AAPC CPC Practice Test Questions Answers

The National Correct Coding Initiative (NCCI) was developed by CMS to:

Prevent unbundling

Define procedure-to-procedure (PTP) edits

Identify when modifiers (such as -59) may be appropriate

NCCI edits are critical for accurate CPT® coding and proper reimbursement.

80324 – Drug test(s), definitive, qualitative or quantitative, LC/MS; acetaminophen

LC-MS = definitive testing

Acetaminophen is specifically identified by 80324

Why others are incorrect:

60143 / 80299 – Therapeutic drug assays (obsolete or nonspecific)

B0329 – HCPCS code (not appropriate here)

1. Procedure and CPT® Code Selection:

The scenario describes the excision of a 5 cm tumor located in the left lower quadrant of the abdominal wall. The tumor was excised down to the dermis and subcutaneous layers and removed using electrocautery.

Code 22903 is appropriate for the excision of a soft tissue tumor in the abdominal wall greater than 5 cm, making it the correct CPT® code.

Code 22901 applies to the excision of a soft tissue tumor in the abdominal wall but only for tumors 5 cm or less. Given that the tumor in this case is exactly 5 cm, it meets the threshold for 22903, which is more appropriate here.

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

ICD-10-CM Code D49.2 is used for a neoplasm of unspecified behavior in the abdominal area, reflecting the fact that the pathology report is pending to determine if the tumor is malignant.

Code C76.2 would be incorrect because it is for malignant neoplasms of unspecified abdominal areas, which we cannot confirm based on the initial excision. Similarly, R19.04 (indicating a mass in the abdominal region) is a symptom code and is not appropriate for a definitive diagnosis when a neoplasm code (D49.2) exists.

3. AAPC and CPT® Coding Guidelines:

Per AAPC coding guidelines, the size of the tumor is critical in selecting the correct excision code for abdominal wall neoplasms. Additionally, if the tumor’s pathology is not confirmed as malignant, it is coded as a neoplasm of unspecified behavior until further details are known.

Therefore, based on CPT® and ICD-10-CM coding guidelines, the verified answer is B. 22903, D49.2.

Complex (arm, 4 cm) → 13121

Intermediate legs total = 20.5 cm → 12036

Simple face closures coded separately:

12013 (cheek)

12011 (nose)

Modifiers allow separate anatomical reporting.

Correct answer: A

In CPT, a code labeled“separate procedure”is typically a service that isnormally includedas part of a more comprehensive procedure andshould not be reported separatelywhen performed as an integral component. However, itmaybe reported when performedindependentlyorunrelatedto the primary procedure—this supports options A, B, and C as true. The false statement isDbecause CPT doesnotinstruct that modifier79is specifically required to report a separate procedure with an unrelated primary service. Modifier selection depends on the actual circumstances and payer rules, and “separate procedure” logic is about whether the service isdistinct and not integral, often supported by documentation of a different site/session or separate clinical intent; when a modifier is needed, it is commonly adistinct procedural servicemodifier (e.g., 59 or X{EPSU}) rather than automatically 79. Modifier79is a global surgery modifier used for anunrelated procedure during the postoperative period, which is a different concept than “separate procedure” designation.