The procedure performed was a mitral
NCCT Full Exam Study Guide valvuloplasy, which means repair of the mitral
Questions and Answers valve. In the index of the CPT® Index, the main
term is Valvuloplasty. The choices below
Graded A Valvuloplasty include mitral valve, code range
CPT® 33425-33427. When reading the
descriptions of these three codes, notice that
CPT®33427 states "radical reconstruction..."
This scenario does not state radical
reconstruction, so that one is not the correct
answer. CPT® 33426 is the correct answer
because it is "Valvuloplasty, mitral valve, with
cardiopulmonary bypass, with prosthetic ring.
Next, in the Index, replacement, aortic valve.
Under that heading, find "with Prosthesis" (for
the prosthesis). CPT® 33405, 33361-33369 are
listed. Since CPT® 33361-33369 are all
"Transcatheter aortic valve replacements
TAVR/TAVI... with percutaneous approach",
these are not the correct codes. CPT®33405 is
the correct code, as it reads "Replacement,
Patient undergoes a mitral valvuloplasty with a
aortic valve, open, with cardiopulmonary
ring insertion and a prosthetic aortic valve
bypass; with prosthetic valve other than
replacement, open, on cardiopulmonary bypass.
homograft or stent-less valve. The correct
Which of the following is the correct CPT® code
coding for the above scenario is CPT®33426,
assignment?
33405-51. Modifier -51 is added to CPT® code
33405 because were performed.
A. 33464, 33406-51 The established patient presents to the doctor's
office for his monthly visit to have his glucose
B. 33426, 33405-51 levels by checked by the nurse. Which of the
C. 33430, 33405-51 following evaluation and management codes
should be assigned?
D. 33468, 33426-51 - -----ANSWER---->33426,
33405-51
A. 99201
B. 99211
Rationale C. 99202
D. 99212 - -----ANSWER---->99211
, Rationale
Rationale
This appointment has all the criteria to code as
a consultation. There are three requirements
CPT® 99201 and CPT® 99202 would be used for
for consultations, request, render, and reply.
a new patient or a patient that has not been to
request was made by the PCP, Dr. Long
this provider for three years. This patient goes
rendered the services, and Dr. Long.
to this office monthly so these two codes would
Consultation codes are grouped by place of
not be used. CPT® 99212 is a low office visit that
service, office and other outpatient services and
requires documentation of PF history, PF exam,
inpatient consultations. New vs. established
and SF MDM. None of those services were
patient does not matter for consultations. The
documented CPT® 99211 is used for low level
appointment was an Expanded Problem
E/M services typically used by the nurse. This is
Focused history and exam with the Medical
the correct code to use for this visit.
Decision Making straightforward, which is code
CPT®
A patient sees Dr. Smith for a consult at the
request of his PCP, Dr. Long, for an ongoing
A patient arrives for skin tag removal. As
problem with allergies. The patient has tried
previously noted in her other visit, she has 3
using Claritin and Alavert but feels his
located on her face, 4 on her shoulder and 15
symptoms continue to worsen. Dr. Smith
on her back. The physician removes all the skin
performs an expanded problem focused history
tags with no complications. Which of the
and exam and discusses options with the
following CPT® codes should be reported for
patient on allergy management. The MDM is
this encounter?
straightforward. The patient would like to be
tested to possibly gain better control of his
allergies. Dr. Smith sends a report to Dr. Long,
thanking him for the referral and includes the
date the patient is scheduled for allergy testing. A. 11201
Dr. Smith also includes his findings from the
encounter. Which CPT® E/M code is reported? B. 11201, 11201-51
C. 11200, 11201-52
D. 11200, 11201 - -----ANSWER---->11200,
11201
A. 99203
B. 99214
C. 99242
D. 99243 - -----ANSWER---->99242
Rationale
, physician. If CPT® codes 80053 and 80050 were
coded, this would result in duplicate coding for
This patient had a total of 22 skin tags removed.
some of the tests. CPT® code 80050 includes
The codes CPT®11200 and CPT®11201 are the
the comprehensive metabolic panel and the
codes for skin tag removal, sequenced in that
other three tests ordered by the physician
order. CPT® code 11200 represents the removal
of the first 15 skin tags and CPT® code
CPT®11201, an add-on code described as
6. An established patient who is diagnosed with
removal of skin tags, each additional 10 lesions.
controlled diabetes mellitus II comes to the
The CPT®modifier 51 would not be used with
doctor's office for elevated BP. The doctor is
CPT®11201, since this is an add-on code and is
busy and the patient is seen by the nurse for a
CPT®modifier 51 exempt. The CPT®modifier 52
five minute BP check. Which of the following is
is for reduced services and would not be
the procedure code for this situation?
applicable to use on CPT® 11201.
This established patient is in for her yearly
physical and lab. The physician orders a A. 99212
comprehensive metabolic panel, a hemogram
automated and manual differential WBC count B. 99213
(CBC), and a thyroid-stimulating hormone. Code C. 99201
the lab only.
D. 99211 - -----ANSWER---->99211
A. 99395, 80050
B. 80050-52
Rationale
C. 80053, 80050
D. 80050 - -----ANSWER---->80050
99201 is for a new patient, and doesn't apply to
this patient. CPT® 99211-99213 are for
established patient visits. The requirements for
codes CPT®99212 and 99213 are not met. There
was no medical history taken, no examination
given, and medical decision making. This patient
Rationale
came in for a blood pressure check and did not
need to be seen by the physician. The correct
code for this service is CPT® 99211. The
The test question specifies to code the lab tests
description of CPT® 99211, is that the time
only so the CPT® code 99395 for a Preventive
usually spent with the patient is about five
Medicine Exam would not be coded. Although
minutes and the patient does not have to be
80053 is a comprehensive metabolic panel. It
seen by a physician or other qualified
does not include all th tests ordered by the
healthcare professional.
, Examination,
The patient had a gastrojejunostomy Medical Decision Making
performed. Which of the following is the correct
coding for this surgery?
Rationale
A. 43820, 48150
B. 43820
The 2018 CPT® manual indicates that the key
C. 48150, 43820
components in the Evaluation and Management
D. 48150 - -----ANSWER---->43820 guidelines are the history, exam and medical
decision making.
Three weeks ago, a patient had a cast applied to
Rationale
his leg for treatment of a fracture. Today the
patient returned to the same physician and had
the cast removed. The physician also removed a
In the CPT® Index, the main term is cyst from the patient's neck. Which of the
"gastrojejunostomy". Gastrojejunostomy following is the correct code assignment?
without vagotomy is listed. The scenario did not
mention a vagotomy. After confirming in the
tabular list, CPT®43820 is the correct code for
this surgery.
A. 29705
B. 10040
Which of the following are considered key
components when assigning a level of E/M C. 29705, 10040
services? (Select the three (3) correct answers.)
D. 10040, 29705 - -----ANSWER---->10040
A. Counseling
B. History
Rationale
C. Time
D. Examination
Per CPT® guidelines, the cast removal is
E. Medical Decision Making - -----ANSWER---- included in the services of treatment of the
>History, fracture and is not a billable service. The cyst
removal is a separate procedure and the
NCCT Full Exam Study Guide valvuloplasy, which means repair of the mitral
Questions and Answers valve. In the index of the CPT® Index, the main
term is Valvuloplasty. The choices below
Graded A Valvuloplasty include mitral valve, code range
CPT® 33425-33427. When reading the
descriptions of these three codes, notice that
CPT®33427 states "radical reconstruction..."
This scenario does not state radical
reconstruction, so that one is not the correct
answer. CPT® 33426 is the correct answer
because it is "Valvuloplasty, mitral valve, with
cardiopulmonary bypass, with prosthetic ring.
Next, in the Index, replacement, aortic valve.
Under that heading, find "with Prosthesis" (for
the prosthesis). CPT® 33405, 33361-33369 are
listed. Since CPT® 33361-33369 are all
"Transcatheter aortic valve replacements
TAVR/TAVI... with percutaneous approach",
these are not the correct codes. CPT®33405 is
the correct code, as it reads "Replacement,
Patient undergoes a mitral valvuloplasty with a
aortic valve, open, with cardiopulmonary
ring insertion and a prosthetic aortic valve
bypass; with prosthetic valve other than
replacement, open, on cardiopulmonary bypass.
homograft or stent-less valve. The correct
Which of the following is the correct CPT® code
coding for the above scenario is CPT®33426,
assignment?
33405-51. Modifier -51 is added to CPT® code
33405 because were performed.
A. 33464, 33406-51 The established patient presents to the doctor's
office for his monthly visit to have his glucose
B. 33426, 33405-51 levels by checked by the nurse. Which of the
C. 33430, 33405-51 following evaluation and management codes
should be assigned?
D. 33468, 33426-51 - -----ANSWER---->33426,
33405-51
A. 99201
B. 99211
Rationale C. 99202
D. 99212 - -----ANSWER---->99211
, Rationale
Rationale
This appointment has all the criteria to code as
a consultation. There are three requirements
CPT® 99201 and CPT® 99202 would be used for
for consultations, request, render, and reply.
a new patient or a patient that has not been to
request was made by the PCP, Dr. Long
this provider for three years. This patient goes
rendered the services, and Dr. Long.
to this office monthly so these two codes would
Consultation codes are grouped by place of
not be used. CPT® 99212 is a low office visit that
service, office and other outpatient services and
requires documentation of PF history, PF exam,
inpatient consultations. New vs. established
and SF MDM. None of those services were
patient does not matter for consultations. The
documented CPT® 99211 is used for low level
appointment was an Expanded Problem
E/M services typically used by the nurse. This is
Focused history and exam with the Medical
the correct code to use for this visit.
Decision Making straightforward, which is code
CPT®
A patient sees Dr. Smith for a consult at the
request of his PCP, Dr. Long, for an ongoing
A patient arrives for skin tag removal. As
problem with allergies. The patient has tried
previously noted in her other visit, she has 3
using Claritin and Alavert but feels his
located on her face, 4 on her shoulder and 15
symptoms continue to worsen. Dr. Smith
on her back. The physician removes all the skin
performs an expanded problem focused history
tags with no complications. Which of the
and exam and discusses options with the
following CPT® codes should be reported for
patient on allergy management. The MDM is
this encounter?
straightforward. The patient would like to be
tested to possibly gain better control of his
allergies. Dr. Smith sends a report to Dr. Long,
thanking him for the referral and includes the
date the patient is scheduled for allergy testing. A. 11201
Dr. Smith also includes his findings from the
encounter. Which CPT® E/M code is reported? B. 11201, 11201-51
C. 11200, 11201-52
D. 11200, 11201 - -----ANSWER---->11200,
11201
A. 99203
B. 99214
C. 99242
D. 99243 - -----ANSWER---->99242
Rationale
, physician. If CPT® codes 80053 and 80050 were
coded, this would result in duplicate coding for
This patient had a total of 22 skin tags removed.
some of the tests. CPT® code 80050 includes
The codes CPT®11200 and CPT®11201 are the
the comprehensive metabolic panel and the
codes for skin tag removal, sequenced in that
other three tests ordered by the physician
order. CPT® code 11200 represents the removal
of the first 15 skin tags and CPT® code
CPT®11201, an add-on code described as
6. An established patient who is diagnosed with
removal of skin tags, each additional 10 lesions.
controlled diabetes mellitus II comes to the
The CPT®modifier 51 would not be used with
doctor's office for elevated BP. The doctor is
CPT®11201, since this is an add-on code and is
busy and the patient is seen by the nurse for a
CPT®modifier 51 exempt. The CPT®modifier 52
five minute BP check. Which of the following is
is for reduced services and would not be
the procedure code for this situation?
applicable to use on CPT® 11201.
This established patient is in for her yearly
physical and lab. The physician orders a A. 99212
comprehensive metabolic panel, a hemogram
automated and manual differential WBC count B. 99213
(CBC), and a thyroid-stimulating hormone. Code C. 99201
the lab only.
D. 99211 - -----ANSWER---->99211
A. 99395, 80050
B. 80050-52
Rationale
C. 80053, 80050
D. 80050 - -----ANSWER---->80050
99201 is for a new patient, and doesn't apply to
this patient. CPT® 99211-99213 are for
established patient visits. The requirements for
codes CPT®99212 and 99213 are not met. There
was no medical history taken, no examination
given, and medical decision making. This patient
Rationale
came in for a blood pressure check and did not
need to be seen by the physician. The correct
code for this service is CPT® 99211. The
The test question specifies to code the lab tests
description of CPT® 99211, is that the time
only so the CPT® code 99395 for a Preventive
usually spent with the patient is about five
Medicine Exam would not be coded. Although
minutes and the patient does not have to be
80053 is a comprehensive metabolic panel. It
seen by a physician or other qualified
does not include all th tests ordered by the
healthcare professional.
, Examination,
The patient had a gastrojejunostomy Medical Decision Making
performed. Which of the following is the correct
coding for this surgery?
Rationale
A. 43820, 48150
B. 43820
The 2018 CPT® manual indicates that the key
C. 48150, 43820
components in the Evaluation and Management
D. 48150 - -----ANSWER---->43820 guidelines are the history, exam and medical
decision making.
Three weeks ago, a patient had a cast applied to
Rationale
his leg for treatment of a fracture. Today the
patient returned to the same physician and had
the cast removed. The physician also removed a
In the CPT® Index, the main term is cyst from the patient's neck. Which of the
"gastrojejunostomy". Gastrojejunostomy following is the correct code assignment?
without vagotomy is listed. The scenario did not
mention a vagotomy. After confirming in the
tabular list, CPT®43820 is the correct code for
this surgery.
A. 29705
B. 10040
Which of the following are considered key
components when assigning a level of E/M C. 29705, 10040
services? (Select the three (3) correct answers.)
D. 10040, 29705 - -----ANSWER---->10040
A. Counseling
B. History
Rationale
C. Time
D. Examination
Per CPT® guidelines, the cast removal is
E. Medical Decision Making - -----ANSWER---- included in the services of treatment of the
>History, fracture and is not a billable service. The cyst
removal is a separate procedure and the
