Question 1
A dermatopathology report uses the term 'acantholysis.' What microscopic change does that term identify?
Show answer & explanation
Correct answer: B - Loss of adhesion between keratinocytes
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The CPCD exam has 100 questions and runs 4 hours.
These 10 free CPCD questions are organized by exam domain, so you can see how each part of the Certified Professional Coder in Dermatology blueprint is tested. Reveal the answer and explanation under each question.
A dermatopathology report uses the term 'acantholysis.' What microscopic change does that term identify?
Correct answer: B - Loss of adhesion between keratinocytes
During a scheduled psoriasis follow-up in a noninstitutional dermatology office, an independently enrolled nurse practitioner evaluates and treats a new, unrelated dermatitis. The dermatologist established the psoriasis plan but has never evaluated the dermatitis. The dermatologist is in the office suite and later co-signs the note without seeing the patient. The NP's service otherwise meets Medicare coverage and scope-of-practice requirements. For this Original Medicare visit, the appropriate billing approach is to:
Correct answer: D - Use the NP's rendering NPI for the personally performed service.
A melanoma surgeon treating a referred patient requests the dermatology record and identifiable lesion photographs to locate the operative site. The office verifies the surgeon's identity and destination, but no separate patient authorization is on file. There is no patient-requested restriction or stricter applicable law. Under HIPAA, what response is appropriate?
Correct answer: C - Transmit the records securely for the surgeon's treatment of the patient.
The signed assessment for an outpatient biopsy reads, 'Skin neoplasm, left shoulder; tissue submitted to determine type.' No behavior is documented, and pathology is not yet available when the encounter is coded. Which diagnosis best represents the information currently established?
Correct answer: B - D49.2 - Neoplasm of unspecified behavior of skin
A claim reviewer returns an office encounter because the dermatologist documented 'sacral pressure ulcer' without a stage. In the same medical record, the wound-care registered nurse's signed assessment identifies a stage 3 pressure ulcer. No documentation conflicts with that assessment. How should the coder resolve the staging issue?
Correct answer: C - Assign stage 3 using the registered nurse's documented assessment.
An established patient has a nonsevere exacerbation of plaque psoriasis while taking methotrexate. The dermatologist adjusts the dose and reviews a CBC and a comprehensive metabolic panel obtained under monthly surveillance for bone-marrow and liver toxicity. No other problems, tests, record reviews, or discussions contribute to this encounter. The level is selected by medical decision making (MDM). Which coding conclusion is justified?
Correct answer: C - 99214; the exacerbation and management risk support moderate MDM.
Procedure record: an incisional wedge biopsy of an indurated cheek plaque, a punch biopsy of a forearm papule, and a tangential biopsy of a thigh macule. These are three separate lesions, each sampled for diagnosis rather than definitive removal. The incisional and punch sites receive simple closures. How should the biopsy services be reported?
Correct answer: A - 11106 + 11105 + 11103
A biopsy-proven invasive squamous cell carcinoma on the calf is removed by full-thickness excision. Before excision, the lesion measures 1.6 cm at its greatest diameter, and the surgeon marks a 0.4-cm margin on each side. The final linear closure measures 4.9 cm. Select the code for the excision itself.
Correct answer: D - 11603 - Malignant lesion, trunk/arms/legs, excised diameter 2.1-3.0 cm
One squamous cell carcinoma of the lower leg is cleared by Mohs surgery. The operating dermatologist performs the mapped microscopic margin examinations. The first stage includes skeletal muscle and produces six tissue blocks; the second stage produces three blocks. Considering only the Mohs portion of the encounter, which code combination applies?
Correct answer: D - 17311 x 1 + 17312 x 1 + 17315 x 1
The debridement note identifies a sacral ulcer measuring 34 cm² and a separate calf ulcer measuring 22 cm². The surgeon actually removes necrotic subcutaneous tissue from 14 cm² of the sacral wound and 13 cm² of the calf wound. Bone is visible in the sacral wound, but no muscle, fascia, or bone is removed from either wound. Which codes and units report the debridement, before any modifier assignment?
Correct answer: B - 11042 x 1 + 11045 x 1
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