AAPC CPC (Certified Professional Coder) Practice Test 79

Question 780

A patient with longstanding hypertension and CKD stage 4 is hospitalized with a separately diagnosed acute kidney injury from dehydration. The physician does not state that chronic kidney disease is unrelated to hypertension. Which diagnosis framework is supported?

  1. Assume acute kidney injury is automatically hypertensive kidney disease
  2. Code essential hypertension alone and omit chronic and acute renal disease
  3. Code only CKD stage 4 and disregard hypertension
  4. Hypertensive CKD with its documented stage plus the separately diagnosed AKI as appropriate

Explanation

Correct Answer

D:

The hypertension–CKD relationship is generally presumed under ICD-10-CM unless documented unrelated. A separately confirmed acute kidney injury should not be erased by the chronic-stage code.

Incorrect Answers

A:

The CKD linkage convention does not make every separate acute renal injury a hypertension manifestation. Here the AKI is specifically attributed to dehydration.

B:

I10 alone would leave out the documented CKD stage and AKI that affected care during the hospitalization. The chart explicitly identifies both stages of renal impairment, chronic and acute, as active clinical problems.

C:

The record supports hypertension and CKD together; dropping the hypertension-related coding ignores the applicable presumed chronic relationship.

Question 781

A child with ear pain and fever has a bulging tympanic membrane. The clinician documents a definitive diagnosis of acute otitis media and prescribes treatment. What level of diagnosis certainty is available for coding?

  1. A hearing-loss diagnosis inferred from the bulging membrane
  2. Only ear pain because outpatient disease codes are never allowed
  3. A confirmed acute otitis media diagnosis
  4. Possible otitis media only, despite the final assessment

Explanation

Correct Answer

C:

The provider’s final assessment confirms the disease. Symptom-only coding is not necessary as a substitute for an established diagnosis that explains the presentation.

Incorrect Answers

A:

The record gives ear pain and acute infection, not an independently established hearing-loss disorder. Coding cannot infer a separate sensory disorder from an infection-related examination finding alone.

B:

Outpatient restrictions concern uncertain diagnoses, not confirmed ones. The clinician explicitly established acute otitis media.

D:

The condition is not documented as merely probable or ruled out. The signed note presents a definite diagnosis.

Question 782

Four weeks after delivery, a patient is evaluated and treated for a clinician-confirmed childbirth-related maternal complication. The visit concerns the mother rather than the infant. Which coding chapter convention is relevant?

  1. Use newborn birth-record codes on the maternal claim
  2. Report a pregnancy-incidental code because delivery is already complete
  3. Use the applicable obstetric/postpartum diagnosis framework for the maternal complication
  4. Report ordinary preventive follow-up because the patient recently delivered

Explanation

Correct Answer

C:

Four weeks after delivery is generally within the postpartum period used by ICD-10-CM. Confirmed childbirth-related maternal conditions are classified using relevant Chapter 15 instructions.

Incorrect Answers

A:

Newborn codes describe the infant’s record. The patient receiving care here is the mother with a postpartum complication.

B:

Pregnancy-incidental coding addresses a different situation; the maternal condition is specifically documented as related to childbirth during the puerperium.

D:

The visit manages a confirmed complication, not routine preventive counseling or an uncomplicated postpartum check alone.

Question 783

At one completed colonoscopy the endoscopist uses a snare to remove one polyp and cold forceps to biopsy a separate lesion in another colonic segment. Both separate sites are precisely documented. What must be assessed before reporting both endoscopic services?

  1. Apply an NCCI modifier without reviewing edits or the distinct-site evidence
  2. Distinct-lesion documentation and applicable NCCI modifier rules
  3. Report diagnostic colonoscopy only because all interventions are included
  4. Automatically report the same code twice because two lesions exist

Explanation

Correct Answer

B:

Different techniques on separate lesions may support reporting both services when CPT and NCCI rules permit. The operator must document genuinely distinct sites and work.

Incorrect Answers

A:

Modifier use is not automatic. The specific codes, edit indicators, and documentation of separate lesions determine whether an exception is supportable.

C:

The snare removal and forceps sampling are actual therapeutic/diagnostic interventions beyond inspection, so diagnostic-only categorization omits work.

D:

Different endoscopic techniques have separate descriptors and bundling relationships. Two lesions do not justify duplicating an arbitrary procedure code.

Question 784

A nurse gives the same therapeutic antiemetic by IV push at 10:00 and again at 10:20 as one continuous encounter. No other drug is infused. Which additional-administration conclusion follows from the interval?

  1. Convert the two pushes to a 20-minute therapeutic infusion
  2. Report an additional same-drug push because any second syringe qualifies
  3. Do not report an additional same-drug push solely for this twenty-minute interval
  4. Report an initial chemotherapy push for the antiemetic

Explanation

Correct Answer

C:

The usual time separation for an additional sequential IV push of the same substance is at least 30 minutes. This documentation shows only 20 minutes.

Incorrect Answers

A:

An IV push is not an infusion just because two administrations occurred over time. Neither entry documents a continuous infusion.

B:

A second syringe alone does not satisfy the required interval for additional same-substance IV-push administration.

D:

A supportive therapeutic antiemetic is not an antineoplastic chemotherapy administration. The drug’s actual role and method control selection.

Question 785

An anesthetic begins with a plan for monitored anesthesia care. The patient fails to tolerate the procedure and the anesthesia professional establishes and documents general anesthesia. Which approach is supported by the final record?

  1. Report no anesthesia because the initial plan changed
  2. Create two separate anesthesia claims because the technique changed during one case
  3. Report monitored anesthesia care as the only technique because that was the plan
  4. General anesthesia as actually delivered after MAC conversion

Explanation

Correct Answer

D:

The anesthesia record must represent real care and its relevant modifiers, not only a preprocedure plan for monitored care. Applicable billing rules and timing govern the final claim.

Incorrect Answers

A:

Changing technique does not erase the continuous anesthesia service that was administered and documented. The anesthesia team still provided qualifying anesthetic care before and after the technique changed.

B:

A change from monitored care to general anesthesia within one continuous case does not by itself establish two separately billable anesthetics. Report the qualifying care actually provided.

C:

A planned technique does not override a documented transition to general anesthesia and an established airway.

Question 786

A radiologist documents systematic ultrasound of all four quadrants and the retroareolar area of each breast, with axillary assessment as indicated. The report is not limited to one palpable spot. Which extent of study is supported?

  1. Complete diagnostic ultrasound of the left breast only
  2. Limited bilateral breast ultrasound focused only on discrete symptomatic spots
  3. Complete bilateral diagnostic breast ultrasound
  4. Limited targeted sonography of the left breast only

Explanation

Correct Answer

C:

Coverage of the required regions of both breasts supports complete rather than limited diagnostic sonographic examinations when documentation satisfies the current descriptor.

Incorrect Answers

A:

A unilateral complete study does not represent the documented systematic evaluation of both breasts, even when the sonographic technique is otherwise similar.

B:

Limited targeted ultrasound does not examine the standard full-breast regions bilaterally. The report specifically documents a complete examination of both breasts.

D:

A limited study focuses on a specific area; the report documents systematic complete examinations of both breasts.

Question 787

A lung-lobe resection begins through thoracoscopic ports. Dense adhesions force conversion to open thoracotomy, and the lobe is removed after the open incision. Which completed operative approach should control the primary procedure classification?

  1. Report two full definitive lobectomies, one thoracoscopic and one open
  2. An open-conversion event without reporting the completed lung-lobe resection
  3. Open lobectomy as ultimately performed, with conversion documented
  4. Thoracoscopic lobectomy alone because ports were used initially

Explanation

Correct Answer

C:

The final resection occurs through an open exposure. The record should not present an uncompleted thoracoscopic-only lobectomy as the definitive service.

Incorrect Answers

A:

A single lobe was removed once. Initial ports followed by conversion do not create two separate completed lobe removals.

B:

The open conversion is not the entire definitive service: the operative note documents removal of the lobe by thoracotomy, so coding only a conversion or access event omits the treatment.

D:

Starting laparoscopically or thoracoscopically does not change how the completed definitive resection was actually carried out after conversion.

Question 788

Years after removal of one thyroid lobe, a surgeon removes the remaining contralateral lobe and residual thyroid tissue during a new operation. Which procedure description accounts for the prior surgery?

  1. Thyroid needle aspiration cytology
  2. Completion thyroidectomy of residual thyroid tissue
  3. First-time total thyroidectomy with both lobes removed today
  4. Parathyroid gland excision

Explanation

Correct Answer

B:

The later operation removes thyroid tissue remaining after an earlier lobectomy. The existing surgical history is central to identifying the completion procedure.

Incorrect Answers

A:

No needle specimen is taken for cytologic diagnosis. The surgeon removes the remaining gland tissue operatively.

C:

One lobe was previously excised years earlier, so the current operation cannot be described as removal of two intact lobes during the same session.

D:

Parathyroids are distinct glands adjacent to the thyroid. This note documents removal of residual thyroid tissue.

Question 789

A raised benign-appearing trunk lesion is tangentially shaved flush for definitive therapeutic removal. The record states it is not a partial sample of a lesion left in place. Which intent is documented?

  1. Excision through the full skin thickness with margins
  2. Cryodestruction with no specimen obtained
  3. Therapeutic shave removal rather than a partial diagnostic biopsy
  4. Tangential diagnostic biopsy of a portion of the lesion

Explanation

Correct Answer

C:

The surgeon intends to remove the lesion therapeutically. Coding distinguishes shave removal from a tangential sample taken for diagnosis with lesion remaining.

Incorrect Answers

A:

A full-thickness excision includes deeper removal and measured margins. A superficial tangential shave does not establish that technique.

B:

Destruction uses ablative treatment, whereas this lesion was removed with a blade and produced a tissue specimen.

D:

Biopsy primarily obtains tissue for diagnosis, often leaving lesion behind. The note expressly describes definitive therapeutic shave removal.

Question 790

An anesthesiologist begins continuous direct preparation and anesthesia care at 08:10 and transfers the patient to PACU staff at 09:35. The surgeon’s incision begins later than 08:10. What is the documented anesthesia time?

  1. Only the interval from incision to skin closure
  2. Zero anesthesia minutes because preparation started before incision
  3. 85 minutes of qualifying continuous anesthesia care
  4. The PACU nurse’s subsequent observation added to the 85 minutes

Explanation

Correct Answer

C:

The documented interval from 08:10 through 09:35 is 85 minutes, assuming continuous qualifying practitioner attendance. Incision-to-closure alone does not define all anesthesia time.

Incorrect Answers

A:

Anesthesia time can start during qualified practitioner preparation before incision and end after surgery when proper handoff occurs.

B:

Qualified continuous anesthesia practitioner work before incision may count, so there is clearly a documented anesthesia interval.

D:

Independent recovery monitoring after transfer to PACU is not anesthesia practitioner time under the usual continuous-care rule.

Certified Professional Coder (CPC) Practice Tests