AAPC-CPC Certified Professional Coder - Set 2 - Part 1

Correct Answer: Epigastric quadrant

The four quadrants are right upper, left upper, right lower and left lower. Epigastric is a name from the nine-region scheme, so it does not describe a quadrant of the abdominopelvic region. Option a is incorrect because the quadrant diagram names it, paired with the right upper quadrant across the top of the abdominopelvic region. Option b is incorrect because it is one of the two upper boxes in the four-section view of the abdominopelvic region, shown on the right side. Option d is incorrect because it appears among the two lower boxes of the quadrant diagram, positioned opposite the right lower quadrant.

Correct Answer: Number of origins

Biceps (two heads), triceps (three heads) and quadriceps (four heads) are named for the number of origins. This is one of the criteria used in naming skeletal muscles. Option a is incorrect because shape terms such as deltoid, rhomboid, teres and trapezius describe the outline of a muscle, not a count of heads. Option c is incorrect because action terms such as flexor, extensor, abductor and adductor describe what a muscle does to a structure, which these three names do not. Option d is incorrect because this criterion covers terms such as rectus, transverse, oblique and orbicularis, which describe how the fibers run rather than how many heads a muscle has.

Correct Answer: Epimysium

Each fiber is surrounded by endomysium, fibers are collected into bundles covered by perimysium, and many bundles, or fasciculi, are wrapped together by the epimysium to form a whole muscle. Option b is incorrect because it surrounds each individual muscle fiber, so it covers a single fiber rather than wrapping many bundles together. Option c is incorrect because fascia is fibrous connective tissue that encloses muscles, and it is not the layer named for wrapping bundles into one muscle. Option d is incorrect because tendons attach muscles to bones; they are not a covering that joins bundles into a whole muscle.

Correct Answer: Corpus callosum

The white matter of the corpus callosum, deep within the cerebrum, provides the major pathway for communication between the right and left cerebral hemispheres of the cerebral cortex. Option a is incorrect because this is one of four major brain regions, listed alongside the cerebrum, diencephalon and cerebellum, and it is not the connection between hemispheres. Option b is incorrect because it is the large separation that divides the cerebrum into right and left hemispheres, so it marks the split rather than connecting the halves. Option d is incorrect because the wrinkled outer covering of the cerebrum, made of gray matter, is not described as the pathway linking one hemisphere to the other.

Correct Answer: Optic disc

The axons of retinal ganglion cells collect at the optic disc and leave the eye at the optic nerve. Because no photoreceptors exist there, the optic disc creates the blind spot in the retina. Option a is incorrect because it is the small indentation at the center of the retina, not the point where ganglion cell axons exit the eye. Option b is incorrect because it is a muscular part of the vascular tunic attached to the lens by zonule fibers, so it has no role in the optic nerve exit. Option c is incorrect because it belongs to the vascular tunic, the middle layer, where it supplies blood to the eyeball rather than collecting retinal axons.

Correct Answer: Adaptive immune response

The adaptive immune response is slower to start but more specific and effective. It becomes progressively stronger and begins to clear the pathogen from the body, a clearance referred to as seroconversion. Option a is incorrect because they are the first obstacle a pathogen must bypass before it multiplies, and they are not described as a response that strengthens over time. Option b is incorrect because it is the term for the clearance of the pathogen that the adaptive response begins, so it names an outcome, not a phase. Option d is incorrect because it acts during the first 4 to 5 days and only partially controls pathogen growth without stopping it, so it is faster but less specific.

Correct Answer: premiums

Part B is financed by monthly premiums of those who voluntarily enroll, plus Federal Government contributions from general revenues. Both are deposited in the Federal Supplementary Medical Trust Fund, which pays only Part B benefits and administrative expenses. Option b is incorrect because appropriations from general revenues are the Government contribution already named in the sentence, so they cannot be the enrollee-paid monthly amount. Option c is incorrect because payroll contributions from employees, employers, and self-employed persons are the financing source for Part A, not for the voluntary Part B program. Option d is incorrect because coinsurance is a cost the beneficiary owes on services received; it is not the monthly payment by enrollees that funds the Part B trust fund.

Correct Answer: A compliance contact

OIG guidance advises a small entity that cannot support a full-time or part-time compliance officer to designate one person as its compliance contact, who ensures that the entity's compliance activities are completed. Option a is incorrect because the chief compliance officer is the leader of a compliance department in a large organization, which a small entity without a part-time officer would not have. Option b is incorrect because deputy compliance officers are described as specialists for areas such as audits or training within a large compliance department, not as a small-entity substitute. Option d is incorrect because a facility liaison is responsible for a specific location within a large organization and does not answer the small entity's staffing limit.

Correct Answer: LCD reconsideration process

The LCD reconsideration process lets a beneficiary or stakeholder request revision of the whole LCD or any provision. It differs from an initial request for an LCD because it is available only for final effective LCDs. Option b is incorrect because informal meetings are held before an LCD is developed, serve educational purposes only, and are not pre-decisional negotiations. Option c is incorrect because an initial request seeks development of an LCD, and the guidance contrasts it with reconsideration, which is available only for final effective LCDs. Option d is incorrect because the notice period is a minimum 45 calendar days that starts when the final LCD is published on the MCD, before the LCD takes effect.

Correct Answer: 30 days

Under the statutory NCD process, the Secretary must provide a 30-day period for public comment beginning on the date the draft of the proposed decision is made available to the public. Option a is incorrect because 45 calendar days is the minimum notice period between publication of a final LCD and its effective date, which is a separate process. Option b is incorrect because 6 months is the time limit for a decision on a request needing no outside assessment or committee deliberation, measured from the request. Option c is incorrect because 60 days is the time allowed after the comment period ends for the Secretary to issue the final decision, not the comment period itself.

Correct Answer: Other

Medicare guidance directs that when a physician bills for a lab test furnished by another physician who maintains a lab in his or her office, the place of service code for "Other" is shown. Option b is incorrect because is reported when the billing physician performs the laboratory service in his or her own office, which is not the situation here. Option c is incorrect because is used when a sample is drawn on a hospital inpatient and billed by an independent lab, which does not describe this test. Option d is incorrect because applies when the billing physician bills for a service furnished by an independent lab, not by another physician's office lab.

Correct Answer: The MAC cannot tell which element is incorrect

When a valid place of service conflicts with the procedure billed, the MAC typically will not know whether the procedure code or the place of service is incorrect, so the services are returned as unprocessable. Option a is incorrect because the guidance limits the Form CMS-1500 to one place of service for MPFS and anesthesia services, but this scenario involves a valid, single entry. Option b is incorrect because a non-site-specific procedure matters when the place of service is missing and cannot be inferred, not when a valid place of service conflicts with the procedure. Option d is incorrect because that describes an invalid place of service, where the number designation has not been assigned or defined by CMS, which is a separate edit for validity.

Correct Answer: Fee schedule approved amount

Medicare determines major surgical procedures from the approved amount in the fee schedule database, not from the amount the provider submits. The surgery with the highest approved amount is the more major procedure. Option b is incorrect because this is how claims with certain increased or reduced service modifiers are priced when documentation is supplied, and it has no role in ranking multiple surgeries. Option c is incorrect because the guidance says the major surgery may or may not carry the larger submitted amount, so charges from the provider do not decide it. Option d is incorrect because that figure is the most a nonparticipating physician may bill a beneficiary on an unassigned claim, which is a billing cap and not a ranking tool.

Correct Answer: The day immediately before the day of surgery

For major surgeries, A/B MACs count 1 day immediately before the day of surgery, the day of surgery, and the 90 days following. The preoperative day is therefore the first day of the global period. Option a is incorrect because the day of surgery is counted, but for major surgeries the count begins one day earlier, so it is not the first day. Option b is incorrect because the initial evaluation to decide on surgery may be paid separately for major procedures, so it does not mark the start of the global count. Option c is incorrect because the 90 postoperative days start here, but they follow the preoperative day and the day of surgery, which are counted before them.

Correct Answer: I, II, and IV

Statements I, II, and IV match the Medicare Global Surgery Rules: the global concept does not apply to XXX procedures, the MAC defines the YYY global period, and MMM procedures are maternity procedures. Option a is incorrect because leaves out statement IV, which is also accurate, since procedures with a global period of MMM are described as maternity procedures. Option c is incorrect because includes statement III, but a ZZZ procedure is related to another procedure and takes its applicable global period from that related procedure. Option d is incorrect because omits statement II, which is accurate because the MAC defines the global period for YYY procedures, and wrongly keeps statement III.

Correct Answer: Report the most comprehensive code describing the services performed

Under the Family of Codes policy, the most comprehensive HCPCS/CPT code describing the services performed is reported, and multiple codes for component services are not reported when one comprehensive code describes the services. Option a is incorrect because component service codes are not reported separately with the more comprehensive code that already includes that component service. Option b is incorrect because a code may be reported if and only if all services described by that code are performed, not most. Option c is incorrect because closest-match reporting is rejected; when no code correctly describes the procedure, a not otherwise specified code is reported instead.

Correct Answer: 12-month period from first Part A entitlement month

For individuals with end stage renal disease, a group health plan may not take into account entitlement to Medicare during the 12-month period beginning with the first month of Part A entitlement, or the earlier month the individual would have been entitled upon application. Option b is incorrect because the statute lets the Secretary add this extension to the response period when more time is needed for claims already paid, which is unrelated to plan duties. Option c is incorrect because this is the deadline given to the Secretary for promulgating final regulations, so it measures rulemaking time and not how long a plan must disregard entitlement. Option d is incorrect because that span is the time the Secretary has to respond after notice of a settlement, judgment, award or other payment, not a group health plan restriction.

Correct Answer: Prohibition of differentiating benefits based on ESRD

The Medicare Secondary Payer statute bars a group health plan from differentiating benefits between individuals with end stage renal disease and other covered individuals based on the disease, dialysis need, or any other manner. Option a is incorrect because that provision lets a party sue a primary plan that fails to pay primary or reimburse appropriately; it does not restrict how benefits are set. Option c is incorrect because that provision bars the Secretary from denying payment solely because an individual did not complete a primary plan questionnaire, so it says nothing about plan benefits. Option d is incorrect because that provision makes it unlawful for an employer or other entity to offer incentives against plan enrollment, which is a different subject from benefit differences.

Correct Answer: Yes, because a decrease occurred and the beneficiary wants care no longer medically reasonable and necessary.

A reduction is an ABN triggering event. The ABN is not issued for every reduction, but it must be issued when the beneficiary wants to receive care that is no longer considered medically reasonable and necessary. Option a is incorrect because reductions are listed with initiations and terminations as ABN triggering events, so a decrease in frequency or duration can call for the notice. Option b is incorrect because the guidance states the ABN is not issued every time a reduction occurs; the beneficiary's wish for non-covered care is what makes it necessary. Option c is incorrect because termination is one separate triggering event, and a reduction triggers the ABN on its own terms when the beneficiary wants non-covered care.

Correct Answer: Defective, with the notifier financially liable

Under the Medicare manual's effective ABN delivery standard, a contractor that finds the notifier refused to answer inquiries or direct the beneficiary to 1-800-MEDICARE treats delivery as defective, and the notifier is held financially liable for the non-covered care. Option a is incorrect because a signature is only one of six delivery elements; a signed notice is still defective when the notifier refuses inquiries. Option b is incorrect because the one-year period applies to repetitive or continuous care after valid delivery, and this delivery was not valid. Option d is incorrect because effective delivery requires the ABN to be explained in full and the beneficiary's questions answered, so a refusal to answer cannot support beneficiary liability.