AAPC Updated CPC Exam Questions and Answers by damir

Omalizumab is a drug reported withHCPCS J2357, and the dose is converted into billable units based on the code’s unit definition. In CPC-style questions,150 mgis commonly represented asJ2357 × 30 units(i.e., 5 mg per unit → 150/5 = 30). Administration is atherapeutic subcutaneous injection, reported with96372(therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular). Vaccine administration codes (90460/90471) are not appropriate because omalizumab is not a vaccine. For diagnosis, the statement includesstatus asthmaticusbut does not specify severity category (mild/moderate/severe persistent). In the options provided,J45.902is the “unspecified asthma with status asthmaticus” concept, whereas J45.52 requires severe persistent asthma with status asthmaticus (not documented). Therefore, the correct pairing is96372 + J2357 × 30 + J45.902. CPC exam tip: match administration code type (therapeutic injection vs immunization) and choose the most specific ICD-10-CM supported by documentation.

The procedure involves a tympanoplasty with a radical mastoidectomy and removal of a cholesteatoma from the middle ear, including grafting of the eardrum without ossicular chain reconstruction.

Procedure Description:

Tympanoplasty.

Radical mastoidectomy.

Removal of cholesteatoma from the middle ear.

Grafting technique used to repair the eardrum without ossicular chain reconstruction.

CPT® Coding:

69645: Tympanoplasty with mastoidectomy (including canalplasty, atticotomy and/or middle ear surgery), radical or complete, with removal of cholesteatoma; with mastoid obliteration.

AMA ' s CPT® Professional Edition (current year).

CPT® Assistant for detailed coding guidelines on otolaryngology procedures.

The correct answer is B. Modifier 32. Modifier 32 identifies a mandated service, meaning the service was required by a third-party payer, governmental body, legal authority, employer, or other regulatory entity rather than being performed solely at the physician’s independent clinical discretion. In professional coding, this modifier communicates the reason the service was rendered and helps distinguish required examinations or evaluations from routine medically indicated services. Typical examples include services requested for insurance review, workers’ compensation requirements, legal determinations, disability evaluation, or other administrative mandates.

The other modifiers do not match the scenario. Modifier 23 is used for unusual anesthesia circumstances. Modifier 76 reports a repeat procedure or service performed by the same physician or other qualified health care professional. Modifier 24 is appended to an unrelated evaluation and management service performed during a postoperative global period. None of these indicate that the service was required by an external payer or regulatory authority.

Reference topics: CPC Modifiers; CPT Appendix A Modifiers; Mandated Services; Regulatory and Third-Party Payer Reporting Requirements.

In coding burns, ICD-10-CM guidelines indicate that each burn site is coded separately, specifying the degree, location, and extent of the burn. Additionally, a code for total body surface area (TBSA) burned is included when burns cover more than 10% of the body. Here’s the breakdown:

1. T24.311A: Represents a third-degree burn on the left thigh, initial encounter.

2. T24.312A: Represents a third-degree burn on the right thigh, initial encounter.

3. T21.21XA: Represents a second-degree burn on the anterior chest wall, initial encounter.

4. T21.23XA: Represents a second-degree burn on the upper back, initial encounter.

5. T31.21: Represents burns with 20–29% TBSA involvement, with third-degree burns covering 10–19% of the TBSA.

Explanation of incorrect answers:

A includes an incorrect TBSA code (T31.21).

B has the correct codes but lists an incorrect TBSA code for third-degree burns.

C uses incorrect burn site codes for the areas involved and incorrect TBSA percentages.

Therefore, the correct answer is D. T24.311A, T24.312A, T21.21XA, T21.23XA, T31.21, which accurately captures the burns ' degrees, locations, and TBSA.