AAPC CPC (Certified Professional Coder) Practice Test 80

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.

Question 791

During a single complete colonoscopy, separate small mucosal biopsies are taken with forceps from the ascending, transverse, and sigmoid colon. There is no snare resection or ablative treatment. Which biopsy procedure quantity is ordinarily appropriate?

  1. One colonoscopy-with-snare-polypectomy service
  2. Diagnostic colonoscopy without biopsy because no large polyp was removed
  3. One colonoscopy-with-biopsy service covering the multiple forceps sites
  4. Three identical colonoscopy-with-biopsy base services

Explanation

Correct Answer

C:

The relevant colonoscopic biopsy descriptor encompasses biopsy, single or multiple. Three sites do not automatically create three separate base services.

Incorrect Answers

A:

No lesion was encircled or removed by snare. The documentation identifies only cold forceps sampling. The forceps obtained tissue fragments from separate sites without resecting a polyp by snare.

B:

Biopsy occurred at three sites. Even small mucosal samples change the recorded service beyond diagnostic-only visualization.

D:

Repeating the full colonoscopy biopsy code for each sampling site double counts a descriptor that already contemplates multiple biopsy specimens.

Question 792

A patient has outward turning of the lower lid with exposure symptoms. The surgeon tightens lower-lid support with a lateral tarsal strip; no upper eyelid levator or tarsal conjunctival turning procedure occurs. Which functional abnormality is corrected?

  1. Upper-eyelid ptosis due to levator dysfunction
  2. Entropion with inward turning of lashes
  3. Trichiasis treatment by epilation of misdirected eyelashes
  4. Lower-eyelid ectropion with loss of lid apposition

Explanation

Correct Answer

D:

The surgery restores the outward-turned lower lid to the globe through lateral support. Ectropion is a different diagnosis and operative objective from ptosis or entropion.

Incorrect Answers

A:

Ptosis reflects drooping of the upper eyelid and may involve levator adjustment. Neither the affected lid nor technique matches this record.

B:

Entropion turns the eyelid margin toward the ocular surface. The lower lid described here turns outward and is tightened accordingly.

C:

Trichiasis describes lashes directed toward the ocular surface and may be treated by lash removal. This case describes an everted lower lid margin corrected by structural tightening.

Question 793

A patient with active breast malignancy attends solely for the scheduled administration of antineoplastic drug treatment. No other acute problem receives a separately evaluated visit. Which first-listed diagnosis principle applies?

  1. Use a screening encounter code because the patient is asymptomatic today
  2. Make the treated breast malignancy the only code, omitting the administration encounter
  3. Use the encounter-for-antineoplastic-treatment designation first as instructed
  4. Use personal history of breast cancer instead of active malignancy

Explanation

Correct Answer

C:

When care is solely for administration of chemotherapy, the designated encounter code is first-listed and the active malignancy is also coded according to applicable guidance.

Incorrect Answers

A:

The purpose is antineoplastic treatment, not screening an asymptomatic person for an undiagnosed disease. The active tumor was already diagnosed and the visit was scheduled specifically for treatment.

B:

The active cancer remains relevant, but a sole-purpose chemotherapy encounter has a specific first-listed coding convention.

D:

The neoplasm is active and being treated. History-only classification does not represent ongoing disease-directed chemotherapy.

Question 794

A physician provides 30 minutes of qualifying critical care in the morning and 35 additional qualifying minutes in the afternoon for the same patient. The periods are properly documented; procedures are excluded. How many total minutes determine the day’s critical-care time category?

  1. 75 minutes with an extra critical-care add-on automatically required
  2. 30 minutes because only the first period can count
  3. 95 minutes by adding the first 30-minute interval twice
  4. 65 minutes, within the first qualifying critical-care interval

Explanation

Correct Answer

D:

Qualifying noncontiguous critical-care periods for the same physician/date can be totaled: 30 + 35 = 65 minutes. This falls within the initial 30–74-minute range.

Incorrect Answers

A:

The total is 65 minutes, not 75 or more. Additional critical-care reporting must follow the actual cumulative qualifying time threshold.

B:

Separate qualifying care periods during the same date may be combined; later medically necessary physician work is not automatically discarded.

C:

The actual recorded work is 30 plus 35 minutes. Double counting the first period would overstate the documented duration.

Question 795

A woman labors with an intended vaginal delivery. Because of fetal distress the physician performs a cesarean section, and the infant is delivered through the uterine incision. What procedure-reporting mistake must be avoided?

  1. Use a vaginal-delivery code alone because labor began with a vaginal-delivery plan
  2. Do not separately code a completed vaginal delivery that never occurred
  3. Report a separate completed vaginal delivery in addition to the cesarean
  4. Report no delivery service because the planned method changed

Explanation

Correct Answer

B:

The completed delivery was cesarean. Attempted labor and an earlier delivery plan do not establish a second, completed vaginal birth.

Incorrect Answers

A:

The intended delivery route does not replace the completed operative delivery method. The infant was delivered by cesarean section, not by completed vaginal birth.

C:

Only one delivery took place and it occurred surgically. The labor trial is not a separate completed vaginal delivery service.

D:

The change in approach does not nullify the cesarean delivery that was performed and documented. The surgeon’s uterine incision culminated in a documented operative delivery.

Question 796

A compliance review finds a high-MDM office visit billed, but the record supports only low-level problems and management risk and no qualifying time for the higher level. What is the appropriate response?

  1. Correct the unsupported E/M level to one justified by the record
  2. Keep the high-level code because it has already been submitted
  3. Replace the visit with a critical-care code automatically
  4. Add unrecorded high-risk decisions retroactively to preserve reimbursement

Explanation

Correct Answer

A:

A claim should reflect actual supported decision making or eligible time. A higher billed level without documentation presents an overcoding risk and requires correction.

Incorrect Answers

B:

Prior submission does not justify inaccurate billing. Claim correction and any required compliance steps should be evaluated.

C:

Critical care has its own clinical and time criteria. A low-complexity office record cannot be converted into critical care to preserve payment.

D:

Documentation must accurately reflect the care that occurred. Fabricating or backfilling unsupported decisions is not a defensible coding correction.

Question 797

A physician completed and billed definitive closed reduction of a radius fracture two weeks earlier. At a routine follow-up during the global fracture-care period, the same practice changes an uncomfortable cast with no new reduction or new injury. What service must not be reported again?

  1. A second treatment of an unrelated new forearm fracture
  2. A new open reduction and internal fixation
  3. A new percutaneous pinning of the fractured bone
  4. A second definitive fracture reduction with manipulation

Explanation

Correct Answer

D:

No repeat realignment was performed. Routine follow-up cast management within the fracture-treatment context does not establish a new fracture-reduction procedure.

Incorrect Answers

A:

The patient has the same healing fracture, not a newly documented independent fracture requiring another definitive treatment episode.

B:

The follow-up involves cast adjustment only. There is no surgical exposure, plate, screw, or other internal-fixation procedure.

C:

Percutaneous fixation requires placement of pins or other fixation devices. The chart documents cast replacement and no invasive fixation.

Question 798

At a pediatric visit, the physician explains a vaccine and documents parental refusal. The vaccine package is never opened, no dose is administered, and counseling is recorded. Which omission is essential?

  1. Do not report vaccine-product or vaccine-administration services that were not performed
  2. Report vaccine administration because counseling occurred
  3. Report a vaccine product with a refusal notation even though no dose was supplied
  4. Report the vaccine product because it was discussed as a future option

Explanation

Correct Answer

A:

Counseling and refusal do not establish a supplied product or administered dose. Any separate E/M or counseling reporting requires its own supported criteria.

Incorrect Answers

B:

Administration codes represent an actual immunization service, not an information discussion with no injection or oral dose.

C:

Discussing a vaccine does not document supply of the product or administration. A refusal notation does not convert an unprovided vaccine into a performed product service.

D:

A proposed product is not supplied or administered. Coding an unused vaccine as furnished would misstate the encounter.

Question 799

A urine culture grows an identified bacterial pathogen. The laboratory then performs and reports susceptibility testing against several antimicrobial agents. Which added work must be distinguished from the initial culture?

  1. Antimicrobial susceptibility testing for the isolated organism
  2. Quantitative colony count for the organism isolated from the urine
  3. Direct urine Gram stain as an additional microbiological observation
  4. A second routine urine culture merely because multiple drugs were tested

Explanation

Correct Answer

A:

Susceptibility testing evaluates how a recovered organism responds to selected agents. It is separate conceptually from the culture that first identified growth.

Incorrect Answers

B:

A colony count estimates the number of organisms grown. It does not measure bacterial response to antimicrobial agents, which was additionally performed and reported.

C:

A Gram stain characterizes organisms by stain reaction and morphology. It does not determine which antimicrobial agents inhibit the isolated pathogen.

D:

Testing several antibiotics against an isolate is not the same as recollecting or regrowing a separate patient specimen for a new culture.

Question 800

A patient has type 2 diabetes and stage 3a CKD. The nephrologist expressly states that CKD is due to biopsy-proven IgA nephropathy and is unrelated to diabetes. How should the ICD-10-CM diabetes-with-CKD convention be interpreted?

  1. Do not assume diabetic CKD when an unrelated cause is documented
  2. Omit the separately diagnosed CKD because a non-diabetic cause is proven
  3. Omit the confirmed diabetes diagnosis entirely
  4. Automatically code diabetic CKD despite the explicit unrelated documentation

Explanation

Correct Answer

A:

The classification’s “with” convention generally presumes certain links, but affirmative provider documentation that the disorders are unrelated overrides that presumption.

Incorrect Answers

B:

A proven unrelated cause prevents the assumed diabetic link, but it does not erase the diagnosed chronic kidney disease or its documented severity.

C:

The diabetes remains a separately diagnosed condition. Lack of causal linkage to CKD does not make diabetes disappear from the record.

D:

The presumed link is not absolute. The treating specialist’s statement directly excludes diabetes as the cause of this patient’s CKD.

Certified Professional Coder (CPC) Practice Tests