AAPC Updated CPC Exam Questions and Answers by zorawar

This question is testing recognition of amaxillofacial prosthetic servicerather than an ophthalmology procedure code. The vignette describesfabrication of a prosthesis using silicone materialswithmodificationsintended to restorecosmetic appearanceafter loss/damage of an eye. Among the provided options,21086is the CPT code that corresponds to fabrication of afacial prosthesis(commonly silicone-based) with the intent of external restoration. The other codes in this small cluster represent different facial/craniofacial repair or prosthetic services and do not match silicone prosthesis fabrication described in the scenario. CPC exam technique: focus on the key nouns—“fabricates a prosthesis,” “silicon materials,” “cosmetic appearance restoration”—which point away from repair codes and towardprosthetic fabrication. Also note the question is not about insertion of an ocular implant during enucleation/evisceration, but about crafting an external prosthetic device. Therefore, the correct selection is21086.

In medical billing, Place of Service (POS) code 31 is used to indicate that a service was performed in a skilled nursing facility (SNF). POS codes are standardized by the Centers for Medicare & Medicaid Services (CMS) to specify the location where services are provided.

A. 32 refers to a nursing facility (NF), which is different from a skilled nursing facility in terms of the level of care provided.

B. 20 indicates urgent care facility.

C. 22 is used for outpatient hospital services.

Thus, the correct answer is D. 31 for a skilled nursing facility.

1. Procedure and CPT® Code Selection:

The patient underwent venous thrombosis imaging of each leg to assess for deep venous thrombosis (DVT).

CPT® Code 78457 is used for a venous thrombosis imaging study. This code is appropriate for imaging to detect DVT.

Modifier 50 is applied to indicate a bilateral procedure, as imaging was performed on both legs.

2. Diagnosis and ICD-10-CM Code Selection:

ICD-10-CM Code I82.403 is used for acute embolism and thrombosis of unspecified deep veins of bilateral lower extremities. This code accurately describes the finding of DVT in both legs.

Other ICD-10-CM options, such as I82.401 and I82.402, specify unilateral lower extremity involvement, which does not accurately reflect the bilateral findings in this case.

3. Rationale for Excluding Other Options:

Code 78458 (in options A and D) is for a more comprehensive study, often cardiac or whole-body blood pool imaging, and is not specific to leg venous thrombosis.

Option C, which lists 78457 with individual RT and LT modifiers, is incorrect as Modifier 50 is appropriate for bilateral imaging on both legs.

4. AAPC and CPT® Coding Guidelines:

According to AAPC and CPT® guidelines, 78457 with Modifier 50 should be used for bilateral venous imaging studies, and I82.403 correctly captures bilateral DVT.

Thus, the correct answer is B. 78457-50, I82.403.

CPT® code 27566 involves excision of the patella. Given the surgical description provided, this code is appropriate as the patella was severely damaged and removed entirely.

Patient ' s Condition: Dislocated patella with cartilage breakdown and severe damage.

Surgical Procedure: The surgeon made an incision, dissected through soft tissue, exposed, and completely removed the patella.

Coding Decision: CPT® 27566 is chosen because it specifies excision of the patella. The modifier LT indicates the procedure was performed on the left side.