Pass the AAPC Certified Professional Coder CPC Questions and answers with ExamsMirror

Medical necessity is determined by whether a procedure or treatment is necessary to treat or manage a health condition. Removing excess skin after significant weight loss from a gastric bypass often meets medical necessity criteria because excess skin can lead to physical complications, such as infections, rashes, and mobility issues. Insurance companies are more likely to cover this procedure when it's needed to alleviate health issues rather than for cosmetic purposes.

A. Speech therapy for a lisp: Typically, therapy for minor speech impediments like a lisp may not be deemed medically necessary unless it severely affects communication or daily functioning.

B. Tummy tuck after a pregnancy: This procedure is generally classified as cosmetic and not medically necessary, as it is often done to improve appearance rather than address a health condition.

C. Second rhinoplasty for a smaller nose: This would likely be considered elective and cosmetic, especially if it is solely for aesthetic preference without any health-related issues.

Thus, the correct answer is D. Removing excess skin in losing weight from a gastric bypass, as it can be essential for physical health and quality of life.

For a complete bilateral mastectomy with insertion of breast prosthesis performed during the same surgical session, the correct CPT® codes are:

1. 19303-50: This code represents a complete mastectomy (removal of breast tissue) performed bilaterally (indicated by the -50 modifier).

2. 19340-50: This code is for the immediate insertion of a breast prosthesis following mastectomy, also performed bilaterally.

Explanation of other options:

A. 19303-50, 19342-50: Incorrect because 19342 is for the insertion of a breast implant, which differs from a prosthesis.

B. 19305-50, 19340-50: 19305 describes a modified radical mastectomy, which is more extensive than what is documented here.

C. 19325-50: This code represents a breast augmentation procedure, not a mastectomy with prosthesis insertion.

Thus, the correct answer is D. 19303-50, 19340-50, which accurately describes a bilateral mastectomy with prosthesis insertion.

The procedure involves a laparoscopic partial colectomy where the surgeon removes the proximal colon and terminal ileum, then reconnects the cut ends of the distal ileum and remaining colon.

Procedure Description:

Laparoscopic partial colectomy.

Removal of the proximal colon and terminal ileum.

Anastomosis of the distal ileum and remaining colon.

CPT® Coding:

44204: Laparoscopy, surgical; colectomy, partial, with anastomosis.

ICD-10-CM Coding:

C18.2: Malignant neoplasm of ascending colon.

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

ICD-10-CM for corresponding diagnosis codes.

The patient had a post-operative complication (cardiac tamponade) following a previous CABG surgery, requiring a return to the operating room for exploration and evacuation of a blood clot. This is coded using CPT code 32658 (Exploration, mediastinum, with or without drainage; for postoperative hemorrhage, drainage of abscess, or to locate foreign body). Modifier 78 is appended to indicate an unplanned return to the operating room by the same physician following the initial procedure for a related procedure during the postoperative period.

69905 = Transmastoid labyrinthectomy

69990 = Operating microscope (separately reportable)

H81.391 = Peripheral vertigo, right ear

R42 (dizziness) is not reported when a definitive diagnosis exists

RADIOLOGY & IMAGING QUESTIONS

47000 = Percutaneous liver biopsy

77021 = MRI guidance for needle placement

Multiple cores are included in the biopsy code

1. Procedure and CPT® Code Selection:

The patient delivered her second child vaginally after having a previous cesarean delivery for her first child. This scenario describes a Vaginal Birth After Cesarean (VBAC).

CPT® Code 59610 is specific for a vaginal delivery after a previous cesarean delivery, including antepartum and postpartum care with the same provider, which matches this case exactly.

2. Rationale for Excluding Other Options:

Code 59410 covers only vaginal delivery with postpartum care but does not include a history of previous cesarean delivery, so it is not appropriate for a VBAC.

Code 59400 is for routine vaginal delivery with antepartum and postpartum care but, again, does not account for a previous cesarean, so it does not apply in this VBAC scenario.

Code 59614 is for a VBAC but does not include antepartum care, making it incomplete for this scenario since the question specifies that antepartum, delivery, and postpartum care were provided by the same provider.

3. AAPC and CPT® Coding Guidelines:

AAPC and CPT® guidelines indicate that 59610 should be used for a complete VBAC service that includes antepartum, delivery, and postpartum care by the same provider.

Therefore, based on CPT® guidelines, the correct answer is B. 59610.

The CPT® codes for skin biopsies depend on the method used and the location of each lesion. Here, the scenario includes:

1. Two punch biopsies on the trunk: CPT® code 11104 is used for a full-thickness punch biopsy of the skin, and 11104 x 2 is appropriate since two lesions on the trunk were sampled.

2. One partial-thickness shave biopsy on the forehead: CPT® code 11102 is used for a tangential (shave) biopsy, which captures a partial-thickness sample, appropriate for the forehead lesion.

Explanation of other options:

B. 11104, 11105, 11103: Incorrect, as 11105 is an add-on for additional punch biopsies at separate sites but not used here.

C. 11104, 11103 x 2: 11103 is an add-on code for additional shave biopsies, which does not apply to the punch biopsies on the trunk.

D. 11104, 11102 x 2: Incorrect, as 11102 is only used for the shave biopsy, not for the punch biopsies.

Frozen section pathology coding rules:

88331 – Frozen section, first tissue block, each specimen

88332 – Frozen section, each additional tissue block, same specimen

Breakdown:

Specimen 1

Block 1 → 88331 × 1

Block 2 → 88332 × 1

Specimen 2

Block 1 → 88331 × 1

Block 2 → 88332 × 1

However, multiple frozen sections per tissue block are separately reportable:

Total first blocks = 4 frozen sections → 88331 × 4

Total additional blocks = 3 frozen sections → 88332 × 3

CPT® pathology guidelines require coding by tissue block and specimen, not by polyp alone.

60220 = Total lobectomy, unilateral thyroid

60500 = Parathyroidectomy (single gland)

Modifier -59 is appropriate to indicate a distinct procedure