CPC Exam Dumps : Certified Professional Coder (CPC) Exam

1. E/M Code Category Selection:

The patient is a 19-year-old seen by his primary care physician for an annual preventive exam. His last exam was four years ago, and he has no complaints, indicating a preventive rather than problem-focused visit.

CPT® Code 99385 is for a new patient preventive visit for ages 18-39. Since the patient’s last visit was four years ago, this qualifies him as a new patient by CPT® standards (a patient is considered new if they have not received any professional services from the physician within the past three years).

2. Rationale for Excluding Other Options:

Code 99395 is for an established patient preventive visit for ages 18-39, which does not apply here since the patient is considered new after four years.

Code 99394 is for a preventive visit for an established patient aged 12-17, which does not match the patient’s age.

Code 99384 is for a new patient preventive visit for ages 12-17, which also does not apply given the patient’s age of 19.

3. AAPC and CPT® Coding Guidelines:

According to CPT® guidelines, 99385 is appropriate for a new patient in the 18-39 age range for a preventive visit, especially when they have not seen the provider in over three years.

Therefore, the correct answer is A. 99385.

Modifier -53 = Discontinued procedure after anesthesia and/or incision due to patient safety

-74 is used by facility, not physician

-52 is for reduced services, not discontinued procedures

1. Procedure and CPT® Code Selection:

The procedure performed was an evisceration of ocular contents without the placement of an implant. The surgical microscope was used for enhanced visualization, but this does not require a separate code if the primary procedure code includes it inherently.

CPT® Code 65091 is used for an evisceration of the ocular contents without implant placement. This code correctly describes the procedure performed on the left eye.

2. Modifier:

Modifier LT is added to indicate that the procedure was performed on the left eye.

3. Exclusion of Code 69990:

Code 69990 is for the use of an operating microscope, but it should not be billed separately when it is used as part of a procedure where enhanced visualization is typical or expected, such as an evisceration procedure. According to CPT® guidelines, 69990 is not separately reported when the microscope is used for visualization in procedures where its use is considered part of the standard of care.

4. Rationale for Excluding Other Options:

Code 65093 is for an evisceration with implant placement, which does not apply since no implant was used.

Options B and C incorrectly include 69990, which is not separately reportable in this scenario.

5. AAPC and CPT® Coding Guidelines:

According to AAPC and CPT® coding guidelines, 65091 is sufficient to capture the procedure without the need to add code 69990 for the microscope.

Therefore, the correct answer is D. 65091-LT.