30 Practice Questions — All Domains

A 4.2cm laceration of the forearm required closure of the subcutaneous tissue layer AND the skin. What type of repair is this and what code range applies?

• A.Simple repair (12001-12021) — single-layer closure
• B.Wound exploration code — subcutaneous involvement requires separate code
• C.Complex repair (13100-13160) — reconstructive elements required
• D.Intermediate repair (12031-12057) — layered closure

Patient has 2.0cm simple scalp repair AND 3.5cm simple neck repair. How is this coded?

• A.12001 + 12002 (code each wound separately)
• B.12002 (add lengths: 2.0 + 3.5 = 5.5cm, same anatomical group)
• C.12002 only (largest wound)
• D.12011 + 12013 (face and neck are different groups)

Patient has a 2.5cm simple cheek repair AND a 3.0cm intermediate cheek repair. How are these coded?

• A.Add lengths, code intermediate only (12052)
• B.12052 only — intermediate includes simple by definition
• C.12052 + 12011 (code each type separately, complex first)
• D.12052 + 12011 with -51 on 12052

A 1.2cm benign lesion of the back is removed with a 1.6cm excision (including margins). What code applies?

• A.11402 (excision benign lesion, trunk, 1.1-2.0cm — excision size with margins)
• B.11401 (benign lesion, trunk, 0.6-1.0cm — lesion size)
• C.11600 (malignant lesion series)
• D.11305 (shave removal)

Autograft is applied to a 30 sq cm wound on the thigh. The donor site is the patient's own lateral thigh. How many codes are reported?

• A.One code for the recipient site (autograft) only
• B.Two codes — recipient site autograft + donor site repair if performed separately
• C.One code for donor site only
• D.Three codes — autograft, donor site, plus wound prep

A patient with a distal radius fracture (skin intact) undergoes manual reduction without surgical incision and a cast is applied. What type of treatment is this?

• A.Closed treatment with manipulation
• B.Open treatment — reduction was performed
• C.Percutaneous skeletal fixation
• D.Open fracture treatment — requires open code

A patient presents with a compound (open skin) tibia fracture. The surgeon opens the fracture site surgically, visualizes the bone ends, and applies internal fixation. What type of treatment is coded?

• A.Closed treatment — because the fracture was already open (compound)
• B.Open fracture treatment code — compound fractures always use open codes
• C.Percutaneous fixation — internal fixation was used
• D.Open treatment — because the surgeon surgically opened and visualized the fracture

A physician injects a corticosteroid into the right knee joint under ultrasound guidance. How many CPT codes are reported?

• A.One code — joint injection only (20610)
• B.Two codes — joint injection (20610) + ultrasound guidance (76942)
• C.One code — ultrasound guidance only
• D.Three codes — injection + guidance + drug administration

During one colonoscopy session, the physician removes 3 polyps by snare technique and 1 by cold forceps. How are these coded?

• A.One code (45385) — the primary technique only
• B.Four codes — one per polyp removed
• C.Two codes — one per technique (snare + cold forceps)
• D.45385 x3 + 45384 — units for each polyp

A surgeon performs a colonoscopy for screening. A polyp is found and removed by hot biopsy. The surgeon also performed a diagnostic colonoscopy at the beginning to visualize the colon. How many colonoscopy codes are reported?

• A.Two — diagnostic colonoscopy + therapeutic polypectomy
• B.One — therapeutic polypectomy only (45384)
• C.Two — screening code + polypectomy
• D.Three — screening, diagnostic, and therapeutic

A physician sees an established patient with 2 stable chronic conditions and reviews external records from a specialist. Risk is determined to be low (OTC drug management). What is the MDM level?

• A.Low
• B.Straightforward
• C.Moderate
• D.High

A patient saw a family medicine physician in a group practice 2 years ago. She now sees a different family medicine physician in the same group practice. What status applies?

• A.New patient — different physician
• B.New patient — more than 1 year has passed
• C.Established patient — same specialty, same group, within 3 years
• D.Established patient — only if same physician

A patient presents for a scheduled trigger point injection. During the visit, the physician identifies and treats a new complaint of hypertension. How is the E/M coded?

• A.E/M not separately billable — included in the injection
• B.E/M coded with modifier -25
• C.E/M coded with modifier -57
• D.E/M coded without a modifier

A patient is evaluated in the office. The physician decides the patient needs a total hip replacement tomorrow (major surgery, 90-day global). What modifier applies to today's E/M?

• A.Modifier -25
• B.Modifier -24
• C.No modifier required
• D.Modifier -57

A physician documents total time of 35 minutes for an established patient office visit on the date of service. What code is reported?

• A.99213 (20-29 minutes)
• B.99214 — 35 minutes falls in 30-39 minute range
• C.99214 (30-39 minutes)
• D.99215 (40-54 minutes)

Code J45.50 (severe persistent asthma, uncomplicated) has an Excludes 1 note for J45.51 (with acute exacerbation). A patient has severe persistent asthma in acute exacerbation. How many codes are reported?

• A.J45.50 + J45.51 — both conditions are present
• B.J45.51 only — Excludes 1 means only one code is used (mutually exclusive)
• C.J45.50 only — the base code captures the exacerbation
• D.Two codes are always reported for asthma exacerbation

A patient is admitted with shortness of breath. Workup confirms congestive heart failure. The shortness of breath is not coded separately. What guideline supports this?

• A.Signs/symptoms integral to a confirmed diagnosis are not coded separately (ICD-10-CM Guidelines)
• B.Only codes with a documented physician diagnosis may be reported
• C.SOB is always a secondary code in inpatient settings
• D.Both SOB and CHF must be coded — each has a separate ICD code

A patient has Type 2 diabetes mellitus with diabetic chronic kidney disease, Stage 3. How many ICD-10-CM codes are reported?

• A.One — combination code E11.65 includes CKD
• B.Two — E11.9 (DM Type 2) + N18.3 (CKD Stage 3)
• C.Three — E11 + E11.65 + N18.3
• D.Two — combination code E11.65 + N18.3 (CKD stage)

A patient takes the correct prescribed dose of warfarin and develops a GI bleed. What is the ICD-10-CM sequencing?

• A.Poisoning code first — drug caused the injury
• B.GI bleed (manifestation) first, then adverse effect code for anticoagulant
• C.GI bleed only — warfarin is irrelevant
• D.Adverse effect code only — drug interaction codes capture the bleed

A patient completed chemotherapy for breast cancer 2 years ago with no evidence of recurrence. She is seen for a follow-up mammogram. What code is sequenced first?

• A.C50.91x — primary malignant neoplasm of breast (right)
• B.Z12.31 — encounter for screening mammogram
• C.Z85.3 — personal history of breast cancer
• D.Z08 — encounter for follow-up after completed treatment for malignant neoplasm

A private practice physician owns the X-ray machine and performs the X-ray AND writes the interpretation report. What modifier is used?

• A.Modifier -26 (professional component only)
• B.No modifier — global billing (both components by one entity)
• C.Both -26 and -TC on separate line items
• D.Modifier -TC (technical component only)

A radiologist reviews MRI images informally for a colleague but does not write a formal interpretation report. Can modifier -26 be billed?

• A.No — a written signed interpretation report is REQUIRED to bill modifier -26
• B.Yes — the radiologist performed the professional service by reviewing images
• C.Yes — verbal communication to the referring physician substitutes for a written report
• D.No — only the ordering physician can bill the professional component

A physician orders a Basic Metabolic Panel (BMP) and separately orders a serum glucose. The lab performs all tests. How is this coded?

• A.80048 + 82947 (glucose separately)
• B.80048 only — glucose is already a panel component, cannot be separately billed
• C.82947 only — individual test code overrides the panel
• D.80047 (basic panel variant) + 82947

A sigmoid colon resection specimen (for cancer) is sent to surgical pathology for gross and microscopic examination. What level and code?

• A.88302 — Level II
• B.88309 — Level VI (neoplastic resection of the colon)
• C.88307 — Level V
• D.88305 — Level IV

A child receives the MMR vaccine administered by intramuscular injection. It is the only vaccine today. How many CPT codes are reported?

• A.One — vaccine product code only (90707)
• B.Two — 90707 + 90472 (additional admin)
• C.Two — 90707 (MMR product) + 90471 (administration)
• D.Three — product, administration, and E/M for counseling

A patient receives IV chemotherapy for 2 hours AND IV therapeutic antibiotic for 1 hour during the same encounter. What is the primary code?

• A.Therapeutic antibiotic — longer duration makes it primary
• B.Chemotherapy — always primary regardless of duration or start time
• C.Whichever infusion was started first is primary
• D.Both are equal — code both as primary with -51

Anesthesia for a right knee arthroscopy has 7 base units. The procedure took 45 minutes. The patient has Type 2 diabetes (mild systemic disease = P2). What is the total unit count?

• A.7 + 3 + 2 = 12 units (P2 adds 2 units)
• B.7 + 3 + 1 = 11 units (P2 adds 1 unit)
• C.7 + 45 + 0 = 52 units (time counted in minutes)
• D.7 + 3 + 0 = 10 units (P2 adds zero units)

Anesthesia is provided for a laparoscopic cholecystectomy. How is the anesthesia code selected?

• A.Based on the type of anesthesia administered (general vs regional)
• B.Based on the patient's physical status modifier
• C.Based on the surgical procedure being performed
• D.Based on the total time of the procedure

A Medicare patient receives an IV infusion of rituximab. The facility wants to report the drug. What code is used?

• A.99232 — E/M code for drug monitoring
• B.Unlisted drug CPT code
• C.96413 — infusion code covers the drug
• D.J9312 — HCPCS J-code for rituximab (Medicare required)

A physician refers Medicare patients to a lab in which he has a financial investment, without disclosing this. The lab performs services covered by Medicare. Which law is MOST directly violated?

• A.Stark Law — physician self-referral to an entity with financial relationship
• B.False Claims Act — billing without proper disclosure is fraud
• C.Anti-Kickback Statute — referral for financial gain
• D.HIPAA — financial information was not properly disclosed