COBGC Certified Obstetrics and Gynecology Coder Exam — Questions and Answers

Question 1: For an E&M service to be separately billable on the same day as a minor procedure, what is required?

Only a different diagnosis code
A different place of service
A significant, separately identifiable reason documented with Modifier 25 (Correct answer)
Prior authorization

Correct answer: A significant, separately identifiable reason documented with Modifier 25

A same-day E&M is payable only when it represents a significant, separately identifiable service supported by documentation and appended with Modifier 25.

Question 2: When a Medicare beneficiary is also covered by an employer group health plan (EGHP) through a spouse's employer, which payer is primary for an OB/GYN procedure?

Medicaid coordination rules apply instead
The EGHP is primary; Medicare is secondary (Correct answer)
The payer with the higher allowed amount is primary
Medicare is always primary for beneficiaries over 65

Correct answer: The EGHP is primary; Medicare is secondary

Under Medicare Secondary Payer (MSP) rules, an active employer group health plan is primary over Medicare when the group has 20 or more employees.

Question 3: When coding a radical hysterectomy with bilateral lymphadenectomy, what is the correct approach for the lymphadenectomy?

Use an unlisted procedure code
Report it with modifier 51
Bill it separately using an add-on code (Correct answer)
It is bundled into the radical hysterectomy code

Correct answer: Bill it separately using an add-on code

Pelvic lymphadenectomy performed with radical hysterectomy is reported separately using the appropriate lymphadenectomy add-on or standalone code.

Question 4: A new obstetrics patient's office visit requires 65 minutes of total physician time on the date of service. Which code should be reported based on time?

99204
99215
99205 (Correct answer)
99203

Correct answer: 99205

CPT 99205 covers new patient visits with 60–74 minutes of total physician time on the date of service.

Question 5: What modifiers are used in obstetric coding?

Only modifier 25
Modifier 22 (increased services), 52 (reduced services), and 59 (distinct procedural service) (Correct answer)
Only modifier 26
No modifiers apply

Correct answer: Modifier 22 (increased services), 52 (reduced services), and 59 (distinct procedural service)

OB modifiers adjust codes when services differ from the standard global package.

Question 6: A patient is diagnosed with a left tubal ectopic pregnancy without a concurrent intrauterine pregnancy. Which ICD-10-CM code is correct?

O00.00 – Abdominal ectopic pregnancy without intrauterine pregnancy
O00.109 – Unspecified tubal pregnancy without intrauterine pregnancy
O00.102 – Left tubal pregnancy without intrauterine pregnancy (Correct answer)
O00.10 – Tubal pregnancy without intrauterine pregnancy, unspecified side

Correct answer: O00.102 – Left tubal pregnancy without intrauterine pregnancy

O00.102 specifies a left-sided tubal ectopic pregnancy without a concurrent intrauterine pregnancy, capturing the laterality required by ICD-10-CM.

Question 7: How are gynecologic cancers coded?

Only by organ
One code for all GYN cancers
Using ICD-10 codes specifying the site (cervix, uterus, ovary), histology, and stage (Correct answer)
Cancer is not coded by gynecologic specialty

Correct answer: Using ICD-10 codes specifying the site (cervix, uterus, ovary), histology, and stage

Cancer coding requires specificity about the primary site, behavior (malignant, in situ), and staging information.

Question 8: What is the coding for ectopic pregnancy?

No specific code exists
Same as normal pregnancy
ICD-10 codes O00.x specify the site (tubal, ovarian, abdominal) of the ectopic pregnancy (Correct answer)
Only coded as a complication

Correct answer: ICD-10 codes O00.x specify the site (tubal, ovarian, abdominal) of the ectopic pregnancy

Ectopic pregnancy codes identify the specific anatomical location of the abnormal implantation.

Question 9: A covering physician performs a vaginal delivery only; the patient's regular OB provided all antepartum care and will provide postpartum care. Which CPT code does the covering physician bill?

59426
59400
59410 (Correct answer)
59430

Correct answer: 59410

CPT 59410 (vaginal delivery only, with or without episiotomy) is used when a physician performs delivery but not antepartum or postpartum care.

Question 10: A physician orders an MRI pelvis for a patient with pelvic pain. The commercial payer requires a 'peer-to-peer' review. What does this process involve?

The patient appeals the denial in writing
The coder calls the payer to dispute a coding error
The billing department submits additional codes to support the claim
The ordering physician speaks directly with the payer's medical reviewer to justify the clinical necessity of the service (Correct answer)

Correct answer: The ordering physician speaks directly with the payer's medical reviewer to justify the clinical necessity of the service

A peer-to-peer review is a phone consultation between the requesting clinician and the payer's medical director to discuss clinical criteria and justify the medical necessity of a requested service.

Question 11: Which term describes surgical removal of the uterus, both fallopian tubes, and both ovaries?

Radical hysterectomy
Total abdominal hysterectomy with bilateral salpingo-oophorectomy (Correct answer)
Total hysterectomy
Subtotal hysterectomy

Correct answer: Total abdominal hysterectomy with bilateral salpingo-oophorectomy

TAH-BSO (Total Abdominal Hysterectomy with Bilateral Salpingo-Oophorectomy) removes the uterus, cervix, both tubes (salpingo), and both ovaries (oophorectomy).

Question 12: In ICD-10-CM, what does the 7th character represent in multiple gestation obstetric codes?

The episode of care
The specific fetus affected (Correct answer)
The trimester
Whether delivery was vaginal or cesarean

Correct answer: The specific fetus affected

The 7th character in multiple gestation codes identifies which specific fetus is affected by the complication (e.g., 1 = fetus 1, 2 = fetus 2).

Question 13: Which coding guideline helps determine whether a procedure should be bundled or separately coded?

National Correct Coding Initiative (NCCI) (Correct answer)
Healthcare Common Procedure Coding System (HCPCS)
International Classification of Diseases (ICD)
Current Procedural Terminology (CPT)

Correct answer: National Correct Coding Initiative (NCCI)

The National Correct Coding Initiative (NCCI) is a set of coding guidelines developed by CMS to promote correct coding methodologies and prevent improper coding. NCCI edits identify code pairs that should not be billed together (mutually exclusive) or services that are typically performed together and should be bundled into a single code, thus determining whether a procedure should be bundled or separately coded.

Question 14: A surgeon performs an anterior colporrhaphy and a posterior colporrhaphy during the same operative session. How is this coded?

57250 only
57260 (Correct answer)
57240 + 57250
57240 only

Correct answer: 57260

CPT 57260 describes combined anteroposterior colporrhaphy and should be used when both repairs are performed at the same session.

Question 15: Which modifier should a coder append when billing for a colposcopy with biopsy that was determined to be medically necessary during a separately reported E/M visit on the same day?

-25 (Correct answer)
-51
-76
-59

Correct answer: -25

Modifier -25 is appended to the E/M code (not the procedure code) to indicate that a significant, separately identifiable evaluation and management service was provided on the same day as a procedure.

Question 16: Which CPT codes are used when billing antepartum visits separately, outside of the global OB package?

59400 and 59410
99213 and 99214
59430 and 59440
59425 and 59426 (Correct answer)

Correct answer: 59425 and 59426

CPT 59425 covers 4-6 antepartum visits and 59426 covers 7 or more antepartum visits when reported separately from the global package.

Question 17: CPT code 59430 is used for which obstetric service?

Postpartum care only (Correct answer)
Cesarean with postpartum care
Antepartum care only
Vaginal delivery only

Correct answer: Postpartum care only

CPT 59430 reports postpartum care only, when the billing provider did not perform the delivery.

Question 18: A GYN patient receives a well-woman preventive exam and also has a new complaint of abnormal uterine bleeding addressed in the same visit. How should this be reported?

Bill only the preventive medicine code for the entire visit
Bill a single unlisted code for the combined preventive and problem service
Bill only the problem-oriented E/M code for the entire visit
Bill both the preventive medicine code and an E/M code with modifier -25 (Correct answer)

Correct answer: Bill both the preventive medicine code and an E/M code with modifier -25

When a significant, separately identifiable problem-oriented E/M is provided on the same day as a preventive medicine service, both may be billed with modifier -25 appended to the E/M code.

Question 19: Which CPT code range covers maternity care and delivery procedures?

59000-59899 (Correct answer)
57000-57426
56405-56821
58100-58579

Correct answer: 59000-59899

CPT codes 59000-59899 are designated specifically for maternity care and delivery procedures.

Question 20: What is the global obstetric package?

Only delivery charges
A single visit code
International coding standards
A bundled code covering antepartum care, delivery, and postpartum care (Correct answer)

Correct answer: A bundled code covering antepartum care, delivery, and postpartum care

The global OB package bundles routine prenatal visits, delivery, and postpartum follow-up into one comprehensive code.

Question 21: In CPT, Category III codes are used for:

Emerging technologies, services, and procedures that do not yet have Category I codes (Correct answer)
HCPCS Level II crosswalk services
Procedures that have been deleted from the main CPT manual
Evaluation and management services only

Correct answer: Emerging technologies, services, and procedures that do not yet have Category I codes

CPT Category III codes are temporary codes assigned to emerging technologies and procedures that lack sufficient data for permanent Category I status.

Question 22: A patient undergoes excision of a vaginal cyst. Which CPT code range covers this procedure?

57135 (Correct answer)
57100–57109
57130
57160

Correct answer: 57135

CPT 57135 describes excision of vaginal cyst or tumor.

Question 23: A 'Code First' note in ICD-10-CM instructs the coder to:

Query the physician before any code is assigned
Assign the instructed code as an additional code only
Sequence the instructed underlying condition code before the manifestation or etiology-specific code (Correct answer)
Use only the manifestation code and omit the underlying code

Correct answer: Sequence the instructed underlying condition code before the manifestation or etiology-specific code

A 'Code First' instruction means the underlying condition or etiology must be sequenced as the principal/first-listed diagnosis before the code with the note.

Question 24: A physician performs a laparoscopic myomectomy to remove four uterine fibroids. How is this coded?

58550 with modifier 22
58546 only for four or more fibroids
58545 once, regardless of fibroid count
58545 + 58546 as an add-on (Correct answer)

Correct answer: 58545 + 58546 as an add-on

CPT 58545 is for laparoscopic myomectomy of 1–4 intramural myomas, and 58546 (add-on) is used when 5 or more myomas total are removed.

Question 25: Which modifier indicates a synchronous telemedicine service rendered via real-time audio and video?

Modifier 93
Modifier GQ
Modifier GT
Modifier 95 (Correct answer)

Correct answer: Modifier 95

Modifier 95 indicates that a synchronous real-time telemedicine service was provided via interactive audio and video telecommunications.

Question 26: Modifier 24 appended to an E&M service code during the global OB period indicates that the service is:

A reduced or eliminated service
A significant E&M performed on the same day as a procedure
An unrelated E&M performed during a postoperative global period (Correct answer)
A prolonged service beyond the typical time

Correct answer: An unrelated E&M performed during a postoperative global period

Modifier 24 signals that the E&M service is unrelated to the original procedure or delivery and is performed during the postoperative or global period.

Question 27: An embryo transfer (CPT 58974) is initiated but cannot be completed due to cervical stenosis preventing catheter passage. Which modifier should be appended?

Modifier 59
Modifier 52
Modifier 22
Modifier 53 (Correct answer)

Correct answer: Modifier 53

Modifier 53 (Discontinued Procedure) is used when a procedure is started but must be terminated due to circumstances such as cervical stenosis preventing completion of the embryo transfer.

Question 28: A semen analysis is performed using strict Kruger morphologic criteria. Which CPT code is reported?

89320
89325
89322 (Correct answer)
89321

Correct answer: 89322

CPT 89322 is reported for semen analysis using strict morphologic criteria (Kruger method), which evaluates sperm shape by more rigorous standards.

Question 29: Which modifier indicates that only postpartum care was provided by the reporting physician?

Modifier 56
Modifier 55 (Correct answer)
Modifier 54
Modifier 79

Correct answer: Modifier 55

Modifier 55 is appended when the reporting physician provided only postpartum follow-up and did not perform the delivery.

Question 30: How is a hysterectomy coded?

Only by surgeon preference
By the approach (abdominal, vaginal, laparoscopic) and the extent (total, subtotal, radical) (Correct answer)
No code differentiation exists
One universal code

Correct answer: By the approach (abdominal, vaginal, laparoscopic) and the extent (total, subtotal, radical)

Hysterectomy coding requires identifying both the surgical approach and the extent of the procedure.

Question 31: When a hysteroscopy with endometrial ablation is performed, which CPT code is used?

58558
58353
58555
58563 (Correct answer)

Correct answer: 58563

CPT 58563 describes hysteroscopy with endometrial ablation (e.g., endometrial resection, electrosurgical ablation, thermoablation).

Question 32: According to ICD-10-CM obstetric coding guidelines, which Z code must be reported as an additional code to indicate the outcome of delivery?

Z37 – Outcome of delivery (Correct answer)
Z23 – Encounter for immunization
Z34 – Encounter for supervision of normal pregnancy
Z3A – Weeks of gestation

Correct answer: Z37 – Outcome of delivery

A Z37 code (Outcome of delivery) is required as an additional code on the mother's delivery record to specify the number of liveborns and stillborns.

Question 33: Which ICD-10-CM code category describes leiomyoma of the uterus?

N83
N80
D26
D25 (Correct answer)

Correct answer: D25

ICD-10-CM category D25 covers leiomyoma of the uterus (uterine fibroids), with subcategories specifying the location.

Question 34: Which hormone surge directly triggers ovulation?

Estrogen
Luteinizing hormone (LH) (Correct answer)
Follicle-stimulating hormone (FSH)
Progesterone

Correct answer: Luteinizing hormone (LH)

A midcycle LH surge from the anterior pituitary triggers final follicular maturation and rupture, releasing the oocyte.

Question 35: What is the minimum total physician time required to support billing CPT 99215 for an established patient under 2021 guidelines?

50 minutes
40 minutes (Correct answer)
60 minutes
30 minutes

Correct answer: 40 minutes

CPT 99215 requires 40–54 minutes of total physician time for established patients; below 40 minutes maps to 99214 (30–39 minutes).

Question 36: When a second surgical procedure is performed during the same operative session, which modifier is typically appended to the secondary procedure?

Modifier 80
Modifier 51 (Correct answer)
Modifier 59
Modifier 22

Correct answer: Modifier 51

Modifier 51 indicates multiple procedures performed during the same surgical session, triggering reduced payment for secondary procedures.

Question 37: Which hormone primarily stimulates milk production (lactogenesis) in the postpartum period?

Progesterone
Estrogen
Prolactin (Correct answer)
Oxytocin

Correct answer: Prolactin

Prolactin, secreted by the anterior pituitary, drives alveolar cell milk synthesis; the postpartum drop in estrogen and progesterone removes their inhibitory effect, allowing prolactin to act.

Question 38: Which CPT code is used for follicle puncture for oocyte retrieval (egg retrieval) during an IVF cycle?

58970 (Correct answer)
89250
58322
58974

Correct answer: 58970

CPT 58970 describes follicle puncture for oocyte retrieval by any method and is the standard surgical code for egg retrieval in IVF.

Question 39: When a procedure is performed during the global period of a prior surgery for an unrelated condition, which modifier is used?

Modifier 78
Modifier 79 (Correct answer)
Modifier 58
Modifier 24

Correct answer: Modifier 79

Modifier 79 indicates the service is unrelated to the original procedure and performed during its postoperative global period.

Question 40: Which document serves as the primary compliance roadmap outlining an OB/GYN practice's commitment to ethical billing and coding standards?

The superbill
The compliance plan (Correct answer)
The fee schedule
The charge master

Correct answer: The compliance plan

A written compliance plan describes the practice's policies, procedures, and training commitments to prevent, detect, and correct fraudulent or erroneous billing.

Question 41: Documentation of medical necessity for a GYN procedure is primarily supported by which part of the medical record?

The CPT code selected by the coder
The operative report header only
The patient's insurance card copy
The ICD-10-CM diagnosis codes linked to the procedure and the clinical notes (Correct answer)

Correct answer: The ICD-10-CM diagnosis codes linked to the procedure and the clinical notes

Medical necessity is established through the diagnosis codes that reflect the clinical condition and the supporting documentation in the physician's notes.

Question 42: What is modifier 25 and when is it used?

Used for follow-up visits only
Applied to all E/M codes automatically
A discount modifier
A significant, separately identifiable E/M service on the same day as a procedure (Correct answer)

Correct answer: A significant, separately identifiable E/M service on the same day as a procedure

Modifier 25 indicates that a separate E/M service beyond the procedure was necessary and documented on the same day.

Question 43: Under the Anti-Kickback Statute, an OB/GYN receiving compensation from a pharmaceutical company for speaking engagements is at risk unless:

The payments are labeled as 'educational grants'
The arrangement meets the requirements of the Personal Services safe harbor (Correct answer)
The pharmaceutical product is not on formulary
The physician discloses the arrangement to patients

Correct answer: The arrangement meets the requirements of the Personal Services safe harbor

The Anti-Kickback Statute's Personal Services safe harbor requires that the arrangement be set out in a written agreement, cover only legitimate services, and provide fair market value compensation.

Question 44: A patient's OB chart documents smoking status but no counseling was provided or documented. The coder wants to bill 99406 for tobacco cessation counseling. This would be:

Allowed because smoking is a universal risk factor in pregnancy
Acceptable because smoking status documents the medical necessity
Fraudulent—services must be performed and documented before they are billed (Correct answer)
Permissible if the physician verbally discussed it

Correct answer: Fraudulent—services must be performed and documented before they are billed

Billing for a service that was not performed and is not documented in the medical record constitutes healthcare fraud regardless of the service's general appropriateness.

Question 45: A patient is diagnosed with a complete (classical) hydatidiform mole. Which ICD-10-CM code applies?

O02.0 – Blighted ovum and nonhydatidiform mole
O01.1 – Incomplete and partial hydatidiform mole
O01.9 – Hydatidiform mole, unspecified
O01.0 – Classical hydatidiform mole (Correct answer)

Correct answer: O01.0 – Classical hydatidiform mole

O01.0 represents a classical (complete) hydatidiform mole, which is genetically distinct from partial moles (O01.1) and requires pathological confirmation.

Question 46: An OB ultrasound is performed using hospital-owned equipment. The physician bills only for interpretation. Which modifier is used?

-TC
-26 (Correct answer)
-52
-59

Correct answer: -26

Modifier -26 identifies the professional component only (physician interpretation and written report) when the technical component is billed separately by the facility.

Question 47: A patient with abnormal uterine bleeding has outside pathology slides independently reviewed, a pelvic ultrasound ordered, and a discussion of medical versus surgical management options. Under 2021 MDM, the data complexity most likely supports:

Moderate data (Correct answer)
Limited data
Minimal data
Extensive data

Correct answer: Moderate data

Reviewing an outside independent interpretation (pathology) and ordering a diagnostic test together satisfy multiple Moderate-level data criteria.

Question 48: A commercial payer's contract includes a 'most favored nation' (MFN) clause. How does this affect OB/GYN billing rates?

The provider can negotiate higher rates for complex OB procedures only
The provider must charge this payer a rate no higher than the lowest rate it accepts from any other commercial payer (Correct answer)
The provider must bill the payer at the highest rate charged to any other payer
MFN clauses only apply to hospital outpatient facilities, not physician practices

Correct answer: The provider must charge this payer a rate no higher than the lowest rate it accepts from any other commercial payer

A most favored nation clause requires the provider to give this payer rates at least as low as the lowest rate offered to any other payer, preventing tiered pricing that disadvantages the contracting payer.

Question 49: When coding a laparoscopic-assisted procedure that was converted to an open procedure due to intraoperative complications, which coding guideline applies?

Code the laparoscopic procedure with modifier 22
Code the open procedure with modifier 22 only
Code both the laparoscopic and open approach with modifier 53
Code the open procedure only; the laparoscopic attempt is not separately billable (Correct answer)

Correct answer: Code the open procedure only; the laparoscopic attempt is not separately billable

When a laparoscopic procedure is converted to open, only the open procedure is coded because the laparoscopic attempt is considered part of the open approach.

Question 50: A patient is injured in a work-related accident that causes a miscarriage. Which payer should the OB/GYN provider bill for the related treatment?

Medicare as the insurer of last resort
The patient's group health insurance as primary
Medicaid if the patient qualifies
Workers' compensation insurance (Correct answer)

Correct answer: Workers' compensation insurance

When an injury or condition is work-related and covered under workers' compensation, the workers' comp carrier is the appropriate primary payer for all treatment related to that injury.

Question 51: CHIP (Children's Health Insurance Program) primarily covers which population relevant to OB/GYN coding?

Pregnant women above Medicaid income limits in participating states
Undocumented immigrants who are pregnant
Elderly women on fixed incomes
Children under age 19 in families with incomes too high for Medicaid but who cannot afford private insurance (Correct answer)

Correct answer: Children under age 19 in families with incomes too high for Medicaid but who cannot afford private insurance

CHIP covers uninsured children in families with incomes too high to qualify for Medicaid but who cannot afford private coverage; some states also extend CHIP to cover pregnant women through CHIP unborn child provisions.

Question 52: An OB/GYN coder discovers a claim was submitted with an incorrect procedure code six months ago. The compliance-appropriate first step is to:

Ignore it if the payment amount was correct
Submit a new claim with the correct code without notifying the payer
Wait for the payer to request a refund before acting
Conduct a self-disclosure, correct the record, and refund any overpayment (Correct answer)

Correct answer: Conduct a self-disclosure, correct the record, and refund any overpayment

Compliance best practice—and the False Claims Act—require prompt self-disclosure, correction, and repayment of any overpayment once an error is identified.

Question 53: A commercial payer's explanation of benefits (EOB) shows a 'COB adjustment' on a claim for an OB delivery. What does this indicate?

The provider is not credentialed with this payer
The claim was denied due to a coding error
Coordination of Benefits rules were applied because the patient has more than one insurance policy (Correct answer)
The claim was paid under a global obstetric contract rate

Correct answer: Coordination of Benefits rules were applied because the patient has more than one insurance policy

A COB adjustment on an EOB means the payer has applied coordination of benefits rules because the patient has dual coverage, adjusting payment based on what the primary payer already paid.

Question 54: The term 'vaginismus' refers to:

Involuntary spasm of the vaginal muscles preventing penetration (Correct answer)
Inflammation of the vagina caused by infection
Thin, atrophic vaginal tissue due to estrogen deficiency
Prolapse of the vaginal walls through the introitus

Correct answer: Involuntary spasm of the vaginal muscles preventing penetration

Vaginismus is the involuntary contraction of vaginal muscles that makes penetration painful or impossible.

Question 55: Which modifier indicates the physician provided only antepartum (preoperative) care and did not perform the delivery?

Modifier 56 (Correct answer)
Modifier 54
Modifier 55
Modifier 52

Correct answer: Modifier 56

Modifier 56 is appended when the physician provided only preoperative or antepartum care management without performing the delivery.

Question 56: Which ICD-10-CM code is assigned as the principal diagnosis when a patient is admitted in normal full-term labor and delivers a single healthy infant with no complications?

Z34.90
O80 (Correct answer)
O09.90
Z37.0

Correct answer: O80

O80 (Encounter for full-term uncomplicated delivery) is the principal diagnosis when delivery is entirely without complication; Z37.0 is added as an additional code.

Question 57: What are the key components of E/M coding for OB/GYN visits?

Only the time spent
History, examination, and medical decision-making complexity (Correct answer)
Only the diagnosis
Only the procedures performed

Correct answer: History, examination, and medical decision-making complexity

E/M code selection is based on the extent of history taken, examination performed, and complexity of medical decision-making.

Question 58: A patient is 10 weeks pregnant with her first pregnancy and presents for a routine prenatal visit with no complications. The principal ICD-10-CM code is:

Z34.81 – Encounter for supervision of other normal pregnancy, first trimester
Z34.01 – Encounter for supervision of first trimester of first normal pregnancy (Correct answer)
O09.011 – Supervision of very young primigravida, first trimester
Z34.00 – Encounter for supervision of normal first pregnancy, unspecified trimester

Correct answer: Z34.01 – Encounter for supervision of first trimester of first normal pregnancy

Z34.01 applies to supervision of a normal first pregnancy in the first trimester (under 14 weeks); Z34.8x is reserved for second and subsequent normal pregnancies.

Question 59: According to ICD-10-CM guidelines, when a delivery occurs during an admission and there is a documented obstetric complication, the principal diagnosis should be:

The obstetric complication that necessitated or resulted from the delivery (Correct answer)
The outcome of delivery code from category Z37
Z34 for supervision of pregnancy as the overriding prenatal category
O80 for full-term uncomplicated delivery regardless of any complications documented

Correct answer: The obstetric complication that necessitated or resulted from the delivery

ICD-10-CM guidelines require the obstetric complication to be sequenced as principal diagnosis when it is the reason for admission or significantly affects the delivery.

Question 60: Which initial hospital care code requires high-complexity Medical Decision Making or 75 or more minutes of physician time?

99224
99223 (Correct answer)
99221
99222

Correct answer: 99223

CPT 99223 represents initial hospital care requiring high-complexity MDM or 75+ minutes of total physician time on the date of service.

Question 61: Which CPT code describes a salpingostomy (e.g., for ectopic pregnancy) performed via laparoscopy?

59120
58672 (Correct answer)
59121
58673

Correct answer: 58672

CPT 58672 describes laparoscopy with fimbrioplasty, while salpingostomy for ectopic is 58671 — however, the correct code for laparoscopic salpingostomy is 58671.

Question 62: Which of the following best describes the correct coding for bilateral tubal ligation performed via laparoscopy using fulguration?

58600 with modifier 50
58670 (Correct answer)
58671
58600 x2 with modifier 50

Correct answer: 58670

CPT 58670 describes laparoscopy with fulguration of oviducts (with or without transection), and bilateral procedures are inherent to this code.

Question 63: Which ICD-10-CM code category is used for supervision of normal pregnancies during antepartum visits with no complications?

Z33
O09
O26
Z34 (Correct answer)

Correct answer: Z34

Category Z34 (Encounter for supervision of normal pregnancy) is used for routine antepartum visits when no complications are present.

Question 64: How are antepartum visits counted for global OB coding?

All visits are coded separately
Visits are not counted
By tracking the total number of visits to determine which global package code applies (Correct answer)
Only the first visit counts

Correct answer: By tracking the total number of visits to determine which global package code applies

The number of antepartum visits determines which modifier or standalone code is used.

Question 65: A bilateral tubal ligation is performed immediately following a vaginal delivery. How should this procedure be coded?

Billed separately with the appropriate sterilization procedure code (Correct answer)
Combined into a single unlisted procedure code
Reported with modifier -62 for co-surgeon services
Included in the global delivery package; no additional code needed

Correct answer: Billed separately with the appropriate sterilization procedure code

Postpartum tubal ligation is an elective sterilization procedure not included in the global obstetric package and is billed separately with its own procedure code.

Question 66: In OB/GYN coding, the term 'endometriosis' is built from which word parts?

endo (within) + metr (uterus) + iosis (abnormal condition) (Correct answer)
endo (within) + metr (measure) + osis (normal process)
endo (outside) + metr (uterus) + itis (inflammation)
endo (between) + metr (uterus) + osis (tumor)

Correct answer: endo (within) + metr (uterus) + iosis (abnormal condition)

Endometriosis = endo (within) + metr/o (uterus) + -osis (abnormal condition), describing endometrial tissue found outside the uterus.

Question 67: Which CPT code describes a diagnostic hysteroscopy without any additional surgical procedure?

58555 (Correct answer)
58560
58558
58550

Correct answer: 58555

CPT 58555 is used for a diagnostic hysteroscopy when no surgical intervention is performed during the procedure.

Question 68: Which category of codes must be assigned as an additional code to every delivery encounter to indicate the number of livebirths and stillbirths?

Z37 (Correct answer)
Z34
Z38
O80

Correct answer: Z37

A code from category Z37 (Outcome of delivery) must always be assigned on the maternal record for each delivery encounter.

Question 69: Which part of the fallopian tube is closest to the uterus?

Infundibulum
Fimbriae
Ampulla
Isthmus (Correct answer)

Correct answer: Isthmus

The isthmus is the narrowest, medial portion of the fallopian tube closest to the uterine wall.

Question 70: CPT code 57267 is an add-on code used in conjunction with which procedure?

Anterior and/or posterior colporrhaphy (Correct answer)
Colposcopy with biopsy
Vaginal hysterectomy
Hymenectomy

Correct answer: Anterior and/or posterior colporrhaphy

CPT 57267 (insertion of mesh or other prosthesis) is an add-on code used with anterior and/or posterior colporrhaphy codes.

Question 71: What does the term 'tocodynamometry' measure in obstetric care?

Uterine contraction frequency and duration (Correct answer)
Fetal position and presentation
Cervical dilation rate
Fetal heart rate patterns

Correct answer: Uterine contraction frequency and duration

'Toco-' means labor/childbirth, 'dynamo-' means force/power, and '-metry' means measurement, so tocodynamometry measures uterine contraction strength.

Question 72: Modifier 25 is appended to an E&M code to indicate what?

A reduced E&M service
A significant, separately identifiable E&M on the same day as a procedure (Correct answer)
An unrelated procedure
A bilateral service

Correct answer: A significant, separately identifiable E&M on the same day as a procedure

Modifier 25 indicates the E&M service was significant, separately identifiable, and above and beyond the care associated with the same-day procedure.

Question 73: What is the timely filing deadline?

Only applies to Medicare
The maximum time after the date of service within which a claim must be submitted to the payer (Correct answer)
Filing within 24 hours
No time limit exists

Correct answer: The maximum time after the date of service within which a claim must be submitted to the payer

Each payer sets timely filing deadlines; missing them can result in claim denial regardless of whether services were properly rendered.

Question 74: When a value-based contract includes a maternity bundled payment, what does the provider typically receive for an uncomplicated vaginal delivery episode?

A single predetermined payment covering all prenatal, delivery, and postpartum care for the episode (Correct answer)
Cost-plus reimbursement based on actual expenses
Fee-for-service payments for each individual CPT code rendered
A capitation payment per member per month regardless of services

Correct answer: A single predetermined payment covering all prenatal, delivery, and postpartum care for the episode

Maternity bundled payment programs provide a single episode-of-care payment covering all services from pregnancy confirmation through postpartum, incentivizing efficiency and quality over volume.

Question 75: When a claim is denied for 'lack of medical necessity,' what is the most appropriate first step for the billing team?

Rebill with a different procedure code
Submit a formal appeal with supporting clinical documentation (Correct answer)
Bill the patient for the full amount immediately
Write off the balance as uncollectible

Correct answer: Submit a formal appeal with supporting clinical documentation

The correct response to a medical necessity denial is to file an appeal within the payer's defined timeframe, submitting clinical documentation that supports the medical necessity of the service.

Question 76: The cervical transformation zone (squamocolumnar junction) is the region where which two epithelial types meet?

Columnar and transitional epithelium
Simple and stratified squamous epithelium
Squamous and columnar epithelium (Correct answer)
Cuboidal and squamous epithelium

Correct answer: Squamous and columnar epithelium

The transformation zone is where the squamous epithelium of the ectocervix meets the columnar epithelium of the endocervix; it is the site of metaplasia and the origin of most cervical dysplasias.

Question 77: Which Z37 code represents the delivery of twins, both liveborn?

Z37.0
Z37.2 (Correct answer)
Z37.61
Z37.3

Correct answer: Z37.2

Z37.2 (Twins, both liveborn) is the outcome of delivery code assigned when both twins are born alive.

Question 78: A patient is diagnosed with a missed abortion at 10 weeks. Which ICD-10-CM code category applies?

O02.1 (Correct answer)
O04
O06
O03

Correct answer: O02.1

O02.1 (Missed abortion) is used when a fetal demise occurs before 20 weeks without passage of the products of conception.

Question 79: A patient presents for an elective (induced) termination of pregnancy with no complications. Which ICD-10-CM code category applies?

O03 – Spontaneous abortion
O04 – Complications following (induced) termination of pregnancy
O07 – Failed attempted termination of pregnancy
Z33.2 – Encounter for elective termination of pregnancy (Correct answer)

Correct answer: Z33.2 – Encounter for elective termination of pregnancy

Z33.2 is used for an encounter for elective termination of pregnancy without complications; O04 codes apply only when documented complications occur following termination.

Question 80: A patient at 28 weeks has gestational diabetes mellitus controlled by diet only. Which ICD-10-CM code is most specific?

E11.9
O24.410 (Correct answer)
O24.010
O24.810

Correct answer: O24.410

O24.410 (Gestational diabetes mellitus in pregnancy, diet controlled) is the correct code for GDM managed with diet alone.

Question 81: What modifier should be appended when the same surgeon performs a diagnostic laparoscopy that leads to an immediate therapeutic laparoscopy during the same session?

Modifier 22
Modifier 51
No modifier needed; only report the therapeutic procedure (Correct answer)
Modifier 59

Correct answer: No modifier needed; only report the therapeutic procedure

When a diagnostic laparoscopy converts to a therapeutic procedure, only the therapeutic (surgical) laparoscopy is reported, as the diagnostic portion is bundled.

Question 82: The term 'dyspareunia' is best defined as:

Painful menstruation
Painful intercourse (Correct answer)
Painful ovulation
Painful urination

Correct answer: Painful intercourse

'Dys-' means difficult or painful, and 'pareun-' derives from Greek meaning 'lying beside' (intercourse), making dyspareunia mean painful sexual intercourse.

Question 83: A physician provided antepartum-only care for 5 visits and will not perform the delivery. Which CPT code is appropriate?

59400
99215
59425 (Correct answer)
59426

Correct answer: 59425

CPT 59425 covers antepartum care only for 4–6 visits when no delivery or postpartum care is provided.

Question 84: What CPT code represents the global obstetric package including antepartum, vaginal delivery, and postpartum care?

59300
59410
59610
59400 (Correct answer)

Correct answer: 59400

CPT 59400 is the all-inclusive global vaginal delivery package covering antepartum visits, delivery, and postpartum care.

Question 85: A patient who had a cesarean delivery is seen two weeks postoperatively for treatment of a urinary tract infection unrelated to her surgery. The appropriate modifier to append to the E&M code is:

Modifier 24 (Correct answer)
Modifier 25
Modifier 59
Modifier 57

Correct answer: Modifier 24

Modifier 24 is required to indicate that the E&M service (UTI management) is unrelated to the global surgical/OB period.

Question 86: Which ligament directly connects the ovary to the lateral wall of the uterus?

Cardinal ligament
Round ligament
Ovarian (utero-ovarian) ligament (Correct answer)
Infundibulopelvic (suspensory) ligament

Correct answer: Ovarian (utero-ovarian) ligament

The ovarian ligament (utero-ovarian ligament) runs within the broad ligament to attach the medial pole of the ovary to the uterine cornua.

Question 87: Which modifier indicates a return to the operating room during the postoperative period due to a complication related to the original procedure?

Modifier 79
Modifier 78 (Correct answer)
Modifier 76
Modifier 58

Correct answer: Modifier 78

Modifier 78 is used when a patient returns to the OR during the global period for a complication related to the initial surgery.

Question 88: What does the suffix "-ectomy" mean in medical terminology?

Study of
Inflammation
Examination
Removal (Correct answer)

Correct answer: Removal

In medical terminology, the suffix "-ectomy" consistently signifies the surgical removal of an organ or part of the body. For example, a 'tonsillectomy' is the removal of tonsils, and an 'appendectomy' is the removal of the appendix. Understanding this suffix is fundamental for interpreting many surgical procedure names.

Question 89: Which of the following best defines a 'clean claim' in medical billing?

A claim sent directly to the patient rather than the insurance company
A previously denied claim that has been corrected and resubmitted
A claim submitted without any diagnosis codes attached
A claim containing all required information that passes edits and can be processed without additional follow-up (Correct answer)

Correct answer: A claim containing all required information that passes edits and can be processed without additional follow-up

A clean claim contains all required data elements, has no errors or missing information, and can be adjudicated and paid without further information from the provider.

Question 90: The National Correct Coding Initiative (NCCI) edits are designed primarily to:

Determine medical necessity for high-risk obstetric care
Assign ICD-10 diagnosis codes for pregnancy complications
Prevent improper payment for services that should be bundled together (Correct answer)
Set Medicare fee schedule amounts for obstetric procedures

Correct answer: Prevent improper payment for services that should be bundled together

NCCI edits identify code combinations that should not be billed together because one code's services are considered inclusive of another code.

Question 91: What is the difference between new and established patient E/M codes?

Only the first visit is a new patient visit
All patients are new
The distinction does not affect coding
New patients have not been seen by the practice within 3 years; established patients have (Correct answer)

Correct answer: New patients have not been seen by the practice within 3 years; established patients have

New patient codes (99201-99205) have higher values than established patient codes (99211-99215) because they require more comprehensive evaluation.

Question 92: A patient is 20 weeks pregnant and diagnosed with gestational hypertension without significant proteinuria. Which ICD-10-CM code is correct?

O10.012 – Pre-existing essential hypertension, second trimester
O11.2 – Pre-existing hypertension with superimposed pre-eclampsia, second trimester
O13.2 – Gestational hypertension without significant proteinuria, second trimester (Correct answer)
O14.02 – Mild to moderate pre-eclampsia, second trimester

Correct answer: O13.2 – Gestational hypertension without significant proteinuria, second trimester

O13.2 is used for gestational (pregnancy-induced) hypertension without significant proteinuria occurring in the second trimester (14–27 weeks).

Question 93: The fimbriae are finger-like projections located at which segment of the fallopian tube?

Isthmus
Infundibulum (Correct answer)
Interstitial portion
Ampulla

Correct answer: Infundibulum

The infundibulum is the distal funnel-shaped end of the fallopian tube; its fimbriae sweep over the ovary to capture the released oocyte at ovulation.

Question 94: A laboratory cultures embryos for 5 days to the blastocyst stage. Which CPT code is most appropriate?

89272 (Correct answer)
89255
89251
89250

Correct answer: 89272

CPT 89272 describes extended culture of oocyte(s)/embryo(s) for 4–7 days, which covers blastocyst-stage culture beyond the standard period.

Question 95: A patient at 35 weeks has premature rupture of membranes (PROM) with labor beginning within 24 hours. Which ICD-10-CM code applies?

O42.113 – Preterm PROM, onset of labor after 24 hours, third trimester
O42.10 – PROM, onset of labor after 24 hours, unspecified weeks of gestation
O42.013 – Preterm PROM, onset of labor within 24 hours, third trimester (Correct answer)
O42.00 – PROM, onset of labor within 24 hours, unspecified weeks of gestation

Correct answer: O42.013 – Preterm PROM, onset of labor within 24 hours, third trimester

35 weeks is in the third trimester (28+ weeks); labor began within 24 hours of rupture; therefore O42.013 (preterm PROM, onset within 24 hours, third trimester) is correct.

Question 96: Under the 2021 CPT E&M revisions, a new patient visit supported by Straightforward MDM maps to which office visit code?

99203
99202 (Correct answer)
99201
99204

Correct answer: 99202

CPT 99201 was deleted in 2021; Straightforward MDM for a new patient now maps to 99202, the lowest billable new patient office visit code.

Question 97: The fallopian tube is divided into which four anatomical segments from proximal to distal?

Infundibulum, ampulla, isthmus, interstitial
Interstitial, isthmus, ampulla, infundibulum (Correct answer)
Isthmus, ampulla, infundibulum, fimbriae
Ampulla, isthmus, interstitial, fimbriae

Correct answer: Interstitial, isthmus, ampulla, infundibulum

From uterus outward, the four segments are interstitial (within the uterine wall), isthmus (narrow), ampulla (wide, site of fertilization), and infundibulum (funnel-shaped opening with fimbriae).

Question 98: A patient at 34 weeks gestation is hospitalized for management of severe preeclampsia. How are these inpatient services billed?

As part of the global antepartum care package
Using antepartum-only codes 59425 or 59426
Separately from the global OB package as a complication (Correct answer)
Only after delivery as part of the postpartum period

Correct answer: Separately from the global OB package as a complication

Complications of pregnancy requiring inpatient hospital care are billed separately from the global OB package using appropriate hospital visit codes.

Question 99: The global obstetric package for vaginal delivery (CPT 59400) includes how many antepartum visits?

10 visits
13 visits (Correct answer)
8 visits
7 visits

Correct answer: 13 visits

The global OB package (59400) includes 13 antepartum visits, the delivery, and postpartum care per standard payer guidelines.

Question 100: A patient at 38 weeks with a prior low transverse cesarean scar is presenting for VBAC planning. The ICD-10-CM code for the uterine scar is:

O34.212 – Maternal care for vertical (classical) scar from previous cesarean delivery
O34.211 – Maternal care for low transverse scar from previous cesarean delivery (Correct answer)
O34.21 – Maternal care for scar from previous cesarean delivery (non-specific, incomplete code)
O34.219 – Maternal care for other type scar from previous cesarean delivery

Correct answer: O34.211 – Maternal care for low transverse scar from previous cesarean delivery

O34.211 specifies maternal care for a low transverse uterine scar from a prior cesarean, the most common incision type requiring documentation for VBAC candidacy.

COBGC Certified Obstetrics and Gynecology Coder Exam

The COBGC (Certified Obstetrics and Gynecology Coder) Exam is administered by the American Academy of Professional Coders (AAPC) and validates expertise in OB/GYN medical coding. It tests knowledge of obstetric and gynecologic CPT procedure coding, ICD-10 diagnosis coding, evaluation and management, payer-specific guidelines, modifiers, reimbursement and billing, OB/GYN anatomy and physiology, medical terminology, and compliance with documentation requirements.

100

Questions

120 min

Time Limit

70%

To Pass

Checking for saved progress...

Exam Rules

You can skip questions and return to them later
Flag questions for review before submitting
No feedback shown until you submit the entire exam
Unanswered questions count as wrong — answer everything
10 pretest questions are mixed in and don't affect your score
Timer auto-submits when time runs out
Your progress is auto-saved every 30 seconds