Free CPC Practice Test: 50 Questions With Answers

Answer: B. R05.9, R50.9

In outpatient settings, a diagnosis documented as "probable," "suspected" or "rule out" isn't coded as if it were confirmed. Code what is established: the cough (R05.9) and the fever (R50.9).

• A and C code pneumonia the record hasn't confirmed.
• D (Z03.89) is for observation of a suspected condition that has been ruled out. Nothing has been ruled out, and the patient has active symptoms.

Source: ICD-10-CM Official Guidelines, FY2026, Section IV.H, p. 114 (uncertain outpatient diagnoses), and Section I.C.21.c.6, pp. 98–99 (observation codes).

Answer: A. 25

Modifier 25 marks a significant, separately identifiable E/M service by the same physician on the same day as a procedure. The blood pressure workup goes well beyond the routine evaluation that is part of the injection.

• B (57) is for an E/M that leads to the decision for major surgery.
• C (59) is a procedure modifier, not an E/M modifier.
• D (24) is for an unrelated E/M during a postoperative period.

Source: CMS Global Surgery Booklet (MLN907166), December 2025, pp. 9–10 and 13 (modifiers 57, 25 and 24); NCCI Medicare Policy Manual 2026, Chapter 1, Sections E.1.b and E.1.d, pp. I-15–I-17 (modifiers 25 and 59).

Answer: D.

An add-on code describes extra work tied to a primary procedure. It's never reported on its own, and add-on codes are exempt from the multiple-procedure modifier 51.

• A contradicts the definition.
• B and C have no basis in the add-on rules.

Source: NCCI Medicare Policy Manual 2026, Chapter 1, Section R, p. I-26 (add-on codes); American Society of Anesthesiologists, Modifier 51 vs Modifier 59, “Modifier 51 — Multiple Procedures” section (add-on exemption).

Answer: B. 12002

Repairs of the same complexity (both simple) in the same anatomic grouping are added together, and the scalp and the extremities share a simple-repair grouping. 2.5 cm + 3.0 cm = 5.5 cm, which falls in the 2.6–7.5 cm band for 12002.

• A and C report the repairs separately. That only happens when the complexity or the anatomic grouping differs.
• D (12004) starts at 7.6 cm.

Open-book move: the "add the lengths" rule is printed in the Repair (Closure) guidelines just before 12001.

Source: ACEP Wound Repair FAQ, updated February 2026, questions 3 and 10 (anatomic groups and adding lengths); CMS October 2026 Physician Fee Schedule relative-value files (RVU26D), code rows 12001, 12002 and 12004 (size bands).

Answer: D. 11403

Excised diameter is the lesion plus the narrowest margin on each side: 1.5 + 0.3 + 0.3 = 2.1 cm. For a benign lesion of the trunk, 2.1–3.0 cm is 11403.

• A codes the lesion size and ignores the margins.
• C is a malignant excision code, and pathology says benign.
• B adds an intermediate repair. The note documents a simple closure, which is included in the excision.

Source: AAFP, Skin Deep: How to Properly Code for Biopsies and Lesion Removal, March/April 2019, excisional-removal measurement section; NCCI Medicare Policy Manual 2026, Chapter 3, Section E.6, p. III-7 (included simple closure); CMS October 2026 Physician Fee Schedule relative-value files (RVU26D), code rows 11402, 11403 and 11603.

Answer: B. 11200, 11201

11200 covers up to 15 skin tags. 11201 is an add-on for each additional 10 lesions or part thereof, so the remaining 7 tags take one unit.

• A stops at 15 tags.
• C would need 26 or more tags.
• D misreads 11201 as a per-lesion code.

Source: AAFP, Skin Deep: How to Properly Code for Biopsies and Lesion Removal, March/April 2019, skin-tag removal paragraph (first 15 and each additional block of up to 10); CMS October 2026 Physician Fee Schedule relative-value files (RVU26D), code rows 11200 and 11201.

Answer: C. 29880-RT

29880 covers meniscectomy of both the medial and lateral menisci in one code. 29881 is for one meniscus (medial or lateral).

• A captures only one meniscus.
• B splits one code into two with a modifier.
• D reports the same work twice.

Source: NCCI Medicare Policy Manual 2026, Chapter 4, Section E.6, p. IV-6 (29880: both menisci; 29881: either meniscus); CMS October 2026 Physician Fee Schedule relative-value files (RVU26D), code rows 29880 and 29881.

Answer: A. 25600

Fracture treatment codes include the first cast or splint applied by the physician who treats the fracture.

• B reports the included cast separately.
• C (25605) requires manipulation.
• D fits only when a cast is applied as an initial service without definitive fracture treatment being reported.

Source: ACEP Orthopedic Fracture/Dislocation Management FAQ, updated February 2025, question 15 (25600); NCCI Medicare Policy Manual 2026, Chapter 4, Section G.6–8, p. IV-11 (initial casting and assumed follow-up); CMS October 2026 Physician Fee Schedule relative-value files (RVU26D), code rows 25600 and 25605.

Answer: D. 20611-RT

The knee is a major joint. 20611 is aspiration or injection of a major joint with ultrasound guidance, including the permanent recording and report, so the guidance is part of the code.

• A (20610) is the major-joint code without ultrasound guidance.
• C reports ultrasound guidance separately instead of using the code that includes it.
• B (20606) is for an intermediate joint, such as the wrist or elbow.

Source: Society of Teachers of Family Medicine, Practice Management Handbook: Outpatient Procedures, joint-injection table (20606, 20610 and 20611); NCCI Medicare Policy Manual 2026, Chapter 4, Section I.29, p. IV-20 (included imaging guidance).

Answer: A. 31625

31625 covers bronchial or endobronchial biopsy of one or more sites, so it's reported once.

• B reports a "single or multiple" code twice.
• C adds diagnostic bronchoscopy (31622), which is included in any surgical bronchoscopy.
• D (31628) is a transbronchial lung biopsy, a different procedure.

Source: Olympus, 2026 Pulmonary Endoscopy Reimbursement Sheet, last revised December 2025, pp. 1–2 (reproduced descriptors for 31622, 31625 and 31628); NCCI Medicare Policy Manual 2026, Chapter 5, Section C.3, p. V-6 (diagnostic endoscopy included).

Answer: C. 33208

33208 is insertion of a new or replacement permanent pacemaker with transvenous electrodes in both the atrium and the ventricle.

• A (33206) has an atrial lead only.
• B (33207) has a ventricular lead only.
• D (33213) is a dual-lead pulse generator only, with no new leads placed.

Source: CMS, Billing and Coding: Single Chamber and Dual Chamber Permanent Cardiac Pacemakers, A54958, revision effective January 1, 2026, public article text for 33206–33208; Medtronic, 2026 Pacemaker Therapy Coding and Payment Guide, pp. 1–2 (lead placement and generator insertion with existing leads).

Answer: B. 32555

32555 is thoracentesis by needle or catheter with imaging guidance, and the guidance is included.

• A (32554) is the same procedure without imaging guidance.
• C reports the guidance separately instead of choosing the code that includes it.
• D (32557) is percutaneous pleural drainage with an indwelling catheter left in place.

Source: ACEP Thoracostomy FAQ, updated December 2025, thoracentesis/pleural-drainage code list and ultrasound section (permanent images and included guidance); NCCI Medicare Policy Manual 2026, Chapter 5, Section H.17, p. V-22 (included radiologic guidance).

Answer: D. 45385, 45380-XS

Each lesion was removed by a different technique, so each technique is reported: 45385 for snare removal and 45380 for removal with biopsy forceps. A distinct-procedure modifier (XS or 59, depending on the payer) on 45380 shows the forceps work was on a separate lesion.

• A drops the forceps removal.
• C ignores the snare technique.
• B adds diagnostic colonoscopy (45378), which is included in any surgical colonoscopy.

Source: NCCI Medicare Policy Manual 2026, Chapter 6, Section C.1, p. VI-5 (diagnostic endoscopy included), and Section H.25, p. VI-15 (45385 and 45380 on separate lesions; modifier 59 or XS); ACS, Coding and reimbursement for colonoscopy, May 2016, p. 43, sample case (snare and cold-forceps code mapping only).

Answer: B. 43239

43239 is EGD with biopsy, single or multiple, so it's reported once however many samples are taken.

• A is a diagnostic EGD only.
• C counts biopsies that the code already covers.
• D adds the diagnostic EGD, which is included in the surgical endoscopy.

Source: CMS October 2026 Physician Fee Schedule relative-value files (RVU26D), code rows 43235 and 43239 (diagnostic EGD versus single-or-multiple biopsy); NCCI Medicare Policy Manual 2026, Chapter 6, Section C.1, p. VI-5 (diagnostic endoscopy included).

Answer: D. 47563

47563 is laparoscopic cholecystectomy with cholangiography. The approach (laparoscopic) and the added cholangiography both decide the code.

• A (47562) is the laparoscopic procedure without cholangiography.
• C (47605) is an open cholecystectomy with cholangiography.
• B (47600) is an open cholecystectomy without it.

Source: ACS, Coding and practice management corner, August 1, 2022, question about 47563 (laparoscopy with versus without cholangiography); ACS-hosted Ingraham et al. appendix, August 2010, Appendix 1, p. 185 (open/laparoscopic code mapping); CMS October 2026 Physician Fee Schedule relative-value files (RVU26D), code rows 47562, 47563, 47600 and 47605.

Answer: B. 52234

Bladder tumor codes are chosen by size. Small tumors of 0.5 to 2.0 cm are 52234.

• A (52224) is for minor lesions under 0.5 cm.
• C (52235) is for medium tumors of 2.0 to 5.0 cm.
• D adds diagnostic cystourethroscopy (52000), which is included.

Source: Olympus, 2026 Bladder Tumor Related Procedures Reimbursement Sheet, revised January 2026, p. 1 (reproduced descriptors for 52000, 52224, 52234 and 52235); NCCI Medicare Policy Manual 2026, Chapter 7, Section C.10, p. VII-6 (diagnostic endoscopy included); CMS October 2026 Physician Fee Schedule relative-value files (RVU26D), corresponding code rows.

Answer: A. 55250

The 55250 descriptor already covers a unilateral or bilateral vasectomy, so it's reported once, without a bilateral or side modifier.

• B, C and D each report the second side separately, double-counting a code that already includes both sides.

Open-book move: before adding modifier 50, check the descriptor for "unilateral or bilateral" or "bilateral." Either phrase means the code already covers both sides.

Source: Iowa HHS, State Family Planning Program Aid Type 906, updated February 2026, p. 1, reproduced 55250 descriptor; CMS October 2026 Physician Fee Schedule relative-value files (RVU26D), 55250 row (bilateral indicator 2), with the indicator definition in the included RVU26D documentation, pp. 11–12.

Answer: C. 57455

57455 is colposcopy of the cervix with biopsy of the cervix.

• A (57452) is colposcopy without a biopsy.
• B (57454) adds endocervical curettage, which wasn't done.
• D (57500) is a cervical biopsy without colposcopy.

Source: Iowa HHS, State Family Planning Program Aid Type 906, updated February 2026, p. 2 (reproduced descriptors for 57452, 57454 and 57455); CMS October 2026 Physician Fee Schedule relative-value files (RVU26D), code rows 57455 and 57500.

Answer: D. 62323

62323 is the lumbar or sacral interlaminar injection with imaging guidance, and the imaging is included.

• A (62322) is the same injection without imaging.
• C reports fluoroscopic guidance separately, which the code already includes.
• B (62321) is the cervical or thoracic version.

Source: CMS 2026 NCCI Policy Manual, Chapter 8, §C.21, p. VIII-8; Aetna Clinical Policy Bulletin 0016, CPT code table for 62321–62323 (reviewed October 6, 2026); CMS October 2026 PFS Relative Value Files, corresponding code rows. Accessed October 20, 2026.

Answer: B. 66984-RT

66984 is the standard extracapsular cataract removal with IOL insertion.

• A (66982) is the complex version. For this adult case, no qualifying device or technique, such as an iris expansion device, is documented.
• C has the wrong eye.
• D reports a bilateral procedure, but only the right eye was done.

Source: CMS Complex Cataract Surgery: Appropriate Use and Documentation (A53047), Article Text; Use of Laterality Modifiers (A56869), RT/LT table; and October 2026 PFS Relative Value Files, 66982 and 66984 rows. Accessed October 20, 2026.

Answer: A. 64721-RT

64721 is open neuroplasty (decompression) of the median nerve at the carpal tunnel.

• B (29848) is the endoscopic carpal tunnel release, which sits in the 20000 series.
• C (64719) is the ulnar nerve at the wrist, a different nerve.
• D reports a bilateral procedure, but only the right side was done.

Source: CMS 2026 NCCI Policy Manual, Chapter 8, §C.13, p. VIII-7; October 2026 PFS Relative Value Files, 64719, 64721 and 29848 rows; and Use of Laterality Modifiers (A56869), RT/LT table. Accessed October 20, 2026.

Answer: D. Established patient

Under CPT's definition, a patient is established after receiving professional services within the past three years from the physician or from another physician of the exact same specialty and subspecialty in the same group. Twenty-six months is inside three years.

• A and B apply a "never seen by this doctor" test and skip the same-group, same-specialty rule.
• C requires a request for a consultation, and none is documented.

Source: AMA CPT E/M guidelines effective in 2023, p. 3, New and Established Patients; CMS E/M Services Guide (MLN006764, May 2026), pp. 23–25. The stem uses the CPT same-specialty-and-subspecialty definition. Accessed October 20, 2026.

Answer: C. 99215

Office visit levels can be chosen by medical decision making (MDM) or by total time on the date of the encounter, whichever supports the service. 99215 requires 40 minutes, and 42 minutes meets it. Time counts the physician's own work that day, face-to-face or not. Clinical staff time and time for separately reported services don't count.

• A is the level MDM alone would support, but time supports more.
• B undercounts the time.
• D adds CPT's prolonged-service code, which starts at 55 minutes with 99215.

Source: AMA CPT Assistant, October 2024 special edition, p. 3 (99215 minimum and CPT 99417 threshold); AMA CPT E/M guidelines, pp. 19–20 (qualifying date-of-encounter time); CMS E/M Services Guide, May 2026, pp. 24–25. Accessed October 20, 2026.

Answer: C. 99214

MDM is set by two of three elements. Problems: a chronic illness with exacerbation is moderate. Data: none. Risk: prescription drug management is moderate. Two moderate elements make moderate MDM, which is 99214 for an established patient.

• A and B undervalue the problem and the risk.
• D needs two high elements, such as a severe exacerbation or a decision about hospitalization.

Source: AMA CPT E/M guidelines, p. 7 and Table 1, pp. 8–12, particularly the moderate row on p. 10; AMA CPT Assistant, October 2024 special edition, p. 3 (99214); CMS E/M Services Guide, May 2026, pp. 24–25. Accessed October 20, 2026.

Answer: C. P3

P3 is a patient with severe systemic disease. The ASA lists poorly controlled diabetes and morbid obesity (BMI over 40) among its examples for this class. The physical status classification is a clinical judgment made by the anesthesiologist after evaluating the patient.

• A is a normal healthy patient.
• B is mild systemic disease, such as well-controlled diabetes.
• D is severe systemic disease that is a constant threat to life.

Source: American Society of Anesthesiologists, Anesthesia Payment Basics Series: #4 Physical Status, physical-status table and the following clinical-determination paragraph; updated July 29, 2024. Accessed October 20, 2026.

Answer: C. 75

Anesthesia time starts when the anesthesia practitioner begins preparing the patient for anesthesia in the operating room or an equivalent area. It ends when the practitioner stops furnishing anesthesia services and the patient can be safely placed under postoperative care. 08:10 to 09:25 is 75 minutes. (Medicare then converts minutes into 15-minute time units.)

• A is surgical time, incision to closure.
• B stops at surgical closure instead of at the end of anesthesia services.
• D has no basis in the times given.

Source: 42 CFR 414.46, paragraphs (a)(3) and (c)(2); CMS 2026 NCCI Policy Manual, Chapter 2, §B.2, pp. II-4–II-5. Accessed October 20, 2026.

Answer: B. 71046-26

The radiologist provided only the professional component: the interpretation and report. The hospital owns the equipment.

• A claims both components.
• C is the technical component.
• D (71045) is a single-view chest x-ray.

Source: CMS Medicare Claims Processing Manual, Chapter 13, §§20.1, 20.2.1 and 150 (professional-component service code); IDTF article A54953, 71045–71046 table entries (revision effective February 26, 2026); CMS October 2026 PFS Relative Value Files, corresponding rows. Accessed October 20, 2026.

Answer: C. 74170

74170 is CT of the abdomen without contrast, followed by contrast and further sections.

• A is without contrast only.
• B is with contrast only.
• D splits a combination that has its own code.

Source: CMS IDTF article A54953, 74150, 74160 and 74170 table entries (revision effective February 26, 2026); 2026 NCCI Policy Manual, Chapter 9, §C introduction and §C.4, pp. IX-5–IX-6; CMS October 2026 PFS Relative Value Files, corresponding rows. Accessed October 20, 2026.

Answer: D. 73562-RT

Knee x-ray codes are chosen by the number of views. Three views is 73562.

• A (73560) is one or two views.
• C (73564) is a complete study of four or more views.
• B (73565) is both knees, standing anteroposterior.

Source: CMS IDTF article A54953, 73560–73565 table entries (revision effective February 26, 2026); AAOS Specialty Care Reimbursement Model, appendix p. 14 (73565 detail; December 2, 2022); CMS October 2026 PFS Relative Value Files, corresponding rows; A56869, RT/LT table. Accessed October 20, 2026.

Answer: A. 80048

These eight tests make up the basic metabolic panel with total calcium. When every component of a panel is performed, report the panel code.

• B (80053) is the comprehensive panel, which needs more tests, such as the liver tests and albumin.
• C (80047) is the basic panel with ionized calcium.
• D ignores the panel rule.

Source: CMS 2026 NCCI Policy Manual, Chapter 10, §C, p. X-6; Medicare Claims Processing Manual, Chapter 16, §90.2 and chemistry-panel table, PDF pp. 57–58; CMS October 2026 PFS Relative Value Files, 80047, 80048 and 80053 rows. Accessed October 20, 2026.

Answer: A. 36415

The office reports 36415 for its venipuncture collection. In this scenario, the independent reference lab performs and bills the tests.

• B and C add a laboratory panel to the office claim even though the reference lab performs and bills the tests.
• D (36416) is a capillary (fingerstick) collection.

Source: CMS Medicare Claims Processing Manual, Chapter 16, §§40.1–40.1.1 (referred tests and single billing) and 60.1.2 (venipuncture), PDF pp. 11–13 and 39; CMS October 2026 PFS Relative Value Files, 36415 and 36416 rows. Accessed October 20, 2026.

Answer: D. 81003

Urinalysis codes split on two questions: was the reading automated, and was microscopy done? Automated without microscopy is 81003.

• A (81000) is non-automated with microscopy.
• B (81001) is automated with microscopy.
• C (81002) is non-automated without microscopy.

Source: CMS October 2026 PFS Relative Value Files, PPRRVU2026_Oct_nonQPP.csv, 81000–81003 code and description rows. Accessed October 20, 2026.

Answer: B. 90471, 90472

For these two vaccines, report 90471 for the first injection and 90472 for the additional vaccine administration.

• A repeats the first-vaccine code.
• C is for patients through age 18 when the physician or other qualified health care professional counsels the patient or family.
• D (96372) is a therapeutic or diagnostic injection, not vaccine administration.

Source: American Academy of Pediatrics, AAP Pediatric Coding Newsletter, September 2025, p. 4, immunization administration (adult/per-vaccine codes, additional injection, pediatric counseling and COVID-19 exception); CMS October 2026 PFS Relative Value Files, 90460, 90461, 90471, 90472 and 96372 rows. Accessed October 20, 2026.

Answer: D. 90834

Psychotherapy codes are chosen by time: 90832 for 16–37 minutes, 90834 for 38–52 minutes, and 90837 for 53 minutes or more. Fifty minutes is 90834.

• A is too short a band.
• C requires at least 53 minutes.
• B adds interactive complexity (90785), which isn't documented.

Source: CMS Psychiatric Diagnostic Evaluation and Psychotherapy Services (A57520), Coding Guidance, time bands and interactive complexity (revision effective January 1, 2025); CMS October 2026 PFS Relative Value Files, 90785, 90832, 90834 and 90837 rows. Accessed October 20, 2026.

Answer: A. 93000

93000 is the complete routine ECG: the tracing plus the interpretation and report. When the same provider does both parts, the complete code is reported.

• B (93005) is the tracing only.
• C (93010) is the interpretation and report only.
• D splits a service that has a single complete code.

Source: CMS IDTF article A54953, 93000, 93005 and 93010 table entries (revision effective February 26, 2026); Medicare Claims Processing Manual, Chapter 13, §150, global service and global service code; CMS October 2026 PFS Relative Value Files, corresponding rows. Accessed October 20, 2026.

Answer: B. Neurorrhaphy

Neur- means nerve, and -rrhaphy means suture.

• A -lysis means breaking down or destruction.
• C -ectomy means removal.
• D -plasty means surgical reconstruction.

Source: MedlinePlus, Appendix A: Word Parts and What They Mean.

Answer: C. A slow heart rate

Brady- means slow, and -cardia refers to the heart.

• A is tachycardia (tachy- means fast).
• B is cardiomegaly.
• D is carditis.

Source: MedlinePlus, Appendix A: Word Parts and What They Mean.

Answer: D. On the right forearm, toward the elbow

Proximal means closer to the trunk or to where a limb attaches. From the wrist, that's up the forearm toward the elbow.

• A describes a distal location.
• B and C describe the palm and back (palmar and dorsal) surfaces, not distance from the trunk.

Source: NCI SEER Training, Anatomical Terminology, directional terms.

Answer: A. Into right and left portions

A sagittal plane runs vertically from front to back and divides the body into right and left parts. It splits the body into equal halves only at the midline.

• B is the frontal (coronal) plane.
• C is the transverse (axial) plane.
• D isn't an anatomical plane.

Source: NCI SEER Training, Anatomical Terminology, planes of the body.

Answer: A. E11.22, N18.31, Z79.4

ICD-10-CM's "with" convention presumes a link between diabetes and the conditions listed under "with" in the Index, including chronic kidney disease, unless the provider says they're unrelated. E11.22 instructs you to add the CKD stage (N18.31 is stage 3a), and Z79.4 reports long-term insulin use.

• B misses the presumed link.
• C uses unspecified stage 3 and drops the insulin code.
• D (E11.65) is diabetes with hyperglycemia, which isn't documented.

Source: ICD-10-CM Official Guidelines, FY2026, Sections I.A.15 and I.C.4.a.3; CMS FY2026 Index and Tabular List, Diabetes/with/chronic kidney disease, E11.22, N18.30–N18.31, E11.9, E11.65 and Z79.4.

Answer: B. I12.9, N18.4

ICD-10-CM presumes a causal relationship between hypertension and CKD. Use I12.9 for CKD stages 1 through 4, then N18.4 to report the stage.

• A misses the presumed relationship.
• C reverses the order; the I12 code comes first.
• D (I13.-) requires heart disease as well.

Source: ICD-10-CM Official Guidelines, FY2026, Sections I.C.9.a.2–3; CMS FY2026 Tabular List, I10, I12.9, I13.10 and N18.4, including the N18 code-first note.

Answer: C. I69.351

Deficits that remain after a stroke are sequelae, coded from category I69. I69.351 is hemiplegia and hemiparesis following cerebral infarction affecting the right dominant side.

• A codes an acute infarction, which this isn't.
• B omits the cause.
• D (I69.95-) follows an unspecified cerebrovascular disease, but the infarction is documented.

Source: ICD-10-CM Official Guidelines, FY2026, Section I.C.9.d; CMS FY2026 Tabular List, I63.9, I69.351, I69.951 and G81.91, including the G81 Excludes1 note.

Answer: C. J0696 × 4

Units equal the dose given divided by the amount in the code descriptor: 1,000 mg ÷ 250 mg = 4 units.

• A treats the code as "per dose."
• B divides by 500 mg instead of 250 mg.
• D reports milligrams instead of units.

The injection itself is reported separately with 96372.

Source: CMS January 2026 Alpha-Numeric HCPCS file, J0696; AMA CPT code 96372, Typical patient description and Care components.

Answer: A. GA

GA shows that a waiver of liability statement (the ABN) was issued as required by payer policy.

• B (GZ) means denial is expected and no ABN is on file.
• C (GY) is for an item or service that is statutorily excluded.
• D (GX) is for a voluntary ABN, used for services that are excluded anyway.

Source: CMS, Medicare Advance Written Notices of Non-coverage (MLN006266), May 2025, pages 3, 5–6 and Table 2 on page 11.

Answer: D.

A provider must report and return an overpayment by the later of 60 days after identifying it or the date any applicable cost report is due, unless a suspension applies. Here, no cost report or suspension applies, so the deadline is 60 days after identification. A timely, good-faith investigation into related overpayments from the same or a similar cause can suspend the deadline. That suspension ends when the investigation is complete and the aggregate amount is calculated, or 180 days after the initial overpayment was identified, whichever comes first. Keeping an identified overpayment past the deadline can create False Claims Act liability.

• A waits for Medicare, but the duty to report and return is the provider's.
• B and C have no basis in the rule.

Source: 42 CFR 401.305, current text, paragraphs (b)(1), (b)(3), (e) and (f), checked October 20, 2026.

Answer: A. 12001, S61.211A, W26.0XXA

A single-layer closure is a simple repair, and 2.0 cm on the hand falls in 12001's band of 2.5 cm or less. S61.211A is a laceration without foreign body of the left index finger without damage to the nail, initial encounter. W26.0XXA is contact with a knife, initial encounter. External cause codes are reported when a state or payer requires them, or voluntarily; here it adds detail without changing the other codes.

• B uses the 2.6–7.5 cm band.
• C (S61.210A) is the right index finger.
• D (12011) is a simple repair of the face, ears, eyelids, nose, lips or mucous membranes.

Source: AMA, Reporting Wound Repair Using Simple, Intermediate, or Complex Repairs (CPT Assistant, August 2025), Simple Repair and Table 1; CMS October 2026 RVU file, 12001, 12002 and 12011; CMS FY2026 Tabular List, S61.210, S61.211 and W26.0 with seventh-character instructions; FY2026 ICD-10-CM guidelines, Sections I.C.19.a and I.C.20.

Answer: A. 45385, Z12.11, K63.5

When screening is the reason for the visit, the screening code is listed first, and a condition found during the screening is added. The polyp was removed by snare, so the procedure is 45385. K63.5 (polyp of colon) fits while pathology is pending.

• B lists the finding first.
• C (45380) describes colonoscopy with biopsy, not the documented snare removal.
• D codes a diagnostic colonoscopy and drops both the polypectomy and the finding.

In practice: payers use a modifier to show that a screening colonoscopy became therapeutic, such as PT for Medicare. Check each payer's policy.

Source: ICD-10-CM Official Guidelines, FY2026, Section I.C.21.c.5; CMS FY2026 Index and Tabular List, Polyp/colon/sigmoid and K63.5; CMS article A53399, Example 1 (45380/45385); CMS article A55069, Coding Guidelines (PT).

Answer: A. 00790-P2

Laparoscopic cholecystectomy is an intraperitoneal procedure in the upper abdomen, and 00790 is anesthesia for upper abdominal intraperitoneal procedures, including laparoscopy, not otherwise specified. The anesthesiologist documented ASA 2 (mild systemic disease), so P2 applies.

• B overstates the documented physical status.
• C (00840) is for lower abdominal intraperitoneal procedures.
• D is the surgeon's procedure code, not an anesthesia code.

Source: ASA, Anesthesia Payment Basics: Codes and Modifiers, 00790 descriptor and gallbladder-removal example; ASA, Anesthesia Payment Basics: Physical Status, P2–P3 table; CMS October 2026 RVU file, 00790, 00840 and 47562.

Answer: B. 99204, R10.13

Level: Ordering three unique tests meets the moderate data requirement. Prescription drug management is moderate risk. Two of three elements at moderate make moderate MDM, which is 99204 for a new patient.

Diagnosis: A "suspected" peptic ulcer isn't coded in the office setting, so the symptom, epigastric pain (R10.13), is reported.

• A undervalues the MDM.
• C codes the suspected ulcer.
• D is an established patient code.

Source: AMA CPT E/M guidelines, Table 1, Levels of MDM (moderate data and prescription management); CMS October 2026 RVU file, 99203, 99204 and 99214; ICD-10-CM Official Guidelines, FY2026, Section IV.H; CMS FY2026 Tabular List, R10.13 and K27.9.

Answer: A. 69210-LT, H61.22

Removing impacted cerumen with an instrument such as a curette is 69210, which is a unilateral code, so LT shows the left ear. H61.22 is impacted cerumen, left ear.

• B (69209) is removal by lavage (irrigation), not instrumentation.
• C (H61.21) is the right ear.
• D reports both ears, but only the left was impacted and treated.

Source: CMS NCCI Policy Manual, 2026, Chapter XI, Section H.6 (69209 and 69210); CMS January 2026 Alpha-Numeric HCPCS file, LT; CMS FY2026 Tabular List, H61.21–H61.23.