AAPC CPB Exam Questions and Answers
1. Which is incorporated by CMS into the NCCI program to limit the number of times
a service or procedure can be reported by a physician on the same date of service?
A. Outpatient Code Editor (OCE)
B. Medically Unlikely Edits (MUE)
C. Physician Fee Schedule
D. National Coverage Determination (NCD)
ANS: B
2. A 10-year-old girl is scheduled for her yearly physical exam. She complains of
watery eyes, scratchy throat, and stuffy nose for two days. The physician performs a
complete physical then evaluates and treats the patient for a URI with separate
documentation of an expanded problem focused exam and low MDM. What CPT
codes are reported?
A. 99393, 99213-25
B. 99393
C. 99213
D. 99393-25, 99213
ANS: A
3. A 25-year-old is 32 weeks pregnant and admitted for severe pre-eclampsia
requiring emergency cesarean section. Reduced payment was sent with a
remittance advice stating preauthorization was not obtained. What does the biller
do?
A. Verify in the payer contract if prior auth is required. If not obtained, bill the patient
the rest.
B. Appeal the claim explaining the reason for the emergency cesarean section
C. Write off the claim because it was denied
D. Verify in the payer contract if prior auth is required. If not obtained, bill the patient
the entire amount.
ANS: B
,4. A 55-year-old female presents with ongoing type I diabetes controlled with insulin.
The physician notes gangrene due to diabetic peripheral angiopathy on her left great
toe. Which ICD-10-CM code is reported?
A. I96, E10.9, Z79.4
B. E11.52, I96, Z79.4
C. E10.52
D. I96, E11.52
ANS: C
5. A 60-year-old woman seeks help to quit smoking. Dr. Lung performs a limited
three-system exam. Counseling was done face to face for 20 minutes of the
30-minute visit on smoking cessation. Select the appropriate CPT code(s):
A. 99203, 99354
B. 99214, 99354
C. 99214
D. 99407
ANS: D
6. A 6-year-old is seen at a pediatrician's office for the first time. He has coverage
through his mother (DOB: 02/08/86) and his father (DOB: 05/15/85). Whose
insurance is primary?
A. Mother's insurance plan
B. Father's insurance plan
C. The policy that has the best benefits
D. Either parent's depending on who brings the child in
ANS: A
7. A 12-month-old established patient comes in for an annual physical. The physician
administers the Hib-HepB vaccine intramuscularly with counseling provided to the
mother about each vaccine. What codes are reported?
A. 99392-25, 90460, 90461, 90748
B. 99391-25, 90460 x 2, 90748
C. 99382-25, 90460 x 2, 90743, 90648
,D. 99391-25, 90460, 90461, 90748
ANS: A
8. A 14-year-old male fell while skateboarding and was diagnosed with a fracture of
the upper right arm. The ICD-10-CM codes reported were S42.301A, V00.131A, and
Y93.51. Is this correct?
A. No; codes should be S43.309B, V00.131B, Y93.51
B. No; codes should be V00.131B, Y93.51, S42.309D
C. No; codes should be V00.131A, Y93.51, S42.301A
D. Yes; the ICD-10-CM codes are correct
ANS: D
9. A 35-year-old HMO member goes to an out-of-network specialty clinic for
evaluation and surgery. Claims total $15,000; in-network would have been $10,000.
What does insurance most likely pay?
A. Pay the $10,000 it would have paid in-network
B. Pay the $15,000 since it was reasonable to go to a superior facility
C. Pay nothing as the provider was out-of-network
D. Negotiate with the provider to accept $10,000
ANS: C
10. A 48-year-old female awakens with severe abdominal pain and vomiting, is taken
by ambulance to the closest hospital (out-of-network HMO). She has a ruptured
appendix and undergoes emergency appendectomy. What will the payer most likely
pay?
A. The hospital claim only
B. Both the hospital and physician claims for emergency services
C. The physician claim only
D. Neither claim since this was not life threatening
ANS: B
11. A 54-year-old male presents with dizziness; BP is 200/130. After workup, the
physician diagnoses stage V kidney disease due to malignant hypertension. What
are the appropriate diagnosis codes?
, A. I12.0, N18.5
B. I12.0, N18.6
C. N18.5, I12.0
D. I12.0
ANS: A
12. A 54-year-old patient is brought to the ED in acute respiratory failure. The
physician documents critical care and performs an endotracheal intubation. Total
physician services were 142 minutes. What are the correct CPT codes?
A. 99291, 99292-51 x 3
B. 99291, 99292 x 3, 31500-51
C. 99291, 99292 x 3, 31500
D. 99291, 99292 x 3
ANS: C
13. A BC/BS insurance plan that allows members to choose any provider but offers
higher levels of coverage when members obtain services from network providers is
an example of:
A. HMO
B. EPO
C. PPO
D. POS
ANS: C
14. A biller at a medical practice notices that all claims contain CPT code 81002. The
nurse states that because they are an OB/GYN office, they bill every patient for a
urinalysis. What does this violate?
A. HIPAA
B. False Claims Act
C. Anti-Kickback Statute
D. Truth in Lending Act
ANS: B
1. Which is incorporated by CMS into the NCCI program to limit the number of times
a service or procedure can be reported by a physician on the same date of service?
A. Outpatient Code Editor (OCE)
B. Medically Unlikely Edits (MUE)
C. Physician Fee Schedule
D. National Coverage Determination (NCD)
ANS: B
2. A 10-year-old girl is scheduled for her yearly physical exam. She complains of
watery eyes, scratchy throat, and stuffy nose for two days. The physician performs a
complete physical then evaluates and treats the patient for a URI with separate
documentation of an expanded problem focused exam and low MDM. What CPT
codes are reported?
A. 99393, 99213-25
B. 99393
C. 99213
D. 99393-25, 99213
ANS: A
3. A 25-year-old is 32 weeks pregnant and admitted for severe pre-eclampsia
requiring emergency cesarean section. Reduced payment was sent with a
remittance advice stating preauthorization was not obtained. What does the biller
do?
A. Verify in the payer contract if prior auth is required. If not obtained, bill the patient
the rest.
B. Appeal the claim explaining the reason for the emergency cesarean section
C. Write off the claim because it was denied
D. Verify in the payer contract if prior auth is required. If not obtained, bill the patient
the entire amount.
ANS: B
,4. A 55-year-old female presents with ongoing type I diabetes controlled with insulin.
The physician notes gangrene due to diabetic peripheral angiopathy on her left great
toe. Which ICD-10-CM code is reported?
A. I96, E10.9, Z79.4
B. E11.52, I96, Z79.4
C. E10.52
D. I96, E11.52
ANS: C
5. A 60-year-old woman seeks help to quit smoking. Dr. Lung performs a limited
three-system exam. Counseling was done face to face for 20 minutes of the
30-minute visit on smoking cessation. Select the appropriate CPT code(s):
A. 99203, 99354
B. 99214, 99354
C. 99214
D. 99407
ANS: D
6. A 6-year-old is seen at a pediatrician's office for the first time. He has coverage
through his mother (DOB: 02/08/86) and his father (DOB: 05/15/85). Whose
insurance is primary?
A. Mother's insurance plan
B. Father's insurance plan
C. The policy that has the best benefits
D. Either parent's depending on who brings the child in
ANS: A
7. A 12-month-old established patient comes in for an annual physical. The physician
administers the Hib-HepB vaccine intramuscularly with counseling provided to the
mother about each vaccine. What codes are reported?
A. 99392-25, 90460, 90461, 90748
B. 99391-25, 90460 x 2, 90748
C. 99382-25, 90460 x 2, 90743, 90648
,D. 99391-25, 90460, 90461, 90748
ANS: A
8. A 14-year-old male fell while skateboarding and was diagnosed with a fracture of
the upper right arm. The ICD-10-CM codes reported were S42.301A, V00.131A, and
Y93.51. Is this correct?
A. No; codes should be S43.309B, V00.131B, Y93.51
B. No; codes should be V00.131B, Y93.51, S42.309D
C. No; codes should be V00.131A, Y93.51, S42.301A
D. Yes; the ICD-10-CM codes are correct
ANS: D
9. A 35-year-old HMO member goes to an out-of-network specialty clinic for
evaluation and surgery. Claims total $15,000; in-network would have been $10,000.
What does insurance most likely pay?
A. Pay the $10,000 it would have paid in-network
B. Pay the $15,000 since it was reasonable to go to a superior facility
C. Pay nothing as the provider was out-of-network
D. Negotiate with the provider to accept $10,000
ANS: C
10. A 48-year-old female awakens with severe abdominal pain and vomiting, is taken
by ambulance to the closest hospital (out-of-network HMO). She has a ruptured
appendix and undergoes emergency appendectomy. What will the payer most likely
pay?
A. The hospital claim only
B. Both the hospital and physician claims for emergency services
C. The physician claim only
D. Neither claim since this was not life threatening
ANS: B
11. A 54-year-old male presents with dizziness; BP is 200/130. After workup, the
physician diagnoses stage V kidney disease due to malignant hypertension. What
are the appropriate diagnosis codes?
, A. I12.0, N18.5
B. I12.0, N18.6
C. N18.5, I12.0
D. I12.0
ANS: A
12. A 54-year-old patient is brought to the ED in acute respiratory failure. The
physician documents critical care and performs an endotracheal intubation. Total
physician services were 142 minutes. What are the correct CPT codes?
A. 99291, 99292-51 x 3
B. 99291, 99292 x 3, 31500-51
C. 99291, 99292 x 3, 31500
D. 99291, 99292 x 3
ANS: C
13. A BC/BS insurance plan that allows members to choose any provider but offers
higher levels of coverage when members obtain services from network providers is
an example of:
A. HMO
B. EPO
C. PPO
D. POS
ANS: C
14. A biller at a medical practice notices that all claims contain CPT code 81002. The
nurse states that because they are an OB/GYN office, they bill every patient for a
urinalysis. What does this violate?
A. HIPAA
B. False Claims Act
C. Anti-Kickback Statute
D. Truth in Lending Act
ANS: B
