AAPC CPC CHAPTER 16 Exam
Questions with Verified Answers & Rationales
1. What physical status modifier best describes a patient who has a severe
systemic disease that is a constant threat to life?
ANS: P4 Response
Rationale: Review the Anesthesia Guidelines in the CPT® codebook to determine that the
Physical Status modifier P4 is the correct choice. Note: Medicare does not recognize physical
status modifiers for additional payment.
2. What modifier is used for medically-directed CRNA services?
ANS: QX Response
Rationale: In the HCPCS Level II codebook look for where the modifiers are listed and refer to
modifier QX. QX is the correct modifier for CRNA services when medically directed by a
physician.
3. What is the anesthesia code for a cast application to the wrist?
ANS: 01860
Rationale: In the CPT® Index for Anesthesia/Cast Application/Forearm, Wrist and Hand which
directs you to 01860. Verify code selection in the numeric section.
4. A 22 year-old patient who has severe medical problems is placed under general
anesthesia by an anesthetist for a service not usually requiring anesthesia. What modifier
would be appended to the service?
ANS: 23
Rationale: In the CPT® codebook go to Appendix A - Modifiers. Review the modifiers to
determine that modifier 23 is reported to indicate a procedure not usually requiring anesthesia
(either none or local) but due to unusual circumstances general anesthesia is necessary.
5. What is the anesthesia code for a tubal ligation?
ANS: 00851 Response
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, Rationale: In the CPT® Index, look for Anesthesia/Fallopian Tube/Ligation or Anesthesia/Tubal
Ligation which directs you to 00851. Review the code in the numeric section to determine that
00851 describes the procedure.
6. A 77-year-old patient was scheduled for a total hip replacement due to degenerative joint
disease (DJD) and the anesthesiologist documented the DJD as primary. The pre-
anesthesia assessment indicates the patient had surgery in 2015 for gastroesophageal
reflux disease (GERD). What ICD-10-CM code(s) is/are reported?
ANS: M16.10 Response
Rationale: The patient's previous surgery (GERD) has no relevance to the anesthesia care
provided for the hip surgery and is not reported with a diagnosis code. In the ICD-10-CM
Alphabetic Index look for Degeneration/joint disease which states to see Osteoarthritis. Look for
Osteoarthritis/hip or Osteoarthritis/primary/hip which directs you to M16.1-. In the Tabular List
confirm the subcategory code. M16.1- indicates that a 5th character is needed to indicate
laterality. We are not told which hip has the DJD so the coder would report M16.10.
7. A patient has foot surgery for a right calcaneal spur. Chronic myocardial ischemia was
listed on the pre-anesthesia assessment. What ICD-10-CM code(s) is/are reported?
ANS: M77.31, I25.9
Rationale: In the ICD-10-CM Alphabetic Index look for Spur, bone/calcaneal which directs you to
M77.3-. Next, in the Alphabetic Index under Ischemia, ischemic/heart (chronic or with a stated
duration of over 4 weeks) which directs you to I25.9. In the Tabular List confirm the code
selection. Code M77.3- indicates that a 5th character is needed to define the laterality of the foot.
Calcaneal spur in the right foot report M77.31, for the foot surgery. The chronic myocardial
ischemia code I25.9 denotes the anesthesia risk and is also reported.
8. What is the anesthesia code for a complete removal of the penis, including removal of
both the left and right inguinal and iliac lymph nodes?
ANS: 00936
Rationale: In the CPT® Index look for Anesthesia/Penis which directs you to code range 00932-
00938. Review the codes in the numeric section to determine 00936 fully describe the procedure
and it is the correct code.
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Questions with Verified Answers & Rationales
1. What physical status modifier best describes a patient who has a severe
systemic disease that is a constant threat to life?
ANS: P4 Response
Rationale: Review the Anesthesia Guidelines in the CPT® codebook to determine that the
Physical Status modifier P4 is the correct choice. Note: Medicare does not recognize physical
status modifiers for additional payment.
2. What modifier is used for medically-directed CRNA services?
ANS: QX Response
Rationale: In the HCPCS Level II codebook look for where the modifiers are listed and refer to
modifier QX. QX is the correct modifier for CRNA services when medically directed by a
physician.
3. What is the anesthesia code for a cast application to the wrist?
ANS: 01860
Rationale: In the CPT® Index for Anesthesia/Cast Application/Forearm, Wrist and Hand which
directs you to 01860. Verify code selection in the numeric section.
4. A 22 year-old patient who has severe medical problems is placed under general
anesthesia by an anesthetist for a service not usually requiring anesthesia. What modifier
would be appended to the service?
ANS: 23
Rationale: In the CPT® codebook go to Appendix A - Modifiers. Review the modifiers to
determine that modifier 23 is reported to indicate a procedure not usually requiring anesthesia
(either none or local) but due to unusual circumstances general anesthesia is necessary.
5. What is the anesthesia code for a tubal ligation?
ANS: 00851 Response
1/8
, Rationale: In the CPT® Index, look for Anesthesia/Fallopian Tube/Ligation or Anesthesia/Tubal
Ligation which directs you to 00851. Review the code in the numeric section to determine that
00851 describes the procedure.
6. A 77-year-old patient was scheduled for a total hip replacement due to degenerative joint
disease (DJD) and the anesthesiologist documented the DJD as primary. The pre-
anesthesia assessment indicates the patient had surgery in 2015 for gastroesophageal
reflux disease (GERD). What ICD-10-CM code(s) is/are reported?
ANS: M16.10 Response
Rationale: The patient's previous surgery (GERD) has no relevance to the anesthesia care
provided for the hip surgery and is not reported with a diagnosis code. In the ICD-10-CM
Alphabetic Index look for Degeneration/joint disease which states to see Osteoarthritis. Look for
Osteoarthritis/hip or Osteoarthritis/primary/hip which directs you to M16.1-. In the Tabular List
confirm the subcategory code. M16.1- indicates that a 5th character is needed to indicate
laterality. We are not told which hip has the DJD so the coder would report M16.10.
7. A patient has foot surgery for a right calcaneal spur. Chronic myocardial ischemia was
listed on the pre-anesthesia assessment. What ICD-10-CM code(s) is/are reported?
ANS: M77.31, I25.9
Rationale: In the ICD-10-CM Alphabetic Index look for Spur, bone/calcaneal which directs you to
M77.3-. Next, in the Alphabetic Index under Ischemia, ischemic/heart (chronic or with a stated
duration of over 4 weeks) which directs you to I25.9. In the Tabular List confirm the code
selection. Code M77.3- indicates that a 5th character is needed to define the laterality of the foot.
Calcaneal spur in the right foot report M77.31, for the foot surgery. The chronic myocardial
ischemia code I25.9 denotes the anesthesia risk and is also reported.
8. What is the anesthesia code for a complete removal of the penis, including removal of
both the left and right inguinal and iliac lymph nodes?
ANS: 00936
Rationale: In the CPT® Index look for Anesthesia/Penis which directs you to code range 00932-
00938. Review the codes in the numeric section to determine 00936 fully describe the procedure
and it is the correct code.
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