AAPC Updated CPC Exam Questions and Answers by rachel

CPT code 99450 is used for the examination of a patient for the purpose of establishing medical baseline information or for insurance purposes. Since Eric ' s primary care provider completed the required physical exam documentation for his life insurance policy, this is appropriately reported with code 99450. References: CPT® Professional Edition (current year), AMA.

CPT70450describes aCT of the head/brain without contrast. When aradiology facilityperforms the technical portion (scanner, technologist, supplies) and theprovider only interprets and reportsthe study, the provider bills theprofessional componentusing modifier-26. That is exactly what the vignette describes: the radiology facility performed the scan, and the provider received images and provided the interpretation—so the provider reports70450-26. Reporting70450alone would imply billing the global service (professional + technical), which would be incorrect because the provider did not supply the equipment/technical resources. Modifier-TCis used to bill thetechnical component, which would be reported by the facility, not the interpreting provider in this scenario. Modifier-26-TCtogether is not appropriate because it would contradict itself (professional and technical simultaneously). CPC exam tip: always determinewho performedthe technical work andwho interpreted; then use-26for interpretation-only billing.

For diabetes coding, you must first select the diabetes category that matches the type:Type 1 diabetesisE10.-(not E11, which is Type 2). “Diabetic chronic kidney disease” maps toE10.22(Type 1 diabetes mellitus with diabetic chronic kidney disease). ICD-10-CM guidelines then require anadditional codeto identify thestage of CKDfromN18.-. Because the question does not specify the CKD stage, you assignN18.9(chronic kidney disease, unspecified). That makesE10.22, N18.9correct (Option B). Option D would only be correct if the stage were specifically documented asCKD stage 1 (N18.1). Option C (E10.21) is diabetes with diabetic nephropathy, which is not the same as “diabetic CKD” in this question. CPC exam tip:E10.22 always needs an N18.- stage codewhen stage is known; if not known, useN18.9.

When a prior malignancy has been eradicated and the patient is no longer receiving treatment for the primary site, ICD-10-CM directs you to use apersonal history of malignant neoplasmcode rather than an active primary cancer code. Here, the breast cancer was treated successfully last year and no further therapy was required, so the breast cancer ishistory, not active. The new current condition ismetastatic cancer to the liver, which is coded as asecondary malignant neoplasm of liver and intrahepatic bile duct (C78.7). Because the primary breast cancer is not documented as active or under current treatment, you donotcode an active breast malignancy (C50.-). Instead, you addZ85.3 (personal history of malignant neoplasm of breast)to show the prior cancer history relevant to the current metastatic disease. Option A incorrectly codes a primary liver cancer. Option C incorrectly codes active breast cancer. Option D codes metastasis to the adrenal gland, not the liver.