Free AAPC CPC Practice Exam with Questions & Answers | Set: 9

Modifier -79 is used to indicate an unrelated procedure or service performed by the same physician during the postoperative (global) period.

-57 = decision for surgery

-25 = significant, separately identifiable E/M

-55 = postoperative management only

Modifier usage is a high-yield CPC exam topic.

The procedure involves eustachian tube inflation to remove serous mucoid fluid in the right ear of a 2-year-old patient with chronic otitis media.

Procedure Description:

Eustachian tube inflation to remove fluid.

General anesthesia.

Incision to the tympanum and suctioning of thick mucoid fluid.

CPT® Coding:

69421-RT: Eustachian tube inflation, transnasal or transoral; with catheterization, including general anesthesia. The modifier -RT indicates the right ear.

AMA ' s CPT® Professional Edition (current year).

CPT® Assistant for detailed coding guidelines on eustachian tube procedures.

CPT Code 62290: Discography, lumbar, single or multiple levels, radiological supervision and interpretation

This code accurately describes the procedure performed. The documentation indicates a lumbar discography was performed at a single level (L3-4) with radiological supervision (C-arm visualization).

ICD-10-CM Code M54.50: Low back pain, unspecified

This code is the most appropriate diagnosis based on the documentation. The preoperative diagnosis states " Low back pain possible spinal stenosis L3-4. " While spinal stenosis was considered, it was not confirmed. The postoperative diagnosis indicates no evidence of spinal stenosis or discogenic pathology. Therefore, the definitive diagnosis is low back pain.

Why other options are incorrect:

62292: This code is for a discography with injection of contrast and/or medication for therapeutic purposes. The documentation doesn ' t indicate any therapeutic injection was performed.

M48.061 and M48.07: These codes represent spinal stenosis, which was not confirmed in the postoperative diagnosis.

1. E/M Code Category Selection:

The patient was placed in observation care on 12/2/20XX for an acute asthma exacerbation and stayed in observation for a total of 16 hours, with discharge occurring on 12/3/20XX.

The appropriate E/M category for patients in observation care for a period that includes both admission and discharge on separate calendar dates is " Hospital Inpatient or Observation Care Services " , with specific codes for admission and discharge on different dates.

2. Code Range and Specific Codes:

Code Range 99234-99236 applies to cases where observation care includes both admission and discharge, particularly when they occur on different calendar days and the total duration of care is under 24 hours.

For discharge on the subsequent day, 99238-99239 (Hospital Inpatient or Observation Discharge Services) applies, depending on the time spent on discharge.

3. Rationale for Excluding Other Options:

Option B and Option D include Initial Hospital Inpatient or Observation Care codes (99221-99223), which are typically used for admissions to inpatient care rather than for observation care scenarios as presented here.

Option C incorrectly combines Subsequent Inpatient or Observation Care codes (99231-99233), which are used for follow-up days rather than discharge services.

4. AAPC and CPT® Coding Guidelines:

According to CPT® guidelines, the 99234-99236 code range is used when observation care requires both admission and discharge on different dates, and 99238-99239 is appropriate for discharge services.

Therefore, the correct answer is A. Hospital Inpatient or Observation Care Services (Including Admission and Discharge Services) (99234-99236) and Hospital Inpatient or Observation Discharge services (99238-99239).

The scenario describes an emergency basic life support (BLS) ambulance service. The appropriate HCPCS Level II code for BLS emergency transport is A0429.

Modifier QN indicates that the service was provided by an ambulance supplier, and SH indicates the services were provided in an emergency situation.

HCPCS Level II, current year

1. E/M Service Code Selection:

On day two, the urologist provided an evaluation and management (E/M) service for a hospitalized patient with a low level for the number and complexity of problems addressed, minimal complexity for data reviewed, and moderate risk of complications.

CPT® Code 99232 is for a subsequent hospital care E/M service with a level of " Expanded Problem Focused " history and examination, with Medical Decision Making (MDM) of Moderate complexity. This matches the description provided, as the MDM includes a low number of problems, minimal data, and moderate risk.

2. Rationale for Excluding Other Options:

Code 99233 is for a subsequent hospital care visit with high complexity MDM (e.g., addressing a high number of problems or higher levels of data review), which does not align with the moderate risk described here.

Code 99221 is for initial hospital care, not a subsequent visit.

Code 99231 represents a lower level of subsequent hospital care with straightforward or low complexity MDM, which does not meet the moderate risk criteria in this scenario.

3. AAPC and CPT® Coding Guidelines:

AAPC and CPT® guidelines indicate 99232 as appropriate for subsequent hospital visits with moderate MDM, such as this visit with moderate risk but minimal data complexity.

Therefore, the correct answer is B. 99232.

Procedure Coding (CPT®):

33533 – CABG, arterial graft; single arterial graft (LIMA to LAD)

Correct for left internal mammary artery → LAD

33519 – CABG, venous grafts; three coronary venous grafts

Saphenous vein grafts placed to:

Obtuse marginal

Ramus intermedius

Posterior descending artery

Total = 3 venous grafts

33508 – Endoscopic harvest of saphenous vein

Separately reportable only when endoscopic

Add-on code (no modifier required)

Why Other Options Are Incorrect:

A / C – Incorrect arterial graft code (33536 = multiple arterial grafts)

B – Incorrect venous graft count (33512 = two grafts)

CPT® Guideline Reference:

CABG codes are selected based on:

Type of conduit (arterial vs venous)

Number of distal anastomoses

Endoscopic harvest is add-on and separately reportable

In CPT, a code labeled“separate procedure”is typically a service that isnormally includedas part of a more comprehensive procedure andshould not be reported separatelywhen performed as an integral component. However, itmaybe reported when performedindependentlyorunrelatedto the primary procedure—this supports options A, B, and C as true. The false statement isDbecause CPT doesnotinstruct that modifier79is specifically required to report a separate procedure with an unrelated primary service. Modifier selection depends on the actual circumstances and payer rules, and “separate procedure” logic is about whether the service isdistinct and not integral, often supported by documentation of a different site/session or separate clinical intent; when a modifier is needed, it is commonly adistinct procedural servicemodifier (e.g., 59 or X{EPSU}) rather than automatically 79. Modifier79is a global surgery modifier used for anunrelated procedure during the postoperative period, which is a different concept than “separate procedure” designation.

56633 = Radical partial vulvectomy

Deep subcutaneous tissue involvement = radical, not simple

VIN II is coded as D07.1 (carcinoma in situ of vulva) per ICD-10-CM guidelines

Supernumerary digit removal coding depends on whether the extra digit hasbone/jointor is asoft-tissue tag/nubbin. The left-hand extra digit includes ametacarpal bone with a joint, so it is treated as removal of an accessory digit with bony involvement, reported with26910(removal of extra digit, hand/foot;withbone and joint reconstruction elements implied by the code family context). Because it is theleftside, append-LT. The right-hand extra digit is described as anubbin with no bony structure, removed bysimple excision—this aligns with askin tag-likeremoval code,11200, for removal of benign skin tags/lesions by simple excision (as represented in the answer options) with-RTfor laterality. You should not bill both sides with a single “-50” here because the procedures arenot the sameon each side (bony digit vs soft-tissue nubbin). Therefore,26910-LT and 11200-RTis correct.