AAPC CPC Exam 50000 Series CPT Practice Test

AAPC CPC Exam 50000 Series CPT Practice Test: the 50000 Series contains Urinary, Male Genital, Female Reproductive and Endocrine Systems questions. Try our free American Academy of Professional Coders (AAPC) Certified Professional Coder (CPC) 50000 Series CPT review questions and answers for r better CPC certification prep.

AAPC CPC Exam 50000 Series CPT Practice Test

Q1. A fracture of the corpus cavernosum penis is repaired. What is the correct code?

  1. 54440
  2. 54420
  3. 54430
  4. 54435
View Correct Answer
 Answer Key: A

Rationale: Repair for penile injury is reported using CPT® 54440. Do not report CPT® codes used for treatment of priapism when there is injury to the penis. In the index locate Repair/Penis/Injury.

Q2. Cystoscopy, left ureteroscopy, holmium laser lithotripsy, stone manipulation, stent removal and replacement are performed. The holmium laser was used to break up a cluster of stones at the UP (uteropelvic) junction, which were removed with a basket. Previous CT scan showed stones in the lower pole, it was decided to proceed with ureteroscopy. Left ureteroscope was inserted, confirming multiple stones within the proximal ureter, these were basketed and removed. What CPT® codes are reported for this service?

  1. a. 52353, 52332-51, 52352-59
  2. b. 52353, 52000-51, 52352-59
  3. c. 52310, 52353-51, 52352-59
  4. d. 52353, 52352-51
View Correct Answer
 Answer Key: A

Rationale: When a stent is removed and replaced, the removal of the initial stent is included in the stent replacement and is not reported. Usually the basketing of the stones is included with the laser lithotripsy; however, because ureteroscopy is performed on a separate part of the ureter than the laser lithotripsy, it is appropriate to add modifier 59 to CPT® 52352. In the Index, look up Cystourethroscopy/Lithotripsy directing you to 52353. In the Index, look up Cystourethroscopy/Insertion/Indwelling Ureteral Stent directing you to 52332.

Q3. Circumcision with adjacent tissue transfer was performed. What CPT® code(s) is/are reported for this service?

  • a. 14040
  • b. 54161-22
  • c. 54163
  • d. 14040, 54161-51
View Correct Answer
 Answer Key: D

Rationale: When a circumcision is performed requiring tissue transfer or reconstruction, you report the circumcision and the tissue transfer codes. You do not append modifier 22 to the circumcision code, and reporting only the tissure transfer is incorrect. Reporting repair of an incomplete circumcision is also incorrect, as we have no documentation to support a previous circumcision. In the Index, look up Circumcision/Surgical Excision directing you to 54161. In the Index, look up Tissue/Transfer/Adjacent/Skin directing you to 14000-14350.

Q4. The patient is a very pleasant 72-year-old female noted to have bilateral nephrolithiasis. Her left stones were treated ureteroscopically and her right stone was very large. It was treated with an ureteroscopic procedure. She comes in today for her second ureteroscopic procedure to remove the remaining stone fragments. Right ureteroscopy, laser lithotripsy and right ureteral stent exchange were performed. What CPT® codes are reported for this service?

  1. 52353-58, 52332-58
  2. 52353, 52310, 52332
  3. 52353, 52332-51
  4. 52353-76, 52332-76
View Correct Answer
 Answer Key: C

Rationale: Ureteroscopic procedures have no global period and the use of modifier 58 or 76 would not be appropriate. Though a stent exchange was performed, you do not report removal of the previous stent (52310). You would report the laser lithotripsy (52353) and stent insertion (52332) with no modifier(s) appended. In the Index, look up Lithotripsy/Ureter directing you to 52353. In the Index, look up Cystourethroscopy/Insertion/Indwelling Ureteral Stent directing you to 52332

Q5. 67-year-old gentleman with localized prostate cancer will be receiving brachytherapy treatment. Following calculation of the planned transrectal ultrasound, guidance was provided for percutaneous placement of 1-125 seeds into the prostate tissue. What CPT® code is reported for needle placement to insert the radioactive seeds into the prostate?

  1. 55860
  2. 55920
  3. 55875
  4. 55876
View Correct Answer
 Answer Key: C

Rationale: Brachytherapy is a form of radiation in which radioactive seeds or pellets are implanted directly into the tissue being treated to deliver their dose of radiation in a direct fashion and longer period of time. The placement of the seeds is performed percutaneously (going through the skin by needle). The code is indexed under Prostate/Insertion/Needle guiding you to code 55875.

Q6. A woman with abdominal pain and bleeding has a diagnosis of multiple fibroid tumors and undergoes laparoscopic resection without hysterectomy. After the abdomen is entered and inspected it is found she has 5 separate intramural fibroid tumors to be removed. The fibroid tumors are successfully removed, with a total weight of 300 grams. Pathology confirms leiomyoma (myomas or fibroids). What are the CPT® and ICD-9-CM codes reported for this service?

  1. 58146, 218.9
  2. 58546, 218.1
  3. 58545, 218.1
  4. 58140, 218.9
View Correct Answer
 Answer Key: B

Rationale: Surgical laparoscopy is performed to remove the five fibroid tumors weighing over 250 grams. This procedure is indexed under Laparoscopy/Removal/Leiomyomata referring you to codes 58545-58546. The diagnosis is indexed in the ICD-9-CM Index to Diseases, under Leiomyoma/uterus/intramural guiding you to code 218.1.

Q7. A patient presents with cervical cancer, it has spread and metastasized throughout the pelvic area. She receives a total abdominal hysterectomy with bilateral salpingo-oophorectomy, cystectomy and creation of an ileal conduit and partial colectomy. What is/are the CPT® code(s) reported for this service?

  1. 58150, 51590, 44140
  2. 58152, 44141
  3. 58150, 51590, 44140, 58720
  4. 58240
View Correct Answer
 Answer Key: D

Rationale: Due to the patient having cervical cancer metastasized to the pelvic area (gynecological malignancy) the procedure performed is a pelvic exenteration. This is a total hysterectomy with removal of ovaries and fallopian tubes (salpingo-oophorectomy). This includes the removal of her bladder (cystectomy) with creation of a passageway to drain the kidneys through an opening on the abdomen (ileal conduit) and partial removal of the large bowel or colon (resection of the rectum and colon). This procedure is located in the CPT® Index under, Exenteration/Pelvis guiding you to codes 45126 and 58240. Code 58420 is the only code needed to report this surgical procedure. Reporting the other codes is considered unbundling

Q8. Operative Report

Preoperative Diagnosis: L5-S1 degenerative disk disease
Postoperative Diagnosis: Same.

OPERATION

1. L5-S1 transforaminal lumbar interbody fusion with the Capatone system.
2. Nonsegmental instrumentation with a Spire plate.
3. Lateral arthrodesis with autograft and allograft consisting of Infuse.
4. Use of intraoperative fluoroscopy, less than one hour.
Anesthesia: General endotracheal anesthesia

DESCRIPTION OF PROCEDURE: The patient was placed in the usual prone position on the Jackson table. After prepping and draping in the usual sterile fashion, and infiltrating the skin subcutaneously with 1% lidocaine with epinephrine, a lineal incision was made in the midline extending from the superior aspect of the spinous process of L5 to the inferior aspect of the spinous process of S1. A subperiosteal dissection of the paraspinous muscles was carried out on the left side to the lateral portion of the lateral facet, on the right side to the medial border of the medial facet.

After obtaining the correct level by fluoroscopy a small laminotomy was carried out on the left side of L5 and a medial facetectomy done with a Midas Rex drill and Kerrisons. The bone dust and bone chips were saved. Once we had exposed the descending S1 root and exiting L5 roots and the thecal sac we protected these with a nerve root retractor. A standard diskectomy was carried out at L5-S1 using various sized curets and pituitary ronguers. Once we had good exposure of the end plates, we distracted the disk space out to 10 mm. An Infuse sponge was then filled with autologous bone dust into a burrito and placed into the disk space towards the anterior portion of the vertebral bodies. This was followed by a 10 x 22 mm Capstone graft which too was filled with an Infuse and autologous bone burrito. Under guidance of the fluoroscopy unit we made sure this was at the anterior portion of the vertebral bodies and in the midline. This confirmed with both the AP and lateral views.

At this point the lamina on the right side of L5 and S1 were decorticated with the Midas Rex drill, and further burritos of Infuse and bone dust were placed over the decorticated regions. The interspinous ligament between L5 and S1 was then removed with a rongeur, and the Spire plate placed under compression over the spinous processes. The set screw was placed and broken off with the attached torque wrench.

At this point we found there was still moderate subcutaneous bleeding, and even though we had Infuse, a Jackson-Pratt drain was placed in the paraspinous muscles and sutured in place with 2-0 silk to the skin. The deep paraspinous muscles and dorsal lumbar fascia were reapproximated with 2-0 Vicryl in a running subcuticular fashion.

Estimated blood loss was 200 cc. Sponge and needle counts were reported to be correct x2. There were no complications from the procedure, and the patient tolerated the procedure well. What CPT® codes are reported?

  1. 22612, 63040-51
  2. 22558, 63042-51, 22840
  3. 22612, 63030-51, 22840
  4. 22558, 63030-51, 22840, 22841
View Correct Answer
 Answer Key: C

Rationale: In the CPT® Index, look for Vertebra/Arthrodesis/Posterior and you are directed to code range 22590-22802. The procedure is performed on the lumbar spine, making 22612 the correct code. Posterior, non segmental spinal instrumentation was used. In the CPT® Index, look for Spinal Instrumentation/Posterior Nonsegmental directs you to 22840. A laminotomy is performed (hemilaminectomy) which is reported with 63030. In thei Index, look for Hemilaminectomy to locate code 63030. Intraoperative fluoroscopy (76000) during an open spine procedures, such as a laminotomy, is considered an integral part of the procedure and is not separately reportable.

Q9. A patient with uterine prolapse presents for laparoscopic hysterectomy and colpopexy. After induction of general anesthesia the laparoscope is introduced into the abdomen with separate placement of ports for visualization. The surgeons began to tie off the uterine artery when the patient had a sudden drop in blood pressure and could not be stabilized. The procedure was discontinued. No procedures were completed. What are the CPT® and modifier code(s) for this service?

  • a. 58570-52, 57425-52
  • b. 58570-53, 57425-53
  • c. 58570-53
  • d. 58570-73
View Correct Answer
 Answer Key: C

Rationale: After general anesthesia was given and the surgery for the laparoscopic hysterectomy had started, the patient’s blood pressure dropped and could not be stabilized. Using the CPT® Index, there are two ways to find the code for a laparoscopic hysterectomy. Start with Hysterectomy/Laparoscopic/Total or see Laparoscopy/Hysterectomy/Total. Both indicate code range 58570-58573. Modifier 53 is the correct modifier to append because there was a threat to the well being of the patient during the surgery. You do not code for the colpopexy (57425) because the colpopexy surgery had not begun.

Q10. A 26-year-old gravida 2 para 1 female has been spotting and has been on bed rest. She awoke this morning with severe cramping and bleeding. Her husband brought her to the hospital. After examination, it was determined she has an incomplete early spontaneous abortion. She is in the 12th week of her pregnancy. She was taken to the OR and a dilation and curettage (D&C) was performed. There were no complications from the procedure. She will follow-up with me in the office. She has had four antepartum visits during her pregnancy.

  1. 59812, 637.91
  2. 59812, 59425, 634.91
  3. 58120, 634.91
  4. 58120, 59425, 634.92
View Correct Answer
 Answer Key: B

See also