OFFICIAL STUDY GUIDE

CPC
®

CERTIFICATION
CERTIFIED PROFESSIONAL CODER
2021

Official Study Guide

CPC® Certification
 

Disclaimer
This course was current when it was published. Every reasonable effort has been made to assure the accuracy of the informa-
tion within these pages. The ultimate responsibility lies with readers to ensure they are using the codes, and following applicable
guidelines, correctly. AAPC employees, agents, and staff make no representation, warranty, or guarantee that this compilation of
information is error-free, and will bear no responsibility or liability for the results or consequences of the use of this course. This
guide is a general summary that explains guidelines and principles in profitable, efficient healthcare organizations.

US Government Rights
This product includes CPT®, which is commercial technical data and/or computer data bases and/or commercial computer soft-
ware and/or commercial computer software documentation, as applicable, which was developed exclusively at private expense
by the American Medical Association, 515 North State Street, Chicago, Illinois, 60610. U.S. Government rights to use, modify,
reproduce, release, perform, display, or disclose these technical data and/or computer data bases and/or computer software and/or
computer software documentation are subject to the limited rights restrictions of DFARS 252.227-7015(b)(2) (November 1995),as
applicable, for U.S. Department of Defense procurements and the limited rights restrictions of FAR 52.227-14 (June 1987) and/
or subject to the restricted rights provision of FAR 52.227-14 (June 1987) and FAR 52.227-19 (June 1987), as applicable, and any
applicable agency FAR Supplements, for non-Department of Defense Federal procurements.

AMA Disclaimer
CPT® copyright 2020 American Medical Association. All rights reserved.

Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of
CPT®, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense
medical services. The AMA assumes no liability for data contained or not contained herein.

CPT® is a registered trademark of the American Medical Association.

Regarding HCPCS Level II

HCPCS Level II codes and guidelines discussed in this book are current as of press time.

Clinical Examples Used in this Book

AAPC believes it is important in training and testing to reflect as accurate a coding setting as possible to students and examinees.
All examples and case studies used in our study guides, exams, and workbooks are actual, redacted office visits and procedure
notes donated by AAPC members. To preserve the real world quality of these notes for educational purposes, we have not
re-written or edited the notes to the stringent grammatical or stylistic standards found in the text of our products. Some minor
changes have been made for clarity or to correct spelling errors originally in the notes, but essentially they are as one would find
them in a coding setting.

© 2020 AAPC
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Updated 12042020. All rights reserved.
Print ISBN: 978-1-646310-593
e-Book ISBN: 978-1-646311-255

CPC®, CIC™, COC™, CPC-P®, CPMA®, CPCO™, and CPPM® are trademarks of AAPC.

ii 2021 Official Study Guide CPC® Certification CPT ® copyright 2020 American Medical Association. All rights reserved.
 

Contributors:
Katherine Abel, CPC, CPB, CPMA, CPPM, CMRS, AAPC Approved Instructor
Paula Allard, CPC, CDEO
Quitrina Carter, CPC, CEMC, AAPC Approved Instructor
Berrie Corley, CPC, AAPC Approved Instructor
Lori A Cox, MBA, CPC, CPMA, CEMC, CGSC, CHONC, AAPC Approved Instructor
Brad Ericson, MPC, CPC, COSC
Cindy Hagle, CPC, CPMA, CRC
Christine Hall, CPC, CPB, CPMA, CRC, AAPC Approved Instructor
Ellen Hinkle, CPC, CPMA, CRC, CEMC, CFPC, CIMC, AAPC Approved Instructor
Carol Hoppe, CPC, CCS-P, AAPC Approved Instructor
Ngina Lynch, CPC, AAPC Approved Instructor
Rachelle Marting, JD, MHSA, CPC, CPMA, CEMC, RHIA, AAPC Approved Instructor
Danielle Price, CPC, RHIT, AAPC Approved Instructor
Gerald Robinson, CPC, AAPC Approved Instructor
Jacqueline J Stack, BSHA, CPC, CPB, CEMC, CFPC, CIMC, CPEDC, AAPC Approved Instructor
Peggy A Stilley, CPC, CPB, CPMA, COBGC, AAPC Approved Instructor
Toni Toone, CPC, CPMA, CRC, AAPC Approved Instructor
Kathy Ware, RN, CPC, CPB, RHIA, CCS, AAPC Approved Instructor
Essie White, CPC, COC, CPMA, CGSC, AAPC Approved Instructor
Renee Whiting, CPC, AAPC Approved Instructor
Wendy Willes
Kathryn L Williams, COC, CPC, CPMA, CRC, CANPC, COSC
Mary Wood, CPC, AAPC Approved Instructor

CPT ® copyright 2020 American Medical Association. All rights reserved. www.aapc.com iii
Contents

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
Chapter 1
The Business of Medicine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
Coding as a Profession. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
The Hierarchy of Providers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
The Different Types of Payers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
Understanding RBRVS. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
Medical Necessity. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
The Need for Privacy and Security. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
Fraud and Abuse. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
Need for Compliance Rules and Audits. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
The OIG Work Plan. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
What AAPC Will Do for You. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

Chapter 2
Medical Terminology and Anatomy Review . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
Medical Terminology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
Integumentary System. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
Musculoskeletal System. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16
Cardiovascular System. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
Lymphatic System. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22
Respiratory System (Pulmonary System) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24
Digestive System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25
Urinary System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26
Reproductive Systems. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26
Nervous System. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26
Endocrine System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28
Hematologic (Hemic) System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28
Immune System. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29

CPT ® copyright 2020 American Medical Association. All rights reserved. www.aapc.com v
Contents

Chapter 3
Introduction to ICD-10-CM . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31
Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31
Overview of ICD-10-CM Layout. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31
Steps to Look Up a Diagnosis Code. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35
ICD-10-CM Official Guidelines for Coding and Reporting. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35
Chapter 22: Codes for Special Purposes (U00–U85). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60
Diagnosis Coding Guidelines for Outpatient Reporting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60
Glossary. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 62

Chapter 4
Introduction to CPT®, Surgery Guidelines, HCPCS Level II, and Modifiers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 65
Introduction to CPT® . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 65
National Correct Coding Initiative (NCCI). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 68
Sequencing CPT® Codes. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69
CPT® Assistant. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 70
CPT® Category II Codes - Performance Measurement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 70
CPT® Category III Codes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 70
CPT® Appendices. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 71
Surgery Guidelines . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 72
HCPCS Level II. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73
HCPCS Level II Modifiers. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 75
Modifiers. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 75
Glossary. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 82

Chapter 5
Integumentary System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 85
Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 85
Anatomy and Medical Terminology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 86
ICD-10-CM Coding . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 86
CPT® Coding. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 90
Glossary. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 96

Chapter 6
Musculoskeletal System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 101
Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 101
Anatomy and Medical Terminology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 101
ICD-10-CM Coding . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 106
CPT® Coding . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 108
HCPCS Level II. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 111
Modifiers. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 111

vi 2021 Official Study Guide CPC® Certification CPT ® copyright 2020 American Medical Association. All rights reserved.
 Contents

Chapter 7
Respiratory, Hemic, & Lymphatic Systems; Mediastinum, and Diaphragm . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 115
Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 115
Anatomy and Medical Terminology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 115
ICD-10-CM Coding . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 116
CPT® Coding . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 119
HCPCS Level II. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 124
Modifiers. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 124
Glossary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 124

Chapter 8
Cardiovascular System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 129
Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 129
Anatomy and Medical Terminology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 129
ICD-10-CM Coding . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 131
CPT® Coding. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 134
Modifiers. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 142
HCPCS Level II. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 142
Glossary. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 143

Chapter 9
Digestive System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 149
Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 149
Anatomy and Medical Terminology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 149
ICD-10-CM Coding . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 150
CPT® Coding. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 152
HCPCS Level II Coding. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 156
Modifiers. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 156
Glossary. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 156

Chapter 10
Urinary System and Male Genital System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 161
Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 161
Anatomy and Medical Terminology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 161
ICD-10-CM Coding . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 163
CPT® Coding. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 166
HCPCS Level II. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 170
Modifiers. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 170
Glossary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 171

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Contents

Chapter 11
Female Reproductive System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 179
Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 179
Anatomy and Medical Terminology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 179
ICD-10-CM Coding . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 180
CPT® Coding . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 182
HCPCS Level II Coding. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 184
Modifiers. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 184
Glossary. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 184

Chapter 12
Endocrine and Nervous System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 191
Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 191
Anatomy and Medical Terminology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 191
ICD-10-CM Coding . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 194
CPT® Coding . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 196
HCPCS Level II. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 203
Modifiers. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 203
Glossary. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 205

Chapter 13
Eye and Ocular Adnexa, Auditory Systems . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 209
Eye: Introduction and Anatomy. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 209
Ear: Introduction and Anatomy. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 210
ICD-10-CM Coding . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 211
CPT® Coding. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 213
Medicine Codes. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 214
HCPCS Level II. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 215
Modifiers. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 215
Glossary. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 215

Chapter 14
Anesthesia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 221
Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 221
Types of Anesthesia. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 221
Anesthesia Providers. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 221
Anesthesia Coding Terminology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 221
Postoperative Pain Management . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 222
ICD-10-CM Coding . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 223
CPT® Coding. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 223
Anesthesia-Related Teaching Rules. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 227
Glossary. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 228

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 Contents

Chapter 15
Radiology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 233
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 233
Anatomy and Medical Terminology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 233
ICD-10-CM Coding . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 233
CPT® Coding. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 234
Types of Radiological Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 235
The Components of a Radiology Service. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 235
Diagnostic Ultrasound. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 236
Radiologic Guidance. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 236
Breast, Mammography. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 237
Bone/Joint Studies. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 237
Radiation Oncology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 237
Nuclear Medicine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 238
HCPCS Level II Coding. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 238
Modifiers. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 238
Glossary. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 239

Chapter 16
Pathology and Laboratory . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 245
Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 245
Anatomy and Medical Terminology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 245
ICD-10-CM Coding . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 246
CPT® Coding . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 247
HCPCS Level II Coding. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 250
Modifiers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 250
Glossary. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 251

Chapter 17
Evaluation and Management . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 255
Introduction and Objectives. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 255
E/M Services Defined. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 255
CPT® E/M Services Guidelines. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 256
E/M Service Categories. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 256
Choosing the E/M Service Level. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 262
Diagnosis Coding for E/M Services. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 281
Glossary. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 282

CPT ® copyright 2020 American Medical Association. All rights reserved. www.aapc.com ix
Contents

Chapter 18
Medicine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 287
Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 287
Anti-infective Immunizations. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 287
Vaccines and Toxoids. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 287
Psychiatry. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 288
Biofeedback. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 288
Dialysis and End Stage Renal Disease Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 288
Gastroenterology. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 289
Ophthalmological Services & Special Otorhinolaryngologic Services. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 289
Cardiovascular Services. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 289
Noninvasive Vascular Diagnostic Studies. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 289
Pulmonary Studies. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 290
Allergy and Immunology. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 290
Endocrinology & Neurology and Neuromuscular Procedures. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 290
Medical Genetics and Genetic Counseling Services. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 290
Central Nervous System Assessments/Tests. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 290
Hydration, Therapeutic, Prophylactic, D
­ iagnostic Injections/Infusions and C
­ hemotherapy,
Highly Complex Drugs, or Highly Complex Biologic Agent Administration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 290
Photodynamic Therapy & Special Dermatological Procedures. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 291
Physical Medicine and Rehabilitation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 292
Education and Training for Patient Self-Management. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 293
Non-Face-to-Face Nonphysician Services. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 293
Special Services, Procedures, and Reports . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 294
Qualifying Circumstances for Anesthesia & Moderate (Conscious) Sedation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 294
Other Services and Procedures. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 294
Home Health Procedures and Services. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 295
Home Infusion Procedures. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 296
Medication Therapy Management Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 297
Glossary. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 297

Chapter 19
Tips for Taking an AAPC Certification Exam . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 303
CPC® Exam. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 303
Preparing for Your Exam. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 303
Exam Registration. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 304
Day of the Exam. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 304
During the Test . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 304
Exam Completion. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 305

x 2021 Official Study Guide CPC® Certification CPT ® copyright 2020 American Medical Association. All rights reserved.
 Contents

Chapter 20
Test Your Knowledge . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 307
Appendix A
Answers and Rationalesfor Chapter Review Questions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 325
Chapter 1. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 325
Chapter 2. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 326
Chapter 3. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 327
Chapter 4. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 329
Chapter 5. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 330
Chapter 6. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 332
Chapter 7. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 334
Chapter 8. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 335
Chapter 9. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 337
Chapter 10. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 338
Chapter 11. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 340
Chapter 12. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 342
Chapter 13. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 343
Chapter 14. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 344
Chapter 15. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 346
Chapter 16. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 347
Chapter 17. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 349
Chapter 18. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 351

Appendix B
Answers and Rationalesfor Test Your Knowledge . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 353
Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 361

CPT ® copyright 2020 American Medical Association. All rights reserved. www.aapc.com xi

The Official CPC® Certification Study Guide, (2021 edition) is
organized to help you prepare for the exam certifying you as a
professional medical coder. The Certified Professional Coder
(CPC®) credential is awarded by AAPC, the primary organiza-
tion of more than 190,000 medical coders, billers, scribes, and
auditors.
This study guide, developed in cooperation with AAPC staff
and members, can help you understand and practice the
concepts, elements, and rules of medical coding. Throughout
the Official CPC® Certification Study Guide are easy-to-under-
stand explanations, examples, coding tips, and exercises meant
to help you prepare for your exam.
Medical coding continues to grow and mature as a profession.
Medical coders report the diagnoses, procedures, and supplies
reported by physicians and other medical professionals to
commercial and federal payers, such as Aetna or Medicare.
They work closely with medical staff and must master medical
terminology, anatomy, and physiology and apply this to health-
care providers’ notes or operative reports.
As healthcare evolves so does medical coding. Medical coders
perform in a variety of situations for physicians and facilities.
They may participate in the actual billing process or audit
claims sent to payers. They may code in independent billing
companies. Medical coders often become the officers in charge
of compliance with federal and state medical billing and
coding regulations. They may work for the payers themselves
as adjustors or auditors. Experienced coders often become
consultants, serving clients who need coding, billing, auditing,
or compliance assistance.
Medical coders will prove even more important as elements of
healthcare reform and standardized electronic medical records
are implemented. Coders will be instrumental as advisers,
decision makers, technicians, medical coders, and auditors in
the coming years.
CPC® Confirms Credibility
The CPC® credential (and its derivative credentials: COC®,
for example) illustrates to employers and colleagues that you
understand the many facets of coding. A CPC® possesses the
following:
CPT ® copyright 2020 American Medical Association. All rights reserved. www.aapc.com 1
Introduction
l Knowledge of anatomy, physiology, and medical
terminology necessary to correctly code provider
diagnoses and services
l Skill in accurate medical coding for diagnoses,
procedures, and services in physician-based settings
l Proficiency across a wide range of services, which include
evaluation and management, anesthesia, surgical services,
radiology, pathology, and medicine
l Sound knowledge of medical coding rules and regulations
including compliance and reimbursement
l Understanding of issues such as medical necessity, claims
denials, bundling, and charge capture
l Expertise of how to integrate medical coding
and reimbursement rule changes into a practice’s
reimbursement processes
A CPC® successfully completes a 150-question examination
in a 5-hour, 40 minute period. You should bring the latest
CPT®, ICD-10-CM, and HCPCS Level II code books to the
exam for code and guideline look-up. More information about
the examination is available at www.aapc.com. A CPC® must
hold membership in AAPC to sit for the exam and maintain a
regimen of continuing education to keep the credential.
The Study Guide
The Official CPC® Certification Study Guide begins with a
view of the business of medicine to help you understand the
overall view of the medical office and how the coder fits in.
After a review of anatomy, you will learn about ICD-10-CM
guidelines with real life examples of how to apply them. Each
body system is reviewed in its entirety, includes a review of the
anatomy, related ICD-10-CM diagnosis coding, CPT® coding,
HCPCS Level II coding, and modifiers. End of chapter reviews
provide certification questions similar to those you will find
on the exam, along with operative notes for each section for
you to code. The study guide concludes with testing techniques
and a 50-question review to test your knowledge for the CPC®
certification exam.
Unlike most coding certification study guides that focus on
each code set, this one more realistically prepares the coder
not only for the examination but for the field, where each case
more likely will include at least two code sets and require
 Chapter
1 The Business of Medicine
Coding as a Profession
Each time an individual receives healthcare, a record is
maintained of the resulting observations, medical or surgical
interventions, diagnostic test and studies, and treatment
outcomes. Coding is the process of translating this written or
dictated medical record into a series of numeric and alphanu-
meric codes. There are separate code sets to describe diagnoses,
medical and surgical services/procedures, and supplies. These
code sets serve as a common language to ease data collection
(for example, to track disease), to evaluate the quality of care,
and to determine costs and reimbursements.
Proper code assignment is determined both by the content
(documentation) in the medical record and by the unique rules
that govern each code set in that instance. Coding rules also
may vary depending on who pays for the patient care, such as
self-pay or health insurance.
Coding is typically performed by either the physician or a
coder. When the physician performs the coding, the coder may
take on the role of an auditor to verify that the documentation
supports the codes the physician selected. In some practices,
the coder will receive the medical record and code the services
based on what is documented in the notes.
If the medical record is inaccurate or incomplete, it will not
translate properly to the language of codes. The coder must
evaluate the medical record for completeness and accuracy and
communicate regularly with physicians and other healthcare
professionals to clarify diagnoses or to obtain additional
patient information.
Outpatient coding focuses on physician professional services
and outpatient facility coding. Outpatient coders will focus on
learning CPT®, HCPCS Level II, and ICD-10-CM codes. They
will work in physician offices, outpatient clinics, and facility
outpatient departments. Outpatient facility coders will also
work with Ambulatory Payment Classifications (APCs).
Hospital inpatient coding focuses on a different subset of skills,
where coders will work with ICD-10-CM and ICD-10-PCS.
These coders also will assign medical severity diagnosis related
groups (MS-DRGs).
Regardless of the setting, code updates and insurance payment
policies may change as often as quarterly. Coders require
continuing education to stay abreast of these changes.
CPT ® copyright 2020 American Medical Association. All rights reserved. www.aapc.com 3
The Hierarchy of Providers
A variety of medical providers staff physician offices and hospi-
tals, including physicians and non-physician providers (NPPs)
(also known as mid-level providers or physician extenders),
such as physician assistants (PA) and nurse practitioners (NP).
NPPs are often reimbursed at a lower rate than physicians and
require physician oversight. Different providers have different
levels of education, and each state has scope of practice guide-
lines for the various provider levels. Check your state health
board’s website for scope of practice information.
The Different Types of Payers
Although some patients will pay in full for their own medical
expenses, most patients will have some type of insurance
coverage. There are two primary types of insurers: commercial
and government.
Commercial carriers are private payers that may offer both
group and individual plans. The contracts they provide vary,
but may include hospitalization, basic, and major medical
coverage. For example, Blue Cross Blue Shield organizations
are private payers who usually operate in the state in which
they are based.
The most significant government insurer is Medicare. Medi-
care is a federal health insurance program — administered
by the Centers for Medicare & Medicaid Services (CMS) —
that provides coverage for people over the age of 65, blind
or disabled individuals, and people with permanent kidney
failure or end-stage renal disease (ESRD). CMS regulations
determine the coding requirements for Medicare and non-
Medicare payers alike. The Medicare program is made up of
several parts:
l Medicare Part A helps cover inpatient hospital care, as
well as care provided in skilled nursing facilities, hospice
care, and home healthcare.
l Medicare Part B helps cover medically necessary
physicians’ services, outpatient care, and other medical
services (including some preventive services) not covered
under Medicare Part A. Medicare Part B is an optional
benefit for which the patient must pay a premium, and
which generally requires a yearly deductible and co-
insurance.
 Chapter
2 Medical Terminology and Anatomy Review

Introduction Myel/o spinal cord, bone marrow

This chapter will review medical vocabulary and terminology Onych/o nail
and introduce the basic elements of human anatomy. You may Oste/o bone
encounter terms not covered here within subsequent chapters. Phleb/o vein
Objectives for this chapter include: Pulm/o, pulmon/o lungs
l Review word elements such as combining forms, prefixes, Synov/i synovial fluid, joint, or membrane
and suffixes
l Acquire an understanding of procedural and diagnostic
terms A prefix typically is attached to the beginning of a word to
l Understand anatomy as it relates to coding
modify or alter its meaning. Prefixes often indicate location,
time, or number.

Some common prefixes include:

Medical Terminology
The best way to learn medical terminology is by understanding Prefix/Definition
word parts and elements of medical language—root words,
prefixes, and suffixes—that serve as the foundation of the Ab- away from
medical vocabulary. Ad- toward, near
The base of the word is considered the root. Root words can Ante- before
stand alone as the main portion of a medical term and the part Ec-, ecto- out, outside
that holds its fundamental meaning. A word can have more End/o- in, within
than one root. Mon/o- one
Poly- many, much
Combining vowels are attached to root words to link the
Post- after, behind
root word with the suffix, or one root word to another root
word. Combining vowels also make medical terms easier to
pronounce. The most common combining vowels are O and
I. Occasionally, these vowels are dropped altogether, such as A suffix is attached to the end of a word to modify or alter its
when the suffix begins with a vowel; however, the combining meaning. In medical terms, suffixes frequently indicate the
vowel is always placed between two root words, even when the procedure, condition, disorder, or disease.
second root word begins with a vowel.
Some common suffixes include:
Examples may include:
Suffix/Definition
Root word/Definition
-centesis puncture, tap
Blephar/o eyelid -desis binding, fusion
Bucc/o cheek -ectomy excision, surgical removal
Cholecyst/o gallbladder -graphy act of recording data
Colp/o vagina -pexy surgical fixation
Cyst/o a fluid sac or pouch, urinary bladder -plasty plastic repair, plastic surgery,
Derm/o skin reconstruction
Encephal/o brain -tripsy crushing
Enter/o intestine
Hem/o, hemat/o blood
My/o muscle

CPT ® copyright 2020 American Medical Association. All rights reserved. www.aapc.com 11
Chapter 2 Medical Terminology and Anatomy Review

The human body contains three types of blood vessels:

1. Most arteries carry oxygenated blood away from the
heart. These vessels get smaller and turn into arteri-
oles as they go into the extremities. Eventually they
comprise the arterial side of the capillary bed.
2. Most veins carry deoxygenated blood back to the heart.
The venous side of the circulation begins in the venous
side of the capillary bed, enlarging to form venules and
eventually forming veins and returning the blood to the
heart. The left ventricle has a muscle mass that is much
greater than any other chamber in the heart.
3. Capillaries are tiny vessels, usually a single cell layer
thick. They are semi-permeable and facilitate the
exchange of fluids, oxygen, nutrients, and waste
between local tissues and the blood stream.

Heart

Heart Flow
From upper body To upper body

Superior vena cava Arteries

Right pulmonary artery Aorta

To right lung
Left pulmonary artery
Sinoatrial node
To left lung

From right lung From left lung

Right pulmonary veins

Left pulmonary veins

Atrioventricular
node Left atrium
Mitral (bicuspid)
Right atrium
valve
Tricuspid valve Left ventricle
Chordae tendinae
Purkinje fibers
Right ventricle
Septum
Inferior vena cava Aorta
From lower body To lower body

Source: ShutterStock.com

CPT ® copyright 2020 American Medical Association. All rights reserved. www.aapc.com 21
Chapter 7 Respiratory, Hemic, & Lymphatic Systems; Mediastinum, and Diaphragm
ICD-10-CM Chapter 10: Diseases of the Respiratory System
has notes at the beginning of the chapter for reporting of respi-
ratory codes:
l A respiratory condition affecting more than one site,
and is not specifically indexed, the coder should classify
the condition to the lower anatomic site. For example,
tracheobronchitis is classified to bronchitis.
l An additional code is reported, when applicable, to
identify the patient’s exposure to, history of, or current
use or dependence of tobacco (smoke).
Acute Respiratory Infections (J00–J06)
Infection may be caused by a virus or bacteria. Viral infections
usually are self-limiting. Bacterial acute respiratory infections
(ARIs) typically are treated with antibiotics (viral infections
are not). ICD-10-CM codes for ARIs are separated by the
anatomy: nose, pharynx, larynx, bronchus, and bronchioles.
Irritation and inflammation of the vocal cords cause laryngitis.
Category J04 includes both laryngitis and tracheitis. Tracheitis
codes are reported based on whether there is an obstruction.
Croup (J05.0) is a common, high pitched, barking cough found
in infants and children with nasal type symptoms. Croup
usually is caused by parainfluenza viruses; however, respira-
tory syncytial virus (RSV), measles, adenovirus, and influenza
all can cause croup. A milder form of croup, stridulus croup
(J38.5), also known as laryngismus stridulus or false croup, is
a sudden onset of spasmodic laryngeal closure with crowing
inspiration.
Pneumonia and Influenza (J09–J18)
Pneumonia, like ARI, can be caused by a virus, fungi, or
bacteria. An acute respiratory infection can lead to pneumonia
if not treated. ICD-10-CM codes for pneumonia are based on
the causative agent and may require you to report an addi-
tional code to describe the underlying disease.
Influenza is a viral infection that can be very serious. ICD-
10-CM coding is based on the influenza strain: Avian (J09.X2),
H1N1/novel influenza A (J10.1), unspecified with pneumonia
or other respiratory manifestations. Code only confirmed cases
of avian flu (see ICD-10-CM guideline 1.C.10.c).
Acute bronchitis (category J20) and acute bronchiolitis (cate-
gory J21) commonly are diagnosed when a patient presents
with symptoms of a severe or productive cough.
Lower respiratory infections that are not otherwise specified
and are associated with documented COVID-19, are reported
with codes U07.1 COVID-19 and J22 Unspecified acute lower
respiratory infection.
CPT ® copyright 2020 American Medical Association. All rights reserved. www.aapc.com 117
Other Diseases of the Upper Respiratory Tract (J30–J39)
Most codes in this section pertain to chronic conditions and
include code J34.2 for an acquired deviated septum of the nose.
This condition is commonly caused by trauma. The septum is
the bone and cartilage that separates the right and left nostrils.
Note the code for a congenital deviated septum is Q67.4. Nasal
polyps (category J33) are sac-like growths inside the nose and
are often associated with chronic sinusitis (category J32). Code
selection will depend on which sinus is infected and inflamed.
Chronic Lower Respiratory Diseases (J40–J47)
In emphysema (category J43), the walls between the air sacs
are damaged causing them to lose their shape and elasticity.
Chronic obstructive pulmonary disease (COPD) is a progres-
sive disease that causes coughing, wheezing, shortness of
breath, and difficulty breathing. Most people who have COPD
have both emphysema and chronic obstructive bronchitis. The
number one cause of COPD is smoking.
Asthma is a chronic inflammatory disease of the airway. When
coding for asthma, the severity of the asthma physician docu-
mented as intermittent, mild persistent, moderate persistent
and severe persistent. The codes in categories J44 Other chronic
obstructive pulmonary disease and J45 Asthma distinguish
between uncomplicated cases and those in acute exacerbation,
which is a worsening or a decompensation of a chronic condition.
Lung Diseases Due to External Agents (J60–J70)
Pneumoconiosis (J60–J65) is a restrictive lung disease caused
by inhalation of dust, causing irreversible scarring of the lungs.
Other ICD-10-CM codes in this section include exposure to
chemical fumes, vapors, solids, and liquids.
Respiratory Failure
The codes for respiratory failure are selected by acute, chronic,
unspecified and if there is the presence of hypoxia or hyper-
capnia. The sequencing of acute respiratory failure (ARF) is
determined by the reason for the encounter. If a patient is
admitted for acute respiratory failure, a code from subcat-
egory J96.0 Acute respiratory failure or J96.2 Acute and chronic
respiratory failure is sequenced first. If the patient is admitted for
multiple reasons, select the condition that required the most care.
Other Diseases of the Respiratory System
Pulmonary edema is found in the ICD-10-CM Alphabetic
Index by looking for Edema/lung and is reported with a code
from category J81.
Interstitial lung disease (ILD), or diffuse parenchymal lung
disease (DPLD), refers to a group of lung diseases affecting
the interstitium (the tissue and space around the air sacs of
the lungs). ILD (category J84) often is the result of pulmonary
fibrosis from exposure to contaminants like asbestos.
Endocrine and Nervous System Chapter 12

Chapter Review Questions

1. Which cells produce hormones to regulate blood sugar?
A. Eosinophils
B. Pancreatic islets
C. Hemoglobin
D. Target cells

2. What are chemicals which relay, amplify, and modulate signals between a neuron and another cell?
A. Neurotransmitters
B. Hormones
C. Interneurons
D. Myelin

3. A 35-year-old has neuroplasty performed in the wrist for carpal tunnel syndrome. The palm is opened through a curved
incision, and further skin flaps are developed. The median nerve of the transverse carpal ligament is divided, decom-
pressing the carpal tunnel. Tension of the nerve is released, and the incision is sutured in layers. What CPT® code describes
this procedure?
A. 64721
B. 64719
C. 64708
D. 64704

4. A 30-year-old male has lumbar facet syndrome. Under fluoroscopic guidance, the affected nerve in the facet joints of the
lumbar region is destroyed by a neurolytic agent in the right segmental medial branches innervating facet joints L3–L4,
and L4–L5. What CPT® codes are reported?
A. 64493, 64494
B. 64635, 64636
C. 64483, 64484
D. 64633, 64634-50

5. A patient has spinal stenosis and disc displacement in the L3–L4 and L4–L5 interspaces and underwent a removal of the
posterior arch of a vertebra to provide additional space for the nerves and to widen the spinal canal. The back was prepped,
and an incision was made down to the deep fascia and the spinous processes of L5, L4 and L3 were identified performing
the laminectomy of L4 up to L3 and a resection of the flavum ligament. There was resection of the facet L3 and L4 on the
right and decompression was carried out laterally to the level of the medial border of the pedicle. Foraminotomies of L3–
L4 and L4–L5 the right was performed with the Kerrison punch and there was plenty of room for the nerve roots to exit in
these regions with no further stenosis above or below this area. What procedure code(s) is/are reported?
A. 63047, 63048
B. 63042, 63044
C. 63017
D. 63005

206 2021 Official Study Guide CPC® Certification CPT ® copyright 2020 American Medical Association. All rights reserved.
 Chapter
13
Eye: Introduction and Anatomy
Ciliary body
Iris
Anterior chamber
with aqueous humor
Pupil
Cornea
Lens
Conjunctiva
Ora serrata
The eyeball is composed of a tough membrane called sclera.
This white outer skin of the eye is covered with a thin protec-
tive layer of conjunctiva. Light first enters the eye through the
cornea. The cornea has five layers; sometimes corneal defects
will be managed by removing one or two layers, rather than
full-thickness cornea. The cornea meets the sclera in a ring
called the limbus, also known as the sclerocorneal junction.
Behind the cornea is the anterior segment of the eye, which is
filled with a clear, salty fluid called aqueous humor.
Next, light from the aqueous humor enters the crystalline
lens, a convex disc suspended on threads just behind the iris.
The iris is a muscle that expands and contracts to regulate
the amount of light entering the posterior chamber of the eye
through the pupil. If the light is too bright, the iris expands so
the size of the pupil shrinks. If there is too little light, the iris
CPT ® copyright 2020 American Medical Association. All rights reserved. www.aapc.com 209
Eye and Ocular Adnexa, Auditory Systems
Eye Structures
Sclera
Retina
Macula
Posterior chamber
with vitreous humor
Artery
Optic nerve
Vein
Rectus medialis
Source: AAPC
contracts to enlarge the pupil and allow more light into the eye.
The threads holding the lens and the ciliary body to which they
are connected automatically tug at the lens to change its shape
to help focus on items near or far.
After the light has been bent by the crystalline lens, it enters
the vitreous humor, a gel-like mass that fills the large poste-
rior chamber of the eye. The vitreous humor presses against
the inner layer of the eye, maintaining the eyeball’s shape
and keeping the blood-rich choroid layer in contact with the
retina. The light is placed upon the retina’s rods and cones
like a projected image at a movie theater, and these images are
transmitted via the optic nerve to the brain.
The eyeball’s shape affects the way light is focused and directed
(refraction). Any reduction in fluid within the eye will affect
Chapter 17 Evaluation and Management

To select an overall MDM level, at least two of three compo-

nents (number and complexity of problems addressed; amount
and complexity of data to be reviewed and analyzed; risk of
complications and morbidity or mortality) for that level must
be met.

Table D: Medical Decision Making (MDM)

Final Results of Tables A, B, C = Level of Medical Decision Making (MDM)
l Must consider 2 of the 3 MDM elements for the overall MDM level

£ Use any two components that meet or exceed

£ Drop the lowest one

Table A Number/Complexity of Problems Minimal Low Moderate High

Addressed
Table B Amount and/or Complexity of Data Minimal or none Limited Moderate Extensive
to be Reviewed and Analyzed
Table C Risk of Complications and/or Minimal Low Moderate High
Morbidity or Mortality of Patient
Management
MDM Level Straightforward Low Moderate High
New Patient Code 99202 99203 99204 99205
Established Patient Code 99212 99213 99214 99215

EXAMPLE
CHIEF COMPLAINT: Right knee pain secondary to underlying
degenerative primary arthritis.
HISTORY OF PRESENT ILLNESS: This 70-year-old female returns to
schedule total knee arthroplasty. She was evaluated last week.
She continues to have constant pain with her activities for about
7 months. Symptoms are present with both weight bearing and
rest. She was found by recent radiograph to have tricompart-
mental degenerative changes.
PHYSICAL EXAMINATION: She is intact to sensation, has
palpable pulses. There is bogginess of the synovium. She has
retropatellar crepitation. There is tenderness through both the
medial and lateral joint line. There is valgus alignment of the
knee.
IMPRESSION: Right knee pain with underlying degenerative
arthritic changes.
PLAN: We will proceed with surgical intervention for right
total knee arthroplasty. Risks and benefits of surgery have
been reviewed. These include the risks of anesthesia, infection,
damage to nerve, vessel, soft tissue, residual loss of motion or
weakness, residual pain, blood clot, blood loss, knee instability,
fracture of bone. A complete history and physical obtained in
the office.
Rationale: This patient is an established patient. The level is
selected based on the AMA CPT® Office or Other Outpatient
E/M Services guidelines.
l The number and complexity of problems addressed –
moderate (chronic problem with exacerbation).
l The amount and complexity of data to be reviewed and
analyzed – none.
l The risk of complications and morbidity or mortality of
patient management – moderate (elective major surgery).
The moderate number and complexity of problems and
moderate risk make 99214 the correct code.
Time
Time can be an element of code selection for a variety of E/M
services. Because different categories use time differently, it is
important to review the instructions for the use of time in each
category of E/M service. In this section, we will discuss time as
it relates to Office or Other Outpatient Services. The amount
of time spent on the encounter must be documented by the
provider.

CPT ® copyright 2020 American Medical Association. All rights reserved. www.aapc.com 267
 Chapter
20 Test Your Knowledge

The following 50 questions will test your comprehension of the information covered in this study guide. You should be able to
complete this exercise in approximately 115 minutes. Answers are found in Appendix B.

Important Note: Although this exercise is a useful assessment tool, the best means to gauge your preparedness to pass the CPC
exam is to take our online practice exams (found at https://www.aapc.com/training/practice-exams.aspx#cpc) which mirror the
actual test format and difficulty level. The practice exams are timed and are created by the CPC exam development team.

1. A 30-year-old is brought into the burn unit with burns covering 30% of his total body. He has third-degree burns to his
chest wall (10%), second-degree burns on his arm and both legs (15%), and first-degree burns on his face (5%).
What ICD-10-CM codes are reported for the burns?
A. T21.30XA, T22.239A, T24.231A, T24.232A, T20.10XA
B. T30.0, T21.60XA, T30.4
C. T21.31XA, T22.20XA, T24.201A, T24.202A, T20.10XA, T31.31
D. T20.10XA, T22.20XA, T21.31XA, T24.201A, T23.202A, T31.31

2. Two malignant lesions on the scalp measuring 1.1 cm and 2.0 cm, and one malignant lesion on the neck measuring 2.2 cm
were destroyed. Electrocautery was used for the first two lesions and laser was used for the third lesion.
What procedure code(s) is/are reported?
A. 17276
B. 17273, 17272-51
C. 17273, 17272-51, 17272-51
D. 17274, 17273-51

CPT ® copyright 2020 American Medical Association. All rights reserved. www.aapc.com 307
 Appendix
Answers and Rationales
B for Test Your Knowledge

1. C. T21.31XA, T22.20XA, T24.201A, T24.202A, T20.10XA, T31.31

RATIONALE: The ICD-10-CM guidelines for reporting the burn codes are found in Section I.C.19.d. The guidelines indicate
that when there is more than one burn, sequence first the code that reflects the highest degree burn. In this case, there are
third degree burns to the chest. In the ICD-10-CM Alphabetic Index, look for Burn/chest wall/third degree T21.31-. Look
for Burn/arm (lower) (upper) - see Burn, upper, limb. Burn/upper/limb/second degree T22.20-. Look for Burn leg(s) (lower)
(upper) - see Burn, lower, lower limb. Burn/lower/limb/right/second degree T24.201- and left/second degree T24.202-.
Look for Burn/face - see Burn, head. Burn/head (and face) (and neck)/first degree T20.10-. A code from category T31 is
also reported to identify the extent of the burn. These codes identify the total body surface areas that were burned (TBSA)
and the percentage of third degree burns. In the Alphabetic Index, look for Burn/extent/30-39 percent/with 10-19 percent
third-degree T31.31.

In the Tabular List, a 7th character is required on these injury codes to identify the episode of care. Based on the ICD-
10-CM guidelines for 7th characters, A is assigned for initial encounter (active treatment). For the codes that are less than
six characters in length, the X placeholders are required to maintain the 7th character in the seventh position.

2. C. 17273, 17272-51, 17272-51

RATIONALE: Codes are selected for the destruction of malignant lesions based on the location and size of the lesion. When
multiple malignant lesions are destroyed, a code is selected for each lesion. Destruction can be accomplished by multiple
methods including electrocautery, cryosurgery, chemosurgery, laser, and curettement. The malignant lesion of the neck
is 2.2 cm, which is reported with CPT® code 17273. The 1.1 cm malignant lesion on the scalp is reported with code 17272.
The 2.0 cm of the scalp is also reported with code 17272. Modifier 51 is appended to indicate multiple procedures were
performed. To locate the codes in the CPT® Index, look for Destruction/Lesion/Skin/Malignant, which refers you to codes
17260–17286.

3. B. 11606, 15220, 15221, C44.719

RATIONALE: An excision of a malignant lesion is performed. Look in the CPT® Index for Excision/Skin/Lesion/Malig-
nant referring you to codes 11600–11646. The code is selected based on the site and size of the malignant lesion removal.
The largest diameter of the lesion is 4.3 cm. The margins are 0.75 cm. The excised diameter (4.3 + 0.75 + 0.75) is 5.80
cm. The excision is reported with CPT® code 11606. The repair is performed using a full thickness skin graft. Look in
the CPT® Index for Full Thickness Graft and you are referred to codes 15200–15261. The code is selected according to
the sq cm of the graft. The measurement is 5 cm x 5 cm, which is 25 sq cm, reported with code 15220 for the first 20 sq
cm and code 15221 for the additional 5 sq cm. The patient is diagnosed with basal cell carcinoma. From the ICD-10-CM
Alphabetic Index, look for Carcinoma/basal cell. You are directed to see also Neoplasm, skin, malignant. Go to the Table
of Neoplasms, look for Neoplasm, neoplastic/skin/limb/lower/basal cell carcinoma and refer to the Malignant Primary
column, C44.71-. A 6th character is required. The correct code is C44.719.

4. C. 11056, L85.9
RATIONALE: In the CPT® Index, look for Paring/Skin Lesion/Benign Hyperkeratotic referring you to codes 11055-11057.
The procedure code for removal of the hyperkeratotic lesion is 11056 Paring or cutting of benign hyperkeratotic lesion; 2 to
4 lesions. The evaluation and management documentation is all related to the surgery and is not reported separately. In the
ICD-10-CM Alphabetic Index, look for Lesion(s)/hyperkeratotic - see Hyperkeratosis. Look for Hyperkeratosis referring
you to L85.9.

5. B. 20610, M10.062
RATIONALE: The knee is aspirated by drawing out fluid from the knee joint using a needle. In the CPT® Index, look for
Aspiration/Joint. Code selection is dependent on the size of the joint and if ultrasound guidance is used. Code 20610

CPT ® copyright 2020 American Medical Association. All rights reserved. www.aapc.com 353
 Index

SA node, 130 Sinusitis, 117 Staged procedure, 73, 79, 123

Sarcoma, 166 Sinusotomy, 120 Standby services, 255, 294
Scar revision, 93, 110 Skin Statin therapy, 65
biopsies, 91, 279
Schwannomas, 198 Status
cancer, 94
asthmaticus, 48
Sclerosis, 34, 131 disease, 291, 292
migrainosus, 196
flap, 93, 94
Scoliosis, 293
graft, 93 STEMI, 47, 133
Scope instrument, 105 infections, 87
Stenosis, 119, 121, 131, 133, 165, 289, 293
substitutes, 93
Screening
tag, 91 Stent, 138, 140, 166-169, 172, 289
codes, 59, 215
ulcers, 88
examination, 233 Stent
mammogram, 58, 233, 237 Smoking cessation, 260 exchange, 169
test, 58, 59, 294 insertion, 167
Snare technique, 154
placement, 140, 167
Scrotal
Solar keratosis, 88
destruction, 170 Stereoscopic guidance, 238
reconstruction, 170 Sonohysterography, 236
Stereotactic radiosurgery, 198, 200, 205
Seborrheic keratosis, 88 Sore throat, 255
Stereotaxis, 198, 200
Segmental instrumentation, 105 Spastic
Steri-Strips, 14
colitis, 151
Selective catheterization, 137, 197
colon, 151 Strabismus, 44, 211, 212
Semi-quantitative, 245, 249
SPECT, 139 Strain, 39, 105, 117
Sensory information, 192
Spectral Doppler, 141 Strep throat, 249
Sepsis, 38, 39, 51
Speech therapy, 295 Streptococcus, 38, 57, 96, 249
Septic shock, 38, 39, 51
Sphenoidotomy, 120 Stress echo, 141
Septicemia, 38, 39
Spina bifida, 205 Stricture, 131, 144, 165, 167, 170, 173
Septoplasty, 119
Spinal Stroboscopy, 121
Sequelae, 36, 47, 49, 52, 58, 133 instrumentation, 110
Stromal tumors, 166
lesions, 293
Seroma, 90
manipulation, 293 ST-segment elevation, 47
Sexual dysfunction, 44 neurostimulators, 200
puncture, 57, 199, 205, 291 Suboccipital
Shave bone, 27
stenosis, 293
biopsy, 91 muscles, 27
stereotaxis, 200
removal, 91
Substance abuse, 60, 260
Spine surgeries, 111
Shoulder
Suicide, 58
disarticulation, 110 Spirometry, 123
pain, 95 Suspected condition, 53, 59
Splenic
Shunt reservoir, 240 flexure, 25, 154 Suspicious lesion, 91
rupture, 119
Shuntogram, 240 Suture
Splenoportography, 123 closure, 91
Sigmoidoscopy, 154, 156
removal, 67
Splenorrhaphy, 123
Simulation, 237, 238, 304
Suturing, 91, 163, 201
Spondylosis, 293
Sinus, 88, 96, 117, 120, 131, 139, 162, 167,
198

CPT ® copyright 2020 American Medical Association. All rights reserved. www.aapc.com 373
 2021 Official Study Guide: CPC®

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