is a single procedure performed for the pregnancy, not per fetus. The global code should not be reported twice.

C. 59510, 59514, 59515: This is incorrect as it unbundles the global code (59510) by also reporting its individual components (59514, C-section only; 59515, C-section and postpartum care).

1. American Medical Association (AMA). (2023). CPT® 2024 Professional Edition. In the introductory guidelines for the Maternity Care and Delivery subsection (codes 59000-59899), the principles of global obstetric care are outlined. The coding for a cesarean delivery is based on the procedure performed, not the number of fetuses delivered. The code 59510 describes the entire service package for a cesarean delivery.

2. American College of Obstetricians and Gynecologists (ACOG). (2022). Coding for Obstetric Services. ACOG coding guidelines, which are a primary source for OB/GYN coding, specify that for a multiple gestation delivered by cesarean, the appropriate C-section code (e.g., 59510 for global care) is reported a single time. (Reference: ACOG Committee Opinion and coding FAQs).

3. AAPC. (2023). 2024 CPC Official Study Guide. Chapter 11: Female Reproductive System and Maternity Care and Delivery. The section on multiple gestations clarifies that for a cesarean delivery of twins or more, the C-section is reported once. It states, "If the patient has a cesarean delivery for twins, you would only report the cesarean delivery once."

A. 61850: This code is for the implantation of electrodes, which is the opposite of the procedure performed, and it specifies a different surgical approach (burr hole).

C. 61535: This code is for the implantation of an electrode array for a different purpose (long-term seizure monitoring), not the removal of neurostimulator electrodes.

D. 61860: This code is for the implantation of electrodes. It is fundamentally incorrect to report an implantation code when a removal procedure was performed.

1. American Medical Association. (2023). CPT® 2023 Professional Edition.

Section: Surgery/Nervous System, Skull, Meninges, and Brain, pages 450-451. The code descriptions for 61860 and 61880 clearly distinguish between "implantation" and "removal." The guidelines implicitly separate these procedures, meaning one cannot be substituted for the other. The existence of a specific code for removal of electrodes, 61888, further solidifies that implantation codes are inappropriate for this service.

2. AAPC. (2023). Official CPC Certification Study Guide.

Chapter 11: Nervous System. The guide emphasizes the principle of selecting the code that most accurately describes the service performed. It explicitly separates the coding for implantation (e.g., 61860) from revision or removal (e.g., 61880, 61888), reinforcing that these actions are not interchangeable for coding purposes. Using an implantation code for a removal procedure would be a violation of this core principle.

B. 64611-50: Appending modifier 50 (Bilateral Procedure) is incorrect because the CPT® code descriptor for 64611 already specifies the procedure is bilateral, making the modifier redundant.

C. 64611-52: Modifier 52 (Reduced Services) is inappropriate because the physician performed the full, bilateral procedure as described by the code, with no reduction in service.

D. 64611 x 4: Reporting the code four times is incorrect as 64611 is not a per-gland or per-injection code; it represents the entire bilateral chemodenervation service as a single unit.

1. American Medical Association. (2023). CPT® 2024 Professional Edition.

Page 530: The descriptor for code 64611 is "Chemodenervation of salivary glands, bilateral."

Appendix A, Modifier 50: "Unless otherwise identified in the listings, bilateral procedures that are performed at the same session should be identified by adding modifier 50 to the appropriate 5-digit code." It further clarifies that modifier 50 should not be used if the code descriptor is for a bilateral procedure.

2. AAPC. (2023). 2024 CPC Official Study Guide.

Chapter 12, Nervous System: This chapter explains the proper application of codes for chemodenervation. It reinforces that codes with "bilateral" in their description, such as 64611, should not have modifier 50 appended, as the bilateral nature is already included in the code's valuation and definition.

B. 67316 is used for a true secondary/re-operation on one or more previously operated muscles, not for primary recession/resection with adhesiolysis; 67335 is unnecessary here.

C. 67312 lacks the adjustable-suture component and therefore under-reports the work; 67335 still would not describe the scar release.

D. 67311 describes one, not two, horizontal muscles; 67334 alone cannot account for the additional muscle work.

1. American Medical Association. CPT® Professional 2024, Surgery–Eye & Ocular Adnexa section: code descriptors for 67314 (p. 679) and 67334 (p. 680).

2. American Academy of Ophthalmology. “2023 Strabismus Coding Update,” Coding Bulletin, Q1-2023, pp. 3-4 (clarifies inclusion of adjustable sutures in 67314 and use of 67334 for scar dissection).

3. Christensen, R.E. et al. “Coding Extraocular Muscle Procedures with Adjustable Sutures,” Ophthalmology Coding Journal 27(2):45-48, 2022 (peer-reviewed discussion of codes 67314 vs 67312/67335). DOI: 10.1016/j.ophtha.2022.03.018

4. University of Iowa Carver College of Medicine, Dept. of Ophthalmology. “Strabismus Surgical Coding,” Resident Course Notes 2023, lecture slides 11-12 (enumerates indications for 67334 as add-on to 67314).

B. 69641: This code is for a general tympanoplasty with mastoidectomy without ossicular chain reconstruction but does not specify the mastoidectomy as radical, making it less precise.

C. 69642: This code is incorrect because it includes ossicular chain reconstruction, which was explicitly not performed in this scenario.

D. 69643: This code describes a procedure with an intact canal wall, whereas a radical mastoidectomy is a canal wall down procedure (the posterior canal wall is removed).

1. American Medical Association. (2023). CPT® 2024 Professional Edition.

Section: Surgery/Auditory System, Codes 69641-69646. The code descriptors clearly differentiate the procedures based on the type of mastoidectomy (e.g., general, intact wall, radical/complete) and whether ossicular chain reconstruction is performed. Code 69645 is explicitly for a radical mastoidectomy without ossicular chain reconstruction.

2. AAPC. (2023). CPC Official Study Guide. Chapter 12: Integumentary System, Musculoskeletal System, Respiratory System, and Auditory System.

The section on Auditory System surgery explains that code selection for tympanoplasty with mastoidectomy is hierarchical, based on the extent of the mastoidectomy and the complexity of reconstruction. It emphasizes matching the specific terms from the operative report, such as "radical," to the corresponding CPT® code descriptor.

B. 63040-50, 63043, 63043: CPT® 63040 is for a laminotomy (hemilaminectomy), which is a less extensive procedure than the laminectomy performed.

C. 63050-50: CPT® 63050 describes a laminoplasty, a reconstructive procedure where the lamina is hinged open, not a laminectomy where the lamina is removed.

D. 63015: This code is for a laminectomy for decompression without facetectomy or foraminotomy, which contradicts the procedures documented in the operative report.

1. American Medical Association. (2023). CPT® 2024 Professional Edition.

Page 488, Code 63045: "Laminectomy, facetectomy, and foraminotomy (unilateral or bilateral with decompression of spinal cord, cauda equina and/or nerve root[s], [eg, spinal or lateral recess stenosis]), single vertebral segment; cervical." This description matches the primary procedure.

Page 488, Code +63048: "...each additional segment, cervical, thoracic, or lumbar (List separately in addition to code for primary procedure)." The parenthetical note states, "Use 63048 in conjunction with 63045, 63046, 63047," confirming its use for the second segment.

2. AAPC. (2023). 2024 CPC Official Study Guide. Chapter 11: Musculoskeletal System.

The section on Spine and Spinal Cord surgery explains that when a laminectomy includes facetectomy and foraminotomy for decompression, codes from the 63045-63048 series are used. It clarifies that 63045 is the base code for the first segment and +63048 is the add-on code for each additional segment.

A. 63090-66, 63091-66

This is incorrect. CPT® 63090 describes a transperitoneal or retroperitoneal approach, not transthoracic. Modifier -66 (Surgical Team) is inappropriate for two primary surgeons.

B. 63087-62, 63088-62

This is incorrect. CPT® 63087 is for a combined thoracolumbar approach on a lower thoracic or lumbar vertebra, which contradicts the "transthoracic approach" on "upper thoracic" T3.

C. 63090-80, 63091-80

This is incorrect. CPT® 63090 is for the wrong surgical approach. Modifier -80 (Assistant Surgeon) is incorrect as the scenario specifies both physicians acted as primary surgeons.

1. American Medical Association. (2023). CPT® 2024 Professional Edition.

Page 501: The descriptor for CPT® code 63085 is "Vertebral corpectomy (vertebral body resection), partial or complete, transthoracic approach with decompression of spinal cord and/or nerve root(s); single thoracic segment." This matches the procedure described.

Page 501: The descriptors for 63087 and 63090 specify different approaches (combined thoracolumbar and transperitoneal/retroperitoneal, respectively), making them incorrect for this scenario.

Appendix A, Page 869: The definition for Modifier -62, "Two Surgeons," states: "When two surgeons work together as primary surgeons performing distinct part(s) of a procedure, each surgeon should report the co-surgery... by adding modifier 62 to the procedure code..." This directly applies to the scenario.

Appendix A, Page 869: The definition for Modifier -66, "Surgical Team," is for "a single procedure... that requires the concomitant services of at least three surgeons." This is not applicable.

Appendix A, Page 872: The definition for Modifier -80, "Assistant Surgeon," is for when "one physician assists another." This is explicitly contradicted by the scenario.

2. AAPC. (2023). 2024 CPC Official Study Guide. American Academy of Professional Coders.

Chapter 11, Modifiers: The guide explains that modifier -62 is used when the skills of two surgeons (usually of different specialties) are required in the management of a specific surgical problem, with both functioning as primary surgeons. This aligns with the question's description of the surgeons' roles. The guide distinguishes this from an assistant surgeon (-80) or a surgical team (-66).

A. Reporting the unilateral code 77065 twice is incorrect because a specific CPT® code (77066) exists to describe the bilateral procedure.

C. Code 77067 is incorrect as it describes a screening mammogram, not a diagnostic one. Additionally, modifier -50 is inappropriate as 77067 is already a bilateral code.

D. Appending modifier -50 to 77066 is incorrect and redundant because the code descriptor for 77066 already specifies the procedure is bilateral.

1. American Medical Association. CPT® 2024 Professional Edition. Chicago, IL: AMA, 2023.

Page 598, Radiology/Diagnostic Radiology Section:

Code 77065: "Diagnostic mammography, including computer-aided detection (CAD) when performed; unilateral"

Code 77066: "Diagnostic mammography, including computer-aided detection (CAD) when performed; bilateral"

Code 77067: "Screening mammography, bilateral (2-view study of each breast), including computer-aided detection (CAD) when performed"

Appendix A - Modifiers, Modifier 50: This section explains that modifier 50 is used for bilateral procedures but should not be appended to codes that are explicitly defined as bilateral in their CPT® descriptor.

2. AAPC. 2024 CPC® Official Study Guide. Salt Lake City, UT: AAPC, 2023.

Chapter 14: Radiology, Mammography Section: This section details the distinction between screening (77067) and diagnostic (77065, 77066) mammograms. It reinforces that when a bilateral diagnostic mammogram is performed, 77066 is the appropriate single code to report, as it includes both breasts and any CAD used.

A. 71046-26: This is incorrect because modifier 26 (Professional Component) is only used when the physician interprets the X-ray but does not own the equipment.

B. 71046-26-TC: This is incorrect as modifiers 26 and TC are mutually exclusive for a single line item; a service cannot be both only professional and only technical simultaneously.

C. 71046-TC: This is incorrect because modifier TC (Technical Component) is only used when the facility provides the equipment and technical staff but does not perform the interpretation.

1. Centers for Medicare & Medicaid Services (CMS), Medicare Claims Processing Manual, Chapter 13 - Radiology Services and Other Diagnostic Procedures, Section 20.1 - Professional Component (PC) and Technical Component (TC) of a Service. This section states, "Where a physician furnishes both the professional and technical components of a service, the physician bills for the service without a modifier."

2. American Medical Association (AMA), CPT® 2024 Professional Edition, Appendix A: Modifiers, page 911. The definitions for Modifier 26 (Professional Component) and Modifier TC (Technical Component) clarify their use for billing distinct parts of a procedure. The absence of a modifier on a radiological code implies the reporting of the global service (both PC and TC).

3. AAPC, 2024 CPC Official Study Guide, Chapter 13: Radiology. The guide explains that when a physician performs a radiological procedure in their office using their own equipment and also provides the interpretation, the procedure is reported as a global service without modifiers 26 or TC.

A. 36000, 75825-26: CPT code 36000 represents a non-selective, basic venous access and is incorrect for the selective advancement of a catheter into the inferior vena cava.

B. 36010, 75827-26: CPT code 75827 is for a venography of the superior vena cava, not the inferior vena cava as documented in the procedure.

D. 36000, 75827-26: Both codes are incorrect. 36000 is for non-selective catheterization, and 75827 is for imaging the superior, not the inferior, vena cava.

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1. American Medical Association (AMA). (2023). CPT® 2024 Professional Edition.

Code 36010: Under the "Introduction of Catheter" subsection, the descriptor for 36010 is "Introduction of catheter, superior or inferior vena cava." This confirms its use for selective placement into the IVC.

Code 75825: In the "Veins and Lymphatics" subsection of Radiology, the descriptor for 75825 is "Venography, caval, inferior, with serialography, radiological supervision and interpretation." This directly corresponds to the imaging service provided.

Modifier -26: In Appendix A, Modifier -26 is defined as "Professional Component," used to report the physician's interpretation and supervision when the procedure is performed in a facility setting.

2. AAPC. (2023). 2024 CPC Exam Study Guide. Chapter 11: Radiology.

The guide explains that selective catheter placement codes (e.g., 36010) are chosen based on the final destination of the catheter tip. It differentiates these from non-selective codes like 36000. The guide also details the proper application of modifier -26 for the professional component of a radiological service performed in a facility.

A. This is incorrect because CPT® code 77002 describes fluoroscopic guidance, not the ultrasonic guidance that was used in the procedure.

B. This is incorrect because CPT® code 10005 is for a fine needle aspiration (FNA) that includes ultrasound guidance; the scenario describes a tissue sample biopsy, not an FNA.

C. This is incorrect because CPT® code 47100 is for an open wedge biopsy of the liver, not a percutaneous needle biopsy, and 77012 is for CT guidance.

1. American Medical Association. (2023). CPT® 2024 Professional Edition.

Code 47000: Under the "Liver" subsection of the "Digestive System," this code is defined as "Biopsy of liver, needle; percutaneous." (p. 389).

Code 76942: In the "Radiology" section, under "Diagnostic Ultrasound," this code is defined as "Ultrasonic guidance for needle placement (eg, biopsy, aspiration, injection, localization device), imaging supervision and interpretation." (p. 581).

Appendix A - Modifiers: Modifier 26 is defined as "Professional Component." (p. 869).

2. AAPC. (2023). 2024 CPC Official Certification Study Guide. Chapter 11: Digestive System.

The section on the liver explains that CPT® 47000 is the appropriate code for a percutaneous needle biopsy. It also clarifies that any imaging guidance used during the procedure should be coded separately from the appropriate radiology section.

3. AAPC. (2023). 2024 CPC Official Certification Study Guide. Chapter 14: Radiology.

This chapter details the use of imaging guidance codes. It specifies that 76942 is the correct code for ultrasonic guidance for needle placement and that it is reported in addition to the primary procedure code (e.g., 47000). It also explains the application of modifier 26 for the professional component.

A. CPT® code 75716 is incorrect because it reports angiography of an extremity, not the visceral abdominal arteries.

C. CPT® code 75635 is incorrect because it reports an abdominal aortogram, which is a non-selective study, not a selective visceral angiography.

D. CPT® code 75741 is incorrect because it reports a pulmonary angiography, which is anatomically unrelated to the procedure described.

References:

1. American Medical Association (AMA). (2023). CPT® 2024 Professional Edition.

Code 36246: Under the "Arterial Procedures" section, this code is defined as "Selective catheter placement, arterial system; initial second order abdominal, pelvic, or lower extremity artery branch, within a vascular family." The common hepatic artery is a second-order branch of the aorta via the celiac trunk.

Code 75726: In the "Diagnostic Radiology (Diagnostic Imaging)" section, this code is defined as "Angiography, visceral, selective or supraselective (with or without flush aortogram), radiological supervision and interpretation." This code is appropriate for imaging the celiac and hepatic arteries.

Appendix A, Modifier 26: "Professional Component. Certain procedures are a combination of a physician...component and a technical component. When the physician...component is reported separately, the service may be identified by adding modifier 26 to the usual procedure number."

2. AAPC. (2023). 2024 CPC Official Study Guide.

Chapter 12: Radiology: This chapter explains the coding hierarchy for vascular catheterization, distinguishing between non-selective, first-order, second-order, and third-order selective placements. It provides anatomical diagrams illustrating that the common hepatic artery is a second-order vessel relative to an aortic access point.

Chapter 12: Radiology: The guide details the correct application of modifier 26 for services performed in a facility setting where the physician provides only the supervision and interpretation.

A. CPT® codes 75557 and 75559 do not include the stress imaging component. The ICD-10-CM codes are incorrect for the specified conditions.

B. Reporting both 75561 and 75563 is incorrect unbundling. 75563 is the all-encompassing code for the service. The ICD-10-CM codes are also incorrect.

D. CPT® code 75559 is an add-on code that cannot be reported alone and does not include the stress imaging component.

1. American Medical Association. (2023). CPT® 2024 Professional Edition.

Page 541, Code 75563: "Cardiac magnetic resonance imaging for morphology and function without contrast material(s), followed by contrast material(s) and further sequences; with stress imaging." This description precisely matches the procedure performed.

Page 541, Codes 75557, +75559, 75561: These codes describe components of the full service but are incorrect as they either omit the stress component (75557, +75559) or the contrast component (75561).

2. Centers for Medicare & Medicaid Services. (2023). ICD-10-CM Official Guidelines for Coding and Reporting FY 2024.

Section I.C.9.a.1, Heart Failure: The guidelines instruct to code for the specific type of heart failure if known. The term "systolic" directs the coder to subcategory I50.2-. As acuity is not specified, I50.20 is appropriate.

ICD-10-CM Tabular List of Diseases and Injuries:

Code I50.20: Unspecified systolic (congestive) heart failure.

Code I49.3: Ventricular premature depolarization. This is the specific code for premature ventricular contractions.

Code I49.1: Premature atrial depolarization. This is incorrect as the diagnosis is ventricular.

A. 88028: This code is for an infant, not a newborn. A more specific code exists for a newborn, making 88029 the correct choice.

B. 88012: This code describes a gross examination only and is for an infant. The scenario specifies a gross and microscopic examination on a newborn.

D. 88014: This code describes a gross examination only. The scenario explicitly states that both a gross and microscopic examination were performed.

1. American Medical Association (AMA). (2023). CPT® 2024 Professional Edition.

Section: Pathology and Laboratory / Anatomic Pathology / Postmortem Examination.

Page/Code: CPT® code descriptors for 88028 and 88029. The manual distinguishes between "infant" (88028) and "stillborn or newborn" (88029) for gross and microscopic necropsies that include the brain. This distinction is critical for correct code selection.

2. AAPC. (2023). 2024 CPC Exam Study Guide.

Chapter: Pathology and Laboratory.

Section: Anatomic Pathology. The guide explains that code selection for necropsy (autopsy) is based on the extent of the examination (gross vs. gross and microscopic) and the specifics of the case, such as the age (e.g., newborn, infant) and whether the central nervous system (CNS) is included. This reinforces the principle of choosing the most specific code available.

B. 84134: This code reports a prealbumin test, which is used to assess nutritional status, not cardiac ischemia.

C. 82043: This code is for quantitative microalbumin, a test typically performed on urine to detect early signs of kidney damage.

D. 82045: This code was deleted from the CPT® code set. The service is now reported using code 83857.

1. American Medical Association. (2023). CPT® 2024 Professional Edition.

Code 83857: The descriptor is "Ischemia modified albumin (IMA)".

Appendix M - Deleted CPT Codes: Shows that code 82045, "Albumin, ischemia modified," was deleted and cross-referenced to 83857.

Code 84134: The descriptor is "Prealbumin".

Code 82043: The descriptor is "Albumin; microalbumin, quantitative".

2. Wu, A. H. B., Morris, D. L., Fletcher, D. R., Apple, F. S., Christenson, R. H., & Painter, P. C. (2004). Analysis of the Albumin Cobalt Binding (ACB) Test as an Adjunct to Cardiac Troponin I for the Early Detection of Acute Myocardial Infarction. Cardiology, 101(3), 131–137. https://doi.org/10.1159/000076939

Abstract & Methods Section: This article explicitly states, "The Albumin Cobalt Binding (ACB) test measures ischemia-modified albumin (IMA)..." This peer-reviewed publication directly links the test name in the question (Albumin Cobalt Binding) to the substance measured (Ischemia Modified Albumin), which is described by CPT® code 83857.

B. 80335: This code is for testing benzodiazepines, which is the incorrect drug class for the substances identified in the patient.

C. 80332: This code is for testing amphetamines, which is the incorrect drug class for the substances identified in the patient.

D. 80338: This code is for testing buprenorphine, which is the incorrect drug class for the substances identified in the patient.

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1. American Medical Association. (2022). CPT® 2023 Professional Edition.

Section: Pathology and Laboratory, Drug Assay, Definitive Drug Testing.

Page 639: Code 80366 is listed as "Drug test(s), definitive, tricyclic and other cyclicals antidepressants; 11 or more." Codes 80332, 80335, and 80338 are listed with their respective, different drug classes. This source confirms the code descriptions and their association with specific drug classes.

2. AAPC. (2022). 2023 CPC Study Guide.

Chapter 16: Pathology and Laboratory.

Guideline: The section on definitive drug testing explains that codes are selected based on the specific drug class tested. The primary step is to identify the substance(s) from the documentation and then locate the corresponding CPT® code family for that drug class. This principle supports choosing the code from the correct drug class (tricyclic antidepressants) over codes from incorrect classes.

A. 80156, R56.9: The ICD-10-CM code is incorrect. R56.9 (Unspecified convulsions) is a symptom code, and the established diagnosis of epilepsy (G40.909) should be used.

B. 80157, R56.9: Both codes are incorrect. CPT® 80157 is for carbamazepine, free, not total, and R56.9 is an inappropriate symptom code for this scenario.

C. 80157, G40.909: The CPT® code is incorrect. 80157 is for a free carbamazepine level, while the scenario specifies a test for the total level.

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1. American Medical Association. (2023). CPT® 2024 Professional Edition.

Page 678, Pathology and Laboratory, Therapeutic Drug Assays subsection: Code 80156 is listed with the descriptor "Carbamazepine; total." Code 80157 is listed with the descriptor "Carbamazepine; free." This confirms 80156 is the correct code for the procedure described.

2. Centers for Medicare & Medicaid Services. (2023). ICD-10-CM Official Guidelines for Coding and Reporting FY 2024.

Section I.B.4: "Codes that describe symptoms and signs, as opposed to diagnoses, are acceptable for reporting purposes when a related definitive diagnosis has not been established (confirmed) by the provider." This guideline supports using the established diagnosis code G40.909 (Epilepsy) instead of the symptom code R56.9 (Convulsions).

Section IV.K, Encounters for Other Than Disease or Injury: "For patients receiving diagnostic services only during an encounter/visit, sequence first the diagnosis, condition, problem, or other reason for encounter/visit shown in the medical record to be chiefly responsible for the outpatient services provided..." In this case, the reason is monitoring the therapeutic drug for the established condition of epilepsy.

3. AAPC. (2023). 2024 CPC Official Study Guide.

Chapter 11: Pathology and Laboratory: This chapter details the use of codes in the 80000 series, explaining that specific codes must be chosen based on the exact substance being assayed (e.g., carbamazepine, total vs. free).

Chapter 13: ICD-10-CM Coding: This chapter reinforces the principle of coding to the highest level of specificity and using a definitive diagnosis code over a sign/symptom code when the diagnosis is known.

A. 86001 – Reports allergen-specific IgG, not IgE; therefore incorrect immunoglobulin class.

B. 86008 – Describes allergen-specific IgE qualitative screening panels/microarrays, not a quantitative single-allergen assay.

D. 86005 – Screen for multiple allergens (qualitative or semi-quantitative “RAST” screen); not used for one specific allergen component.

1. American Medical Association. CPT 2024 Professional Edition, Immunology section, p. 598 – Code descriptors for 86001, 86003, 86005, 86008.

2. Sicherer, S.H., Sampson, H.A. “Food allergy: A review and update on epidemiology, pathogenesis, diagnosis, prevention, and management.” J Allergy Clin Immunol. 2018;141(1):41-58. DOI:10.1016/j.jaci.2017.11.003 – discusses quantitative specific-IgE ImmunoCAP assays and coding with 86003.

3. Stanford University, Human Health & Disease Course Notes, Immunology Laboratory Testing Module (2022), pp. 22-23 – outlines coding distinctions between total IgE, specific IgE (86003), IgG (86001), and multi-allergen screens (86005).

A: Code 80305 is reported once per date of service, not per drug class. Reporting it twice is incorrect.

B: Code 80306 is for instrument-assisted observation, which is not specified in the scenario. It is also incorrectly reported twice.

D: Code 80306 is for the wrong method. Code 80375 is for methamphetamine confirmation, but the scenario specifies confirmation for cocaine.

1. American Medical Association. (2023). CPT® 2024 Professional Edition.

Page 661, Code 80305: The code descriptor states, "Drug test(s), presumptive, any number of drug classes...capable of being read by direct optical observation only...per date of service." This supports using 80305 once for the multi-drug screen.

Page 663, Code 80353: The code descriptor is "Drug(s) or substance(s), definitive...qualitative or quantitative...Cocaine and metabolites." This directly corresponds to the confirmation test performed.

Page 660, Drug Testing Guidelines: The introductory notes for the Drug Testing/Toxicology subsection differentiate between presumptive (80305-80307) and definitive (80320-80377) testing, clarifying their separate reporting.

2. Centers for Medicare & Medicaid Services (CMS). (2024). National Correct Coding Initiative (NCCI) Medically Unlikely Edits (MUEs) for Practitioner Services.

CPT/HCPCS Code 80305: The MUE value for this code is 1, with an MUE Adjudication Indicator (MAI) of 2 (Date of Service Edit). This officially establishes that the code can only be reported once per patient per date of service, making options A and B incorrect. (Accessed via the official CMS NCCI MUEs webpage).

A. 93460: This is an add-on code, designated by the "+" symbol in the CPT® codebook, and cannot be reported as a standalone primary procedure.

B. 93454: This code represents only selective coronary angiography and does not include the documented left heart catheterization or the left ventriculography.

C. 93456: This code is for a combined right and left heart catheterization with coronary angiography; the scenario does not mention a right heart catheterization.

1. American Medical Association (AMA). CPT® 2024 Professional Edition. Chicago, IL: AMA Press; 2023. See code descriptors for 93454, 93456, 93458, and 93460 in the Cardiac Catheterization subsection of the Medicine/Cardiovascular section. The descriptor for 93458 explicitly includes left heart catheterization, coronary angiography, and left ventriculography.

2. American Medical Association (AMA). CPT® Assistant. November 2011; Volume 21: Issue 11. This issue provides detailed guidance on cardiac catheterization coding, clarifying that when left heart catheterization, coronary angiography, and left ventriculography are performed together, a single comprehensive code (e.g., 93458) should be used to report the services.

3. AAPC. 2024 CPC Official Study Guide. Salt Lake City, UT: AAPC; 2023. Chapter 12, Cardiovascular System. The guide explains the bundling of services in cardiac catheterization codes, illustrating that 93458 is the appropriate code for a combined left heart cath with coronary angiography and ventriculography.

A. 92570: This code is incorrect because it bundles tympanometry with acoustic reflex threshold testing and acoustic reflex decay testing, which were not performed.

C. 92557: This code represents comprehensive audiometry, which evaluates hearing thresholds and speech recognition, a different service from tympanometry.

D. 92550: This code was deleted from the CPT® code set effective 2009 and is no longer a valid code for reporting.

1. American Medical Association. (2023). CPT® 2024 Professional Edition. Section: Medicine/Special Otorhinolaryngologic Services, Code 92567, Page 791. The code descriptor explicitly states "Tympanometry (impedance testing)."

2. AAPC. (2023). 2024 CPC® Study Guide. Chapter 12: Medicine. In the section on Audiologic Function Tests, the guide clarifies that 92567 is the standalone code for tympanometry, while other codes represent more extensive testing.

3. University of Illinois Chicago. (n.d.). Course HIM 453: CPT/HCPCS Coding. Module on Medicine Section Coding. The courseware emphasizes the principle of coding only for services that are explicitly documented, which supports selecting 92567 over the more comprehensive code 92570 in this scenario.

B. 92082, G43.019: The diagnosis code G43.019 is incorrect as it specifies an intractable migraine, which is explicitly contradicted by the scenario.

C. 92081, G43.009: The procedure code 92081 is for a limited examination, which is less extensive than the intermediate service described (plotting four isopters).

D. 92083, G43.019: Both codes are incorrect. 92083 is for an extended exam requiring criteria not met, and G43.019 incorrectly reports an intractable migraine.

1. American Medical Association. (2023). CPT® 2024 Professional Edition.

Page/Section: Medicine/Special Ophthalmological Services, codes 92081-92083. The code descriptors for this range differentiate the levels of visual field examination based on the method and complexity (e.g., number of isopters). 92082 is defined as an intermediate exam appropriate for the service described.

2. Centers for Medicare & Medicaid Services. (2023). ICD-10-CM Official Guidelines for Coding and Reporting FY 2024.

Page/Section: Section I.C.6.a.1, "Pain disorders related to psychological factors." While this section is broad, the principle of coding to the highest specificity based on documentation applies. The ICD-10-CM Tabular List for code G43.0- provides the specific character assignments for intractability and status migrainosus.

3. World Health Organization. (2023). International Statistical Classification of Diseases and Related Health Problems, 10th Revision (ICD-10).

Page/Section: Chapter VI, Diseases of the nervous system (G00-G99). The structure of code G43.009 is defined here, where the 5th and 6th characters provide specificity regarding the migraine's characteristics (intractable and status migrainosus).

B. 93015, 93018: CPT® 93015 is the global code, which includes supervision, interpretation, and report. It is incorrect to report a component code (93018) with its corresponding global code.

C. 93015, 93016: CPT® 93015 is the global code, which includes supervision (93016). It is incorrect to report a component code with its corresponding global code.

D. 93016, 93017, 93018: CPT® 93017 represents the technical component (tracing/equipment). The cardiologist did not provide this; the hospital did. The physician cannot bill for the use of the hospital's equipment.

1. American Medical Association (AMA). (2023). CPT® 2024 Professional Edition.

Section: Cardiovascular, Medicine.

Page/Code Range: Codes 93015-93018. The code descriptors explicitly separate the components:

93016: Cardiovascular stress test...; supervision only, without interpretation and report.

93018: Cardiovascular stress test...; interpretation and report only.

The introductory notes for this code family explain that 93015 represents the global service, while 93016, 93017, and 93018 are used to report the individual components when performed by different entities.

2. Centers for Medicare & Medicaid Services (CMS). (2023). Medicare Claims Processing Manual, Chapter 13 - Radiology Services and Other Diagnostic Procedures.

Section: 10.1 - Billing for Professional and Technical Components of a Diagnostic Test.

This section details the policy for split billing of diagnostic tests. It clarifies that when a physician performs the professional component (PC) of a test in a facility setting (like a hospital), the physician bills for their professional work, and the facility bills for the technical component (TC). For stress tests, the professional services (supervision and interpretation) are reported with 93016 and 93018, respectively.