20 free CPC practice questions

Correct answer: C · Cystotomy

MedlinePlus, the National Library of Medicine's consumer health site, lists cyst- as bladder or sac, -otomy as incision, -ectomy as removal, and -ostomy as an opening. Cystotomy therefore means an incision into the bladder, which matches a report where the bladder is opened, a stone is taken out, and the wall is closed again. Cystectomy would mean the bladder itself was removed, which the report rules out. Cystostomy means creating an opening, such as one for a drainage tube, which the report does not describe. Cholecystotomy adds chol- (bile), so it names an incision into the gallbladder rather than the urinary bladder. Reading word parts this way is how a coder checks an operative note against the procedure being coded.

Look for this next time: -otomy is an incision, -ectomy a removal, and -ostomy an opening; cyst- alone is the bladder, chol- plus cyst- the gallbladder.

Correct answer: A · Transverse colon

The National Cancer Institute's SEER training module on colorectal anatomy divides the colon into five segments, in order: cecum, ascending colon, transverse colon, descending colon, and sigmoid colon, and it treats the rectum as a separate organ. After the ascending colon comes the transverse colon. The descending colon follows the transverse colon, one step further along. The sigmoid colon is the last colon segment before the rectum. The rectum is not a colon segment at all in this description. Knowing the order matters when a report states how far a scope reached or which segment a specimen came from, because that location drives both the procedure and the diagnosis codes.

Look for this next time: The colon runs cecum, ascending, transverse, descending, then sigmoid; the rectum is a separate organ.

Correct answer: D · No NCCI-associated modifier can be used to bypass this edit

CMS's NCCI Policy Manual for Medicare Services (2026), Chapter I, says every procedure-to-procedure edit carries a correct coding modifier indicator. A 0 means NCCI-associated modifiers cannot be used to bypass the edit, a 1 means they may be used in appropriate circumstances, and a 9 means modifier use is not specified, the value used for pairs whose deletion date equals their effective date. With a 0, appending 59 or an X modifier does not unlock the pair, however well documented, which is what the option about modifiers describes for an indicator of 1. The deleted-edit option describes a 9. Saying both codes are always paid together reverses what an edit does: it stops the pair from being paid together.

Look for this next time: CCMI 0: no modifier bypasses the edit; CCMI 1: a modifier may bypass it when documented; CCMI 9: not specified.

Correct answer: B · The cough and the fever documented at the visit

Section IV.H of the ICD-10-CM Official Guidelines for Coding and Reporting (FY 2027, in effect October 1, 2026 through September 30, 2027) says not to code diagnoses documented as probable, suspected, questionable, rule out, or similar terms for outpatient encounters, and to code to the highest degree of certainty instead, such as signs, symptoms, or abnormal findings. The cough and fever are the most certain information, so they are reported. Coding pneumonia, alone or ahead of the symptoms, treats an uncertain diagnosis as confirmed; the guidelines note that hospital inpatient coding handles uncertain diagnoses differently. Waiting for the X-ray is not required, because the visit is coded from what was known at that encounter.

Look for this next time: In outpatient coding, never code a probable or suspected diagnosis; code the documented signs and symptoms.

Correct answer: A · XS, for a separate organ or structure

CMS's NCCI Policy Manual (2026), Chapter I, defines four modifiers that may be used in place of modifier 59 whenever possible: XE for a service distinct because it occurred during a separate encounter, XS for one performed on a separate organ or structure, XP for one performed by a different practitioner, and XU for an unusual service that does not overlap the usual components of the main service. Two different anatomic sites at the same session fit XS, and the edit's indicator of 1 allows a modifier when the record supports it. XE would need two encounters on the same date, not one session. XP would need a second practitioner. XU describes non-overlapping components, which is not the documented reason here.

Look for this next time: XE is a separate encounter, XS a separate structure, XP a separate practitioner, and XU a non-overlapping service.

Correct answer: C · Report both codes when the patient has both conditions

Section I.A.12 of the ICD-10-CM Official Guidelines (FY 2027) describes two kinds of excludes notes. An Excludes2 note means "not included here": the excluded condition is not part of the code above it, but a patient may have both at the same time, so both codes may be used together when appropriate. Never reporting them together is the rule for an Excludes1 note, which marks conditions that cannot occur together, with an exception when the two are unrelated. Requiring the provider to say the conditions are related borrows from that Excludes1 exception, where the coder queries the provider when relatedness is unclear. Neither kind of note makes one code replace the other.

Look for this next time: Excludes2 means not included here, so both codes may be reported; Excludes1 means the two are not coded together.

Correct answer: B · GA

CMS's Medicare Claims Processing Manual, Chapter 30, treats the GA modifier as the signal that a signed ABN was obtained, and the GZ modifier as the signal that a signed ABN was not obtained when a denial is expected. With a valid signed notice on file before the service, GA is the modifier to report. GZ would tell Medicare that no signed notice exists, which contradicts the scenario. PT, under Chapter 18 of the same manual, marks a colorectal cancer screening test that became a diagnostic or therapeutic service. XU is one of the NCCI modifiers, for a service that does not overlap the usual components of the main service, and has nothing to do with ABNs.

Look for this next time: GA reports that a signed ABN is on file; GZ reports that an expected denial has no signed ABN.

Correct answer: D · It may be reported with the excision if medically necessary

Chapter III of CMS's NCCI Policy Manual (2026) says dressings, strip closures, and simple closures are integral to lesion removal and are not reported separately, but intermediate or complex repairs may be separately reportable if medically reasonable and necessary. The exception is a benign lesion with an excised diameter of 0.5 cm or less, where any repair is included. At 1.5 cm with a layered closure, the repair may be reported alongside the excision. Treating every closure as included ignores the intermediate-repair rule. Reporting only the repair drops the excision that was performed. For a lesion larger than 0.5 cm, the NCCI repair rule turns on the closure type, not on whether pathology later shows malignancy.

Look for this next time: Simple closure is bundled into lesion removal; an intermediate or complex repair may be reported, except for benign lesions of 0.5 cm or less.

Correct answer: A · Not separately; the fracture treatment code includes it

Chapter IV of the NCCI Policy Manual (2026) says codes for closed, percutaneous, or open treatment of fractures include the application of casts, splints, or strapping, and that a physician who applies the initial cast and also assumes the follow-up care cannot report the casting codes. Adding modifier 59 to a casting code tries to bypass a bundled service that is not distinct. The casting-plus-supply option describes a different situation the manual allows: a physician who applies a cast as an initial service, without any other definitive procedure, and expects to provide only that initial care. Moving the charge to a follow-up visit does not change what the fracture treatment code already includes.

Look for this next time: Fracture treatment codes include the initial cast or splint; casting codes are for care without definitive fracture treatment.

Correct answer: C · Nothing extra, since it is part of the bronchoscopy

Chapter V of the NCCI Policy Manual (2026) says that evaluating the access regions is standard practice during a diagnostic or surgical endoscopy of the respiratory system and is not reported separately, and gives the example that fiberoptic bronchoscopy routinely includes an examination of the nasal cavity, pharynx, and larynx, whether limited or complete. So the look on the way in adds no code. A separate laryngoscopy, with or without XS, may be reportable only when medically necessary procedures on two regions use different types of endoscopes, which did not happen here. A diagnostic bronchoscopy is not reported with a surgical bronchoscopy, because the surgical endoscopy includes the diagnostic one.

Look for this next time: A bronchoscopy includes the exam of the nose, pharynx, and larynx it passes through; code only the bronchoscopy.

Correct answer: D · One snare removal code with a single unit of service

Chapter VI of CMS's NCCI Policy Manual (2026) says that when the same endoscopic procedure, with polypectomy as its example, is performed several times at one encounter in the same region as the CPT code set defines it, only one code may be reported, with one unit of service. Three polyps removed the same way therefore produce one code with one unit. Reporting three units counts each polyp separately, which the policy rules out. Adding modifier XS for each extra polyp tries to make the same procedure in the same region look like separate structures. Splitting the removal by colon segment invents regions that the code does not use.

Look for this next time: The same endoscopic procedure repeated in one region at one encounter is one code with one unit, however many polyps.

Correct answer: B · An obstetric ultrasound performed during the pregnancy

Chapter VII of the NCCI Policy Manual (2026) says the total obstetric packages include antepartum care, the delivery, and postpartum care, and do not include other services such as ultrasound, amniocentesis, special screening tests for genetic disorders, visits for unrelated conditions, or added visits for high-risk conditions. An obstetric ultrasound is therefore outside the package and may be reported on its own. The same chapter says antepartum care includes urinalysis, so routine urine testing is not billed separately. It also lists episiotomy among the services included in the delivery codes. Routine postpartum care is one of the package's three parts, so that visit is already covered.

Look for this next time: The global obstetric package covers antepartum care, delivery, and postpartum care; ultrasound and unrelated visits are outside it.

Correct answer: A · Not separately, since the injection code already includes it

Chapter VIII of the NCCI Policy Manual (2026) says the epidural and subarachnoid injection codes for the different spinal levels describe injections with fluoroscopic or CT guidance, and that imaging guidance, whether by fluoroscopy or by CT, is included in those procedures and should not be reported separately. Adding a fluoroscopic guidance code with modifier 59 would unbundle a service the injection code already contains. Switching to CT guidance does not change the rule, because the manual names both kinds of guidance. A separate radiology supervision and interpretation charge would bill the same included guidance under another name.

Look for this next time: Epidural injection codes that describe imaging guidance include it; do not add a fluoroscopy or CT guidance code.

Correct answer: D · The X-ray code with modifier 26, for the interpretation

CMS's Medicare Claims Processing Manual, Chapter 13, explains that many diagnostic services, radiology among them, have a technical component (TC) and a professional component (PC), allows global billing only when the same physician or supplier entity furnishes both, and marks the components with modifier TC and modifier 26. The radiologist furnished only the interpretation and report, the professional component, so modifier 26 applies. TC describes the equipment and staff part of the service, which the hospital has already billed. A global service with no modifier requires the same entity to furnish both components. Appending both modifiers would claim both parts, although the radiologist furnished only one of them.

Look for this next time: Modifier 26 reports the professional interpretation; TC reports the technical part; a global code means one entity did both.

Correct answer: C · The lipid panel code, which covers all three of the tests

Chapter X of the NCCI Policy Manual (2026) says that when all the tests of a panel defined in the CPT code set are performed, the panel code is billed, and gives this case as its example: cholesterol, triglycerides, and HDL cholesterol ordered individually are reported as a lipid panel. Ordering the tests by name does not change that. NCCI also pairs each panel code with each of its component tests in its edits, so adding the three individual codes to the panel code reports the same tests twice. Modifiers 59 or 91 are for a medically necessary repeat of a component test on the same day, not for the first run of each test.

Look for this next time: When every test in a defined panel is performed, report the panel code instead of the individual tests.

Correct answer: B · HCPCS code G0008, used for flu vaccine administration

CMS's Medicare Claims Processing Manual, Chapter 18, treats the vaccine and its administration as separate items, and its billing instructions name HCPCS code G0008 for influenza vaccine administration, with a separate code for the vaccine itself. That makes G0008 the administration code for this Medicare flu shot rather than the CPT® immunization administration code. An office visit code with modifier 25 would claim a significant, separately identifiable evaluation and management service, which this visit does not describe. The vaccine product code does not include the administration: Medicare covers the vaccine and its administration as separate services, and the manual gives the administration its own code.

Look for this next time: For a Medicare flu shot, report the vaccine product code plus HCPCS G0008 for the administration.

Correct answer: D · Established patient, since she was seen within 3 years

CMS's Medicare Claims Processing Manual, Chapter 12, section 30.6.7, defines a new patient as one who has not received any professional service, such as an E/M visit or another face-to-face service, from the physician or the group practice of the same specialty within the previous 3 years. Both physicians are family physicians in the same group, and her last face-to-face visit was 2 years ago, so she is an established patient. Seeing a different physician of the same specialty in the group does not reset the status. One year is not the cutoff in this definition. How much history is documented affects the visit's content, not whether the patient is new.

Look for this next time: For Medicare, a patient seen face to face by the same group and specialty within 3 years is established.

Correct answer: C · 4.8 time units, rounded to one decimal place

CMS's Medicare Claims Processing Manual, Chapter 12, section 50, says actual anesthesia time in minutes is reported on the claim, and the contractor computes time units by dividing that time by 15 minutes and rounding to one decimal place. Step by step: 72 ÷ 15 = 4.8 time units. Rounding up to 5 or dropping to 4 ignores the one-decimal rule. Dividing by 10 instead of 15 gives 7.2, which uses the wrong unit length. The same section defines anesthesia time as starting when the anesthesia practitioner begins preparing the patient in the operating room or an equivalent area, and ending when the patient can be safely placed under postoperative care.

Look for this next time: Medicare anesthesia time units are minutes divided by 15, rounded to one decimal place.

Correct answer: A · The fracture code, with the 7th character for routine healing

Section I.C.19 of the ICD-10-CM Official Guidelines (FY 2027) says traumatic fractures take an initial-encounter 7th character while the patient is receiving active treatment, and a subsequent-care character once active treatment is complete and the patient is receiving routine care during healing or recovery. It also says aftercare Z codes are not used for injuries, because the 7th characters identify subsequent care. The closed reduction and casting were the active treatment, and this visit checks routine healing, so the subsequent routine-healing character applies. The initial-encounter character no longer fits once active treatment is done. The sequela character S is for a condition that results from the injury, such as a scar after a burn.

Look for this next time: Once active fracture treatment is done, routine follow-up takes the subsequent-encounter 7th character, not an aftercare Z code.

Correct answer: B · A code from category I12 plus an N18 code for the stage

Section I.C.9.a of the ICD-10-CM Official Guidelines (FY 2027) says the classification presumes a causal relationship between hypertension and kidney involvement, so the two are coded as related unless the documentation clearly states they are unrelated. It directs a code from category I12, hypertensive chronic kidney disease, when both conditions are present, with a code from category N18 as a secondary code to identify the CKD stage. Essential hypertension (I10) with a separate CKD code would apply only if the provider documented that the CKD is unrelated. The I12 code alone leaves out the stage. Coding only the CKD drops the hypertension, and no explicit link is needed here.

Look for this next time: Hypertension with CKD is presumed related: report category I12 plus an N18 code for the stage unless the provider says they are unrelated.