2024 CPC Chapter 17 - Radiology

MULTIPLE CHOICE

1. An axillary view might be included in an X-ray of what part of the skeleton?

a. Neck c. Forearm
b. Shoulder d. Pelvis

ANS: B
Rationale: The axillary view is an X-ray view taken of the shoulder.

PTS: 1 DIF: Easy

2. Which anatomic position has the patient lying at an angle instead of lying flat or directly on
their side?
a. Lateral c. Prone
b. Supine d. Oblique

ANS: D
Rationale: The oblique position is a slanted position where the patient is lying at an angle that
is neither prone nor supine.

PTS: 1 DIF: Easy

3. Which plane divides the body into anterior and posterior halves?
a. Coronal c. Sagittal
b. Transverse d. Axial

ANS: A
Rationale: The coronal (frontal) plane cuts the body into front (anterior) and back (posterior)
halves.

PTS: 1 DIF: Easy

4. AP and Lateral chest X-rays were performed for a cough. What CPT® and ICD-10-CM codes
are reported?
a. 71045, R05.9 c. 71046, F45.8
b. 71046, R05.9 d. 71045, F45.8

ANS: B
Rationale: In the CPT® Index look for X-ray/Chest and you are guided to code range 71045-
71048. In looking at the descriptions, this is a 2-view chest X-ray. In the AP (Anteroposterior)
position the X-ray beam enters the front of the body and exits through the back. In the lateral
position, the X-ray beam enters through the side of the body. This is reported with 71046.
Look in the ICD-10-CM Alphabetic Index for cough and you are directed to R05.9.

PTS: 1 DIF: Easy

5. A non-Medicare patient reports for a bilateral screening mammography with CAD. What CPT®
code(s) is/are reported?
a. 77062 c. 77049
b. 77066 d. 77067

ANS: D
 Rationale: In the CPT® Index look for Mammography/Screening Mammography and you are
guided to 77067.

PTS: 1 DIF: Easy

6. The patient presents for a screening CT colonography. What CPT® code(s) is/are reported?
a. 74150, 74263 c. 74261
b. 74263 d. G0121

ANS: B
Rationale: The patient presents for a colonography. In the CPT® Index look for
Colonography/CT Scan/Screening. You are referred to 74263. Refer to the code descriptions to
confirm selection of the correct code. The purpose of the test is for a screening. 74263 is the
correct code.

PTS: 1 DIF: Easy

7. A 40-year-old female is scheduled for a routine screening baseline bilateral mammogram with
computer-aided detection (CAD). What are the CPT® and ICD-10-CM codes reported?
a. 77062, 77063, Z12.31 c. 77067, Z12.31
b. 77067, R92.2 d. 77066, Z12.31

ANS: C
Rationale: In the CPT® Index look for Mammography/Screening Mammography or
Mammography/ with Computer-Aided Detection (CAD). Code 77067 is for the screening
bilateral mammography with computer aided detection. Look in the ICD-10-CM Alphabetic
Index for Screening/neoplasm (malignant) (of)/breast/routine mammogram and you are
guided to Z12.31.

PTS: 1 DIF: Easy

8. A patient arrives at the urgent care facility with a swollen ankle. Anteroposterior and lateral
view X-rays of the ankle are taken to determine whether the patient has a fractured ankle.
What CPT® code(s) is/are reported?
a. 73600 c. 73610
b. 73600, 73610 d. 73600 x 2

ANS: A
Rationale: In the CPT® Index look for X-ray/Ankle and you are guided to range 73600-73610.
There were two views taken (anteroposterior and lateral views), so CPT® code 73600 is
correct.

PTS: 1 DIF: Easy

9. A patient arrives at the hospital unable to stand on his leg after a collision in a soccer game.
The patient’s shin is sore to the touch. Two view X-rays of the tibia and fibula are taken. What
is the CPT® code reported by the radiologist for the X-rays?
a. 73552-26 c. 73592-26
b. 73590-26 d. 73700-26

ANS: B
Rationale: In the CPT® Index look for X-ray/Fibula, or X-ray/Tibia; either one leads you to
73590. Modifier 26 is needed because the X-ray is taken at the hospital and only the
professional component is billed by the physician.
 PTS: 1 DIF: Easy

10. A patient on estrogen replacement therapy (ERT) receives a DXA study of the hips. What is the
CPT® code reported for the bone density study?
a. 77077 c. 77080
b. 77078 d. 77081

ANS: C
Rationale: In the CPT® Index look under Bone Density Study/Axial Skeleton/Dual Energy X-
ray Absorptiometry (DXA) referring you to 77080, 77081, 77085. Review in the numeric
section shows 77080 for axial skeleton is the correct code for reporting DXA study of the hips.

PTS: 1 DIF: Easy

11. A 56-year-old patient who has been admitted requires a tunneled CV catheter insertion. The
physician uses ultrasound guidance to perform the insertion. The physician documented vessel
patency and that permanent recordings are in the patient’s record. What CPT® codes are
reported for the physician’s services?
a. 36556, 76937-26 c. 36558, 77001-26
b. 36558, 76937-26 d. 36558, 76000-26

ANS: B
Rationale: The physician inserts a tunneled CV catheter (central venous). The patient is 56
years old and there is no indication that a port or pump is involved. In the CPT® Index look for
Central Venous Catheter Placement/Insertion/Central/Tunneled without Port or Pump 36557,
36558, 36565. The correct code is 36558. The physician uses ultrasound guidance, which is
reported with 76937. In the coding guidelines for Central Venous Access Procedures, it states
that imaging can be reported separately. The codes you are referred to are 76937 and 77001.
Because the imaging used is ultrasound, report with 76937. Note that 76937 is an add-on code
and it can only be reported if the physician documents selected vessel patency and permanent
ultrasound recordings are in the patient records. Modifier 26 is appended to report the
professional component.

PTS: 1 DIF: Moderate

12. A patient reports to the hospital radiology department for a functional MRI of the brain. The
technologist asks the patient to perform small tasks. He takes the images of the patient at rest
and while performing the tasks. What CPT® code is reported?
a. 70554 c. 70551
b. 70555 d. 70552

ANS: A
Rationale: The test performed is a functional MRI of the brain. From the CPT® Index look for
Magnetic Resonance Imaging (MRI)/Diagnostic/Brain. You are referred to 70551-70555. Refer
to the code descriptions. There are two codes describing functional MRI, which are 70554 and
70555. Because the test is performed by the technician, not a physician, the service is
reported with 70554.

PTS: 1 DIF: Moderate

13. A parent brings her child to the ED. She thinks she swallowed a small toy figure. A radiology
exam from the nose to the rectum is performed. The foreign body is not located. What CPT®
code(s) is/are reported for the radiology services?
a. 70160, 70370, 71045, 74240, 74248
b. 43235, 44363
c. 76010
d. 70160, 70370, 71045, 43235, 44363
 ANS: C
Rationale: The radiology exam is performed to locate a foreign body, yet no foreign body is
found. In the CPT® Index look for X-ray/Nose to Rectum/Foreign Body. Refer to the code
description and the correct code is 76010.

PTS: 1 DIF: Moderate

14. Procedure: Body PET-CT Skull Base to Mid-thigh

History: A 65-year-old male Medicare patient with a history of rectal carcinoma presenting for
restaging examination. Description: Following the IV administration of 15.51 mCi of F-18
deoxyglucose (FDG), multiplanar image acquisitions of the neck, chest, abdomen and pelvis to
the level of mid-thigh were obtained at one hour post radiopharmaceutical administration.
What CPT® code(s) is/are reported?
a. 78815 c. 70542, 71555, 74182
b. 70491, 71551, 74176 d. 78816

ANS: A
Rationale: The procedure performed is a PET-CT scan. The appropriate code is selected based
on the anatomical location of the study. In this scenario, we know the test was performed on
the skull base to the mid-thigh. In the CPT® Index look PET, which refers you to See Positron
Emission Tomography (PET). Look for Positron Emission Tomography (PET)/with Computed
Tomography (CT). Code 78815 is correct to report for skull base to mid-thigh. According to
CPT® coding guidelines, the IV administration of FDG (96365) is not reported separately. It is
bundled in the service for the radiology procedure.

PTS: 1 DIF: Moderate

15. A 40-year-old female has cholelithiasis with chronic cholecystitis. She is in the Ambulatory
Surgical Center to have a laparoscopic cholecystectomy. A dye was injected to perform an
intraoperative cholangiogram. The surgeon who performed the procedure included a separate
report with his interpretation of the cholangiogram that indicated there was normal, free flow
into the duodenum, with no evidence of filling defects with no stones or strictures seen. What
CPT® codes are reported for the professional services of the surgeon?
a. 47562, 74300 c. 47563, 74300-26
b. 47563, 74300 d. 47562, 74300-26

ANS: C
Rationale: The patient is having her gallbladder removed along with having a dye injection for
an intraoperative cholangiogram. The cholangiogram is performed to make sure there are no
gallstones, tumors or strictures causing partial or total obstruction of the flow of dye into the
duodenum. In the CPT® Index look for Cholecystectomy/Any Method/with Cholangiography
47563, 47605, 47620. Code 47563 describes a laparoscopic cholecystectomy with
cholangiography. There is a parenthetical note for intraoperative cholangiography radiological
supervision and interpretation, see 74300, 74301. For the radiology service you can also look
in the CPT® Index for Cholangiography/Intraoperative directing you to 74300-74301. Code
74300 is the correct code. The procedure is performed in the Ambulatory Surgical Center
indicating the radiological service will need modifier 26 for the professional service. The
surgeon only performed the radiological supervision and interpretation (the professional
component) and did not own the equipment used to perform this service.

PTS: 1 DIF: Moderate

16. A 66-year-old male with a history of anemia presents for a liver core biopsy to evaluate for
possible cirrhosis. The patient was brought to the CAT scan suite in which limited CT images of
the upper abdomen were performed for biopsy needle placement. The appropriate site for the
liver core biopsy was chosen. The patient's skin was then marked with the computer
coordinates. An 18-gauge needle was advanced into the appropriate site and a sample was
obtained. What CPT® codes are reported?
a. 47100, 76942-26 c. 47100, 74150-26
b. 47000, 77012-26 d. 47000, 77002-26

ANS: B
Rationale: Biopsy of the liver is taken by a needle (percutaneous) under computed tomography
guidance (CT). In the CPT® Index look for Biopsy/Liver. Code 47000 describes a percutaneous
needle biopsy of the liver. Below CPT code 47000 you are given codes for imaging guidance.
Code 77012 describes the CT guidance for needle placement. Modifier 26 is appended to
indicate the professional service.

PTS: 1 DIF: Moderate

17. A 38-year-old male seen in the Emergency Department sustained an injury several hours ago
to his left hand when he fell, and a team member stepped on it when playing tackle football.
X-ray was taken in lateral, external oblique and PA positions. The interpretation of the X-rays
revealed a fracture of the shaft of the third metacarpal. What CPT® and ICD-10-CM codes are
reported for the radiological services?
a. 73140-26, S62.349B, W18.09XB, Y93.61
b. 73120-26, S62.323A, W50.0XXA, Y93.61
c. 73130-26, S62.323A, W50.0XXA, Y93.61
d. 73130-26, S62.349B, W18.09XB, Y93.62

ANS: C
Rationale: A total of three views were taken of the hand. Lateral (side), oblique (diagonal) and
PA (posterior-anterior) views. Look in the CPT® Index for X-ray/Hand. Code 73130 describes a
radiologic examination of the hand with a minimum of 3 views. Modifier 26 denotes the
professional service. The diagnosis is found in the ICD-10-CM Alphabetic Index by looking for
Fracture traumatic/ metacarpal/third/shaft (displaced) guiding you to code S62.32-. Tabular
List indicates a 6th character is required to indicated laterality and a 7 th character is required
for the episode of care. A for initial encounter is selected as the 7 th character for initial
encounter. A review of the ICD-10-CM guideline, I.C.19.c., states “A fracture not indicated as
closed or open should be classified as closed. A fracture not indicated whether displaced or not
displaced should be coded to displaced.” The next two codes are found in the ICD-10-CM
External Cause of Injuries Index. The first external cause code is found by looking for Stepped
on/by/person guiding you to code W50.0.-. Tabular List indicates seven characters are needed
to complete the code. The 5th and 6th characters will have X as placeholders and the 7th
character will report A for the initial encounter. Only one code is reported for the patient falling
down while playing sport activity and then getting stepped on. The second external cause code
is found by looking for Activity/football (American) NOS/tackle guiding you to code Y93.61.

PTS: 1 DIF: Moderate

18. A patient with hydronephrosis has a left nephrostomy and he has agreed to a pyelography
(IVP) to rule out a right renal obstruction. The patient was placed prone on the X-ray table one
hour after IV infusion of contrast. Contrast flowed from the left and right renal pelvis, down the
ureters into the bladder where a Foley catheter was positioned. The IVP showed no obstruction
or abnormalities in the urinary tract aside from the left hydronephrosis of the pelvis. The right
kidney and ureter showed no obstruction. Bladder appeared within normal limits. What CPT®
code is reported for the radiological services?
a. 74415-26 c. 74425-26
b. 74400-26 d. 74420-26
 ANS: B
Rationale: A radiographic exam of the urinary tract is performed with IV injection of contrast
medium and radiographs are taken. This is performed to assess the anatomy and function of
the kidneys, bladder, and ureters. In the CPT® Index look for X-ray/with Contrast/Urinary
Tract or Urography/Intravenous. Reviewing the codes in the numeric section leads you to
report 74400 for an intravenous pyelography. Modifier 26 is appended to indicate the
professional service.

PTS: 1 DIF: Moderate

19. A 25-year-old female in her last trimester of her pregnancy comes into her obstetrician’s office
for a fetal biophysical profile (BPP). An ultrasound is used to first monitor the fetus’
movements showing three movements of the legs and arms (normal). There are two breathing
movements lasting 30 seconds (normal). Non-stress test (NST) of 30 minutes showed the
heartbeat at 120 beats per minute that increased with movement (normal or reactive). Arms
and legs were flexed with fetus’ head on its chest, opening and closing of a hand. Two pockets
of amniotic fluid at 3 cm were seen in the uterine cavity (normal). Biophysical profile scored 9
out of 10 points (normal or reassuring). What CPT® code is reported by the obstetrician?
a. 76818 c. 76815
b. 76819 d. 59025, 76818

ANS: A
Rationale: A biophysical test (BPP) measures the health of the fetus during pregnancy. Points
are given (0, 1 or 2) in five areas (fetal movement, tone, heart rate, breathing, amniotic fluid
volume). This is found in the CPT® Index by looking for Fetal Biophysical Profile directing you
to 76818, 76819. A non-stress test (NST) monitors the baby's heart rate over a period of 20
minutes or more looking for accelerations with the baby's movements. Because fetal non-
stress testing is included in code 76818, code 59025 is not reported separately.

PTS: 1 DIF: Moderate

20. A patient 14 weeks pregnant is coming back to her obstetrician’s office for a repeat
transabdominal ultrasound to measure fetal size and to confirm abnormalities seen in a
previous scan. The obstetrician documented the ultrasound results in the medical record. What
CPT® code is reported by the obstetrician?
a. 76805 c. 76816
b. 76805-26 d. 76816-26

ANS: C
Rationale: The patient is coming back for a follow-up (repeat) ultrasound to re-evaluate
conditions affecting the fetus seen on the last ultrasound scan. In the CPT® Index look for
Ultrasound/Obstetrical/Pregnant Uterus. The correct code for a follow-up ultrasound is 76816.
No modifier 26 is needed because the ultrasound and the interpretation of the results were
performed in the obstetrician’s office.

PTS: 1 DIF: Moderate

21. Tomographic axial images (CT or CAT scan) through the abdomen were obtained without
administration of intravenous contrast. This showed a 3 cm diameter mass in the upper pole of
the right kidney abutting the liver. Cryoablation of the lesion was performed utilizing two
freezing cycles with good cosmetic results. What CPT® codes are reported?
a. 50250, 76940-26 c. 50250, 77013-26
b. 50593, 77022-26 d. 47381, 77012-26

ANS: C
 Rationale: A kidney (renal) mass, not tumor, is being destroyed (ablation) by freezing
(cryoablation) the lesion to remove it. This procedure was performed under CT (computed
tomography) guidance to ablate parenchymal (vital organ-example: kidney) tissue. Look in the
CPT® Index for Ablation/Cryosurgical/Renal Mass directing you to 50250.
Cryosurgery/Lesion/Kidney also leads to 50250. 50250 includes ultrasound guidance if
performed. The CT guidance was performed to locate the mass and not to accomplish the
ablation. CT guidance is found in the CPT® Index by looking for Ablation/CT Scan Guidance
directing you to code 77013. Modifier 26 denotes the professional service.

PTS: 1 DIF: Moderate

22. A 52-year-old female is sent to radiology for a lymphangiography of both arms. The patient
has swelling in both arms which is suspected to be lymphangitis. She also has a history of
breast cancer having had a double mastectomy 5 years ago. What CPT® and ICD-10-CM codes
are reported?
a. 75801, M79.89, Z80.3, Z90.13
b. 75801, L03.123, L03.124, Z80.3, Z90.13
c. 75803, M79.89, Z85.3, Z90.13
d. 75803, L03.123, L03.124, Z85.3, Z90.13

ANS: C
Rationale: Look in the CPT® Index for Lymphangiography/Arm referring you 75801-75803.
Patient is having a lymphangiography of bilateral extremities (both arms) indicating the use of
code 75803. In the ICD-10-CM Alphabetic Index look for Swelling/arm referring you to code
M79.89. Patient also has history of breast cancer. In the Alphabetic Index, look for
History/personal (of)/ malignant neoplasm (of)/breast directing you to Z85.3. The patient had
removal of both breasts. In the Alphabetic Index, look for Absence/breast(s) (and
nipple(s)(acquired) directing you to Z90.1-. Verification in the Tabular List indicates a 5th
character of 3 is reported for bilateral. The lymphangitis is suspected and is not a definitive
diagnosis, so it is not reported.

PTS: 1 DIF: Moderate

23. A patient who may have a stricture of the artery is undergoing an aortogram in which the left
femoral artery was cannulated with a catheter advanced into the infrarenal abdominal aorta.
Contrast medium was injected, and films taken by serialography showing the aortoiliac inflow
vessels were widely patent. The bilateral common femoral arteries appear normal. What CPT®
codes are reported for the professional component?
a. 36200, 75625-26 c. 36200, 75635-26
b. 36200, 75630-26 d. 36200, 75805-26

ANS: B
Rationale: The patient is having abdominal aortography, which is a radiographic visualization
of the aorta and its branches. It was performed by injecting contrast medium through a
catheter to see if there is an aneurysm, atherosclerotic disease or trauma to the aorta. The
nonselective catheterization of the aorta is found in the CPT® Index under
Catheterization/Aorta. Code 36200 is correct for the Introduction of the aorta. In the CPT®
Index look for Serialography/Aorta. A review of the codes in the numeric section code 75630 is
correct to report because it includes serialography abdomen plus bilateral ileofemoral lower
extremity.

PTS: 1 DIF: Moderate

24. A patient with prostate cancer has his first dose of radiation treatment of a single area that
requires a single port and an energy level of 7 milli-electron volts (MeV). What CPT® code is
reported?
a. 77402 c. 77412
b. 77407 d. 77373
 ANS: A
Rationale: A patient with prostate cancer is receiving radiation treatment delivery by port of a
single treatment area. In the CPT® Index look for Radiation Therapy/Treatment Delivery.
Upon verification, code 77402 is the only code that represents a single treatment area with 7
MeV of energy.

PTS: 1 DIF: Moderate

25. A patient is seen in the clinic with sharp abdominal pain, vomiting and nausea, and a history of
cholelithiasis. An ultrasound of the gallbladder is performed revealing she has stones in the
gallbladder. What CPT® code is reported?
a. 76975 c. 76700
b. 74018 d. 76705

ANS: D
Rationale: The patient has a limited ultrasound performed because only a single organ
(gallbladder) was examined. A complete ultrasound of the abdomen is defined in the
subsection guidelines under the heading of Abdomen and Retroperitoneum. This is found in the
CPT® Index by looking for Ultrasound/Abdomen directing you to 76700-76706. Pay close
attention to the guidelines throughout the ultrasound codes to determine what must be
examined and documented to be considered a complete exam.

PTS: 1 DIF: Moderate

26. A 32-year-old patient is coming into an outpatient facility to have a catheterization performed
of the uterus with saline infusion sonohysterography due to dysfunctional uterine bleeding. A
previous scan showed suspected endometrial polyps. What CPT® and ICD-10-CM codes are
reported?
a. 58340, 76831-26, N93.8
b. 51700, 58340, 76831-26, N93.9
c. 51701, 58340, 74740-26, N92.5, N84.0
d. 58340, 76831-26, N93.8, N84.0

ANS: A
Rationale: The uterus is being catheterized not the bladder. Look in the CPT® Index for
Sonohysterography/Saline Infusion/Injection Procedure directing you to 58340. The
catheterization is included in the code description for 58340. A parenthetical note under this
code states “For radiological supervision and interpretation of saline infusion, use 76831.”
Modifier 26 is reported for the professional service. The diagnosis to report is the dysfunctional
uterine bleeding, which is found in the ICD-10-CM Alphabetic Index by looking for
Bleeding/uterus, uterine NEC/dysfunctional of functional which guides you to code N93.8.
According to ICD-10-CM guideline IV.H you do not code for a condition documented as
suspected such as the endometrial polyps in the outpatient setting.

PTS: 1 DIF: Moderate

27. A patient needing scoliosis measurements is coming in to have standing anteroposterior and
lateral views of his entire thoracic and lumbar spine. What CPT® code(s) is/are reported for
radiology?
a. 72084 c. 72082
b. 72040, 72070, 72100 d. 72083

ANS: C
 Rationale: X-rays of the thoracic and lumbar (thoracolumbar) spine are being taken. In the
CPT® Index look for X-ray/Spine/Thoracolumbar. Reviewing the code range in the Radiology
Section, because anteroposterior and lateral, two views, of the spine are done for scoliosis,
guides you to code 72082.

PTS: 1 DIF: Moderate

28. A one-year post-thyroidectomy patient who had thyroid cancer is coming in for area imaging of
the neck and chest to evaluate for metastases. What CPT® code(s) is/are reported for the
nuclear medicine exam?
a. 78013 c. 78014
b. 78015 d. 78015, 78020

ANS: B
Rationale: The patient is having thyroid imaging for carcinoma (cancer) metastases limited to
the chest and neck only. In the CPT® Index look for Nuclear
Medicine/Diagnostic/Thyroid/Imaging for Metastases. 78015 is the correct code for limited area
imaging. A thyroid uptake is a test to measure the thyroid function in determining how much
iodine will be absorbed by the thyroid. This is not performed therefore add-on code 78020 is
not reported.

PTS: 1 DIF: Moderate

29. A 65-year-old female has a 2.5 cm x 2.0 cm non-small cell lung cancer in her right upper lobe.
The tumor is inoperable due to severe respiratory conditions. She is receiving stereotactic body
radiation therapy today under image guidance. Beams arranged in 8 fields will deliver 25 Grays
per fraction for 4 fractions. What CPT® and ICD-10-CM codes are reported?
a. 77435, C34.11, Z51.0 c. 77373, Z51.0, C34.11
b. 77371, C34.91 d. 77431, Z51.0, C34.11

ANS: C
Rationale: Patient is having stereotactic radiation therapy technique delivered, not managed,
in a large radiation dose to tumor sites in the upper right lobe of the lung. In the CPT® Index
look for Radiation Therapy/Stereotactic Body referring you to 77373. Codes 77371-77373 do
not need modifier TC or 26, because they are facility only codes. 77373 is correct with
stereotactic body radiation not exceeding 5 fractions.
According to ICD-10-CM guideline I.C.2.a. “If a patient admission/encounter is solely for the
administration of chemotherapy, immunotherapy or radiation therapy, assign the appropriate
Z51.-code as the first-listed or principal diagnosis, and the diagnosis or problem for which the
service is being performed as a secondary diagnosis.” In the ICD-10-CM Alphabetic Index look
for Encounter/radiation therapy (antineoplastic) which directs you to Z51.0. In the ICD-10-CM
Table of Neoplasms look for Neoplasm, neoplastic/lung/upper lobe and select from the
Malignant Primary column referring you to C34.1-. Verification in the Tabular List indicates a
4th character is needed, report 1 for the right lung.

PTS: 1 DIF: Moderate

30. A 32-year-old patient with cervical cancer is in an outpatient facility to have HDR
brachytherapy. The cervix is dilated and under ultrasound guidance six applicators are inserted
with iridium via the vagina to release its radiation dose. The placement is in the cervical cavity
(intracavitary). What CPT® code is reported for the physician service?
a. 77761-26 c. 77799-26
b. 77762-26 d. 77789-26

ANS: B
 Rationale: Patient is receiving a type of internal radiation therapy delivering a high dose of
radiation (HDR) from implants (applicators with the iridium) placed via the vaginal cavity
(intracavitary). This is found in the CPT® Index by looking for Brachytherapy/Intracavitary
Application directing you to 0395T, 77761-77763. The CPT® subsection guidelines under the
heading Clinical Brachytherapy, definitions are given to differentiate simple, intermediate and
complex brachytherapy. Code 77762 is reported for the intracavitary application of five to 10
sources (intermediate); six applicators were used for this procedure making 77762 the correct
code.

PTS: 1 DIF: Moderate

31. A 37-year-old has multilevel lumbar degenerative disc disease and is coming in for an epidural
injection. Localizing the skin over the area of L5-S1, the physician uses the transforaminal
approach under fluoroscopy guidance for needle positioning. The spinal needle is inserted, and
the patient experienced paresthesias into her left lower extremity. The anesthetic drug is
injected into the epidural space. What CPT® code(s) is/are reported?
a. 64483, 77003-26 c. 64493, 77003-26
b. 64483 d. 64493

ANS: B
Rationale: In the CPT® Index look for Epidural/Injection/Transforaminal. Review the codes to
choose the appropriate service. Code 64483 is the correct code because the anesthetic was
injected into the epidural space in one single level (L5-S1) using the transforaminal approach.
Fluoroscopic guidance is included in the procedure and not reported separately.

PTS: 1 DIF: Difficult

32. A patient is taken to the inpatient cardiac cath lab and 1% Lidocaine is infused into the skin of
the right groin. The artery is punctured with a needle and a guidewire with a catheter is
advanced into the abdominal aorta. The guidewire is removed. Contrast medium is injected
through the catheter and abdominal aortography is performed. What CPT® code(s) is/are
reported for the physician’s services?
a. 36200, 75605-26 c. 36200, 75630-26
b. 36200, 75625-26 d. 36200, 75716-26

ANS: B
Rationale: The physician gains access to the aorta through the right groin (femoral artery). In
the CPT® Index look for Catheterization/Aorta. The procedure is reported with 36200. In the
CPT® Index look for Aorta/Aortography or see Aortography/Aorta Imaging. Abdominal
aortography is performed which is reported with 75625. There is no documentation that both
iliofemoral arteries of the lower extremities were also performed, code 75630 is not reported.
The services were provided by the physician in the inpatient setting. Append modifier 26 to
indicate the professional component.

PTS: 1 DIF: Difficult

33. A patient with thickening of the synovial membrane undergoes a fluoroscopic guided
radiopharmaceutical therapy joint injection on his right knee without ultrasound. What CPT®
code(s) is/are reported by the physician if performed in an ASC setting?
a. 79440 c. 79999, 77002
b. 79440, 20610 d. 79440-26, 20610, 77002-26

ANS: D
 Rationale: Look in the CPT ® Index Radiopharmaceutical Therapy/Intra-articular. Because the
injection is intra-articular, the radiopharmaceutical therapy is reported with 79440. The CPT®
guidelines in the numeric section for Radiology/Nuclear Medicine under the Therapeutic
heading indicates to also use the appropriate injection and/or procedure codes as well as
imaging guidance. In the CPT® Index look for Arthrocentesis/Large Joint directing you to
20610, 20611. The joint injection was performed without ultrasound guidance on the knee,
which is considered a large joint reported with 20610. Then look in the CPT® Index look for
Needle Localization/Fluoroscopic Guidance directing you to 77002. Fluoroscopic image
guidance for a joint injection is reported with 77002. Modifier 26 is appended to both radiology
codes to report the professional services performed by the physician in the ASC setting.

PTS: 1 DIF: Difficult

34. The patient is a 63-year-old gentleman diagnosed with rectal cancer, who had a resection of
the cancer performed. He now presents to have a Port-A-Cath (a central venous access device)
inserted for postoperative adjuvant therapy. An 18-gauge introducer needle was inserted into
the left subclavian vein through which a soft tipped guide wire was inserted into the superior
vena cava under fluoroscopy. A subcutaneous pouch in the anterior part of the chest was
created for the port. The catheter was then tunneled and measured to length. The dilator and
introducer sheath were passed over the wire into the superior vena cava under fluoroscopic
guidance. The catheter was passed through the sheath and the port was applied with good
venous return. What CPT® codes are reported?
a. 36561, 77001-26 c. 36571, 77001-26
b. 36563, 77003-26 d. 36560, 77002-26

ANS: A
Rationale: The insertion of a tunneled Port-A-Cath via the subclavian vein (which is a central
venous access device with a subcutaneous port) was performed on a 63-year-old. It is
important to note, it is tunneled. The procedure was performed under fluoroscopic guidance for
placement of a central venous access device. The Port-A-Cath procedure is found in the CPT®
Index by looking for Central Venous Catheter Placement/Insertion/Central/Tunneled with Port
directs you to 36560, 36561, 36566. Code 36561 is the correct code. If the procedure was
performed going through the basilic or cephalic vein in the arm you would report code 36571.
Code 36563 would be reported if a pump was placed. The guidelines for central venous access
procedures instruct you to use 77001 for fluoroscopic guidance. This can be found in the CPT®
Index by looking for Fluoroscopy/Guidance/Venous Access Device or Venous Access
Device/Fluoroscopic Guidance directing you to add-on code 77001.

PTS: 1 DIF: Difficult

35. The patient has malignant ascites due to ovarian cancer. She is coming back to the operating
room for a planned ultrasound guided abdominal paracentesis. This is the second time she has
needed fluid removed from her abdominal cavity. The global days for the initial abdominal
paracentesis are zero. What CPT® and ICD-10-CM codes are reported?
a. 49083-78, 77002-26, R18.0 c. 49082, 77012-26, R18.0, C56.9
b. 49082-76, 76942-26, R18.0, C56.9 d. 49083, C56.9, R18.0

ANS: D
Rationale: The patient is coming in for a subsequent (second or staged) abdominal
paracentesis. In the CPT® Index look for Paracentesis/Abdomen directing you to 49082,
49083. Code 49083 includes imaging guidance, so the radiology codes are not separately
reported. 49083 does not have a post-operative period because it has 000 for the global days
indicator. Modifier 58 is not required.
 Look in the ICD-10-CM Alphabetic Index for Cancer and you are directed to see also Neoplasm,
by site, malignant. Go to the ICD-10-CM Table of Neoplasms and look for Neoplasm,
neoplastic/ovary and select from the Malignant Primary (column) guiding you to code C56.-. In
the Tabular List a 4th character is reported to complete the code. Malignant ascites is found by
looking for Ascites/malignant which directs you to code R18.0. In the Tabular List there is a
code first note under code R18.0 indicated to “Code first malignancy, such as: malignant
neoplasm of ovary (C56.-); secondary malignant neoplasm of retroperitoneum and peritoneum
(C78.6).” This means the malignant ascites is reported as a secondary code and the ovarian
cancer is reported as the primary diagnosis code.

PTS: 1 DIF: Difficult

36. An 82-year-old female with a right leg medial malleolar non-healing ulcer elected to proceed
with peripheral angiography. Using a RIM catheter from a left femoral artery access, the
contralateral right iliac artery was accessed, and the catheter was gradually advanced to the
right common femoral artery. The right lower extremity angiography was performed with both
C02 injection and subsequently localized pictures of femoral distal bypass grafts were
performed using contrast injections. This revealed the right superficial femoral artery is 100%
occluded at its origin. Decision for angioplasty was made and intervention was performed
through this area with a 7 mm x 20 mm balloon inflated up to 7 atmospheres. The gradual
inflation resulted in enlarging the artery to a more normal flow of blood. What CPT® codes
is/are reported?
a. 37224, 75716-26-59 c. 36902, 36246
b. 37224, 75710-26-59 d. 37220, 75710-26-59

ANS: B
Rationale: In the CPT® Index look for Angioplasty/Femoral Artery/Intraoperative which directs
you to 37224. The second order selective catheterization (36246) for the diagnostic
angiography will not be reported as an additional code because the catheterization was
performed through the same access site as the interventional angioplasty, code 37224. The
diagnostic angiography is reported with 75710-26-59. Because the decision to perform the
angioplasty was made after reading the films for the diagnostic angiography, modifier 59 is
appended to show that it is not bundled with code 37224. Next, look for Angiography/Leg
Artery. This information is found in the Vascular Procedures Guidelines of the Radiology
Section in the CPT® code book.

PTS: 1 DIF: Difficult

37. A patient was admitted to observation status after losing control and crashing his motorcycle
into the guardrail on the highway. A CT scan of the brain without contrast and the chest is
performed. It revealed a fracture of the skull base with no hemorrhage in the brain. There was
no puncture of the lungs. Three views of the right and left sides of the ribcage reveal fractures
of the left third and fifth rib. What CPT® and ICD-10-CM codes are reported?
a. 70460-26, 71260-26, 71101-26, S02.0XXA, S22.43XA, V27.99XA, Y92.412
b. 70450-26, 71275-26, 71101-26, S02.19XA, S22.41XA, V27.09XA, Y92.413
c. 70450-26, 71250-26, 71101-26, S02.109B, S22.43XB, V27.29XA, Y92.411
d. 70450-26, 71250-26, 71110-26, S02.109A, S22.42XA, V27.49XA, Y92.411

ANS: D
Rationale: First, look CPT® Index for CT Scan/without contrast/Brain. The first radiological
code is 70450 because a CT scan without contrast of the brain was performed. Next, look in
the CPT® Index for CT Scan/without contrast/Thorax. Code 71250 is correct because thorax is
a synonym for chest, and the CT was performed without contrast. Code 71275 is a CTA
(computed tomographic angiography) which is used for imaging vessels to find a blood clot,
aneurysm and other vascular irregularities in the chest making it an inappropriate code to
report for this scenario. Then, look in the CPT® Index for X-ray/Ribs. Confirmation in the
numeric section shows 71110 is correct for the three views taken bilaterally (left and right
side) of the ribs. Modifier 26 denotes the professional service performed in a facility setting.
 The first diagnosis is found in the ICD-10-CM Alphabetic Index by looking for Fracture,
traumatic/skull/base directing you to code S02.10-. Verification in the Tabular List indicates
the codes needs seven characters to be complete. Report 9 for the 6th character and then A
for 7th character to indicate initial encounter. Two left ribs were fractured. Look in the
Alphabetic Index for Fracture, traumatic/rib/multiple guiding you to S22.4-. Verification in the
Tabular List indicates the need for seven characters to complete the code. Report 2 for as the
5th character for the left side. Report placeholder X for the 6th character and then an A for
initial encounter as the 7th character. The next two codes are found in the External Cause of
Injuries Index.

PTS: 1 DIF: Difficult

38. A 41-year-old male is in his doctor’s office for a follow up of an abnormality which was noted
on an abdominal CT scan. He also had a chest X-ray (PA and lateral views) performed in the
office due to chest tightness. He states he otherwise feels well and is here to go over the
results of his chest X-ray performed in the office, and the CT scan performed at the diagnostic
center. The results of the chest X-ray were normal. CT scan was sent to the office, and the
physician interpreted and documented that the CT scan of the abdomen showed a small mass
in his right upper quadrant. What CPT® codes are reported for the doctor’s office radiological
services?
a. 71046-26, 74150-26 c. 71046-26, 74150
b. 71046, 74150 d. 71046, 74150-26

ANS: D
Rationale: Look in the CPT® Index for X-ray/Chest. Code 71046 is the correct code for two
views, PA and lateral. The chest X-ray was taken in the doctor’s office and interpreted. This
means the doctor’s office can bill for the code without appending a modifier. Next, look in the
CPT® Index for CT Scan/without Contrast/Abdomen. The correct code for the CT Scan is
74150. Modifier 26 is appended to the CT scan code, as it was performed at another site and
the physician only interpreted the image.

PTS: 1 DIF: Difficult

39. A patient has a history of chronic venous embolism in the superior vena cava (SVC) and is
having a radiographic study to visualize any abnormalities. In outpatient surgery center, the
physician accesses the subclavian vein and the catheter is advanced to the SVC for injection
and imaging. The supervision and interpretation of the images is performed by the physician.
What codes are reported for this procedure?
a. 36010, 75827-26 c. 36000, 75827-26
b. 36000, 75820-26 d. 36010, 75820-26

ANS: A
Rationale: A radiographic study of the SVC is performed to visualize and evaluate any
abnormalities. For the insertion of the catheter look in the CPT® Index for
Catheterization/Vena Cava referring you to code 36010. For the radiology code look in the
CPT® Index for Venography/Vena Cava guiding you to code range 75825-75827. Radiology
code 75827 is correct for the SVC. Modifier 26 is appended to the radiology code because the
physician is performing the procedure in an outpatient facility setting and does not own the
radiology equipment.

PTS: 1 DIF: Difficult

40. A 70-year-old female presents with a complaint of right knee pain with weight bearing
activities. She is also developing pain at rest. She denies any recent injury. There is pain with
stair climbing as well as start-up pain. AP, Lateral and Sunrise views of the right knee are
ordered and interpreted. They reveal calcification within the vascular structures. There is
decreased joint space through the medial compartment where she has near bone-on-bone
contact, flattening of the femoral condyles, no fractures noted. The diagnosis is right knee pain
secondary to underlying primary localized degenerative arthritis. What CPT® and ICD-10-CM
codes are reported?
a. 73560, M17.11 c. 73562, M17.11
b. 73562, M17.9, M25.561 d. 73565, M17.11, M25.561

ANS: C
Rationale: Look in the CPT® Index for X-ray/Knee which directs you to 73560-73564, 73580.
Code 73562 reports three views of one knee. The scenario is reported with one ICD-10-CM
code. Look in the ICD-10-CM Alphabetic Index for Arthritis/degenerative which states to see
Osteoarthritis. Look for Osteoarthritis/knee which guides you to code M17.1. A 4th character is
reported for laterality. Report code M17.11 for the right knee. You do not report the ICD-10-
CM code for knee pain as this is a symptom of the degenerative arthritis and included in the
code.

PTS: 1 DIF: Difficult

41. Myocardial Perfusion Imaging (MPI)—Office Based Test

Indications: Chest pain.
Procedure: Resting tomographic myocardial perfusion images were obtained following injection
of 10 mCi of intravenous Cardiolite. At peak exercise, 30 mCi of intravenous Cardiolite was
injected, and post-stress tomographic myocardial perfusion images were obtained. Post stress
gated images of the left ventricle were also acquired. Myocardial perfusion images were
compared in the standard fashion.
Findings: This is a technically fair study. There was no stress induced electrocardiographic
changes noted. There were no significant reversible or fixed perfusion defects noted. Gated
images of the left ventricle reveal normal left ventricular volumes, normal left ventricular wall
motion, and an estimated left ventricular ejection fraction of 50%.
Impression: No evidence of myocardial ischemia or infarction. Normal left ventricular ejection
fraction. What CPT® code(s) is/are reported?
a. 78472 c. 78453
b. 78452 d. 78454

ANS: B
Rationale: Tomographic myocardial perfusion imaging was performed. In this procedure the
patient receives an intravenous injection of a radionuclide which localizes in nonischemic
tissue. SPECT (single photon emission computed tomographic) images of the heart are taken
immediately to identify areas of perfusion vs. infarction. In the CPT® Index look for
Heart/Myocardium/Perfusion Study which directs you to 78451-78454. The MPI was performed
at rest and exercise (which is stress), reporting code 78452 for multiple studies.

PTS: 1 DIF: Difficult

42. After intravenous administration of 5.1 millicuries Tc-99m DTPA, flow imaging of the kidneys
was performed for approximately 30 minutes. Flow imaging demonstrated markedly reduced
flow to the kidneys bilaterally. What CPT® code is reported?
a. 78700, 78434 c. 78708
b. 78701 d. 78725

ANS: B
 Rationale: The nuclear imaging test follows the blood as it flows to the kidneys identifying any
obstruction and to determine the rate at which the kidneys are filtering. The scenario does not
document the function of the kidneys’ tubes and ducts. In the CPT® Index look for Nuclear
Medicine/Diagnostic/Vascular Flow directing you to code range 78701-78709. Only vascular
flow was performed making code 78701 the correct code to report.

PTS: 1 DIF: Difficult

43. An oncology patient is having weekly radiation treatments with a total of seven conventional
fractionated treatments. Two fractionated treatments daily for Monday, Tuesday and
Wednesday and one treatment on Thursday. What radiology code(s) is/are appropriate for the
clinical management of the radiation treatment?
a. 77427 c. 77427 x 2
b. 77427 x 7 d. 77427-22

ANS: A
Rationale: In the CPT® Index look for Radiation Therapy/Treatment Management/Weekly
directing you to 77427. There are seven fractions given in this patient’s weekly treatment.
According to CPT® guidelines, radiation treatment management is reported in units of five
fractions or treatment sessions, regardless of the actual time-period in which the services are
furnished. Code 77427 is also reported if there are three or four fractions beyond a multiple of
five at the end of a course of treatment, one or two fractions beyond a multiple of five at the
end of a course of treatment are not reported separately.” This instruction is found in CPT®
under the heading Radiation Treatment Management in the Radiology/Radiation Oncology
Section of the Radiology Chapter.

PTS: 1 DIF: Difficult

44. Magnetic resonance imaging of the chest is first done without contrast medium enhancement
and then is performed with an injection of contrast. What CPT® code(s) is/are reported for the
radiological services?
a. 71550, 71551 c. 71555
b. 71552 d. 71275

ANS: B
Rationale: The patient is having magnetic resonance imaging in which the images were
performed first without contrast and again following the injection of contrast. In the CPT®
Index look for Magnetic Resonance Imaging (MRI)/Diagnostic/Chest directing you to 71550-
71552.

PTS: 1 DIF: Difficult

45. A Computed tomography scan (CT) confirms improper ossification of cartilages in the upper
jawbone and left side of the face of a patient with facial defects. A CT scan is performed with
contrast material in the hospital. What CPT® code is reported by an independent radiologist
contracted by the hospital?
a. 70460-26 c. 70487-26
b. 70481-26 d. 70542-26

ANS: C
Rationale: The CT scan with contrast is performed on the maxillofacial area. The maxilla is the
upper part of the jawbone. In the CPT® Index look for CT Scan/with Contrast/Maxilla directing
you to 70487. Modifier 26 denotes the professional service.

PTS: 1 DIF: Difficult

46. A patient is positioned on the scanning table headfirst with arms at the side for an MRI of the
thoracic spine and spinal canal. A contrast agent is used to improve the quality of the images.
The scan confirms the size and depth of a previously biopsied leiomyosarcoma metastasized to
the thoracic spinal cord. What CPT® and ICD-10-CM codes are reported?
a. 72255, D49.2 c. 72070, C72.0
b. 72157, D48.0 d. 72147, C79.49

ANS: D
Rationale: In the CPT® Index look for Magnetic Resonance Imaging
(MRI)/Diagnostic/Spine/Thoracic. Code 72147 describes an MRI of the thoracic spine with
contrast. The diagnosis is a secondary (metastasized) cancer to the thoracic spinal cord. Look
in the ICD-10-CM Alphabetic Index for Leiomyosarcoma which states see also Neoplasm,
connective tissue, malignant. In the ICD-10-CM Table of Neoplasms look for Neoplasm,
neoplastic/connective tissue NEC/cord (true) (vocal)/spinal (thoracic) and select from the
Malignant Secondary (column) you are guided to code C79.49.

PTS: 1 DIF: Difficult

47. A young child is taken to the OR to reduce a meconium plug bowel obstruction. A therapeutic
enema is performed with fluoroscopy. The patient is in position and barium is instilled into the
colon through the anus for the reduction. What CPT® code is reported by the independent
radiologist for the radiological service?
a. 74270-26 c. 74283-26
b. 74280-26 d. 74246-26

ANS: C
Rationale: A therapeutic enema was performed with contrast (barium) to reduce the meconium
plug (intraluminal obstruction). In the CPT® Index look for Enema/Therapeutic/for
Intussusception directing you to 74283. The code description includes therapeutic enema with
contrast for intraluminal obstruction. Modifier 26 denotes the professional service.

PTS: 1 DIF: Difficult

48. A patient in her 2nd trimester with a triplet pregnancy is seen in the obstetrician’s office for an
obstetrical ultrasound only for obtaining fetal heartbeats and position of the fetuses. What
CPT® code(s) is/are reported for the ultrasound?
a. 76805, 76810, 76810 c. 76815 x 3
b. 76811, 76812, 76812 d. 76815

ANS: D
Rationale: This is a limited ultrasound performed on three fetuses. Look in the CPT® Index for
Ultrasound/Obstetrical/Pregnant Uterus. CPT® code 76815 has in its code description the
ultrasound is for 1 or more fetuses. There is also a parenthetical note stating Use 76815 only
once per exam and not per element.

PTS: 1 DIF: Difficult

49. A CT study of the lumbar spine (L2–L4) was performed with IV contrast in the hospital
outpatient radiology department and the interpretation of the images is performed by the
radiologist. What CPT® code(s) should be reported by the radiologist who is not an employee
of the hospital?
a. 72132-TC c. 72132-26
b. 72132 d. 72132-26, 72132-TC

ANS: C
 Rationale: Look in the CPT® Index for CT Scan/with Contrast/Spine/Lumbar which directs you
to 72132. Modifier 26 is appended to the radiological service for the professional service. The
hospital would also bill the radiological service for the technical component as the hospital
owns the equipment used for the service.

PTS: 1 DIF: Difficult

50. A 55-year-old female is having a diagnostic mammogram performed on her left breast because
a screening mammogram detected density in the breast. What CPT® and ICD-10-CM codes
are reported?
a. 77067-LT, R92.30 c. 77065-LT, R92.30
b. 77066-LT, Z12.39, R92.30 d. 77046-LT, Z12.31, R92.30

ANS: C
Rationale: Diagnostic mammograms differ from screening mammograms. The examination
focuses specifically on an area of breast tissue appearing abnormal in a screening
mammogram. In the CPT® Index look for Mammography; or look for Breast/Diagnostic
Imaging/Mammography, Diagnostic. The mammogram was performed only on the left breast
(unilateral) reporting code 77065 and appending the LT modifier. Because this is not a
screening mammogram, the Z codes for screening would be inappropriate to report. In the
ICD-10-CM Alphabetic Index look for Dense breasts which has a see also Density, breast.
Density / breast refers you to code R92.30. Verify code selection in the Tabular List.

PTS: 1 DIF: Difficult

51. In ICD-10-CM when a patient is seen for a routine examination, what additional information is
needed to accurately code the routine examination?
a. The frequency of the routine exam (i.e. monthly, yearly)
b. Whether or not laboratory tests were also performed.
c. Whether or not abnormal findings were identified.
d. When the next routine examination is scheduled.

ANS: C
Rationale: In ICD-10-CM the codes for radiologic exam have been expanded to specify when
abnormal findings are found on the radiology exam. Look in the ICD-10-CM Alphabetic Index
for Examination/radiological. There is a subentry for with abnormal findings. These entries
default to the codes for a general adult medical examination.
Z00.00 Encounter for general adult medical examination without abnormal findings.
Z00.01 Encounter for general adult medical examination with abnormal findings.

PTS: 1 DIF: Moderate REF: ICD-10-CM

52. What ICD-10-CM code is reported for a routine screening mammogram?

a. C50.919 c. Z12.31
b. C50.929 d. Z12.39

ANS: C
Rationale: Look in the ICD-10-CM Alphabetic Index for Screening/neoplasm (malignant)
(of)/breast/routine mammogram which refers you to Z12.31. ICD-10-CM only has one code to
report a screening mammogram. Verify code selection in the Tabular List.

PTS: 1 DIF: Moderate REF: ICD-10-CM

53. What ICD-10-CM codes are reported for a radiotherapy session?

a. Z51.0 c. Z51.5
b. Z51.11 d. Z51.12
 ANS: A
Rationale: Look in the ICD-10-CM Alphabetic Index for Radiotherapy session which refers you
to Z51.0. Verify code selection in the Tabular List.

PTS: 1 DIF: Moderate REF: ICD-10-CM

54. What ICD-10-CM code is reported for an adverse effect to diagnostic iodine, initial encounter?
a. T49.0X1A c. T49.0X5A
b. T50.8X5A d. T50.995A

ANS: B
Rationale: Look in the ICD-10-CM Table of Drugs and Chemicals for Iodine/diagnostic. Report
the code from the Adverse effect column which refers you to T49.0X5. In the Tabular List
T50.8X5 requires a 7th character. A is reported for the initial encounter.

PTS: 1 DIF: Difficult REF: ICD-10-CM

55. What ICD-10-CM code is reported for a routine chest X-ray?

a. R07.1 c. Z01.89
b. R07.9 d. Z00.01

ANS: C
Rationale: ICD-10-CM coding guideline IV.K states: For encounters for routine
laboratory/radiology testing in the absence of any signs, symptoms, or associated diagnosis,
assign Z01.89, Encounter for other specified special examinations.

PTS: 1 DIF: Easy REF: ICD-10-CM