Exam (elaborations)
AAPC CPB Practice Exam Questions & answers
AAPC CPB Practice Exam Questions & answers
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AAPC CPB Practice Exam____________ is incorporated by CMS into the NCCI program to limit the number of times a
service or procedure can be reported by a physician on the same date of service to a patient.
A. Outpatient Code Editor (OCE)
B. Medically Unlikely Edits (MUE)
C. Physician Fee Schedule
D. National Coverage Determination (NCD) - ANS-B. Medically Unlikely Edits (MUE)
10-year-old girl is scheduled for her yearly physical exam with her pediatrician .At the time of her
visit, the patient complains of watery eyes, scratchy throat, and stuffy nose for the past two
days. The physician first performs a complete physical. Then he also evaluates and treats the
patient for a URI supported with separate documentation of an expanded problem focused
exam and low medical decision making. What CPT® code(s) is/are reported for this visit?
A. 99393, 99213-25
B. 99393
C. 99213
D. 99393-25, 99213 - ANS-A. 99393, 99213-25
25 year-old is 32 weeks pregnant. She was admitted to the labor and delivery unit because she
was having severe pre-eclampsia and needed to have an emergency cesarean section.
Reduced payment was sent to the obstetrician by the payer with a remittance advice stating that
preauthorization for the cesarean section was not obtained. What does the biller do?
A. Verify in the payer contract/policies that prior authorization is required for this procedure. If
preauthorization was not obtained, bill the patient the rest of what is due to the obstetrician.
B. Appeal the claim, explaining the reason for the emergency cesarean section
C. Write off the claim because it was denied.
D. Verify in the payer contract/policies that prior authorization is required for this procedure. If
preauthorization was not obtained, bill the patient for the entire amount. - ANS-B. Appeal the
claim, explaining the reason for the emergency cesarean section
55-year-old female presents to the office with ongoing history of type I diabetes which has been
controlled with insulin. During the exam the physician notes that gangrene has set in due to the
diabetic peripheral angiopathy on her left great toe. Patient is recommended to see a general
surgeon for treatment of the gangrene on her left great toe.
A. I96, E10.9, Z79.4
B. E11.52, I96, Z79.4
C. E10.52
,D. I96, E11.52 - ANS-C. E10.52
60-year-old woman is seeking help to quit smoking. She makes an appointment to see Dr. Lung
for an initial visit. The patient has a constant cough due to smoking and some shortness of
breath. No night sweats, weight loss, night fever, CP, headache, or dizziness. She has tried
patches and nicotine gum, which has not helped. Patient has been smoking for 40 years and
smokes 2 packs per day. She has a family history of emphysema. A limited three system exam
was performed. Dr. Lung discussed in detail the pros and cons of medications used to quit
smoking. Counseling and education was done face to face for 20 minutes on smoking cessation
of the 30 minute visit. Prescriptions for Chantix and Tetracycline were given. The patient to
follow up in 1 month. A chest X-ray and cardiac work up was ordered. Select the appropriate
CPT® code(s) for this visit:
A. 99203, 99354
B. 99214, 99354
C. 99214
D. 99407 - ANS-D. 99407
A _____ is a correspondence sent from the insurance payer to the patient after they receive
healthcare services to explain the status of their claim. - ANS-Explanation of Benefits
A "reasonable" charge in UCR is:
A. What Medicare deems reasonable
B. A computer calculation for a particular service based on all the claims data submitted by
individual doctors and group practices.
C. A fee which meets the criteria of usual and customary charges or (after appropriate peer
review) is justified because of the special circumstances of a case.
D. The fee generally charged by an individual doctor or group for a particular service (the claim
form charge). - ANS-C. A fee which meets the criteria of usual and customary charges or (after
appropriate peer review) is justified because of the special circumstances of a case.
A 12-month-old established patient is coming in to see the pediatrician for an annual physical
exam. The physician decides to administer the Hib-HepB vaccine intramuscularly. Counseling
was provided by the physician to the mother about each vaccine. What codes are reported for
this encounter?
A. 99392-25, 90460, 90461, 90748
B. 99391-25, 90460 x 2, 90748
C. 99382-25, 90460 x 2, 90743, 90648
D. 99391-25, 90460, 90461, 90748 - ANS-A. 99392-25, 90460, 90461, 90748
,A 14-year-old male patient fell while skateboarding. He went to the emergency department at
the local hospital. The diagnosis was a fracture of the upper right arm. The ICD-10-CM codes
reported were S42.301A, V00.131A, and Y93.51.Is this correct?
A. No; the codes reported should be S43.309B, V00.131B, Y93.51
B. No; the codes reported should be V00.131B, Y93.51, S42.309D
C. No; the codes reported should be V00.131A, Y93.51, S42.301A
D. Yes; the ICD-10-CM codes reported are correct - ANS-D. Yes; the ICD-10-CM codes
reported are correct
A 21 year old patient presents for fillings for two of his teeth. Are these services covered under
EPSDT? - ANS-No, because the patient is not *under* the age of 21
A 21 year-old patient presents for fillings for two of his teeth. Are these services covered under
EPSDT? - ANS-No, because the patient is not under the age of 21.
A 35-year-old female member of an HMO decides to go to an out-of-network specialty clinic for
evaluation and surgery because she heard that this clinic provides superior services. The clinic
submits claims totaling $15,000 for all services provided to this member. The insurance would
typically have paid $10,000 for an in-network provider for the same services. This insurance
would most likely pay as follows:
A. Pay the $10,000 it would have paid leaving the patient responsible for the balance
B. Pay the $15,000 since it was reasonable for the patient to go to a superior facility
C. Pay nothing as this provider was out-of-network
D. Negotiate with the provider to accept the $10,000 as payment in full - ANS-C. Pay nothing as
this provider was out-of-network
A 48-year-old female awakens in the middle of the night with severe abdominal pain and
excessive vomiting. She calls for an ambulance, which takes her to the closest hospital. She
had a ruptured appendix and underwent an emergency appendectomy. Neither the hospital nor
physician was in the payer network for her HMO. In this situation, the payer will most likely pay
the following:
A. The hospital claim because it was reasonable to go to the closest hospital, but not the
physician claim
B. Both the hospital and physician claims for the emergency services
C. The physician claim for the emergency services provided, but not the hospital claim
D. Neither claim, as the member should have gone to an in-network facility since this was not a
life threatening emergency. - ANS-B. Both the hospital and physician claims for the emergency
services
A 54-year-old male presents to his family physician with dizziness. During the physical exam his
blood pressure is 200/130. After a complete work-up, including laboratory tests, the physician
, makes a diagnosis of stage V kidney disease due to malignant hypertension. What is the
appropriate diagnosis code(s) for this encounter?
A. I12.0, N18.5
B. I12.0, N18.6
C. N18.5, I12.0
D. I12.0 - ANS-A. I12.0, N18.5
A 54-year-old patient is brought to the ED by ambulance suffering from acute respiratory failure.
The physician documents critical care services and also performs an endotracheal intubation.
Physician services were provided for a total of 142 minutes. What are the correct CPT® codes
to report?
A. 99291, 99292-51 x 3
B. 99291, 99292 x 3, 31500-51
C. 99291, 99292 x 3, 31500
D. 99291, 99292 x 3 - ANS-C. 99291, 99292 x 3, 31500
A 6 year-old is seen in the pediatrician office for the first time. He has insurance coverage
through both his mother (DOB: 02/08/86 and his father (DOB: 05/15/85). Whose insurance is
primary?
A. Mother's insurance plan
B. Father's insurance plan
C. The policy that has the best benefits
D. Either mother's or father's insurance plan depending who brings the child in for medical care.
- ANS-A. Mother's insurance plan
A BC/BS insurance plan that allows members to choose any provider, but offers higher level of
coverage when members obtain services from network provider would be an example of: -
ANS-PPO
A BCBS insurance plan that allows members to choose any provider but offers higher levels of
coverage when members obtain services from network providers would be an example of: -
ANS-PPO
A biller at a medical practice notices that all claims contain CPT code 81002. She questions the
nurse who tells her that because they are an OB/GYN office they bill every patient for a
urinalysis. What does this violate? - ANS-False Claims Act
A biller at a medical practice notices that all claims contain CPT code 81002. She questions the
nurse who tells her that because they are an OB/Gyn office, they bull every patient for a
urinalysis. What does this violate? - ANS-FCA
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