2025 Medical Coding Training: CPC® Answer Key PDF

2025 Medical Coding Training: CPC® Answer Key  Disclaimer This course was current when it was published. Every reasonable effort has been made to ensure the accuracy of the information within these pages. The ultimate responsibility lies with readers to ensure they are using the code...

2025 Medical Coding Training: CPC® Answer Key  Disclaimer This course was current when it was published. Every reasonable effort has been made to ensure the accuracy of the information within these pages. The ultimate responsibility lies with readers to ensure they are using the codes, and following applicable guidelines, correctly. AAPC employees, agents, and staff make no representation, warranty, or guarantee that this compilation of information is error-free, and will bear no responsibility or liability for the results or consequences of the use of this course. This guide is a general summary that explains guidelines and principles in profitable, efficient healthcare organizations. US Government Rights This product includes CPT®, which is commercial technical data and/or computer data bases and/or commercial computer software and/or commercial computer software documentation, as applicable, which was developed exclusively at private expense by the American Medical Association, 515 North State Street, Chicago, Illinois, 60610. U.S. Government rights to use, modify, reproduce, release, perform, display, or disclose these technical data and/or computer data bases and/or computer software and/or computer software documentation are subject to the limited rights restrictions of DFARS 252.227-7015(b)(2) (November 1995), as applicable, for U.S. Department of Defense procurements and the limited rights restrictions of FAR 52.227-14 (June 1987) and/or subject to the restricted rights provision of FAR 52.227-14 (June 1987) and FAR 52.227-19 (June 1987), as applicable, and any applicable agency FAR Supplements, for non-Department of Defense Federal procurements. AMA Disclaimer CPT® copyright 2024 American Medical Association. All rights reserved. Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT®, and the AMA is not recommendation their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein. CPT® is a registered trademark of the American Medical Association. Regarding HCPCS Level II HCPCS Level II codes and guidelines discussed in this book are current as of press time. The 2025 code set for HCPCS Level II was unavailable when published. Clinical Examples Used in this Book AAPC believes it is important in training and testing to reflect as accurate a coding setting as possible to students and examinees. All examples and case studies used in our study guides, exams, and workbooks are actual, redacted office visit and procedure notes donated by AAPC members. To preserve the real-world quality of these notes for educational purposes, we have not re-written or edited the notes to the stringent grammatical or stylistic standards found in the text of our products. Some minor changes have been made for clarity or to correct spelling errors originally in the notes, but essentially they are as one would find them in a coding setting. © 2024 AAPC 2233 South Presidents Dr. Suite F, Salt Lake City, UT 84120 800-626-2633, Fax 801-236-2258, www.aapc.com Updated 09272024. All rights reserved. CPC®, CIC®, COC®, CPC-P®, CPMA®, CPCO®, and CPPM® are trademarks of AAPC. ii www.aapc.com CPT® copyright 2024 American Medical Association. All rights reserved. Contents Section Review—Answers and Rationales............................................................................ 1 Section Review 1.1................................................................................................ 1 Section Review 1.2............................................................................................... 1 Section Review 2.1................................................................................................ 2 Section Review 2.2............................................................................................... 3 Section Review 2.3............................................................................................... 3 Section Review 2.4............................................................................................... 4 Section Review 2.5............................................................................................... 4 Section Review 2.6............................................................................................... 5 Section Review 2.7................................................................................................ 6 Section Review 2.8............................................................................................... 6 Section Review 2.9............................................................................................... 7 Section Review 2.10.............................................................................................. 7 Section Review 2.11.............................................................................................. 8 Section Review 3.1................................................................................................ 8 Section Review 3.2............................................................................................... 9 Section Review 3.3............................................................................................... 9 Section Review 3.4.............................................................................................. 10 Section Review 4.1............................................................................................... 11 Section Review 4.2.............................................................................................. 12 Section Review 4.3.............................................................................................. 12 Section Review 4.4.............................................................................................. 13 Section Review 4.5.............................................................................................. 13 Section Review 4.6.............................................................................................. 14 Section Review 4.7............................................................................................... 14 Section Review 4.8.............................................................................................. 14 Section Review 4.9.............................................................................................. 15 Section Review 4.10............................................................................................. 15 Section Review 4.11............................................................................................. 16 Section Review 5.1............................................................................................... 16 Section Review 5.2.............................................................................................. 16 Section Review 5.3.............................................................................................. 17 Section Review 5.4.............................................................................................. 17 Section Review 5.5.............................................................................................. 18 Section Review 5.6.............................................................................................. 18 Section Review 5.7............................................................................................... 19 2025 Medical Coding Training: CPC®—Answer Key www.aapc.com iii Contents Section Review 5.8.............................................................................................. 19 Section Review 5.9.............................................................................................. 20 Section Review 5.10............................................................................................. 21 Section Review 6.1.............................................................................................. 21 Section Review 6.2.............................................................................................. 22 Section Review 6.3.............................................................................................. 22 Section Review 6.4.............................................................................................. 23 Section Review 6.5.............................................................................................. 24 Section Review 7.1............................................................................................... 24 Section Review 7.2............................................................................................... 25 Section Review 7.3............................................................................................... 25 Section Review 7.4............................................................................................... 26 Section Review 8.1.............................................................................................. 27 Section Review 8.2.............................................................................................. 28 Section Review 8.3.............................................................................................. 28 Section Review 9.1............................................................................................... 29 Section Review 9.2.............................................................................................. 30 Section Review 9.3.............................................................................................. 31 Section Review 10.1............................................................................................. 33 Section Review 10.2............................................................................................. 33 Section Review 10.3............................................................................................. 34 Section Review 10.4............................................................................................. 34 Section Review 10.5............................................................................................. 35 Section Review 11.1.............................................................................................. 36 Section Review 11.2............................................................................................. 37 Section Review 11.3............................................................................................. 38 Section Review 12.1............................................................................................. 38 Section Review 12.2............................................................................................. 39 Section Review 12.3............................................................................................. 40 Section Review 12.4............................................................................................. 41 Section Review 12.5............................................................................................. 42 Section Review 13.1............................................................................................. 43 Section Review 13.2............................................................................................. 43 Section Review 13.3............................................................................................. 44 Section Review 14.1............................................................................................. 44 Section Review 14.2............................................................................................. 45 Section Review 14.3............................................................................................. 46 Section Review 14.4............................................................................................. 47 Section Review 15.1............................................................................................. 47 iv www.aapc.com CPT® copyright 2024 American Medical Association. All rights reserved.  Contents Section Review 15.2............................................................................................. 49 Section Review 15.3............................................................................................. 50 Section Review 16.1............................................................................................. 52 Section Review 16.2............................................................................................. 53 Section Review 16.3............................................................................................. 53 Section Review 16.4............................................................................................. 54 Section Review 17.1.............................................................................................. 55 Section Review 17.2.............................................................................................. 55 Section Review 17.3.............................................................................................. 56 Section Review 17.4.............................................................................................. 57 Section Review 17.5.............................................................................................. 57 Section Review 18.1............................................................................................. 58 Section Review 18.2............................................................................................. 58 Section Review 18.3............................................................................................. 59 Section Review 19.1............................................................................................. 60 Section Review 19.2............................................................................................. 60 Section Review 20.1............................................................................................. 62 Section Review 20.2............................................................................................. 62 Section Review 20.3............................................................................................. 62 Section Review 20.4............................................................................................. 63 Section Review 20.5............................................................................................. 63 Section Review 20.6............................................................................................. 63 Section Review 20.7............................................................................................. 64 Section Review 20.8............................................................................................. 64 Section Review 20.9............................................................................................. 64 Section Review 20.10............................................................................................ 65 Section Review 20.11............................................................................................ 65 Section Review 20.12............................................................................................ 65 Section Review 20.13............................................................................................ 66 Section Review 20.14............................................................................................ 66 Section Review 20.15............................................................................................ 66 Section Review 20.16............................................................................................ 66 Section Review 20.17............................................................................................ 67 Section Review 20.18............................................................................................ 67 Section Review 20.19............................................................................................ 67 Section Review 20.20............................................................................................ 68 2025 Medical Coding Training: CPC®—Answer Key www.aapc.com v  Section Review—Answers and Rationales Section Review 1.1 1. Answer: B. Using the least radical service/procedure that allows for effective treatment of the patient’s complaint or condition. Rationale: Medical necessity is using the least radical services/procedure that allows for effective treatment of the patient’s complaint or condition. 2. Answer: B. Chronic venous insufficiency Rationale: According to the LCD, chronic venous insufficiency is a systemic condition that may result in the need for routine foot care. 3. Answer: D. ABN Rationale: An Advanced Beneficiary Notice (ABN) is used when a Medicare beneficiary requests or agrees to receive a procedure or service that Medicare may not cover. This form notifies the patient of potential out of pocket costs for the patient. 4. Answer: A. ABNs may not be recognized by non-Medicare payers. Rationale: ABNs may not be recognized by non-Medicare payers. Providers should review their contracts to determine which payers will accept an ABN for services not covered. 5. Answer: C. $100 or 25 percent Rationale: CMS instructions stipulate, “Notifiers must make a good faith effort to insert a reasonable estimate…the estimate should be within $100 or 25 percent of the actual costs, whichever is greater.” Section Review 1.2 1. Answer: D. Patients Rationale: Covered entities in relation to HIPAA include healthcare providers, health plans, and healthcare clearing houses. The patient is not considered a covered entity although it is the patient’s data that is protected. 2. Answer: A. Only individuals whose job requires it may have access to protected health information. Rationale: It is the responsibility of a covered entity to develop and implement policies best suited to its particular circumstances to meet HIPAA requirements. As a policy requirement, only those individuals whose job requires it may have access to protected health information. 2025 Medical Coding Training: CPC®—Answer Key www.aapc.com 1 Section Review—Answers and Rationales 3. Answer: B. HITECH Rationale: The Health Information Technology for Economic and Clinical Health Act (HITECH) was enacted as a part of the American Recovery and Reinvestment Act of 2009 (ARRA) to promote the adoption and meaningful use of health information technology. Portions of HITECH strengthen HIPAA rules by addressing privacy and security concerns associated with the electronic transmission of health information. 4. Answer: A. OIG Compliance Program Guidance Rationale: The OIG has offered compliance program guidance to form the basis of a voluntary compliance program for physician offices. Although this was released in October 2000, it is still considered as active compliance guidance today. In 2023, the OIG released the General Compliance Program Guidance (GCPG). The provider's office should refer to both of these documents when creating and updating their compliance plan. 5. Answer: C. OIG Work Plan Rationale: On its website, the OIG releases a Work Plan outlining its priorities. Within the Work Plan, potential problem areas with claims submissions are listed and will be targeted with special scrutiny. Section Review 2.1 1. Answer: C. Root Rationale: The root is the word part holding the fundamental meaning to the medical term, and each medical term contains at least one root or base word. 2. Answer: B. Eyelid Rationale: The root Blephar- means eyelid, indicating a blepharoplasty is performed on the eyelid. 3. Answer: D. Surgical removal of an ovary and tube. Rationale: The root salpingo- means oviduct or tube. The root oophor- means ovary. The suffix -ectomy means excision or surgical removal of. The pairing of salpingo- with oophor- tells you the procedure was performed on the female reproductive organs and not the auditory system. 4. Answer: B. Nail Rationale: The root onych- means nail. Paronychia is inflammation of the nail fold surrounding the nail plate. 5. Answer: B. Beneath the fascia. Rationale: The root fasci- means fascia. Subfascial is beneath the fascia. Fascia is a sheath of fibrous tissue covering individual skeletal muscles or certain organs. 6. Answer: B. Creation of a hole in the trachea. Rationale: The root trache- means trachea. The suffix -ostomy means surgical creation of an opening. A tracheostomy is surgical creation of an opening in the trachea and is used to help a patient breath. 2 www.aapc.com CPT® copyright 2024 American Medical Association. All rights reserved.  Section Review—Answers and Rationales 7. Answer: A. White blood cells. Rationale: The root leukocyte- means white blood cell. Leukocytosis is an increase in white blood cells, which can indicate infection in the body. 8. Answer: B. Surgical removal of the tongue. Rationale: The root gloss- means tongue. The suffix -ectomy means excision or surgical removal of. A glossectomy is partial or total removal of the tongue and can be performed to remove tongue cancer. 9. Answer: C. Common bile duct Rationale: The root choledoch- means common bile duct. A choledochal cyst originates from the common bile duct and usually has symptoms including right upper abdominal pain and jaundice. 10. Answer: A. Bladder and urethra Rationale: The root cyst- means urinary bladder. The root word urethr- means urethra. A cystourethroscopy is an examination of the urinary bladder and urethra. Section Review 2.2 1. Answer: D. Epithelial tissue Rationale: Squamous cell carcinoma and basal cell carcinoma are both cancers of cells in epithelial tissue. Epithelial tissue is found in the skin, lining of the blood vessels, respiratory, intestinal and urinary tracts, and other body systems. 2. Answer: C. Thoracic cavity Rationale: The thoracic, or chest cavity is the space containing the heart, lungs, esophagus, trachea, bronchi, and thymus. 3. Answer: A. Mucous membrane Rationale: Mucous membranes lines the interior walls of the organs and tubes open to the outside of the body, such as those of the digestive, respiratory, urinary, and reproductive systems. Mucous membranes are often adapted for absorption and secretion. 4. Answer: B. Stratum Lucidum Rationale: The stratum lucidum is a clear layer normally found only on the palms of the hands and the soles of the feet. 5. Answer: C. Hypodermis Rationale: The hypodermis (subcutaneous) serves to protect the underlying structures, prevent loss of body heat and anchor skin to the underlying musculature. Fibrous connective tissue referred to as superficial fascia is included in this layer. Section Review 2.3 1. Answer: D. Greenstick fracture Rationale: A greenstick fracture is a fracture where only one side of the shaft is broken, and the other is bent. It is common in children due to their soft bones. The greenstick fracture is named due to the analogy of breaking a young tree branch where the outer side breaks and the inner side bends. 2025 Medical Coding Training: CPC®—Answer Key www.aapc.com 3 Section Review—Answers and Rationales 2. Answer: B. Pelvic Girdle Rationale: The axial skeleton includes the skull, hyoid and cervical spine, ribs, vertebrae, and sacrum. The appendicular skeleton includes the shoulder girdle, pelvic girdle, and extremities. 3. Answer: A. Metacarpals Rationale: Long bones are named for their shape, not their size. Metacarpals are long bones found in the hand that form the skeletal structure of the palm. 4. Answer: C. Synovial Rationale: Most joints in the body are synovial joints. All joints in the extremities are synovial joints. Synovial joints allow for smooth motion within the joint. 5. Answer: A. Arthr/o Rationale: The root Arthr/o stands for joint. You will notice in the list of medical terms related to the musculoskeletal system, all of the words beginning with “arthr” are conditions or procedures related to the joint. Section Review 2.4 1. Answer: C. Inferior and Superior Vena Cava Rationale: Deoxygenated blood enters the right atrium through the superior vena cava and inferior vena cava. 2. Answer: B. Left and right pulmonary veins Rationale: Blood is circulated through the pulmonary vascular tree in the lungs and sent back into the left atrium through the left and right pulmonary veins. 3. Answer: C. Angiocarditis Rationale: The root angi/o means vessel, the root cardi/o means heart, and the suffix -itis means inflammation. Angiocarditis is inflammation of the heart and vessels. 4. Answer: D. Endocardium Rationale: The prefix endo- means inner. The root cardi/o means heart. The endocardium is the inner lining of the heart. 5. Answer: B. Oxygen deficiency Rationale: Cyanosis is bluing of the skin and mucous membranes caused by oxygen deficiency. Section Review 2.5 1. Answer: C. With a system of one-way valves Rationale: The lymphatic system operates without a pump by using a series of valves to ensure the fluid travels in one direction to the heart. 4 www.aapc.com CPT® copyright 2024 American Medical Association. All rights reserved.  Section Review—Answers and Rationales 2. Answer: B. Phagocytes Rationale: Lymphoid organs scattered throughout the body house phagocytic cells and lymphocytes, which are essential to the body’s defense system. 3. Answer: D. Splenectomy Rationale: Splen- is the root for spleen. The suffix -ectomy is surgical removal of. A splenectomy is removal of the spleen, total or partial. If only part of the spleen is removed from a patient under 12 years of age, it can regenerate. 4. Answer: B. Subclavian veins Rationale: Both of the lymphatic ducts empty their contents into the subclavian veins. The right lymphatic duct empties into the right subclavian vein and the thoracic duct empties into the left subclavian vein. 5. Answer: B. Lymphangitis Rationale: Lymphangitis is inflammation of lymphatic vessels as a result of bacterial infection. It appears as painful red streaks under the skin. Section Review 2.6 1. Answer: D. At the bifurcation of the trachea into two bronchi Rationale: At the last cartilage of the trachea, there is a spar of cartilage projecting posteriorly from its inner face, marking the point where the trachea branches into the two main bronchi. This cartilage projection is the carina. 2. Answer: B. Nose Rationale: The nose is responsible for providing an airway to breathe, moistening, warming, and filtering inspired air, serving as a resonating chamber for speech, and housing the smell receptors. 3. Answer: B. Incision into the chest wall Rationale: The root thorac/o means chest. The suffix -otomy means cutting into. Thoracotomy is making an incision into the chest wall. 4. Answer: C. Alveoli and capillaries Rationale: Gases are exchanged across the single cell layer of tissue comprising the alveolar sac into the pulmonary circulation. Capillaries from the pulmonary circulation are also a single cell layer thick. They form a bed around eachalveolus; gas is exchanged between the alveoli and the capillaries via the principles of diffusion. 5. Answer: B. -pnea Rationale: The suffix -pnea means breathing. You can derive this from the Medical Terms Related to the Respiratory System section. Each definition relating to breathing is for a word ending in -pnea. 2025 Medical Coding Training: CPC®—Answer Key www.aapc.com 5 Section Review—Answers and Rationales Section Review 2.7 1. Answer: A. Duodenum Rationale: The first portion of the small intestine is the duodenum, the second portion is the jejunum, and the distal portion is the ileum. 2. Answer: C. Liver Rationale: The gallbladder stores bile produced in the liver. Bile secreted into the intestines from the gallbladder helps the body digest fats. 3. Answer: B. Transverse colon Rationale: The ascending colon proceeds from the ileocecal valve upward to the hepatic flexure, becomes the transverse colon, and then turns downward to become the descending colon at the splenic flexure. 4. Answer: A. Buccal Rationale: Bucca means cheek. Buccal is relating to the cheek. Buccal swabs can be used for DNA testing. 5. Answer: D. Peristalsis Rationale: Wave like contractions called peristalsis move food through the digestive tract. Section Review 2.8 1. Answer: B. Urethra Rationale: The male and female urethras are quite different anatomically in position and length; however, they perform the same function with regard to urine, and are treated similarly for many surgical procedures in the coding genre. 2. Answer: A. Excretion of metabolic wastes, and fluid and electrolyte balance Rationale: The production of urine for the excretion of metabolic wastes along with fluid and electrolyte balance is the main function of the urinary system. This system also provides transportation and temporary storage of urine prior to the intermittent process of urination. 3. Answer: C. Cowper’s glands Rationale: Internal organs of the male genital system include the prostate gland, seminal vesicles, and Cowper’s glands. Cowper’s gland is also called the bulbourethral gland. It is a small gland secreting part of the seminal fluid. 4. Answer: B. Epispadias Rationale: Epispadias is a congenital defect in which the urethra opens on the dorsum of the penis. Hypospadias is a congenital defect in which the urethra opens on the underside of the penis. (epi=on, over, hypo= under, below.) 5. Answer: D. Either side of the introitus in the female Rationale: Bartholin’s glands are found on either side of the introitus (external opening to the vagina). 6 www.aapc.com CPT® copyright 2024 American Medical Association. All rights reserved.  Section Review—Answers and Rationales Section Review 2.9 1. Answer: C. Central Nervous System Rationale: The brain and spinal cord are the components of the central nervous system (CNS). The Somatic Nervous System and the Autonomic Nervous System are the two divisions of the Peripheral Nervous System. 2. Answer: B. Choroid Rationale: The eyeball has three layers: the retina (innermost), choroid (middle), and sclera (outermost). 3. Answer: D. Vitreous humor Rationale: A clear gel-like substance filling the posterior segment of the eye is called the vitreous and prevents the eyeball from collapsing. 4. Answer: B. Labyrinth Rationale: The ear has three distinct and separate anatomical divisions: the outer ear (external ear), middle ear (tympanic cavity), and inner ear (labyrinth). 5. Answer: B. Otopyorrhea Rationale: Otopyorrhea is pus draining from the ear. Section Review 2.10 1. Answer: D. Thyroid gland Rationale: The thyroid gland regulates metabolism and serum calcium levels through the secretion of thyroid hormone and calcitonin. 2. Answer: B. Carotid body Rationale: The carotid body is not a true endocrine structure, but is made of both glandular and nonglandular tissue. 3. Answer: C. Thymus gland Rationale: The thymus gland does much of its work in early childhood and is largest shortly after birth. By puberty, it is small and may be replaced by fat. 4. Answer: B. Pituitary gland Rationale: The pituitary gland is also known as the hypophysis cerebri. 5. Answer: A. Adrenal glands Rationale: The adrenal glands have two separate structural parts; the inner portion is the medulla and the outer portion is the cortex. Each structure performs a separate function. 2025 Medical Coding Training: CPC®—Answer Key www.aapc.com 7 Section Review—Answers and Rationales Section Review 2.11 1. Answer: A. Erythrocytes Rationale: Erythrocyte disorders include anemia (a deficiency in the amount of hemoglobin in the blood) and polycythemia (any condition in which there is a relative increase in the percent of red blood cells in whole blood). 2. Answer: B. Lymphocytes Rationale: Lymphocytes are involved in protection of the body from viral infections such as measles, rubella, chicken pox, or infectious mononucleosis. 3. Answer: C. Monocytes Rationale: Monocytes fight severe infections and are considered the body’s second line of defense against infection. 4. Answer: D. Eosinophils Rationale: The body uses eosinophils to protect against allergic reactions and parasites; elevated levels may indicate an allergic response. 5. Answer: C. Mononucleosis Rationale: Mononucleosis is a disease of excessive mononuclear leukocytes in the blood due to an infection with the Epstein- Barr virus. Section Review 3.1 1. Answer: C. NEC Rationale: NEC - Not elsewhere classifiable. This abbreviation, in the ICD-10-CM Alphabetic Index, represents “other specified.” When a specific code is not available for a condition, the Alphabetic Index directs the coder to the “other specified” code in the Tabular List. When a specific code is not available for a condition, the Tabular List includes an NEC entry under a code to identify the code as the “other specified” code. 2. Answer: B. D70.4, R50.81 Rationale: The instructions under code category D70 state to use additional code for any associated: fever (R50.81); mucositis (J34.81, K12.3-, K92.81, N76.81). Cyclic neutropenia with an associated fever is reported with D70.4, R50.81. Additional codes are not reported as primary codes. 3. Answer: D. They do not affect code assignment. Rationale: Parentheses are used in both the ICD-10-CM Alphabetic Index and Tabular List to enclose supplementary words that may be present in the statement of a disease or procedure without affecting the code number to which it is assigned. The terms within the parentheses are referred to as nonessential modifiers. 4. Answer: C. The code that represents the condition most commonly associated with the main term. Rationale: The default code represents the condition that is most commonly associated with the main term, or is the unspecified code for the condition. 8 www.aapc.com CPT® copyright 2024 American Medical Association. All rights reserved.  Section Review—Answers and Rationales 5. Answer: B. Category Rationale: Categories are three-character codes representing a single condition or disease. Section Review 3.2 1. Answer: D. Always consult the Alphabetic Index first. Refer to the Tabular List to locate the selected code. Rationale: Introduction ICD-10-CM—How to Use the ICD-10-CM—Steps to Correct Coding tells us to locate the main term in the Alphabetic Index, then verify the code in the Tabular List. 2. Answer: B. S80.02XA Rationale: In the ICD-10-CM Alphabetic Index, look for the main term Bruise. You are directed to see also Contusion. Look for the main term Contusion, locate the site (subterm) knee and you are referred to S80.0-√. Review in the Tabular List. There is a 5th character symbol in front of subcategory code S80.0 to indicate the laterality of the contusion. The contusion is on the left knee, reporting so far is S80.02. There is a symbol for a 7th character, indicating you need to report two more characters to complete this code. Because you only have five characters, S80.02, you need to report an X as a placeholder for your 6th character and then an A to indicate the initial encounter for your 7th character. There is an instructional note under category code S80 that indicates which letters can be used as the 7th character. Correct code choice is S80.02XA. 3. Answer: D. N40.1, R33.8 Rationale: Look in the ICD-10-CM Alphabetic Index for Hyperplasia, hyperplastic/prostate/with lower urinary tract symptoms, which refers you to N40.1. In the Tabular List, code N40.1 has instructions to use an additional code for associated symptoms. Code R33.8 is listed as one of those additional codes to report the urinary retention. Correct code choice is N40.1 and R33.8. In ICD-10-CM, go to the Tabular List at the beginning of Chapter 14: Diseases of Genitourinary System (N00-N99); there is information on Anatomy of the Male Reproductive System/Common Pathologies/Benign Prostate Hyperplasia (BPH), which gives you a description of this condition. 4. Answer: D. I10 Rationale: In the ICD-10-CM Alphabetic Index, look for Hypertension. You will see next to the main term Hypertension subterms (or nonessential modifiers) listed in parentheses, and the subterm essential is in parenthesis. Subterms that follow the main term, and are enclosed in parentheses, are nonessential modifiers, which clarify the diagnosis but are not required. Verify in the Tabular List that code I10 is for Essential Hypertension. 5. Answer: D. M25.551, M25.552 Rationale: In the ICD-10-CM Alphabetic Index, look for Pain(s)/joint/hip. You are directed to subcategory code M25.55-. In the Tabular List, a 6th character is assigned to indicate laterality. Because there is no code choice for bilateral, M25.551 is reported for the right hip pain and M25.552 is reported for the left hip pain. Section Review 3.3 1. Answer: B. R11.2 Rationale: The ICD-10-CM Official Guidelines for Coding and Reporting, section I.B.9, give instructions to code both conditions together when a combination code applies. Look in the ICD-10-CM Alphabetic Index for Nausea/with vomiting. R11.2 combines the nausea and vomiting conditions. R11 is an incomplete code and requires additional characters. 2025 Medical Coding Training: CPC®—Answer Key www.aapc.com 9 Section Review—Answers and Rationales 2. Answer: C. There is no time limit on sequelae. Rationale: ICD-10-CM Official Guidelines for Coding and Reporting, section I.B.10, state there is no time limit when sequela codes can be used. 3. Answer: B. Code the acute condition first, followed by the chronic condition. Rationale: ICD-10-CM Official Guidelines for Coding and Reporting, section I.B.8, state to code the acute condition first, followed by the chronic condition. 4. Answer: A. Check the ICD-10-CM Alphabetic Index to see if there are listings under threatened or impending; and if not, code the existing underlying condition(s) rather than the condition described as impending. Rationale: ICD-10-CM Official Guidelines for Coding and Reporting, section I.B.11, state to check the Alphabetic Index for listings under threatened or impending; and if not, code the existing underlying condition(s), not the condition described as impending. 5. Answer: C. S82.891A, S82.892A Rationale: ICD-10-CM Official Guidelines for Coding and Reporting, sections I.B.12 and I.B.13, state to use a diagnosis code only once for an encounter and to identify laterality when possible. This applies to bilateral conditions when there are no distinct codes identifying laterality or two different conditions classifies to the same ICD-10-CM diagnosis code. If no bilateral codes are provided and the condition is bilateral, assign separate codes for both the left and right side. If the side is not identified in the medical record, assign the code for the unspecified side. Look for Fracture, traumatic/ankle and you are referred to S82.899-. In the question, the ankle fracture does not further indicate a specific location or bone in the ankle that has been fractured, so subcategory S82.89- is correct. Verification in the Tabular List shows that there are specific codes for the right and left ankle and the codes require additional characters for laterality and initial encounter. Code S82.891A for the right ankle and S82.892A for the left, since there is not a code choice for bilateral. Section Review 3.4 1. Answer: A. K80.20, G89.18 Rationale: According to the ICD-10-CM Official Guidelines for Coding and Reporting, section IV.A.2, when a patient presents for outpatient surgery and develops complications requiring admission to observation, code the reason for the surgery as the primary diagnosis and the complications as secondary diagnosis. Look for the main term Gallstone in the ICD-10-CM Alphabetic Index and you are referred to see also Calculus, gallbladder. Look for Calculus/gallbladder, which refers you to K80.20. For the postoperative pain, look for Pain(s)/postoperative NOS and you are referred to G89.18. Verify codes in the Tabular List. 2. Answer: D. N83.201, J06.9, Z53.09 Rationale: ICD-10-CM coding guidelines, section IV.A.1, state to report the reason for surgery as the first listed diagnosis even if the surgery is cancelled due to a contraindication. Look in the ICD-10-CM Alphabetic Index for Cyst/ovary, ovarian (twisted) and you are referred N83.201. In the Tabular List, 6th character 1 is reported for the right side. For the respiratory infection, look in the Alphabetic Index for Infection/respiratory (tract)/upper (acute) NOS and you are referred to J06.9. Then, look for Canceled procedure/because of/contraindication, which refers you to Z53.09. Verify codes in the Tabular List. 10 www.aapc.com CPT® copyright 2024 American Medical Association. All rights reserved.  Section Review—Answers and Rationales 3. Answer: C. R07.9, R50.9, R05.9 Rationale: ICD-10-CM coding guidelines, section IV.H, instruct you to code signs and symptoms when the diagnosis is uncertain. Diagnosis stated as “rule out,” “suspected,” “questionable,” “probable,” “compatible with,” “consistent with,” “working diagnosis,” or other similar terms indicating uncertainty are not reported. The pneumonia is a rule out diagnosis and is not coded. Instead, code the symptoms. In the ICD-10-CM Alphabetic Index, look for Pain(s)/chest (central) (R07.9), Fever (R50.9), and Cough (R05.9). Verify code selection in the Tabular List. 4. Answer: D. Z00.01, L98.9 Rationale: ICD-10-CM coding guidelines, section IV.P. requires the coder to report first the general medical exam diagnosis and then the abnormal finding. Look in the ICD-10-CM Alphabetic Index for Examination (for) (following) (general) (of) (routine)/annual (adult) (periodic) (physical)/with abnormal findings Z00.01. In the Tabular List, there is a note to also report the code to identify the abnormal finding. Look in the ICD-10-CM Alphabetic Index for Lesion/Skin L98.9. Verify code selection in the Tabular List. 5. Answer: D. Z01.811, D73.1, J44.9 Rationale: ICD-10-CM coding guidelines, section IV.M, state to sequence first a code from subcategory Z01.81, Encounter for preprocedural examinations. Assign a code for the condition to describe the reason for the surgery as an additional diagnosis. Look in the ICD-10-CM Alphabetic Index for Examination/pre-procedural/respiratory (Z01.811). Next, report the findings related to the reason for the pre-operative screening. Look for Hypersplenia, hypersplenism (D73.1). Then, look in the Alphabetic Index for Disease, diseased/pulmonary/chronic obstructive referring you to J44.9. Verify the codes in the Tabular List. Section Review 4.1 1. Answer: D. S72.052B, B20 Rationale: ICD-10-CM guideline I.C.1.a.2.b. states, “If a patient with HIV disease is admitted for an unrelated condition (such as a traumatic injury), the code for the unrelated condition (e.g., the nature of the injury code) should be the principal diagnosis. Other diagnoses would be B20 followed by additional diagnosis codes for all reported HIV-related conditions.” The open fracture of the head of the femur (S72.052B) is reported first as the reason for the visit because it is unrelated to HIV. To locate the diagnosis, look in the ICD-10-CM Alphabetic Index for Fracture, traumatic/femur, femoral/upper end/head referring you to subcategory code S72.05-. In the Tabular List, 6th character 2 indicates the left femur. 7th character B indicates the initial encounter for a type 1 open fracture. HIV is symptomatic so it is reported secondarily with B20. 2. Answer: A. A41.9, R65.20, N17.9 Rationale: ICD-10-CM guideline I.C.1.d.1.b indicates: The coding of severe sepsis requires a minimum of two codes. First, a code for the underlying systemic infection, followed by a code from subcategory R65.2, Severe sepsis. If the causal organism is not documented, assign code A41.9, Sepsis, unspecified organism, for the infection. Additional codes(s) for the associated acute organ dysfunction are also required (if present). The first code to report is sepsis; look for the main term Sepsis in the ICD-10-CM Alphabetic Index referring you to code A41.9. Next, look for Sepsis/with organ dysfunction (acute) (multiple) referring you to code R65.20. For the last code, look for Failure/renal/acute referring you to code N17.9. In the Tabular List, you will find an instructional note under subcategory R65.2 indicating what codes should be reported first and what codes should be reported as additional codes. 3. Answer: B. J15.212 Rationale: Look in the ICD-10-CM Alphabetic Index for Pneumonia/in (due to)/staphylococcus/aureus/methicillin resistant (MRSA) J15.212. According to ICD-10-CM guideline 1.C.1.e.1.(a), when a combination code exists for MRSA and the infection, only the combination code should be reported. Pneumonia due to Methicillin-resistant Staphylococcus aureus is reported with J15.212. 2025 Medical Coding Training: CPC®—Answer Key www.aapc.com 11 Section Review—Answers and Rationales Section Review 4.2 1. Answer: D. C78.01, Z85.3 Rationale: According to ICD-10-CM guidelines 1.C.2.d., when a primary malignancy has been previously excised and there is no evidence of any existing primary malignancy, a code from category Z85.-, Personal history of malignant neoplasm should be used. Any mention of metastasis to another site is coded as a secondary malignant neoplasm to that site and the secondary site may be the first-listed with the Z85- code used as a secondary code. For the metastasized lung cancer, look in the Table of Neoplasms for lung and use the code from the Malignant Secondary column (C78.0-). In the Tabular List, C78.01 is selected for the right lung. For the history of breast cancer, look in the ICD-10-CM Alphabetic Index for History/personal (of)/malignant neoplasm (of)/breast Z85.3. The correct codes and sequencing are C78.01 and Z85.3. 2. Answer: A. D64.81, C56.9, T45.1X5A Rationale: According to ICD-10-CM guidelines 1.C.2.c.2., because the treatment is directed at the anemia associated with chemotherapy, and the treatment is only for the anemia, the anemia should be sequenced first, followed by the appropriate codes for the neoplasm and the adverse effect (T45.1X5). Look in the ICD-10-CM Alphabetic Index for Anemia/due to (in) (with)/antineoplastic chemotherapy (D64.81). According to guideline 1.C.2.c.2. the malignancy is reported secondarily followed by code T45.1X5. Look in the ICD-10-CM Table of Neoplasms for ovary and report the code from the Malignant Primary column (C56.-). In the Tabular List, C56.9 is reported because the laterality is not stated. Next, to locate T45.1X5, look in the Table of Drugs and Chemicals for Antineoplastic NEC and selecting the code from the Adverse effect column (T45.1X5). In the Tabular List, T45.1X5 requires a 7th character extender. A is selected because this is considered active treatment. 3. Answer: D. Z51.11, C34.12 Rationale: The ICD-10-CM Official Coding Guidelines, Section 1.C.2.e.2., states that if the reason for the encounter is solely chemotherapy, a diagnosis for chemotherapy administration should be listed first, and a diagnosis for the malignancy requiring the chemotherapy is reported secondarily. Look in the ICD-10-CM Alphabetic for Chemotherapy (session) (for)/ neoplasm or Encounter (with health service) (for)/chemotherapy for neoplasm (Z51.11). A Pancoast’s tumor is a rapid growing tumor in the apex of the lung. The apex of the lung is in the upper lobe for Pancoast’s Tumor. Look for Tumor/Pancoast’s - see Pancoast’s syndrome. Look for Pancoast’s syndrome or tumor C34.1-. Add 2 as the 5th character for left lung. The correct codes and sequencing are Z51.11 and C34.12. Section Review 4.3 1. Answer: C. The chronic condition causing the anemia Rationale: ICD-10-CM Official Coding Guidelines, Section I.A.13., state when using a code from a category that indicates “in diseases classified elsewhere,” such as in category D63, it is necessary to code first the chronic condition (underlying condition) causing the anemia. The codes from category D63 are manifestation codes that must be reported as the additional code following the underlying condition. 2. Answer: A. C61, D63.0 Rationale: ICD-10-CM Official Coding Guidelines, Section I.C.2.c.1, states when the admission/encounter is for management of an anemia associated with the malignancy, and the treatment is only for the anemia, the appropriate code for the malignancy is sequenced as the principal or first-listed diagnosis followed by the appropriate code for the anemia. The patient visited the oncologist for the prostate cancer and the lab tests indicate anemia due to cancer. According to the guidelines, the primary diagnosis reported for the visit, is prostate cancer. Look in the Table of Neoplasms for prostate (gland) and select the code from the Malignant Primary column C61. Then look in the Alphabetic Index for Anemia/in (due to) (with)/neoplastic disease D63.0. Verify codes in the Tabular List. 12 www.aapc.com CPT® copyright 2024 American Medical Association. All rights reserved.  Section Review—Answers and Rationales 3. Answer: B. N18.30, D63.1 Rationale: ICD-10-CM Official Coding Guidelines, Section I.A.13., states codes that fall under the category “in diseases classified elsewhere,” are manifestation codes. There will be an instructional note (such as a code first note) with these manifestation codes that will indicate the proper sequencing order of the codes. Look in the ICD-10-CM Alphabetic Index for Anemia/in (due to) (with)/chronic kidney disease D63.1. See the Code first note instructing to report the CKD (N18-) code first. Look in the ICD-10-CM Alphabetic Index for Disease/kidney/chronic/stage 3 (moderate) N18.30. Verification in the Tabular List verifies correct sequencing as N18.30, D63.1 Section Review 4.4 1. Answer: A. When a patient’s insulin pump malfunctions Rationale: The ICD-10-CM Official Coding Guidelines, Section I.C.4.a.5.a states to use a code from category T85.6 as the primary diagnosis for an underdose of insulin, due to insulin pump malfunction. The second code would be T38.3x6-, for the underdosing of insulin, followed by the appropriate diabetes mellitus code based on documentation. 2. Answer: A. E11.9, Z79.84 Rationale: According to ICD-10-CM Official Coding Guidelines, Section I.C.4.a.1, the age of the patient is not the determining factor in what type of diabetes is coded. In addition, Section I.C.4.a.2 says if the type of diabetes mellitus is not documented in the medical record the default type is type 2. To find the code, look in the ICD-10-CM Alphabetic Index for Diabetes, diabetic (mellitus) (sugar). The default code is E11.9. Verification in the Tabular List verifies code selection. ICD-10-CM guideline I.C.4.a.3 directs the coder to report Z79.84 to indicate the patient uses oral hypoglycemic or antidiabetic drugs. Look in the Alphabetic Index for Long-term (current) (prophylactic) drug therapy (use of)/oral/antidiabetic Z79.84. 3. Answer: A. E11.311 Rationale: According to ICD-10-CM Official Coding Guidelines, Section I.C.4.a the diabetes codes are combination codes that include the type of diabetes, the body system affected, and the complications affecting that body system. To locate the codes in the ICD-10-CM code book, look in the ICD-10-CM Alphabetic Index for Diabetes, diabetic/with/retinopathy/with macular edema E11.311. Verify code choice in the Tabular List. Section Review 4.5 1. Answer: D. F50.019 Rationale: In the ICD-10-CM Alphabetic Index, look for Anorexia/nervosa/restricting type which directs you to subcategory code F50.01, without further specificity, the 6th character is 9. The patient is losing weight due to restricting her intake of food; this is considered restricting type. Weight loss is integral to the diagnosis of anorexia nervosa; therefore, no additional codes are assigned. Verify code selection in the Tabular List. 2. Answer: B. F10.20 Rationale: The patient’s diagnosis is uncomplicated alcohol dependence. In the ICD-10-CM Alphabetic Index, look for dependence/alcohol F10.20. Verify code selection in the Tabular List. 3. Answer: A. F90.0 Rationale: The patient is diagnosed with Attention Deficit Hyperactivity Disorder (ADHD), predominately inattentive type. In the ICD-10-CM Alphabetic Index, look for Disorder (of)/attention deficit hyperactivity (adolescent) (adult) (child)/inattentive/ type F90.0. Verify code selection in the Tabular List. 2025 Medical Coding Training: CPC®—Answer Key www.aapc.com 13 Section Review—Answers and Rationales Section Review 4.6 1. Answer: B. When the pain control or pain management is the purpose of the encounter Rationale: According to ICD-10-CM Official Coding Guidelines, Section I.C.6.b.1(a), when pain control or pain management is the reason for the admission/encounter, a diagnosis from G89 can be reported as the primary diagnosis. 2. Answer: B. C34.92, G89.3 Rationale: According to ICD-10-CM Official Coding Guidelines, 1.C.6.b.5, when the reason for the admission/encounter is management of the neoplasm and the pain associated with the neoplasm is also documented, code G89.3 may be assigned as an additional diagnosis. In the Table of Neoplasms, look for lung and select the code from the Malignant Primary column. The Tabular List indicates a 5th character 2 for the left lung. To report the pain associated with the neoplasm, look in the ICD-10-CM Alphabetic Index for Pain/due to cancer G89.3. 3. Answer: C. G89.21, M54.50 Rationale: According to ICD-10-CM Official Coding Guidelines, Section I.C.6.b.1(a), when a patient is admitted for the insertion of a neurostimulator for pain control, assign the appropriate pain code as the first listed diagnosis. According to ICD-10-CM guideline 1.C.6.b.1.b.ii, a code to report the site of pain may be sequenced as a secondary diagnosis. In the ICD-10-CM Alphabetic Index, look for Pain/Chronic/due to trauma G89.21 (because the pain is due to the falling off a roof). To report the location of the pain, look in the ICD-10-CM Alphabetic Index for Pain/low back M54.50. Section Review 4.7 1. Answer: D. H40.1312, H40.1321 Rationale: ICD-10-CM Official Coding Guidelines, Section 1.C.7.a.3, state when the glaucoma codes report laterality, and each eye is in a different stage, a code is reported for each eye. Look in the ICD-10-CM Alphabetic Index for Glaucoma/pigmentary and you are directed to see Glaucoma, open angle, primary, pigmentary. This path directs you to code H40.13-. In the Tabular List, 6th character 1 indicates the right eye, 7th character 2 indicates moderate stage. For the left eye, 6th character 2 indicates the left eye and 7th character 1 indicates mild stage. The moderate stage is reported first because it is more severe. 2. Answer: B. H10.021 Rationale: Look in the ICD-10-CM Alphabetic Index for Pink/eye and you are directed to see conjunctivitis, acute, mucopurulent. Mucopurulent is a secretion of mucus or pus from the eye. This path directs you to H10.02-. In the Tabular List, 6th character 1 indicates the right eye. 3. Answer: A. H25.12 Rationale: Look in the ICD-10-CM Alphabetic Index for Cataract/age-related and you are directed to see Cataract, senile. Cataract/senile/nuclear (sclerosis) directs you to H25.1-. A 5th character 2 is selected for the left eye. Section Review 4.8 1. Answer: D. H66.91 Rationale: Look in the ICD-10-CM Alphabetic Index for Otitis (acute)/media/acute, subacute H66.90. In reviewing the Tabular List, H66.90 is unspecified and there are more specific codes that indicate laterality. The 5th character 1 indicates the right ear. Right ear pain (H92.01) and fever (R50.9) are signs/symptoms for the acute otitis media and not separately reported (refer to ICD-10-CM guideline I.B.5). 14 www.aapc.com CPT® copyright 2024 American Medical Association. All rights reserved.  Section Review—Answers and Rationales 2. Answer: B. H81.01 Rationale: Look in the ICD-10-CM Alphabetic Index for Meniere’s disease, syndrome or vertigo H81.0-. The 5th character 1 indicates the right ear. The vertigo (R42), loss of hearing (H91.91) and the tinnitus (H93.11) are signs/symptoms for the Meniere’s disease and not separately reported (refer to ICD-10-CM Guideline Section I.B.5.). 3. Answer: A. H61.23 Rationale: Look in the ICD-10-CM Alphabetic Index for Impaction, impacted/cerumen (ear) (external) H61.2-. In the Tabular List, a 5th character 3 indicates bilateral. Because there is a bilateral code for this condition only one code is reported for both ears (refer to ICD-10-CM guideline I.B.13). Section Review 4.9 1. Answer: D. Sequencing is based on the reason for the encounter. Rationale: ICD-10-CM Official Coding Guidelines, Section I.C.9.a.5, state Background retinopathy and retinal vascular changes, should be used with a code from category I10-I15 to identify the hypertension. Sequencing is based on the reason for the encounter. 2. Answer: C. Code only STEMI Rationale: ICD-10-CM Official Coding Guidelines, Section 1.C.9.e.1, state that if STEMI converts to NSTEMI due to thrombolytic therapy, it is still coded as STEMI. 3. Answer: B. Hypertension and chronic kidney disease Rationale: ICD-10-CM Official Coding Guidelines, Section 1.C.9.a.2 - Section I.C.9.a.3, state that hypertension has a presumed cause-and-effect relationship with CKD. Section Review 4.10 1. Answer: B. Worsening or decompensation of asthma or COPD Rationale: ICD-10-CM Official Coding Guidelines, Section 1.C.10.a.1, states an acute exacerbation is a worsening or decompensation of a chronic condition. 2. Answer: C. J45.902 Rationale: The final diagnosis is asthma with status asthmaticus. To locate the code in the ICD-10-CM Alphabetic Index, look for Asthma/with/status asthmaticus, J45.902. Verify code selection in the Tabular List. 3. Answer: C. J44.0, J20.9 Rationale: Locate the correct code in the ICD-10-CM Alphabetic Index by looking for Disease/pulmonary/chronic obstructive/ with/acute bronchitis, J44.0. In the Tabular List, there is a note under J44.0 to use an additional code to identify the infection. Look in the Alphabetic Index for Bronchitis/acute or subacute (with bronchospasm or obstruction) J20.9. Verify code selection in the Tabular List. 2025 Medical Coding Training: CPC®—Answer Key www.aapc.com 15 Section Review—Answers and Rationales Section Review 4.11 1. Answer: B. K41.91 Rationale: In the ICD-10-CM Alphabetic Index, look for Hernia/femoral/recurrent. You are directed to K41.91. Verify the code selection in Tabular List. 2. Answer: B. K70.30, F10.20 Rationale: In the ICD-10-CM Alphabetic Index, look for Cirrhosis, cirrhotic (hepatic) (liver)/Laennec’s/alcoholic K70.30. In this scenario the patient has a history of alcohol use making K70.30 the correct code. There is an instructional note under category code K70 to use additional code to identify alcohol abuse and dependence. The patient is alcohol dependent. In the Alphabetic Index, look for Dependence/alcohol referring you to code F10.20. Verify code selection in the Tabular List. 3. Answer: C. K80.10 Rationale: The patient is diagnosed with gallstones (cholelithiasis) and gallbladder inflammation (cholecystitis). In the ICD-10-CM Alphabetic Index, look for Cholecystitis/with calculus, stones in/gallbladder; you are referred to - see Calculus gallbladder, with cholecystitis. Look for Calculus/gallbladder/with cholecystitis which directs you to K80.10. Because code K80.10 is a combination code for both cholelithiasis and cholecystitis only one code is reported, not each separately (Refer to ICD-10-CM guideline I.B.9). Verify code selection in Tabular List. Section Review 5.1 1. Answer: D. L89.614, L89.624 Rationale: Codes for pressure ulcers are determined by site, stage, and laterality. In this case, the patient has pressure ulcers on each heel, stage 4. Look in the ICD-10-CM Alphabetic Index for Ulcer/pressure/stage 4/heel L89.6-. In the Tabular List, a 5th character is required for laterality and 6th character is required for the stage. Report L89.614 for the right and L89.624 for the left. 2. Answer: D. L24.0 Rationale: The patient is diagnosed with dermatitis due to detergent. In the ICD-10-CM Alphabetic Index, look for Dermatitis/ due to/detergents (contact) (irritant). You are referred to L24.0. Verify the code selection in the Tabular List. 3. Answer: A. L02.416 Rationale: In the ICD-10-CM Alphabetic Index, look for Abscess/leg. This refers you to see Abscess, lower limb L02.41-. In the Tabular List, a 6th character is required for laterality and location. 6th character 6 is reported for the left lower limb. Section Review 5.2 1. Answer: A. M51.17 Rationale: L5 and S1 refer to the 5th lumbar disc and the 1st sacral disc in the vertebra. Look in the ICD-10-CM Alphabetic Index for Hernia, hernial/intervertebral cartilage or disc, you are referred to see Displacement, intervertebral disc. Look for Displacement, displaced/intervertebral disc NEC/lumbosacral region/with neuritis, radiculitis, radiculopathy or sciatica M51.17. Verify code selection in the Tabular List. 16 www.aapc.com CPT® copyright 2024 American Medical Association. All rights reserved.  Section Review—Answers and Rationales 2. Answer: B. M75.111, M19.011 Rationale: The patient has a degenerative incomplete rotator cuff tear on the right shoulder and primary degenerative arthritis. The primary reason for the procedure is the tear, so it is reported first. In the ICD-10-CM Alphabetic Index, look for Tear, torn/rotator cuff (nontraumatic)/incomplete M75.11-. A trauma or injury needs to be indicated to report a traumatic rotator cuff tear code. In the Tabular List, complete the code for right shoulder. 6th character 1 is reported for the right shoulder. The complete code is M75.111. For the second diagnosis, look for Arthritis, arthritic/degenerative. You are referred to see Osteoarthritis. Look for Osteoarthritis/primary/shoulder M19.01-. In the Tabular List, a 6th character is required to report laterality. 6th character 1 reports the right shoulder. The complete code is M19.011. 3. Answer: C. M80.051A Rationale: A combination code is reported for the pathological fracture and osteoporosis. In the ICD-10-CM Alphabetic Index, look for Osteoporosis/age related/with current pathological fracture/hip M80.05-. In the Tabular List, this section includes osteoporosis with current pathological fracture and the subcategory code is reported for age-related osteoporosis with current pathological fracture of femur, which includes the hip. A 6th character is required. Complete the code with 6th character 1 for right femur and 7th character A for initial encounter. Section Review 5.3 1. Answer: C. N13.30 Rationale: The indication for the surgery is hydronephrosis. In the ICD-10-CM Alphabetic Index, look for the main term Hydronephrosis. There is no indication of causal organism, or that it is a congenital condition. The default code is N13.30. A review of this code in the Tabular List confirms this is the correct diagnosis. 2. Answer: D. D25.9 Rationale: The patient is diagnosed with a uterine fibroid. The symptoms, heavy bleeding and painful menstruation, she is experiencing are integral to the definitive diagnosis and should not be coded. In the ICD-10-CM Alphabetic Index, look for main term Fibroid and then uterus. You are referred to D25.9. There is no location given of where the fibroid (leiomyoma) is located. Review of the code in the Tabular List confirms this is the correct code. 3. Answer: C. N40.1, R39.15 Rationale: The patient is diagnosed with BPH (Benign Prostatic Hypertrophy) and urgency, which is a symptom of this condition. Look in the ICD-10-CM Alphabetic Index for the main term Hypertrophy then prostate, which directs you to see Enlargement, enlarged, prostate. Look for Enlargement, enlarged/prostate/with lower urinary tract symptoms (LUTS) N40.1. In the Tabular List, N40.1 has a note to “Use additional code for associated symptoms, when specified.” Use R39.15 to report the urinary urgency. Because code R39.15 is listed as an additional code, it is not reported as primary code. Section Review 5.4 1. Answer: C. O99.012, D50.9, Z3A.21 Rationale: Codes O99.012, Z3A.21 are both assigned. ICD-10-CM guideline 1.C.15.b.3 indicates, “in episodes where no delivery occurs, the principal diagnosis should correspond to the principal complication of the pregnancy which necessitated the encounter”. Look in the Alphabetic Index for Pregnancy/complicated by/anemia O99.01-. Verification in the Tabular List indicates the code is completed with a 6th character based on trimester. Choose O99.012 for second trimester. There is an instructional note under category code 099 that indicates to use an additional code to identify the specific condition. Code D50.9 is reported for iron deficiency anemia. Use additional code for number of weeks. Look for Pregnancy/ weeks of gestation/21 weeks Z3A.21. 2025 Medical Coding Training: CPC®—Answer Key www.aapc.com 17 Section Review—Answers and Rationales 2. Answer: A. O72.2 Rationale: Look in the ICD-10-CM Alphabetic Index for Retention/placenta/portions or fragments (with hemorrhage) O72.2. Verification in Tabular List confirms correct code choice. 3. Answer: D. T22.212A, T22.211A, T31.0, Z33.1 Rationale: The pregnancy is incidental to the problem for which the patient is treated, so complication pregnancy code O09.90 is not reported. The first listed code is for the burns. The patient has a second degree burn to both forearms. In the ICD-10-CM Alphabetic Index, look for Burn/forearm/right/second degree T22.211 and Burn/forearm/left/second degree T22.212. The 7th character, A, completes the code to indicate initial encounter. A code from category T31 is coded to indicate the TBSA burned, as well as the percentage of the burn that is third-degree. The TBSA is 9 percent and there are no third-degree burns. Look for Burn/extent (percentage of body surface)/less than 10 percent T31.0. The last code is for the pregnancy. Look for State (of)/pregnant, incidental or status (post)/pregnancy, incidental referring you to Z33.1. A code from category Z34 is not reported because that is if the patient was being seen for routine care or check-up of the pregnancy. Section Review 5.5 1. Answer: B. It ends at 28 days Rationale: According to the ICD-10-CM Guidelines for Coding and Reporting, Section I.C.16, “For coding and reporting purposes the perinatal period is defined as before birth through the 28th day following birth.” 2. Answer: D. Z38.00, P59.9 Rationale: The question is asking for the codes for the newborn’s record. According to the ICD-10-CM guidelines I.C.16.a.1 codes from the obstetric chapter (Chapter 15) are never permitted on the newborn record, do not report codes O80 and Z37.0. ICD-10-CM guideline I.C.16.a.2 indicates, the first listed diagnosis code, Z38.00, is used to report the birth episode, followed by additional codes for perinatal conditions. Look in the ICD-10-CM Alphabetic Index for Newborn/born in hospital. You are referred to Z38.00. In the Alphabetic Index, look for Newborn/jaundice and you are referred to P59.8. Look in the Alphabetic Index for Jaundice/newborn and you are referred to P59.9. In the Tabular List, P59.9 is unspecified which is correct for this case. Verify all codes in the Tabular List. 3. Answer: B. P92.9 Rationale: In the ICD-10-CM Alphabetic Index, look for Feeding/problem/newborn. You are referred to P92.9. Verify the code in the Tabular List. Section Review 5.6 1. Answer: A. They can be used throughout the life of the patient unless it has been corrected. Rationale: ICD-10-CM guideline I.C.17 states that codes Q00-Q99 “may be used throughout the life of the patient. If a congenital anomaly has been corrected, a personal history code should be used to identify the history of the malformation/ deformation or deformity.” 18 www.aapc.com CPT® copyright 2024 American Medical Association. All rights reserved.  Section Review—Answers and Rationales 2. Answer: C. Z38.00, Q90.9 Rationale: According to ICD-10-CM guideline I.C.17 for birth admission, the appropriate code from category Z38- Liveborn infants, according to the type of birth should be sequenced as the principal diagnosis, followed by any congenital anomaly codes Q00-Q99. To find the type of birth, look in the ICD-10-CM Alphabetic Index for Newborn/born in hospital Z38.00. Down Syndrome is reported secondarily and is found in the ICD-10-CM Alphabetic Index by looking for the main term Down Syndrome, Q90.9. Although category Q90 has a use additional note to also report associated physician condition and degree of intellectual disabilities, this is a newborn and this information is not known so it is not reported. 3. Answer: C. Q36.9 Rationale: Look in the ICD-10-CM Alphabetic Index for Cheiloschisis referring you to see Cleft, lip. Look for Cleft/lip, you are directed to Q36.9. Verification in the Tabular List reports Cleft lip NOS under code Q36.9. Section Review 5.7 1. Answer: B. R63.0, E86.0 Rationale: ICD-10-CM guidelines tell us not to report an unsubstantiated, probable, or rule out diagnosis; therefore, a diagnosis of dementia is not appropriate at this time. The symptoms are dehydration and anorexia. Each of these terms requires a simple look-up in the ICD-10-CM Alphabetic Index. Although anorexia often is a short way of describing anorexia nervosa, in this case, there is no documentation of an eating disorder as a psychological disorder; look for the main term anorexia, R63.0, which is the correct diagnosis. Look for the main term Dehydration, E86.0. Verify all codes in the Tabular List. 2. Answer: B. R03.0 Rationale: Elevated blood pressure is a nonspecific finding with no formal diagnosis of hypertension. This is considered an incidental finding. Hypertension should not be coded unless it is documented specifically by the physician. Look in the ICD-10-CM Alphabetic Index for Elevated, elevation/blood pressure/reading (incidental) (isolated) (nonspecific), no diagnosis of hypertension. 3. Answer: C. When it is not integral to the definitive diagnosis. Rationale: Signs and symptoms are reported when a definitive diagnosis has not been established. If the sign or symptom is not integral to the definitive diagnosis, the sign(s) and symptom(s) should be reported. Section Review 5.8 1. Answer: A. S82.402A, S82.202A Rationale: Look in the ICD-10-CM Alphabetic Index for Fracture, traumatic/fibula (shaft) (styloid) S82.40-. Next look for Fracture, traumatic/tibia (shaft) S82.20-. Verification in the Tabular List indicates the 6th character 2 for left side. 7th character A for initial encounter is also reported. S82.402A, S82.202A. According to the ICD-10-CM guidelines, when a fracture is not specified as open or closed, the default is to code it as closed. Even though an open repair is performed, the diagnosis is not determined by the type of treatment. 2025 Medical Coding Training: CPC®—Answer Key www.aapc.com 19 Section Review—Answers and Rationales 2. Answer: C. T80.218A, A49.02 Rationale: When complications are reported, a code for the complication is reported first. If the cause of the complication is known, it is reported as the additional code(s). Look in the ICD-10-CM Alphabetic Index for Infection/due to or resulting from/ central venous catheter/specified NEC T80.218-. Verification in the Tabular List indicates this code needs a 7th character. 7th character extension A is reported for the initial encounter. T80.218A is correct because we do know that this is an MRSA infection, however, we do not know whether it is a local infection or bloodstream infection. Next look for MRSA (Methicillin resistant Staphylococcus aureus)/infection A49.02. Verify code in the Tabular List. 3. Answer: D. T43.201A, R42, R61 Rationale: The patient took the correct medication but accidently did not take it as prescribed. This is considered poisoning. The first code to report is the poisoning code for type of medicine, followed by the symptoms. Look in the Table of Drugs and Chemicals for antidepressant. The first code reported is the code from the Poisoning, Accidental (unintentional) column T43.201. Verification in the Tabular List indicates the need for a 7th character choosing A for initial encounter, T43.201A. The manifestation or condition codes are reported next. Look in the Alphabetic Index for Dizziness R42 and Sweating, excessive R61. Verify codes in the Tabular List. Section Review 5.9 1. Answer: D. S52.302B, S52.202B, S02.630A, V43.62XA Rationale: A code is reported for each fracture. The radius and ulna fracture is open, which makes it the most severe injury; therefore, it is reported first. Look in the ICD-10-CM Alphabetic Index for Fracture, traumatic/radius/shaft S52.30-. Verification in Tabular List indicates for the 6th character 2 for left radius and B for the 7th character for initial encounter for open Type 1 fracture, S52.302B. Next look for Fracture, traumatic/ulna (shaft) S52.20-. 6th character 2 is for the left radius and B for the 7th character for initial encounter for open Type I fracture, S52.202B. Look in the ICD-10-CM Alphabetic Index for Fracture, traumatic/jaw (bone) (lower) - see Fracture, mandible. Look for Fracture, traumatic/mandible (lower jaw (bone))/ coronoid process S02.63. In the Tabular List, 6th character 0 is reported for unspecified side and an A for the 7th character for initial encounter for a closed fracture, S02.630A. The patient was a passenger in a car that collided with another car. Look in the External Cause of Injuries Index for Accident/car - see Accident/transport, car occupant. Look for Accident/transport (involving injury to)/car occupant/passenger/collision (with)/car(traffic) V43.62-. Add placeholder X for the 6th character and A for the 7th character for initial encounter. There are no other circumstances known about the collision, so no other external cause codes are reported. 2. Answer: B. R04.0, W21.05XA, Y92.39, Y93.67, Y99.8 Rationale: The epistaxis is caused from an injury; it is not hereditary. This is found by looking in the ICD-10-CM Alphabetic Index for Epistaxis (multiple) and using the default code R04.0. Four external cause codes are required in this case. The first code indicates how the injury occurred (hit with a ball). Look in the External Cause of Injuries Index for Struck (accidentally) by/ball (hit) (thrown)/basketball W21.05-. Add a placeholder X for the 6th character and an A for the 7th character to indicate initial encounter, W21.05XA. The next code reports where the accident occurred. Look for Place of occurrence/Gymnasium, Y92.39. Next, code the activity he was involved in at the time. Look for Activity/basketball Y93.67. The last external cause code is a status code. Look for Status of external cause/student activity, Y99.8. 3. Answer: A. External cause codes are never sequenced first. Rationale: According to the ICD-10-CM guideline I.C.20.a.6, an external cause code can never be a principal/first-listed diagnosis. 20 www.aapc.com CPT® copyright 2024 American Medical Association. All rights reserved.  Section Review—Answers and Rationales Section Review 5.10 1. Answer: C. Z02.1 Rationale: The patient has no complaints. The diagnosis codes for employment exams are found under the main term Examination in the ICD-10-CM Alphabetic Index. Look for Examination/medical (adult) (for) (of)/pre-employment you are referred to Z02.1. Verification in the Tabular List confirms this is the correct code. 2. Answer: D. Z12.39, R92.30, R92.2, Z80.3 Rationale: Code the special screening as a reason for the encounter, along with codes to report the patient’s inconclusive mammogram due to dense breasts, which provides medical necessity for a more extensive test. Dense breast tissue occurs in many premenopausal women and can interfere with reading a mammogram and may mask abnormalities in the image. Look in the ICD-10-CM Alphabetic Index for Screening/neoplasm (malignant) (of)/breast Z12.39. For the breast density, look in the Alphabetic Index for Dense breasts which refers you to see Density/breast R92.30. There is also a Code also note with subcategory R92.3- to add an additional code to report inconclusive mammogram, R92.2, if applicable. These codes together provide medical necessity of an ultrasound. To report the family history of breast cancer, look in the Alphabetic Index for History/family (of)/malignant neoplasm (of)/breast Z80.3, which may provide medical necessity information for the screening exam in a young patient. Verify all codes in the Tabular List. 3. Answer: B. The Z code to identify the screening Rationale: According to the ICD-10-CM guidelines I.C.21,c.5, when a screening test is performed and an abnormality is found, sequence the Z code for the screening first, followed by an additional code to report the abnormal findings. Section Review 6.1 1. Answer: D. Gastrectomy, total; with formation of intestinal pouch, any type Rationale: The full descriptor of 43622 includes the common portion before the semi-colon of code 43620, followed by the description next to 43620 (with formation of intestinal pouch, any type). 2. Answer: D. 37650 Rationale: CPT® code 37650 has a parenthetic instruction below it stating to report 37650 with modifier 50 when performed bilaterally. CPT® code 22510 states it is for a unilateral or bilateral procedure so modifier 50 is not appropriate. CPT® code 36251 is for a unilateral procedure and CPT® code 36252 is for the same procedure performed bilaterally. Because there is a code option for unilateral and an-other code option for bilateral, modifier 50 is not appropriate for either code. 3. Answer: C. Codes exempt from modifier 51 are identified with the universal forbidden symbol. Rationale: Codes exempt from modifier 51 are identified with the universal forbidden symbol. Add-on codes are also exempt from modifier 51. A list of modifier 51-exempt codes can be found in Appendix E of the CPT® code book. 4. Answer: A. A CCM is not allowed and will not bypass the edits. Rationale: A CCM modifier of 0 indicates a CCM is not allowed and will not bypass the edits. 5. Answer: B. 33620 Rationale: The parenthetical instructions under CPT® code 33690 include: (For right and left pulmonary artery banding in a single ventricle [eg, hybrid approach stage 1], use 33620) and (Do not report modifier 63 in conjunction with 33690). 2025 Medical Coding Training: CPC®—Answer Key www.aapc.com 21 Section Review—Answers and Rationales Section Review 6.2 1. Answer: A. AMA Rationale: The CPT® code set (HCPCS Level I) is copyrighted and maintained by American Medical Association (AMA). 2. Answer: B. Categories I, II, and III Rationale: The main body of the CPT® code book is comprised of the Category I CPT® codes (00100–99607), Category II CPT® codes (0001F–9007F), Category III CPT® codes (0042T–0783T). 3. Answer: B. Condition, synonyms, abbreviations Rationale: The CPT® code book’s index is alphabetized with main terms organized by condition; procedure; anatomic site; synonyms, eponyms, and abbreviations. This is listed in the first page of the CPT® Index, under the heading for Main Terms. 4. Answer: C. Malpractice insurance costs, physician work, practice expense Rationale: RVUs are configured utilizing physician work, practice expense and malpractice insurance costs 5. Answer: D. Both B and C Rationale: Facility practice RVU expenses include services performed in emergency rooms, hospital settings (inpatient and outpatient), skilled nursing facilities, nursing homes, or ambulatory surgical centers (ASCs). The non-facility RVUs include services performed in non-hospital owned physician practices or privately owned practices. 6. Answer: B. Category II codes Rationale: CPT® Category II codes are supplementary tracking codes and are reported voluntarily by eligible physicians. 7. Answer: A. New and emerging Rationale: Category III codes do not indicate the service or procedure is experimental, only that they are new and emerging and are being tracked for trending purposes. This information is found in the guidelines for the Category II Codes section. 8. Answer: B. Appendix N Rationale: Appendix N provides a summary of CPT® codes not appearing in numeric sequence. This allows existing codes to be relocated to an appropriate location. Section Review 6.3 1. Answer: D. Preoperative visits, Intraoperative services, Postsurgical pain management Rationale: The Surgical Global Package includes: Preoperative Visits, Intraoperative Services, Complications Following Surgery, Postoperative Visits, Postsurgical Pain Management, and Miscellaneous Services. 2. Answer: C. 90 days Rationale: The global period of major procedures is 90 days. 22 www.aapc.com CPT® copyright 2024 American Medical Association. All rights reserved.  Section Review—Answers and Rationales 3. Answer: D. All of the above Rationale: Services included in the surgical package include: l Evaluation and Management (E/M) service(s) subsequent to the decision for surgery on the day before and/or day of surgery (including history and physical). l Local infiltration, metacarpal/metatarsal/digital block, or topical anesthesia l Immediate postoperative care, including dictating operative notes, talking with the family and other physicians or other qualified healthcare professionals l Writing orders l Evaluating the patient in the post-anesthesia recovery area l Typical postoperative follow-up care 4. Answer: C. 24, 25, 57 Rationale: Modifiers 24 Unrelated evaluation and management service by the same physician during a postoperative period, 25 Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service, and 57 Decision for surgery are used on evaluation and management CPT® codes only. 5. Answer: A. 000 Rationale: Status Indicator 000—Endoscopies or minor procedures Section Review 6.4 1. Answer: C. Miscellaneous Codes, Permanent National Codes, Temporary National Codes Rationale: Three types of HCPCS codes printed in the HCPCS Level II code book consist of: Permanent National Codes, Miscellaneous Codes/not otherwise classified, Temporary National Codes. This can be verified by reviewing the HCPCS Coding Procedures in the front of the HCPCS Level II code book. 2. Answer: C. Quarterly Rationale: Temporary codes can be added, changed, or deleted on a quarterly basis and once established; temporary codes are usually implemented within 90 days. 3. Answer: B. C codes Rationale: C codes are required for use under the Medicare Outpatient Prospective Payment System (OPPS). Hospitals report new technology procedures, drugs, biologicals, and radiopharmaceuticals that do not have other HCPCS codes assigned with C codes. 4. Answer: C. G codes Rationale: The G codes are temporary HCPCS Level II codes assigned by CMS. The G codes are reviewed by the AMA for possible inclusion in the CPT®. Until these codes are replaced by CPT® codes and appropriate descriptions, CMS uses the G codes to report specific services and procedures that do not otherwise have a Level I or Level II code. 5. Answer: D. J codes Rationale: The J code category contains codes and descriptions specific to drugs and biologicals (J0120–J8999) as well as chemotherapy drugs (J9000–J9999). The list of drugs described in the J category can be injected by one of three means: subcutaneously, intramuscularly, or intravenously. 2025 Medical Coding Training: CPC®—Answer Key www.aapc.com 23 Section Review—Answers and Rationales Section Review 6.5 1. Answer: B. 50 Rationale: 50 Bilateral Procedure 2. Answer: B. CPT®, ASC, HCPCS, Anesthesia Physical Status Modifiers Rationale: Appendix A lists modifiers for CPT®, Anesthesia Physical Status Modifiers, ASC, and HCPCS Level II. 3. Answer: D. NU Rationale: New Equipment. For example, append NU when a new walker, folding, wheeled, adjustable or fixed height is sold to a patient. 4. Answer: C. 32 Rationale: CPT® modifier 32—Mandated Services 5. Answer: B. When specificity is required for eyelids, fingers, toes, and coronary arteries Rationale: HCPCS Level II Modifiers are required to add specificity to CPT® procedure codes performed on eyelids, fingers, toes, and coronary arteries. Section Review 7.1 1. Answer: A. L64.8 Rationale: Alopecia is hair loss. You can find the correct code by looking for Loss (of)/hair, which directs you to see Alopecia. Look for Alopecia in the ICD-10-CM Alphabetic Index. Alopecia/premature L64.8. Verify in the Tabular List. L65.0 Telogen effluvium is hair loss due to stress, but the provider only suspects it is due to stress so it is not coded. 2. Answer: D. L57.0 Rationale: Look in the ICD-10-CM Alphabetic Index for Keratosis/actinic and you are referred to L57.0. This is verified by looking in the Tabular List under L57.0. 3. Answer: B. L89.223 Rationale: A bed sore is a pressure ulcer. If you look in the ICD-10-CM Alphabetic Index for Sore/bed, you are directed to see Ulcer, pressure, by site. Look in the ICD-10-CM Alphabetic Index for Ulcer/pressure/stage 3/hip and you find L89.2-. Subcategory L89.2 requires a 5th character for laterality and a 6th character for the stage. The complete code is L89.223. 4. Answer: C. Sequence first the code reflecting the highest degree of burn. Rationale: ICD-10-CM Official Coding Guidelines Section I.C.19.d.1. Sequencing of burn and related condition codes, “Sequence first the code that reflects the highest degree of burn when more than one burn is present.” 24 www.aapc.com CPT® copyright 2024 American Medical Association. All rights reserved.  Section Review—Answers and Rationales 5. Answer: A. S61.411A, S00.00XA Rationale: The more serious injury is the laceration to the right hand; this injury is sequenced first. To find laceration in the ICD-10-CM Alphabetic Index, look for Laceration/hand/right S61.411-. Add 7th character A for the initial encounter. S61.411A is the correct code. The injury to the scalp is stated as superficial. In the ICD-10-CM Alphabetic Index, look for Injury/