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最新的 Certified Professional Coder CPC 免費考試真題 (Q223-Q228):問題 #223
A 1-year-old is with his mom to have his scheduled vaccinations. The physician provides counseling for routine immunizations and carries out measles, mumps, rubella and varicella (MMRV) subcutaneously and dose 3 of Hepatitis B intramuscularly without difficulty.
What CPTcodes are reported?

• A. 90471, 90472, 90707, 90746
• B. 90460, 90461, 90710, 90744
• C. 90460 x 2, 90461 x 3, 90710, 90744
• D. 90471, 90472 x 4, 90707, 90746
  

答案：C
解題說明：
1. Procedure and CPTCode Selection:
The physician administered the MMRV (measles, mumps, rubella, and varicella) vaccine subcutaneously and dose 3 of Hepatitis B vaccine intramuscularly. The physician also provided counseling on routine immunizations.
CPTCode 90460 is used for immunization administration with counseling by the physician for patients 18 years or younger for the first or only component of each vaccine.
CPTCode 90461 is used for each additional component in a vaccine with counseling.
90710 is the code for the MMRV vaccine.
90744 is the code for the Hepatitis B vaccine (pediatric).
2. Application of 90460 and 90461:
For the MMRV vaccine (which has four components: measles, mumps, rubella, and varicella), 90460 is reported once for the first component, and 90461 is reported three times (once for each additional component).
For the Hepatitis B vaccine, 90460 is reported again since it is a separate vaccine with one component.
3. Rationale for Excluding Other Options:
Option A (90471, 90472 x 4, 90707, 90746) uses codes for vaccine administration without counseling and incorrect vaccine codes (90707 for MMR instead of MMRV and 90746 for adult Hepatitis B instead of pediatric).
Option B and Option D also contain incorrect vaccine codes and do not correctly apply the counseling administration codes.
4. AAPC and CPTCoding Guidelines:
According to AAPC guidelines, 90460 and 90461 are the appropriate administration codes for vaccines with counseling provided to pediatric patients, with each component of a multi-component vaccine coded separately.
Therefore, the correct answer is C. 90460 x 2, 90461 x 3, 90710, 90744.

問題 #224
A three-year-old patient is in the operative suite for stage 2 of treatment for double right outlet syndrome. The patient previously had the pulmonary artery banded and is returning for removal of the pulmonary band and transposition repair of the great vessels via aortic pulmonary reconstruction.
The surgeon performs a time-out and pre-incision review of respiration and BP then the previous sternal incision site is inspected and lightly painted with povidone. Next, reopens the sternal cavity and inserts central cannulae in the IVC, SVC and ascending aorta for extra corporeal membrane oxygenation (ECMO) bypass, chemical cardioplegia is initiated, stopping the heart and ECMO is initiated. A physician assistant monitors vitals and oxygenation until heart function resumes. The surgeon carefully incised and removes the Dacron band encircling the pulmonary artery, with nominal need for dilation. A section of coronary ostia is removed and sutured to the root of the pulmonary trunk. The pulmonary trunk and aortic root are then transected and transposed to allow for ideal cardiac circulation. Once structural integrity is visually confirmed, the physician assistant is permitted to administer the cardioplegia reversal solution and the surgeon removes the central cannulae after heart function safely resumes. The sternotomy is closed and the patient is transported to the NICU.
What CPT codes are reported for the surgery today?

• A. 33779-78, 33953-78, 33985-78
• B. 33778-58, 33955-58, 33985-58
• C. 33778-78, 33953-78, 33985-78
• D. 33779-58, 33955-58, 33985-58
  

答案：A
解題說明：
1. Procedure Details and CPT Code Selection:
The patient is undergoing stage 2 treatment for double outlet right ventricle (DORV) with a removal of the pulmonary artery band and transposition repair of the great vessels.
Code 33779 is specific for correction of a double outlet right ventricle, with transposition of the great arteries. This code accurately reflects the procedure performed, including the complex repair involving the transposition of the pulmonary trunk and aortic root.
Code 33953 is used to report the initiation of extracorporeal membrane oxygenation (ECMO), which was used to maintain oxygenation during the procedure.
Code 33985 is for the termination of ECMO following the surgical repair once heart function has resumed. Both 33953 and 33985 accurately document the initiation and termination of ECMO during this complex heart repair.
2. Modifier Selection:
Modifier 78 (unplanned return to the operating room for a related procedure during the postoperative period) is appropriate here. This is a subsequent stage in the treatment plan, but due to the complexity and specific surgical intervention required, it is treated as a return to the OR for related procedure coding.
Modifier 58 (staged or related procedure during the postoperative period) would not be as suitable here because the procedure involves a new return to the OR.
3. AAPC and CPT Coding Guidelines:
AAPC guidelines support the use of specific modifiers (78 for unplanned return) and appropriate ECMO codes (33953 and 33985) in complex cardiac cases requiring bypass and staged treatment.
Thus, the correct CPT codes based on CPT and AAPC coding standards are C. 33779-78, 33953-78, 33985-78.

問題 #225
A patient who was training for a marathon collapsed due to heat exhaustion on a very hot day. The patient is driven by his wife to a non-facility urgent care center for him to be treated. On examination, the physician diagnoses heat exhaustion and dehydration. The physician began IV therapy of normal saline that consists of pre-packaged fluid and electrolytes. The hydration lasts for 1 and 30 minutes.
What CPTcoding is reported?

• A. 0
• B. 96365, 96366
• C. 1
• D. 96360, 96361
  

答案：D
解題說明：
1. Procedure and CPTCode Selection:
The patient received IV hydration therapy with normal saline, which lasted for 1 hour and 30 minutes.
CPTCode 96360 is used for initial IV hydration for the first hour. This code applies to the first 31-60 minutes of hydration therapy.
CPTCode 96361 is used for each additional hour of IV hydration. Since the hydration lasted 1 hour and 30 minutes, 96361 should be reported once to cover the additional 30 minutes after the initial hour.
2. Rationale for Excluding Other Options:
Code 96365 is for initial IV infusion for therapeutic, prophylactic, or diagnostic purposes, rather than hydration, and is not applicable in this case.
Code 96366 is used for additional therapeutic, prophylactic, or diagnostic infusions and does not apply to hydration services.
Option A (96360) would only cover the initial hour of hydration, missing the additional 30 minutes, which is appropriately coded with 96361.
3. AAPC and CPTCoding Guidelines:
According to AAPC and CPTguidelines, 96360 should be used for the first hour of IV hydration, and
96361 should be used for each additional hour or portion of an hour beyond the initial 60 minutes.
Therefore, the correct answer is D. 96360, 96361.

問題 #226
The surgeon performs Roux-en-Y anastomosis of the extrahepatic biliary duct to the gastrointestinal tract on a
45-year-old patient.
What CPT code is reported?

• A. 0
• B. 1
• C. 2
• D. 3
  

答案：A
解題說明：
The Roux-en-Y anastomosis of the extrahepatic biliary duct to the gastrointestinal tract is a specific surgical procedure that involves connecting the biliary duct to the gastrointestinal tract.
* Procedure Description: Roux-en-Y anastomosis of the extrahepatic biliary duct involves creating a direct connection between the biliary duct and the gastrointestinal tract.
* Procedure Specificity: The procedure is complex and involves extensive surgical technique and anastomosis.
Coding Decision:
* CPT 47780 specifically describes the Roux-en-Y anastomosis of the extrahepatic biliary duct to the gastrointestinal tract.
References:
* AMA's CPT Professional Edition (current year).
* CPT Assistant for detailed coding guidelines on biliary and gastrointestinal procedures.

問題 #227
View MR 005398
MR 005398
Operative Report
Preoperative Diagnosis: Nonfunctioning right kidney with ureteral stricture.
Postoperative Diagnosis: Nonfunctioning right kidney with ureteral stricture.
Procedure: Right nephrectomy with partial ureterectomy.
Findings and Procedure: Under satisfactory general anesthesia, the patient was placed in the right flank position. Right flank and abdomen were prepared and draped out of the sterile field. Skin incision was made between the 11th and 12th ribs laterally. The incision was carried down through the underlying subcutaneous tissues, muscles, and fascia. The right retroperitoneal space was entered. Using blunt and sharp dissection, the right kidney was freed circumferentially. The right artery, vein, and ureter were identified. The ureter was dissected downward where it is completely obstructed in its distal extent. The ureter was clipped and divided distally. The right renal artery was then isolated and divided between 0 silk suture ligatures. The right renal vein was also ligated with suture ligatures and 0 silk ties. The right kidney and ureter were then submitted for pathologic evaluation. The operative field was inspected, and there was no residual bleeding noted, and then it was carefully irrigated with sterile water. Wound closure was then undertaken using 0 Vicryl for the fascial layers, 0 Vicryl for the muscular layers, 2-0 chromic for subcutaneous tissue, and clips for the skin. A Penrose drain was brought out through the dependent aspect of the incision. The patient lost minimal blood and tolerated the procedure well.
What CPT coding is reported for this case?

• A. 0
• B. 1
• C. 2
• D. 3
  

答案：A
解題說明：
The procedure involves a right nephrectomy with partial ureterectomy for a nonfunctioning right kidney with ureteral stricture.
* Procedure Description:
* Right nephrectomy (removal of the kidney).
* Partial ureterectomy (removal of part of the ureter).
* CPT Coding:
* 50220: Nephrectomy, including partial ureterectomy, any open approach.
References:
* AMA's CPT Professional Edition (current year).
* CPT Assistant for detailed coding guidelines on nephrectomy procedures.

問題 #228
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