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New Code for Identifying Alternative Care Sites

A new Point of Origin (PoO) code has been created for reporting patient transfers from a designated disaster alternative care site (ACS). The new PoO was necessary to align with the Discharge Status Code for ACSs, DS code 69, created in response to the COVID-19 public health emergency (PHE). Initially, the National Uniform Billing Committee […]

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HCPCS Level II Code Changes in Effect July 1

The Centers for Medicare & Medicaid Services (CMS) released on May 13 the July 2020 quarterly update to the HCPCS Level II file. There are 61 added codes to describe healthcare equipment and supplies not identified by CPT® codes, as well as nine deleted codes and three revised codes. The July update to the HCPCS […]

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Upcoming HCPCS (DELETED/REVISED) Code Changes Effective from October 1, 2019

Deleted Codes:

J1942 Injection, aripiprazole lauroxil, 1 mg
S1090 Mometasone furoate sinus implant, 370 micrograms

Revised Codes:

J0641 Inj., levoleucovorin, 0.5 mg
J2794 Inj., risperdal consta, 0.5 mg
J7311 Inj., retisert, 0.01 mg
J7313 Inj., iluvien, 0.01 mg
Q4122 Dermacell, awm, porous sq cm
Q4165 Keramatrix, Kerasorb sq cm
Q4184 Cellesta or duo per sq cm


Coding Ahead

Upcoming HCPCS (NEW) Code Changes Effective from October 1, 2019

New Codes:

J0121 Injection, omadacycline, 1 mg
J0122 Injection, eravacycline, 1 mg
J0222 Injection, Patisiran, 0.1 mg
J0291 Injection, plazomicin, 5 mg
J0593 Injection, lanadelumab-flyo, 1 mg (code may be used for Medicare when drug administered under direct supervision of a physician, not for use when drug is self-administered)
J1096 Dexamethasone, lacrimal ophthalmic insert, 0.1 mg
J1097 phenylephrine 10.16 mg/ml and ketorolac 2.88 mg/ml ophthalmic irrigation solution, 1 ml
J1303 Injection, ravulizumab-cwvz, 10 mg
J1943 Injection, aripiprazole lauroxil, (aristada initio), 1 mg
J1944 Injection, aripiprazole lauroxil, (aristada), 1 mg
J2798 Injection, risperidone, (perseris), 0.5 mg
J3031 Injection, fremanezumab-vfrm, 1 mg (code may be used for Medicare when drug administered under the direct supervision of a physician, not for use when drug is self-administered)
J3111 Injection, romosozumab-aqqg, 1 mg
J7314 Injection, fluocinolone acetonide, intravitreal implant (Yutiq), 0.01 mg
J7331 Hyaluronan or derivative, synojoynt, for intra-articular injection, 1 mg
J7332 Hyaluronan or derivative, triluron, for intra-articular injection, 1 mg
J7401 Mometasone furoate sinus implant, 10 micrograms
J9118 Injection, calaspargase pegol-mknl, 10 units
J9119 Injection, cemiplimab-rwlc, 1 mg
J9204 Injection, mogamulizumab-kpkc, 1 mg
J9210 Injection, emapalumab-lzsg, 1 mg
J9269 Injection, tagraxofusp-erzs, 10 micrograms
J9313 Injection, moxetumomab pasudotox-tdfk, 0.01 mg
Q4205 Membrane graft or membrane wrap, per square centimeter
Q4206 Fluid flow or fluid GF, 1 cc
Q4208 Novafix, per square cenitmeter
Q4209 Surgraft, per square centimeter
Q4210 Axolotl graft or axolotl dualgraft, per square centimeter
Q4211 Amnion bio or Axobiomembrane, per square centimeter
Q4212 Allogen, per cc
Q4213 Ascent, 0.5 mg
Q4214 Cellesta cord, per square centimeter
Q4215 Axolotl ambient or axolotl cryo, 0.1 mg
Q4216 Artacent cord, per square centimeter
Q4217 Woundfix, BioWound, Woundfix Plus, BioWound Plus, Woundfix Xplus or BioWound Xplus, per square centimeter
Q4218 Surgicord, per square centimeter
Q4219 Surgigraft-dual, per square centimeter
Q4220 BellaCell HD or Surederm, per square centimeter
Q4221 Amniowrap2, per square centimeter
Q4222 Progenamatrix, per square centimeter
Q4226 MyOwn skin, includes harvesting and preparation procedures, per square centimeter
Q5116 Injection, trastuzumab-qyyp, biosimilar, (trazimera), 10 mg
Q5117 Injection, trastuzumab-anns, biosimilar, (kanjinti), 10 mg
Q5118 Injection, bevacizumab-bvcr, biosimilar, (Zirabev), 10 mg


Coding Ahead

Upcoming CPT (DELETED) Code Changes Effective from October 1, 2019

Deleted Codes:


0104U Hereditary pan cancer (eg, hereditary breast and ovarian cancer, hereditary endometrial cancer, hereditary colorectal cancer), genomic sequence analysis panel utilizing a combination of NGS, Sanger, MLPA, and array CGH, with MRNA analytics to resolve variants of unknown significance when indicated (32 genes[sequencing and deletion/duplication], EPCAM and GREM1 [deletion/duplication only])

90619 Meningococcal conjugate vaccine, serogroups A, C, W, Y, quadrivalent, tetanus toxoid carrier (MenACWY-TT), for intramuscular use


Coding Ahead

Upcoming CPT (NEW) Code Changes Effective from October 1, 2019

New Codes:


0105U Nephrology (chronic kidney disease), multiplex electrochemiluminescent immunoassay (ECLIA) of tumor necrosis factor receptor 1A, receptor superfamily 2 (TNFR1, TNFR2), and kidney injury molecule-1 (KIM-1) combined with longitudinal clinical data, including APOL1 genotype if available, and plasma (isolated fresh or frozen), algorithm reported as probability score for rapid kidney function decline (RKFD)
0106U Gastric emptying, serial collection of 7 timed breath specimens, non-radioisotope carbon-13 (13C) spirulina substrate, analysis of each specimen by gas isotope ratio mass spectrometry, reported as rate of 13CO2 excretion
0107U Clostridium difficile toxin(s) antigen detection by immunoassay technique, stool, qualitative, multiple-step method
0108U Gastroenterology (Barrett’s esophagus), whole slide–digital imaging, including morphometric analysis, computer-assisted quantitative immunolabeling of 9 protein biomarkers (p16, AMACR, p53, CD68, COX-2, CD45RO, HIF1a, HER-2, K20) and morphology, formalin-fixed paraffin-embedded tissue, algorithm reported as risk of progression to high-grade dysplasia or cancer
0109U Infectious disease (Aspergillus species), real-time PCR for detection of DNA from 4 species (A. fumigatus, A. terreus, A. niger, and A. flavus), blood, lavage fluid, or tissue, qualitative reporting of presence or absence of each species
0110U Prescription drug monitoring, one or more oral oncology drug(s) and substances, definitive tandem mass spectrometry with chromatography, serum or plasma from capillary blood or venous blood, quantitative report with steady-state range for the prescribed drug(s) when detected
0111U Oncology (colon cancer), targeted KRAS (codons 12, 13, and 61) and NRAS (codons 12, 13, and 61) gene analysis utilizing formalin-fixed paraffin-embedded tissue
0112U Infectious agent detection and identification, targeted sequence analysis (16S and 18S rRNA genes) with drug-resistance gene
0113U Oncology (prostate), measurement of PCA3 and TMPRSS2-ERG in urine and PSA in serum following prostatic massage, by RNA amplification and fluorescence-based detection, algorithm reported as risk score
0114U Gastroenterology (Barrett’s esophagus), VIM and CCNA1 methylation analysis, esophageal cells, algorithm reported as likelihood for Barrett’s esophagus
0115U Respiratory infectious agent detection by nucleic acid (DNA and RNA), 18 viral types and subtypes and 2 bacterial targets, amplified probe technique, including multiplex reverse transcription for RNA targets, each analyte reported as detected or not detected
0116U Prescription drug monitoring, enzyme immunoassay of 35 or more drugs confirmed with LC-MS/MS, oral fluid, algorithm results reported as a patient-compliance measurement with risk of drug to drug interactions for prescribed medications
0117U Pain management, analysis of 11 endogenous analytes (methylmalonic acid, xanthurenic acid, homocysteine, pyroglutamic acid, vanilmandelate, 5-hydroxyindoleacetic acid, hydroxymethylglutarate, ethylmalonate, 3-hydroxypropyl mercapturic acid (3-HPMA), quinolinic acid, kynurenic acid), LC-MS/MS, urine, algorithm reported as a pain-index score with likelihood of atypical biochemical function associated with pain
0118U Transplantation medicine, quantification of donor-derived cell-free DNA using whole genome next-generation sequencing, plasma, reported as percentage of donor-derived cell-free DNA in the total cell-free DNA
0119U Cardiology, ceramides by liquid chromatography–tandem mass spectrometry, plasma, quantitative report with risk score for major cardiovascular events
0120U Oncology (B-cell lymphoma classification), mRNA, gene expression profiling by fluorescent probe hybridization of 58 genes (45 content and 13 housekeeping genes), formalin-fixed paraffin-embedded tissue, algorithm reported as likelihood for primary mediastinal B-cell lymphoma (PMBCL) and diffuse large B-cell lymphoma (DLBCL) with cell of origin subtyping in the latter
0121U Sickle cell disease, microfluidic flow adhesion (VCAM-1), whole blood
0122U Sickle cell disease, microfluidic flow adhesion (P-Selectin), whole blood
0123U Mechanical fragility, RBC, shear stress and spectral analysis profiling
0124U Fetal congenital abnormalities, biochemical assays of 3 analytes (free beta-hCG, PAPP-A, AFP), time-resolved fluorescence immunoassay, maternal dried-blood spot, algorithm reported as risk scores for fetal trisomies 13/18 and 21
0125U Fetal congenital abnormalities and perinatal complications, biochemical assays of 5 analytes (free beta-hCG, PAPP-A, AFP, placental growth factor, and inhibin-A), time-resolved fluorescence immunoassay, maternal serum, algorithm reported as risk scores for fetal trisomies 13/18, 21, and preeclampsia
0126U Fetal congenital abnormalities and perinatal complications, biochemical assays of 5 analytes (free beta-hCG, PAPP-A, AFP, placental growth factor, and inhibin-A), time-resolved fluorescence immunoassay, includes qualitative assessment of Y chromosome in cell-free fetal DNA, maternal serum and plasma, predictive algorithm reported as a risk scores for fetal trisomies 13/18, 21, and preeclampsia
0127U Obstetrics (preeclampsia), biochemical assays of 3 analytes (PAPP-A, AFP, and placental growth factor), time-resolved fluorescence immunoassay, maternal serum, predictive algorithm reported as a risk score for preeclampsia
0128U Obstetrics (preeclampsia), biochemical assays of 3 analytes (PAPP-A, AFP, and placental growth factor), time-resolved fluorescence immunoassay, includes qualitative assessment of Y chromosome in cell-free fetal DNA, maternal serum and plasma, predictive algorithm reported as a risk score for preeclampsia
0129U Hereditary breast cancer–related disorders (eg, hereditary breast cancer, hereditary ovarian cancer, hereditary endometrial cancer), genomic sequence analysis and deletion/duplication analysis panel (ATM, BRCA1, BRCA2, CDH1, CHEK2, PALB2, PTEN, and TP53)
0130U Hereditary colon cancer disorders (eg, Lynch syndrome, PTEN hamartoma syndrome, Cowden syndrome, familial adenomatosis polyposis), targeted mRNA sequence analysis panel (APC, CDH1, CHEK2, MLH1, MSH2, MSH6, MUTYH, PMS2, PTEN, and TP53) (List separately in addition to code for primary procedure)
0131U Hereditary breast cancer–related disorders (eg, hereditary breast cancer, hereditary ovarian cancer, hereditary endometrial cancer), targeted mRNA sequence analysis panel (13 genes) (List separately in addition to code for primary procedure)
0132U Hereditary ovarian cancer–related disorders (eg, hereditary breast cancer, hereditary ovarian cancer, hereditary endometrial cancer), targeted mRNA sequence analysis panel (17 genes) (List separately in addition to code for primary procedure)
0133U Hereditary prostate cancer–related disorders, targeted mRNA sequence analysis panel (11 genes) (List separately in addition to code for primary procedure)
0134U Hereditary pan cancer (eg, hereditary breast and ovarian cancer, hereditary endometrial cancer, hereditary colorectal cancer), targeted mRNA sequence analysis panel (18 genes) (List separately in addition to code for primary procedure)
0135U Hereditary gynecological cancer (eg, hereditary breast and ovarian cancer, hereditary endometrial cancer, hereditary colorectal cancer), targeted mRNA sequence analysis panel (12 genes) (List separately in addition to code for primary procedure)
0136U ATM (ataxia telangiectasia mutated) (eg, ataxia telangiectasia) mRNA sequence analysis (List separately in addition to code for primary procedure)
0137U PALB2 (partner and localizer of BRCA2) (eg, breast and pancreatic cancer) mRNA sequence analysis (List separately in addition to code for primary procedure)
0138U BRCA1 (BRCA1, DNA repair associated), BRCA2 (BRCA2, DNA repair associated) (eg, hereditary breast and ovarian cancer) mRNA sequence analysis (List separately in addition to code for primary procedure)

See Deleted Codes


Coding Ahead

New CPT® Code for Reporting COVID-19 Test

On Jan. 30, the World Health Organization (WHO) declared the 2019 novel coronavirus (COVID-19) disease outbreak a public health emergency of international concern. The outbreak has since been elevated to a pandemic and President Trump has declared the coronavirus pandemic a national emergency in the United States. Communities across the country are shutting down to […]

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Code Change for Influenza Season 2020-2021

The 2019-2020 influenza season is winding down, so now is a good time to start preparing for the 2020-2021 influenza season. Let’s start with a new CPT® code for the flu vaccine. Flu Activity Report The Centers for Disease Control and Prevention (CDC) reports that viral activity is decreasing in the United States. According to […]

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Radiology Code Update for 2020

Quite a few code changes and revisions were made to the Radiology section of CPT® for 2020. Less confusing language and expanded code categories will make life easier for medical coders. Here’s a quick review. Gastrointestinal System A mini overhaul of the gastrointestinal system codes removed the confusing language of “with or without KUB” and […]

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New Diagnosis Code Released for Vaping-Related Disorder

A new ICD-10-CM code for reporting vaping-related disorders has been created. This new code and updated guidance supersedes previous vaping coding guidance released in October 2019. ICD-10-CM code U07.0 Vaping-related disorder is effective April 1, 2020. Illnesses Related to Vaping Continue As of Dec. 27, 2019, there are been 2,561 reported cases of e-cigarette, or […]

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