if you're getting ready to take the CPC exam and thinking to yourself gosh I wish I could just watch someone else go through some of these cases to see if I'm doing this the right way while you're in luck because today we're going to go through some sample cases things that are similar to what you might see on the CPC exam if you're new here I am Victoria I'm the medical coder auditor educator and content creator and I have been in this industry for over 15 years and my favorite thing is helping people like you pass your certification exams or just feel more confident more strong more well informed in the medical coding industry so you definitely want to make sure that you subscribe and hit the notification Bell so that you can get alerts when I post new episodes so just a quick refresher the CPC exam is 100 questions you will have four hours to complete it it is an open book exam you are allowed to take your code books your CPT your hick picks your ICD-10 CM check with the aapc on the regulations of which versions you're allowed to take typically it's any version of IC 10 any version of hick picks but you need to have the AMA edition of the CPT book so those are the books you are allowed to take you are not allowed to take your training textbooks whether they be the ones through the aapc or if you're using bucks or some other version these leave these at home tuck them away you're not allowed to have them for the exam in order to pass the exam you need a 70 overall or that means 70 questions correct there is a breakdown on the aapc website of what is on the CPC exam so you can see here there will be four questions specific to Med term now that doesn't mean you only need to know Med term for those four questions it means that there's only going to be four questions that are specifically testing you on Med term there's going to be other questions where you're going to need to know the med term in order to get to the correct answer for that question four questions on Anatomy three are on compliance and Regulatory seven questions that are just going to be testing you on the coding guidelines either on icd-10-cm or on CPT things like modifier usage ordering of the codes things like that five questions on icd-10-cm now that means five questions that are just going to be icd-10-cm there's going to be several cases where they'll test you on CPT and ICD-10 but there's going to be five specific questions that are just ICD-10 questions three questions on hick picks three questions just on hick fix codes again you might see some questions that are maybe a case study that has a hit pix code in it but generally speaking you could probably leave your hick picks book at home and would still have a good chance of passing the exam because it's not heavily into hick picks this is the breakdown of what's going to be questioned on CPT six questions on the 10 000 Series 6 on 20 6 on 30 6 on 40 6 on fifty six on the 60s six Radiology questions six path and lab questions six medicine questions six e m questions for anesthesia and then 10 cases Don't Panic about the cases too much some people see the cases and they think oh my gosh those are cases I'm going to have to code them from scratch this is entirely multiple choice for the CPC exam those case questions are going to be multiple choice questions when they say cases what does that mean well if you go through like the official curriculum with the aapc and you have maybe one of their CPC books and I think they may have some of these in the study guide as well but if you look in them they've got these long questions and they call these long questions cases so case basically means it's going to be like a longer operative note or a longer visit note of some kind for some of the other certification exams they might give you a case and ask you like three or four questions based off of that note for the CPC it says that they will have one question each for those 10 cases let's start with this question it says patient was seen in the office for a bilateral screening mammogram what code should be assigned find to the mammogram this is a procedure so we're going to want to be in our CPT book so we can try starting out in the index and looking under mammogram all right so here's mammography and we've got a couple of options here we have computer aided detection localization with lesions MRIs this was a screen so here we are screening mammography 77067 now this is the only option that we've been given there's no range here right so we have a good amount of certainty at this point that this is going to be the correct code you could at this point go you know what I'm going to take a little bit of a risk I'm just going to say that that's the correct code and not double check it but it's better that we do right looking back on the question 77067 is one of the potential answers on there and if we look here description 77067 screening mammography bilateral which means since it already says bilateral in the description we do not need the 50 modifier include putting the cad when performed some of the other options here like the 7066 which would be our option b that would not be for a screening that would be for Diagnostic um and the D you know it has the rtlt and again this is bilateral so we don't need a modifier to indicate that it's bilateral because it's in it's in the code description it's an inherent part of it so our answer for this one would be our option A 77067 now on to our next question this patient is seen for a laparoscopic cholecystectomy with intra-operative chalangiogram what CPT code should be assigned for the procedure now if you've ever watched any of my other videos where I've gone through case studies you know that I'd say to not always use the index you can just start with the section so if this one we wanted to go into our digestive section and find the section for cholecystectomy which would be under bilary bile duct stuff that is where we would find our cholecystectomy codes the perk of doing that of course would be you'd already be in that section you'd already be in the digestive section you wouldn't have to go all the way to the index and then flip back to the digestive section anyway to get to those codes but let's start over here with the digestive section so this one if we look back on the question that we have this was a laparoscopic cholecystectomy so we can see here a couple of things that's laparoscopic we're doing a cholecystectomy and we have the chalangiogram so those are our three key things we're going to be looking for when we're checking through this list in the indexed so cholecystectomy laparoscopic and it's going to give us this range but then oh okay with chalangiography and then we've got this range we've got 47563 47605 47620 and then here we have the range typically I would say you're going to have a better chance going by the laparoscopic because this might give us some opens not sure but I'm gonna I'm gonna say let's stay over with these laparoscopic codes because we can see our option A is within that range right our option b is within that range we've just got one other ooh 47605 is our option C option D is 47610 which with exploration of the common duct probably not that one so we're ruling out option D I would say rule out option D right away but let's let's head over and see what it says in the section okay laparoscopy Surgical cholecystectomy and then this one does say with the chalangiography so that one looks like the right one four seven five six three what's R2 that's the one that doesn't have this added into it and let's see just real quick since we're right here 6 605 c605 isn't in the laparoscopic section so this would be an open code it says for the laparoscopic approach to use this other code range so in this case our answer is going to be our option b the 47563 now those were some relatively easy examples but let's take a look at some that maybe aren't quite as easy I'm going to ask you to just pause this screen and read through it and then we'll go through and figure out how we're going to piece this together with lesion removal some of the things we have to look at is was it cancerous or was it benign where was the location what was the size depending on what it is we might have to look at depth but this is just a basic skin tag basic skin removal so we're going to start there so one of the things we want to look at is again is this benign or malignant so if we look here this was a squamous cell carcinoma we're going to want to know the type the location right it's on the left forearm and the size here was three centimeters now with lesion excisions a simple one layer closure is included intermediate complex are not so this one here if we look it was an intermediate closure which means we have to code that out as a separate CPT code and then here's the length of that again it was also on the left forearm and then skin tags are not included in that skin tags are based off of not size or depth or location but basically the number of skin tags that you're doing now if you don't know this off the top of your head because there's tons and tons of codes and we can't know everything off of the top of our heads when you go and look up skin tags it'll give you the difference of the two codes the one is one quantity the other is a different quality or when you go to look up the lesion excisions because in this case we have the questions the the answers for the questions potentially answers so we could just start looking up some of the codes like I would start this looking at the 11603s or the 12032 codes and see where we are from there so we have five skin tags and we're just just to separate the fact that this was not part of what was included in here we're going to say make sure we highlight this just to say this was the neck this was not part of that squamous cell carcinoma stuff now if we look at the right in the answer potentials if we look at the ICD-10 codes c4469 c4469 c4469c4469 so we don't even have to look at that because no matter what option we select it's going to have c446 um two nine it's going to have the L9 1.8 and you know if you see those C codes if you think C for cancer that's probably going to be our squamous cell carcinoma code right and then the l918 skin tag right so we have uh 603 602 603 -603 some of these it looks like all of them have the 59 modifier on them we also have this 12032 in the mix this one here option C does not have 12032 um and then the one one two zero zero so let's take a look 11603 so since we're seeing that on three options we need to look okay is there a difference between the O3 and the O2 and what is it so if we look at our O3 versus the O2 so this these codes are both from this section here excision malignant lesion including margins trunk arms or legs and the forearms of course are part of the arms so one one six zero two is one point one to two the O3 is 2.1 to 3 centimeter diameter now if we look at that remember we highlighted this section in yellow so what's in our yellow section it is the three centimeter so that's the code size that we're going to go with for this so here is our three centimeter so that means option b is out now we also have to code for that intermediate closure right if you read through the guidelines for closures it'll tell you that the symbols are included intermediates are not so we want to code for that closure and that's our green section there intermediate closure 3.5 so here we want to make sure that we're in the right location right so scalp axilla trunk and or extremities is the forearm and extremity right orm is an extremity it says excluding hands and feet that's a separate section but the forearm is an extremity is it 2.5 or less no is it 2.627.5 yes so 12032 so we want to do make sure that we have that in the code since option C doesn't have that option C is out so let's take a look now at our difference between a and b the difference here is this code here the one one two zero zero or the one one four zero zero times five so let's look at our one one two zero zero ah one one two zero zero removal of skin tags any area up to and including 15 lesions and how many did we take off five we took off five now if we were to look up that one one four zero zero code that would basically be for a 0.5 centimeter or less benign lesion but we have a code specifically for skin tags and this one it says here by any method of scissoring sharp ligature strangulation etc etc if we look at ours it was removed with a surgical scissor so that would be our correct code here is that one one two zero zero which means our answer here is option C and those 59 modifiers you'll see those a lot when there's lesions removed from other areas because basically Medicare put this edit in place they want to make sure that no one is double dipping on the same lesion like saying oh we we removed the skin tag but it was also a an excision of a lesion so we're going to build for both so next question and patient with end-stage renal disease presents to the Ambulatory Surgery Center for revision of his autogenous radiosophyllic fistula that needs is needed for continued hemodialysis what CPT codes should be utilized now when I look at these potential answers for this I see something in common do you see it three of the answers start with three six eight so my first thought is I'm not going to go to the index I'm just going to go look at those 368 codes and figure out which one of those it possibly is and if it's not that maybe I'll look at 36904 so we have eight two five eight three one eight three two two five creation of arteriovenous fistula by other than direct arterial venous anastomosis autogenous graft here we have thrombectomy we didn't remove a thrombus this one here revision open arterial venous fistula without thrombectomy okay autogenous or not onogenous dialysis graft so there's some key things in there that are in here right too this was for hemodialysis right oh I got my pen on instead of my highlighter one stuck here so for hemodialysis it's an autogenous radioscephalic there's nothing in here about a thrombus and also it was a revision just like in the CPT code description so in this case this matches up the six eight six three six eight three two so for this one that means our answer is option b now this one again I'm going to ask you to read through and then just pause or screenshot it and if you look we're going to be looking at the CPT and ICD-10 CM codes for this one now when we go through and we verify everything that's in that procedural note what we're going to come up with and I didn't want to shrink it down into nothing into that little corner but what we're going to come up with is that this is a placement of a feeding tube now here's something where you are either going to need to know a little bit of Med term or how to use some other terminology to look something up or just know how to go to the digestive section go to stomach and start looking for things that way because if you look up feed or you look up tube in the index you're not going to get anything what you are going to want to look up is nasogastric tube now again four three seven five two is one of the answers that we have so if you want to go ahead and go okay well I'm just gonna pick that one right away like it depends on how much risk you want to take as to whether you want to rule out the other options or not but based off of the mapping here it looks fairly likely that four three seven five two is going to be the correct code so if we look at four three seven five two these are orogastric tube placement requiring physician skill and fluoroscopic guidance five three here gastric intubation and aspiration and aspirations therapeutic necessitating physician skill including lavage if performed so clearly R7 2 is the correct one so we can go ahead and rule out our a and then what are we looking at differently from these components everything's five two so what is the icd-10-cm code k3184 uh this one's k81 k3184 with this e1143 which is a diabetic code anything that's in E11 or e10s those are diabetes codes I think E12 e13 so we could look at this right away and go I didn't see anything on here about this patient having diabetes and I would I would rule that one out as well so really we're looking at is it k3184 or r63.8 considering the K was on the others probably a higher likelihood that this is the right one but we'll see all right so here we are k3184 gastroparesis there is a note here that says code first any underlying disease such as and includes the diabetes complications code but again this patient did not have diabetes so we would be able to just code the k31.84 for the gastroparesis I think the r63.3 is just difficulty feeding um which is not as specified as our gastroparesis so option b which is our four three seven five two and k3184 so when you're working through these questions you know what is the fastest method for you is it going to be going to the index is it going to be going right to that specific chapter in CPT is it going to be assessing what the options are and then just looking up those codes a lot of people find that fast faster and I always say you know you should really be looking at what your potential answers are before you're spending time lamenting over reading a long operative note or long case or question you know in the comments if there are other types of questions you would like to see me cover if you found this helpful if you think there would be a better format I will see you guys in the next video and until then just keep on coding on