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CPC Medical Coding study materials
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CPC Medical Coding practice questions

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Question 1Core Coding Knowledge (ICD-10-CM, CPT, HCPCS Level II, guidelines and sequencing)

An ICD-10-CM code in the tabular list is only five characters long but requires a seventh character. What character is entered in the empty sixth position?

  1. 9
  2. X Correct answer.
  3. 0
  4. Z

Explanation

ICD-10-CM uses the letter X as a placeholder so that a required seventh character can be placed in the correct position. The placeholder does not change the meaning of the code and is never used when the code already contains six characters. Coders must not substitute a zero or leave the position blank.

Question 2Core Coding Knowledge (ICD-10-CM, CPT, HCPCS Level II, guidelines and sequencing)

A patient is diagnosed with primary osteoarthritis involving both knees. Which ICD-10-CM code is assigned?

  1. M17.11
  2. M17.12
  3. M17.0 Correct answer.
  4. M17.9

Explanation

ICD-10-CM provides the code M17.0 specifically for bilateral primary osteoarthritis of the knee, so a single code captures both sides. Separate right and left codes are used only when the disease is documented as unilateral. An unspecified code is used only when the site is not documented.

Question 3Core Coding Knowledge (ICD-10-CM, CPT, HCPCS Level II, guidelines and sequencing)

A patient is treated in the emergency department for the first time for a closed fracture of the ankle and is discharged the same day. Which seventh character is assigned to the fracture code?

  1. D
  2. S
  3. A Correct answer.
  4. P

Explanation

The seventh character A designates the initial encounter for a condition while the patient is receiving active treatment. Subsequent visits after active treatment has been completed use D, and sequelae use S. The fact that the patient was discharged the same day does not change the initial designation.

Question 4Core Coding Knowledge (ICD-10-CM, CPT, HCPCS Level II, guidelines and sequencing)

Which service is reported using a HCPCS Level II code?

  1. Ambulance transport services Correct answer.
  2. Inpatient hospital discharge day management
  3. Coronary artery bypass grafting
  4. Laparoscopic cholecystectomy

Explanation

HCPCS Level II codes identify supplies, drugs, durable medical equipment, and services such as ambulance transport that are not described in the CPT code set. Surgical procedures and hospital observation or discharge management services are reported with CPT codes.

Question 5Core Coding Knowledge (ICD-10-CM, CPT, HCPCS Level II, guidelines and sequencing)

A patient is seen for the first time by Dr. Lee, who practices in a multispecialty group. Eighteen months earlier the patient was treated by a different physician in the same group in the same specialty. How is the patient classified for the visit with Dr. Lee?

  1. New patient, because Dr. Lee has never personally seen the patient
  2. Established patient, because the same group and specialty provided a service within the past three years Correct answer.
  3. New patient, because the earlier encounter was with a different physician
  4. Established patient, because every patient in a group practice is considered established

Explanation

For evaluation and management coding, a new patient has not received professional services from the physician or from another physician of the same specialty in the same group practice within the previous three years. Because the prior visit was in the same specialty and group within that window, the patient is established. The identity of the individual physician does not control the classification.

Question 6Core Coding Knowledge (ICD-10-CM, CPT, HCPCS Level II, guidelines and sequencing)

A patient at 28 weeks of gestation is seen for a routine prenatal visit. Which ICD-10-CM code reports the weeks of gestation?

  1. O09.529
  2. Z3A.28 Correct answer.
  3. Z33.1
  4. Z34.90

Explanation

Codes in category Z3A identify the weeks of gestation and are reported as additional codes on maternal records. The code Z3A.28 corresponds to 28 weeks gestation. Supervision of a normal pregnancy and other pregnancy-related conditions are reported with separate codes.

Question 7Core Coding Knowledge (ICD-10-CM, CPT, HCPCS Level II, guidelines and sequencing)

Which statement describes a CPT add-on code?

  1. It is reported in addition to a primary procedure and is exempt from modifier 51 Correct answer.
  2. It must be appended with modifier 51 to show multiple procedures
  3. It carries a zero-day global period and can be reported without a primary code
  4. It may be reported alone when the primary procedure is not performed

Explanation

Add-on codes describe services always performed in addition to a primary procedure and are never reported alone. CPT designates add-on codes as exempt from modifier 51 because the multiple-procedure reduction does not apply to them.

Question 8Core Coding Knowledge (ICD-10-CM, CPT, HCPCS Level II, guidelines and sequencing)

What is the purpose of CPT Category II codes?

  1. They track performance measures and quality data Correct answer.
  2. They report unlisted procedures that have no Category I code
  3. They report laboratory tests that are paid only by Medicare
  4. They report new technology procedures pending FDA approval

Explanation

Category II codes are supplemental tracking codes used for performance measurement and quality reporting rather than for payment. They often describe findings, such as laboratory values or patient history elements, that support quality initiatives. Category III codes serve the emerging technology purpose.

Question 9Core Coding Knowledge (ICD-10-CM, CPT, HCPCS Level II, guidelines and sequencing)

During a visit scheduled for hypertension management, the physician also performs a medically necessary, separately identifiable lesion excision. The documentation supports both services. Which modifier is appended to the evaluation and management code?

  1. Modifier 57
  2. Modifier 59
  3. Modifier 24
  4. Modifier 25 Correct answer.

Explanation

Modifier 25 indicates that a significant, separately identifiable evaluation and management service was performed by the same physician on the same day as a procedure or other service. It is used when the E/M service goes beyond the usual preoperative and postoperative work of the procedure.

Question 10Core Coding Knowledge (ICD-10-CM, CPT, HCPCS Level II, guidelines and sequencing)

A patient with breast cancer is seen solely for an encounter for antineoplastic chemotherapy administration. Which code is sequenced first?

  1. Z79.899, Other long term current drug therapy
  2. Z51.89, Encounter for other specified aftercare
  3. Z51.11, Encounter for antineoplastic chemotherapy Correct answer.
  4. C50.911, Malignant neoplasm of unspecified site of right female breast

Explanation

When the reason for the encounter is chemotherapy administration and the visit is not directed at the malignancy itself, the chemotherapy encounter code is sequenced first. The malignancy code is then reported as an additional code to identify the condition being treated.

Question 11Core Coding Knowledge (ICD-10-CM, CPT, HCPCS Level II, guidelines and sequencing)

Which statement correctly describes ICD-10-CM coding of diabetes mellitus with a complication?

  1. An additional code for uncontrolled diabetes is required at every encounter
  2. Only the manifestation is coded when the diabetes is controlled by diet
  3. The diabetes code and the manifestation code are both selected from Chapter 4 of ICD-10-CM
  4. A combination code from the diabetes category reports both the diabetes and the complication Correct answer.

Explanation

ICD-10-CM provides combination codes in categories such as E11.2-, E11.3-, and E11.6- that capture the diabetes and its associated complication in a single code. Additional codes are added only for details the combination code does not include, such as the stage of chronic kidney disease.

Question 12Core Coding Knowledge (ICD-10-CM, CPT, HCPCS Level II, guidelines and sequencing)

A radiologist interprets an MRI that was performed in a hospital outpatient department using hospital-owned equipment. Which modifier is appended to the radiologist's CPT code?

  1. 26 Correct answer.
  2. 22
  3. TC
  4. 50

Explanation

Modifier 26 identifies the professional component of a diagnostic test when the physician interprets the study but does not own or operate the equipment. The technical component is billed separately by the facility using modifier TC.

Question 13Core Coding Knowledge (ICD-10-CM, CPT, HCPCS Level II, guidelines and sequencing)

A surgeon performs a procedure with a 90-day global period. Nineteen days later the surgeon sees the patient for a routine, uncomplicated postoperative visit related to that procedure. How is the visit reported?

  1. Report the visit with modifier 25 appended to the E/M code
  2. Report the visit with modifier 24 appended to the E/M code
  3. Report the visit with modifier 79 appended to the E/M code
  4. Do not report the visit separately; routine postoperative care is included in the surgical package Correct answer.

Explanation

The surgical package includes routine postoperative care during the global period, so follow-up visits for the surgery itself are not billed separately. A visit during the global period is separately reportable only when it is for an unrelated problem or involves a service beyond the usual care.

Question 14Core Coding Knowledge (ICD-10-CM, CPT, HCPCS Level II, guidelines and sequencing)

Two distinct procedures are performed during the same operative session in non-overlapping anatomic sites. Which modifier best indicates that the services were distinct because they were performed in separate structures?

  1. XU
  2. XS Correct answer.
  3. XE
  4. XP

Explanation

The X{EPSU} modifiers replaced modifier 59 in many circumstances to provide greater specificity. XS indicates a separate structure, which is the appropriate choice when procedures are performed at distinct anatomic sites.

Question 15Core Coding Knowledge (ICD-10-CM, CPT, HCPCS Level II, guidelines and sequencing)

A surgeon performs a procedure that has no dedicated Category I CPT code. How should the claim be submitted?

  1. Select the closest existing Category I code instead
  2. Report the appropriate unlisted code with a copy of the report describing the procedure Correct answer.
  3. Append modifier 22 to the unlisted codes in that section
  4. Report the unlisted code alone with no supporting documentation

Explanation

Unlisted procedure codes are reported with a narrative report or operative note so the payer can determine the nature of the service and the appropriate payment. Substituting a similar Category I code is improper because it misrepresents the service performed.

Question 16Core Coding Knowledge (ICD-10-CM, CPT, HCPCS Level II, guidelines and sequencing)

A patient is diagnosed with a stage 3 pressure ulcer of the right heel. Which ICD-10-CM code is assigned?

  1. L89.313
  2. L89.143
  3. L89.613 Correct answer.
  4. L89.619

Explanation

In category L89 the fifth character identifies the site and the sixth character identifies the stage. L89.61 designates the right heel, and the sixth character 3 designates stage 3, giving L89.613.

Question 17Core Coding Knowledge (ICD-10-CM, CPT, HCPCS Level II, guidelines and sequencing)

A patient with type 2 diabetes mellitus is diagnosed with diabetic chronic kidney disease, stage 3a. Which code is sequenced first?

  1. N18.9, Chronic kidney disease, unspecified
  2. E11.9, Type 2 diabetes mellitus without complications
  3. N18.31, Chronic kidney disease, stage 3a
  4. E11.22, Type 2 diabetes mellitus with diabetic chronic kidney disease Correct answer.

Explanation

When a diabetic complication is present, the combination code that identifies the diabetes and the manifestation is sequenced before the code for the manifestation itself. The CKD stage code N18.31 is added to provide the stage that the combination code does not capture.

Question 18Core Coding Knowledge (ICD-10-CM, CPT, HCPCS Level II, guidelines and sequencing)

During the 90-day global period of a procedure, the same surgeon evaluates the patient for an unrelated acute condition. Which modifier is appended to the E/M code?

  1. Modifier 57
  2. Modifier 24 Correct answer.
  3. Modifier 25
  4. Modifier 79

Explanation

Modifier 24 identifies an evaluation and management service provided during a postoperative period for a condition unrelated to the procedure. The service must be documented as unrelated to the surgery for separate payment to apply.

Question 19Core Coding Knowledge (ICD-10-CM, CPT, HCPCS Level II, guidelines and sequencing)

An evaluation and management visit results in the decision to perform a major procedure with a 90-day global period later the same day. Which modifier is appended to the E/M code?

  1. Modifier 57 Correct answer.
  2. Modifier 32
  3. Modifier 25
  4. Modifier 24

Explanation

Modifier 57 is used when an E/M service results in the initial decision to perform surgery and the procedure is a major one with a global period. For minor procedures with a zero- or ten-day global period, modifier 25 is used instead.

Question 20Core Coding Knowledge (ICD-10-CM, CPT, HCPCS Level II, guidelines and sequencing)

A single-dose vial contains 100 mg of a drug, and 70 mg is administered to the patient while 30 mg must be discarded. Which modifier is reported on the line for the discarded amount?

  1. Modifier JW Correct answer.
  2. Modifier 76
  3. Modifier 22
  4. Modifier JZ

Explanation

Modifier JW identifies the portion of a single-dose vial that was discarded after the administered amount was drawn. The units administered are billed on one line and the discarded units on a separate line with modifier JW.

Question 21Core Coding Knowledge (ICD-10-CM, CPT, HCPCS Level II, guidelines and sequencing)

A patient is admitted with severe sepsis due to group B streptococcus without septic shock, along with acute respiratory failure. Which code is sequenced as the principal diagnosis?

  1. J96.00, Acute respiratory failure, unspecified
  2. A40.1, Sepsis due to Streptococcus, group B Correct answer.
  3. R65.21, Severe sepsis with septic shock
  4. R65.20, Severe sepsis without septic shock

Explanation

When sepsis and severe sepsis are present, the sepsis code identifying the causative organism is sequenced first, followed by the code for severe sepsis and then the code for the acute organ dysfunction. Septic shock is not documented, so the severe sepsis without shock code is used rather than R65.21.

Question 22Core Coding Knowledge (ICD-10-CM, CPT, HCPCS Level II, guidelines and sequencing)

A patient is admitted with chest pain, and acute myocardial infarction is suspected. After study, the myocardial infarction is ruled out and the chest pain is determined to be caused by gastroesophageal reflux disease. Which is the principal diagnosis?

  1. Acute myocardial infarction, because it was suspected at admission
  2. Gastroesophageal reflux disease and chest pain, sequenced in either order
  3. Chest pain, because it was the reason for admission
  4. Gastroesophageal reflux disease, the condition established after study as chiefly responsible for the admission Correct answer.

Explanation

The principal diagnosis for an inpatient admission is the condition established after study to be chiefly responsible for the admission. A suspected condition that is ruled out during the stay is not reported as the principal diagnosis. Because the reflux disease is confirmed and explains the admission, it becomes the principal diagnosis.

Question 23Core Coding Knowledge (ICD-10-CM, CPT, HCPCS Level II, guidelines and sequencing)

A patient with known metastatic breast cancer is admitted for treatment of a pathologic fracture of the femur caused by the bone metastasis. Which condition is sequenced first?

  1. The secondary malignant neoplasm of the bone
  2. The encounter for antineoplastic therapy
  3. The primary malignant neoplasm of the breast
  4. The pathologic fracture of the femur Correct answer.

Explanation

When the reason for admission is treatment of a complication caused by a malignancy, the complication is sequenced first, followed by the neoplastic condition. Because treatment was directed at the fracture rather than the tumor, the fracture code leads. The secondary and primary malignancy codes are then reported as additional codes.

Question 24Core Coding Knowledge (ICD-10-CM, CPT, HCPCS Level II, guidelines and sequencing)

Two surgeons of different specialties act as primary surgeons, each performing a distinct part of a single reportable procedure. Which modifier is appended to each surgeon's claim?

  1. Modifier 80
  2. Modifier 62 Correct answer.
  3. Modifier 66
  4. Modifier 50

Explanation

Modifier 62 identifies co-surgery, in which two surgeons work together as primary surgeons, each performing a distinct portion of one procedure. Each surgeon reports the same procedure code with modifier 62 and the appropriate percentage of the fee.

Question 25Core Coding Knowledge (ICD-10-CM, CPT, HCPCS Level II, guidelines and sequencing)

Which ICD-10-CM instructional note indicates that the condition being coded should be sequenced after another code?

  1. Code also
  2. See also
  3. Code first Correct answer.
  4. Use additional code

Explanation

A 'code first' note appears under a manifestation or secondary condition and directs the coder to sequence the underlying cause first. 'Code also' and 'use additional code' notes direct the coder to add codes without specifying which one is sequenced first.

Question 26Core Coding Knowledge (ICD-10-CM, CPT, HCPCS Level II, guidelines and sequencing)

A patient purchases a walker for home use. Which code set is used to report the walker?

  1. A CPT Category I code
  2. An ICD-10-CM code
  3. A CPT Category II code
  4. A HCPCS Level II code Correct answer.

Explanation

HCPCS Level II codes report supplies, durable medical equipment, and other items not represented in CPT. A walker is durable medical equipment and is reported with an E code from HCPCS Level II. CPT codes describe professional services and procedures rather than equipment.

Question 27Core Coding Knowledge (ICD-10-CM, CPT, HCPCS Level II, guidelines and sequencing)

In ICD-10-CM, what is the function of the placeholder character X?

  1. It indicates that the condition is bilateral
  2. It identifies a chronic condition rather than an acute one
  3. It holds a character position when a required character is absent Correct answer.
  4. It marks a code as a sequela of an earlier condition

Explanation

The placeholder X is used when a code requires a seventh character but has no sixth character, so it preserves the correct character position. It does not add clinical meaning to the code. Coders must not omit the placeholder when the code requires it.

Question 28Core Coding Knowledge (ICD-10-CM, CPT, HCPCS Level II, guidelines and sequencing)

A patient is diagnosed with osteoarthritis of the right knee. How does laterality affect ICD-10-CM code assignment?

  1. Laterality is captured with an external cause code
  2. Laterality is not captured in ICD-10-CM codes
  3. A right knee code is assigned rather than an unspecified knee code Correct answer.
  4. Laterality is reported only with a CPT modifier

Explanation

Many ICD-10-CM musculoskeletal codes include laterality, so the side documented in the record determines the code. When the right side is documented, the right knee code is assigned rather than an unspecified knee code. CPT modifiers may also be used, but laterality is not solely a CPT issue.

Question 29Core Coding Knowledge (ICD-10-CM, CPT, HCPCS Level II, guidelines and sequencing)

What do CPT Category III codes represent?

  1. Temporary codes for emerging technology and services Correct answer.
  2. Codes used only for performance measurement
  3. Codes for durable medical equipment and supplies
  4. Permanent codes for established surgical procedures

Explanation

CPT Category III codes are temporary codes that track emerging technology, services, and procedures. They allow data collection before a service may receive a Category I code. They are not used for performance measures or equipment.

Question 30Core Coding Knowledge (ICD-10-CM, CPT, HCPCS Level II, guidelines and sequencing)

Which service is included in the surgical global package?

  1. An unrelated E/M service during the global period
  2. Routine postoperative care by the same surgeon Correct answer.
  3. A return to the operating room for a related complication
  4. Care for an unrelated medical condition during the global period

Explanation

The surgical global package includes the procedure itself, routine preoperative care, and routine postoperative care by the same physician. Unrelated services and returns to the operating room for related complications are handled with specific modifiers or separate reporting rules. They are not part of routine global care.

Question 31Core Coding Knowledge (ICD-10-CM, CPT, HCPCS Level II, guidelines and sequencing)

When is an unspecified ICD-10-CM code appropriately assigned?

  1. When the coder wishes to avoid querying the provider
  2. Only when the patient requests a general code
  3. Whenever the specific type of condition is documented
  4. When the record lacks detail needed for a more specific code Correct answer.

Explanation

An unspecified code is used when the documentation does not provide enough detail to assign a more specific code. Coders should not use unspecified codes to avoid querying the provider when clarification is possible. Specific documentation should always lead to the most specific code supported.

Question 32Core Coding Knowledge (ICD-10-CM, CPT, HCPCS Level II, guidelines and sequencing)

A CPT code is described as time-based. What determines selection of the code?

  1. The physician's scheduled appointment slot
  2. The total time from arrival to departure, including waiting
  3. The number of diagnoses addressed during the visit
  4. The actual time spent performing the service as documented Correct answer.

Explanation

For time-based CPT codes, code selection is based on the actual time spent performing the service, as supported by documentation. Waiting room time and scheduling blocks are not counted. The number of diagnoses does not determine the time-based code.

Question 33Core Coding Knowledge (ICD-10-CM, CPT, HCPCS Level II, guidelines and sequencing)

How is the principal diagnosis defined for inpatient coding?

  1. The most resource-intensive condition treated during the stay
  2. The first code listed on the discharge summary by the physician
  3. The condition chiefly responsible for admission after study Correct answer.
  4. The most severe comorbidity documented in the record

Explanation

The principal diagnosis is the condition established after study to be chiefly responsible for the inpatient admission. It is not simply the first code written by the physician. Comorbidities and resource use may affect DRG assignment but do not define the principal diagnosis.

Question 34Core Coding Knowledge (ICD-10-CM, CPT, HCPCS Level II, guidelines and sequencing)

An ICD-10-CM code has an Excludes1 note listing a condition. What does this instruction mean?

  1. The excluded condition may be reported with an additional code
  2. The note is only a coding suggestion
  3. The excluded condition is always the principal diagnosis
  4. The two conditions cannot be reported together Correct answer.

Explanation

An Excludes1 note means the excluded condition is not coded here and cannot be reported at the same time as the code bearing the note. Excludes2, by contrast, allows reporting the excluded condition as an additional diagnosis when present. Excludes1 notes are not optional suggestions.

Question 35Core Coding Knowledge (ICD-10-CM, CPT, HCPCS Level II, guidelines and sequencing)

In ICD-10-CM, what does the word 'with' mean in a code title or index entry?

  1. A causal relationship is presumed unless documented otherwise Correct answer.
  2. A causal link must be specifically documented by the provider
  3. The word requires a physician query before code assignment
  4. The two conditions must always be coded separately

Explanation

The ICD-10-CM convention 'with' means 'with' or 'due to,' and a causal relationship is presumed unless the documentation indicates otherwise. Coders do not need a provider to explicitly state a causal link for a 'with' condition. The convention supports assignment of combination codes when the conditions are present.

Question 36Core Coding Knowledge (ICD-10-CM, CPT, HCPCS Level II, guidelines and sequencing)

A patient is treated in the emergency department for a new closed wrist fracture and receives a cast. Which seventh character applies?

  1. P, subsequent encounter with malunion
  2. D, subsequent encounter
  3. S, sequela
  4. A, initial encounter Correct answer.

Explanation

The seventh character A is used for an initial encounter, which includes active treatment such as an emergency department visit and cast application. Subsequent encounter characters are used for routine healing follow-up. Sequela characters are used for late effects of a prior condition.

Question 37Core Coding Knowledge (ICD-10-CM, CPT, HCPCS Level II, guidelines and sequencing)

A surgeon performs the same procedure on both the right and left knees during one session. Which modifier should be appended?

  1. 51
  2. 50 Correct answer.
  3. 62
  4. 59

Explanation

Modifier 50 reports bilateral procedures performed on paired anatomic sites during the same session. Modifier 51 reports multiple procedures, modifier 59 reports a distinct procedural service, and modifier 62 reports co-surgeons. Bilateral procedures have their own reporting rule.

Question 38Core Coding Knowledge (ICD-10-CM, CPT, HCPCS Level II, guidelines and sequencing)

A procedure requires substantially more work than usual because of extensive adhesiolysis. Which modifier reports increased procedural services?

  1. 52
  2. 25
  3. 22 Correct answer.
  4. 57

Explanation

Modifier 22 reports increased procedural services when the work is substantially greater than typically required, with supporting documentation. Modifier 25 reports a significant, separately identifiable E/M service. Modifier 52 reports reduced services, and modifier 57 reports the decision for surgery.

Question 39Core Coding Knowledge (ICD-10-CM, CPT, HCPCS Level II, guidelines and sequencing)

During a 90-day global period, a patient returns to the operating room for a related complication requiring a repeat procedure. Which modifier is used?

  1. 78 Correct answer.
  2. 79
  3. 24
  4. 57

Explanation

Modifier 78 reports an unplanned return to the operating room for a related procedure during the postoperative global period. Modifier 24 reports an unrelated E/M service during the global period. Modifier 79 reports an unrelated procedure during the global period.

Question 40Core Coding Knowledge (ICD-10-CM, CPT, HCPCS Level II, guidelines and sequencing)

During the postoperative global period, the same surgeon performs a procedure for an unrelated condition. Which modifier applies?

  1. 24
  2. 78
  3. 58
  4. 79 Correct answer.

Explanation

Modifier 79 reports an unrelated procedure or service performed by the same physician during the postoperative global period. Modifier 78 reports a related return to the operating room. Modifier 58 reports a staged or related procedure planned during the global period.

Question 41Core Coding Knowledge (ICD-10-CM, CPT, HCPCS Level II, guidelines and sequencing)

A patient is treated for a wrist sprain after falling from a ladder. How are external cause codes reported in ICD-10-CM?

  1. They are never used with injury codes
  2. They are sequenced as the principal diagnosis
  3. They are secondary codes that follow the injury code Correct answer.
  4. They must be listed before the injury code

Explanation

External cause codes describe how and where an injury occurred and are reported as secondary codes after the injury code. They are not sequenced as the principal diagnosis. The injury code itself identifies the nature of the condition.

Question 42Core Coding Knowledge (ICD-10-CM, CPT, HCPCS Level II, guidelines and sequencing)

A lymph node biopsy shows metastatic carcinoma, and the primary site is unknown. How is the lymph node metastasis coded?

  1. As a secondary malignant neoplasm of the lymph node Correct answer.
  2. As a primary malignant neoplasm of the lymph node
  3. As a benign neoplasm of the lymph node
  4. As an unknown primary with no lymph node code

Explanation

Metastatic carcinoma in a lymph node is coded as a secondary malignant neoplasm at that site. The primary site is coded separately when known; if unknown, an unknown primary code may also be used. A lymph node metastasis is not coded as a primary malignancy of the lymph node.

Question 43Core Coding Knowledge (ICD-10-CM, CPT, HCPCS Level II, guidelines and sequencing)

A patient undergoes a screening colonoscopy, and a polyp is found and removed during the same procedure. How is the encounter coded?

  1. Screening code with a procedure modifier
  2. Polyp code only
  3. Screening code first, then the polyp code Correct answer.
  4. Screening code only

Explanation

When a screening examination becomes diagnostic or therapeutic because a condition is found, the screening code is listed first, followed by the code for the condition found. The polyp code is therefore reported after the screening code. Modifiers do not replace the required diagnosis coding.

Question 44Core Coding Knowledge (ICD-10-CM, CPT, HCPCS Level II, guidelines and sequencing)

When a single ICD-10-CM combination code fully describes two diagnoses, what should the coder do?

  1. Assign two separate codes instead
  2. Assign the combination code plus a code for the second condition
  3. Query the physician for a different diagnosis
  4. Assign only the combination code Correct answer.

Explanation

A combination code is used when it fully identifies all elements of the documented diagnoses. The coder should not assign an additional code for a condition already included in the combination code. Separate codes are used only when no combination code fully describes the conditions.

Question 45Core Coding Knowledge (ICD-10-CM, CPT, HCPCS Level II, guidelines and sequencing)

A patient on long-term aspirin therapy for coronary artery disease is seen for an unrelated complaint. How is the long-term aspirin use reported?

  1. It is not reportable
  2. With Z79.82, long-term use of aspirin Correct answer.
  3. With an external cause code
  4. As the principal diagnosis

Explanation

Z79 codes report long-term current drug use, and Z79.82 specifically identifies long-term use of aspirin. Such status codes are generally secondary and do not replace the reason for the encounter. They are not reported as the principal diagnosis.

Question 46Core Coding Knowledge (ICD-10-CM, CPT, HCPCS Level II, guidelines and sequencing)

A coder must report a procedure that is distinct from another procedure performed on the same day. Which modifier set is preferred by Medicare because it gives more specific information than modifier 59?

  1. Modifier 22
  2. Modifier 50
  3. Modifier 80
  4. X{EPSU} modifiers Correct answer.

Explanation

The X{EPSU} modifiers (XE, XP, XS, XU) were developed to provide more specific reasons for a distinct procedural service than modifier 59. They indicate whether the service was separate due to encounter, practitioner, site, or unusual non-overlap. Modifier 59 remains available but is less specific.

Question 47Core Coding Knowledge (ICD-10-CM, CPT, HCPCS Level II, guidelines and sequencing)

A CPT code designated as a 'separate procedure' is performed along with a more extensive procedure in the same area. How is it reported?

  1. Reported as an add-on code with no modifier
  2. Not reported separately when integral to the larger procedure Correct answer.
  3. Reported with modifier 50 for bilateral services
  4. Always reported separately with modifier 59

Explanation

A separate procedure code is not reported separately when it is performed as part of a more extensive procedure in the same anatomic area. It may be reported separately only when it is truly distinct and unrelated to the larger service. Add-on status and bilateral status are separate coding concepts.

Question 48Core Coding Knowledge (ICD-10-CM, CPT, HCPCS Level II, guidelines and sequencing)

An ICD-10-CM code has a 'Code also' note. What does this instruction require?

  1. The note prohibits coding the additional condition
  2. An additional code is assigned when applicable Correct answer.
  3. The additional code is optional and never required
  4. The additional condition is always sequenced first

Explanation

A 'Code also' note indicates that an additional code should be assigned when the associated condition is present. The sequencing of the additional code depends on the reason for the encounter and the specific guidelines. It is neither always first nor prohibited.

Question 49Core Coding Knowledge (ICD-10-CM, CPT, HCPCS Level II, guidelines and sequencing)

A procedure is partially completed because the patient cannot tolerate the full examination. Which modifier reports reduced services?

  1. 53
  2. 52 Correct answer.
  3. 22
  4. 58

Explanation

Modifier 52 reports reduced or eliminated services when a procedure is partially performed. Modifier 53 reports a discontinued procedure, typically due to a patient safety or medical reason. Modifier 22 reports increased services, and modifier 58 reports a staged procedure.

Question 50Core Coding Knowledge (ICD-10-CM, CPT, HCPCS Level II, guidelines and sequencing)

A surgeon performs a procedure and another surgeon assists. Which modifier is appended to the assistant surgeon's claim?

  1. 80 Correct answer.
  2. 62
  3. 81
  4. 66

Explanation

Modifier 80 identifies an assistant surgeon who assists at surgery. Modifier 62 reports co-surgeons, modifier 66 reports team surgery, and modifier 81 reports a minimum assistant surgeon. The assistant surgeon's role must be documented in the record.