AAPC CPB P RACTICE EXAM 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 dizz iness. 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 a nd 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 - D. 99407 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 - 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 advi ce 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. - 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 - 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 dizz iness. 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 a nd 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 - 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. - 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). - 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. ____________ 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) - B. Medically Unlikely Edits (MUE) 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 c odes 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 - 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 - 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? - 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? - 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 - 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
