COBGC Certified Obstetrics and Gynecology Coder Exam — Questions and Answers

Question 1: What does the suffix '-ectomy' mean in surgical terminology?

Creating an opening
Surgical repair
Surgical removal of a body part (Correct answer)
Viewing or examining

Correct answer: Surgical removal of a body part

Common examples: hysterectomy (uterus removal), oophorectomy (ovary removal), salpingectomy (fallopian tube removal).

Question 2: What modifiers are used in obstetric coding?

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

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

Modifier 58
Modifier 78
Modifier 79 (Correct answer)
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 4: A patient at 32 weeks gestation is seen in the office for supervision of a high-risk pregnancy due to advanced maternal age. Which code set applies?

O09.53 – Supervision of elderly multigravida, third trimester
O09.52 – Supervision of elderly multigravida, second trimester
O09.523 – Supervision of elderly multigravida, third trimester (Correct answer)
O09.522 – Supervision of elderly multigravida, second trimester

Correct answer: O09.523 – Supervision of elderly multigravida, third trimester

At 32 weeks gestation (third trimester), supervision of elderly multigravida is coded O09.523, which specifies the third trimester for a patient with advanced maternal age who has had prior deliveries.

Question 5: A physician performs a laparoscopic myomectomy to remove four uterine fibroids. How is this coded?

58545 once, regardless of fibroid count
58550 with modifier 22
58546 only for four or more fibroids
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 6: Which CPT code is used for follicle puncture for oocyte retrieval (egg retrieval) during an IVF cycle?

89250
58322
58974
58970 (Correct answer)

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 7: Under the standard prenatal care schedule, the global OB package (e.g., 59400) typically encompasses approximately how many antepartum visits?

10
8
13 (Correct answer)
16

Correct answer: 13

The global OB package includes approximately 13 antepartum visits following the standard schedule of monthly visits early in pregnancy, bi-weekly around 28–36 weeks, and weekly near term.

Question 8: Which CPT code describes a comprehensive semen analysis including volume, count, motility, and differential?

89322
89320 (Correct answer)
89310
89300

Correct answer: 89320

CPT 89320 is the comprehensive semen analysis code that includes all four parameters: volume, count, motility, and differential.

Question 9: In ICD-10-CM, the trimester assigned to an obstetric complication is based on:

The gestational age at the time of the encounter (Correct answer)
The estimated due date
The date of the last menstrual period
The gestational age at onset of the complication

Correct answer: The gestational age at the time of the encounter

The trimester is assigned based on the number of weeks of gestation at the time of the current encounter, not the onset of the complication.

Question 10: When a second surgical procedure is performed during the same operative session, which modifier is typically appended to the secondary procedure?

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

Correct answer: Modifier 51

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

Question 11: Which HCPCS Level II code category is used to report injectable drugs administered in the OB/GYN office, such as Rho(D) immune globulin?

G codes (temporary procedures and services)
J codes (drugs administered other than oral method) (Correct answer)
Q codes (temporary codes for specific services)
E codes (durable medical equipment)

Correct answer: J codes (drugs administered other than oral method)

HCPCS Level II J codes represent drugs administered other than by the oral method, including injections given in a physician's office.

Question 12: Which modifier is required when billing Medicare for a surgical procedure performed during the global period of a previous surgery by the same physician?

Modifier -24
Modifier -25
Modifier -57
Modifier -79 (Correct answer)

Correct answer: Modifier -79

Modifier -79 indicates an unrelated procedure or service performed by the same physician during the postoperative period of a prior surgery.

Question 13: 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 both the laparoscopic and open approach with modifier 53
Code the open procedure only; the laparoscopic attempt is not separately billable (Correct answer)
Code the open procedure with modifier 22 only

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

99213 and 99214
59400 and 59410
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 15: Which claim form is used by a physician's office to bill Medicare for OB/GYN professional services?

ADA Dental Claim Form
UB-04
CMS-1450
CMS-1500 (Correct answer)

Correct answer: CMS-1500

The CMS-1500 is the standard claim form used by physicians and non-institutional providers for billing Medicare and most commercial payers.

Question 16: 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:

O09.011 – Supervision of very young primigravida, first trimester
Z34.01 – Encounter for supervision of first trimester of first normal pregnancy (Correct answer)
Z34.81 – Encounter for supervision of other normal pregnancy, 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 17: Which modifier indicates the physician provided only antepartum (preoperative) care and did not perform the delivery?

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

Correct answer: Modifier 56

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

Question 18: Which ICD-10-CM code represents female infertility of tubal origin?

N97.9
N97.0
N97.2
N97.1 (Correct answer)

Correct answer: N97.1

ICD-10-CM N97.1 specifically classifies female infertility associated with tubal origin, such as blocked or damaged fallopian tubes.

Question 19: Which CPT code describes a cesarean delivery only, without antepartum or postpartum care?

59520
59510
59514 (Correct answer)
59515

Correct answer: 59514

CPT 59514 is used when the physician performs only the cesarean section without providing pre- or post-delivery care.

Question 20: When coding vulvectomy procedures, what factor primarily differentiates simple from radical vulvectomy?

Bilateral vs. unilateral excision
Use of intraoperative frozen section
Anesthesia type used
Skin and deep subcutaneous tissue involvement vs. skin only (Correct answer)

Correct answer: Skin and deep subcutaneous tissue involvement vs. skin only

Radical vulvectomy involves removal of skin and deep subcutaneous tissues, while simple vulvectomy removes skin and superficial subcutaneous tissues only.

Question 21: Which Medicare administrative contractor (MAC) resource should an OB/GYN coder consult to confirm local coverage policies for a specific procedure?

The AMA CPT codebook
Local Coverage Determinations (LCDs) from the relevant MAC (Correct answer)
The ACOG Practice Bulletins
The ICD-10-CM Official Guidelines only

Correct answer: Local Coverage Determinations (LCDs) from the relevant MAC

LCDs issued by MACs establish coverage criteria, covered diagnoses, and documentation requirements for specific procedures in a geographic region.

Question 22: Under the 2021 revised E&M guidelines, which of the following lists the Medical Decision Making complexity levels in correct ascending order?

Straightforward, Moderate, Low, High
Straightforward, Low, Moderate, High (Correct answer)
Minimal, Low, Moderate, High
Low, Straightforward, Moderate, High

Correct answer: Straightforward, Low, Moderate, High

The four MDM levels in ascending order are Straightforward, Low, Moderate, and High complexity.

Question 23: Which initial hospital care code requires high-complexity Medical Decision Making or 75 or more minutes of physician time?

99223 (Correct answer)
99224
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 24: Which modifier indicates a return to the operating room during the postoperative period due to a complication related to the original procedure?

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

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 25: Which OIG compliance guidance element focuses on training and education of staff on fraud and abuse laws?

Effective lines of communication
Response to detected offenses
Monitoring and auditing
Training and education programs (Correct answer)

Correct answer: Training and education programs

The OIG's Seven Elements of an Effective Compliance Program include training and education to ensure all relevant staff understand applicable laws and billing requirements.

Question 26: Which HCPCS modifier indicates that a PA, NP, or CNS acted as assistant surgeon?

Modifier 82
Modifier AS (Correct answer)
Modifier 81
Modifier 80

Correct answer: Modifier AS

HCPCS modifier AS is used specifically when a physician assistant, nurse practitioner, or clinical nurse specialist serves as assistant at surgery.

Question 27: Under the surgical package rule, which service is NOT included in the global surgical package for a major procedure?

Intraoperative services normally part of the procedure
Postoperative follow-up visits within the global period
Preoperative visit the day before surgery
Treatment of complications unrelated to the surgery (Correct answer)

Correct answer: Treatment of complications unrelated to the surgery

Treatment of complications that are unrelated to the original surgery is billed separately and is not part of the global surgical package.

Question 28: A patient is diagnosed with a complete (classical) hydatidiform mole. Which ICD-10-CM code applies?

O02.0 – Blighted ovum and nonhydatidiform mole
O01.9 – Hydatidiform mole, unspecified
O01.1 – Incomplete and partial hydatidiform mole
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 29: A patient undergoes excision of a vaginal cyst. Which CPT code range covers this procedure?

57160
57135 (Correct answer)
57100–57109
57130

Correct answer: 57135

CPT 57135 describes excision of vaginal cyst or tumor.

Question 30: For an E&M service to be separately billable on the same day as a minor procedure, what is required?

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

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 31: The term 'preeclampsia' is characterized by which triad of findings?

Hypertension, proteinuria, and edema after 20 weeks gestation (Correct answer)
Vaginal bleeding, uterine contractions, and cervical dilation
Seizures, coma, and hypertension
Elevated liver enzymes, low platelets, and hemolysis

Correct answer: Hypertension, proteinuria, and edema after 20 weeks gestation

Preeclampsia is defined by new-onset hypertension and proteinuria (and/or edema) after 20 weeks of gestation.

Question 32: The term 'fundus' in uterine anatomy refers to:

The narrow lower segment of the uterus
The dome-shaped upper portion above the fallopian tube insertions (Correct answer)
The internal cervical opening into the uterine cavity
The muscular middle layer of the uterine wall

Correct answer: The dome-shaped upper portion above the fallopian tube insertions

The fundus is the rounded superior portion of the uterus above the insertion points of the fallopian tubes.

Question 33: According to ICD-10-CM guidelines, codes from Chapter 15 (Pregnancy, Childbirth, and the Puerperium) are used only on:

The maternal medical record (Correct answer)
The newborn's medical record to document the mother's conditions affecting the infant
Outpatient prenatal encounter records only
Inpatient records only — they are not to be used on outpatient encounter records

Correct answer: The maternal medical record

ICD-10-CM guidelines specify that Chapter 15 codes are assigned exclusively to the maternal record and are never used on the newborn's chart.

Question 34: 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?

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

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 35: A patient at 28 weeks gestation develops severe preeclampsia. Which ICD-10-CM code is correct?

O14.13 – Severe pre-eclampsia, third trimester (Correct answer)
O11.3 – Pre-existing hypertension with superimposed pre-eclampsia, third trimester
O14.03 – Mild to moderate pre-eclampsia, third trimester
O15.03 – Eclampsia in the third trimester

Correct answer: O14.13 – Severe pre-eclampsia, third trimester

28 weeks falls in the third trimester; severe preeclampsia uses subcategory O14.1, and the third-trimester designation yields O14.13.

Question 36: What is the appeals process for denied claims?

Billing the patient directly
Accepting all denials as final
Resubmitting the same claim unchanged
A formal process to challenge payer denials by providing additional documentation or arguing coding accuracy (Correct answer)

Correct answer: A formal process to challenge payer denials by providing additional documentation or arguing coding accuracy

Appeals involve reviewing the denial reason and submitting additional information or arguments to overturn the decision.

Question 37: Which term describes the annual cap on a patient's total out-of-pocket costs, after which the insurer covers 100% of covered services for the rest of the plan year?

Annual deductible
Out-of-pocket maximum (Correct answer)
Annual premium
Copayment ceiling

Correct answer: Out-of-pocket maximum

The out-of-pocket maximum is the annual limit on a patient's cost-sharing obligations; once reached, the health plan pays 100% of covered services for the remainder of the plan year.

Question 38: How are OB complications coded in ICD-10?

Using specific codes from Chapter 15 that identify the condition and trimester (Correct answer)
As regular disease codes
Complications are not coded
Only in progress notes

Correct answer: Using specific codes from Chapter 15 that identify the condition and trimester

Each pregnancy complication has specific ICD-10 codes that include trimester and other clinical details.

Question 39: The placenta is derived primarily from which fetal tissue?

Amnion
Trophoblast (chorion) (Correct answer)
Allantois
Yolk sac

Correct answer: Trophoblast (chorion)

The trophoblastic cells of the early embryo differentiate into cytotrophoblast and syncytiotrophoblast, which form the fetal portion of the placenta.

Question 40: In OB/GYN surgical billing, what does the global surgical period encompass?

Pre-operative, intra-operative, and post-operative care bundled into one payment (Correct answer)
Only the preoperative workup
The period covered by the patient's insurance
Only the surgery itself

Correct answer: Pre-operative, intra-operative, and post-operative care bundled into one payment

The global surgical period bundles all pre-operative, intra-operative, and post-operative care into a single reimbursement within a defined timeframe (0, 10, or 90 days).

Question 41: A patient has a uterine leiomyoma (fibroid) described as intramural in location. The correct ICD-10-CM code is:

D25.1 – Intramural leiomyoma of uterus (Correct answer)
D25.0 – Submucous leiomyoma of uterus
D25.9 – Leiomyoma of uterus, unspecified
D25.2 – Subserosal leiomyoma of uterus

Correct answer: D25.1 – Intramural leiomyoma of uterus

D25.1 identifies a leiomyoma within the myometrium (uterine wall), as distinguished from submucous (D25.0, toward the uterine cavity) and subserosal (D25.2, toward the serosa).

Question 42: The term "endometriosis" refers to:

Inflammation of the ovaries
Infection of the fallopian tubes
Tumor of the endometrium
Abnormal growth of endometrial tissue outside the uterus (Correct answer)

Correct answer: Abnormal growth of endometrial tissue outside the uterus

Endometriosis is a condition characterized by the abnormal growth of endometrial tissue, which normally lines the inside of the uterus, outside of the uterus. This misplaced tissue can be found on organs such as the ovaries, fallopian tubes, or the outer surface of the uterus. It behaves similarly to normal endometrial tissue, thickening and bleeding with the menstrual cycle, often causing pain and other symptoms.

Question 43: Which pelvic diameter is the most clinically critical for assessing safe vaginal delivery?

Diagonal conjugate
Transverse diameter of the outlet
True conjugate
Obstetric conjugate (Correct answer)

Correct answer: Obstetric conjugate

The obstetric conjugate (from the inner surface of the pubic symphysis to the sacral promontory) is the shortest AP diameter of the pelvic inlet and is the critical measurement for engagement of the fetal head.

Question 44: When a hysteroscopy with endometrial ablation is performed, which CPT code is used?

58353
58555
58563 (Correct answer)
58558

Correct answer: 58563

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

Question 45: Which ICD-10-CM code category describes leiomyoma of the uterus?

N83
D26
D25 (Correct answer)
N80

Correct answer: D25

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

Question 46: What is the difference between diagnostic and therapeutic coding in gynecology?

Diagnostic procedures are never coded
Only therapeutic procedures are coded
They use the same codes
Diagnostic procedures identify conditions; therapeutic procedures treat them — each has distinct codes (Correct answer)

Correct answer: Diagnostic procedures identify conditions; therapeutic procedures treat them — each has distinct codes

The purpose of the procedure determines whether diagnostic or therapeutic codes apply.

Question 47: In ICD-10-CM, what does the 7th character represent in multiple gestation obstetric codes?

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

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 48: 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)
No time limit exists
Filing within 24 hours

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 49: Audio-only telephone E&M services that do not include a video component are reported using which code set?

99212–99215
99202–99205
99441–99443 (Correct answer)
99421–99423

Correct answer: 99441–99443

CPT codes 99441–99443 are designated for physician telephone evaluation and management services conducted without a video component.

Question 50: 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 51: What are Medicare OB/GYN billing guidelines?

Specific rules for coding and billing OB/GYN services to Medicare including global package rules and screening coverage (Correct answer)
No specific guidelines exist
Only commercial insurance guidelines apply
The same as all other payers

Correct answer: Specific rules for coding and billing OB/GYN services to Medicare including global package rules and screening coverage

Medicare has specific guidelines for OB/GYN services including well-woman exams, screening frequencies, and global package requirements.

Question 52: 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 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)
Bill only the preventive medicine code for the entire visit
Bill a single unlisted code for the combined preventive and problem service

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 53: Which modifier is appended to a CPT code to indicate that a procedure was performed bilaterally?

Modifier 52
Modifier 59
Modifier 51
Modifier 50 (Correct answer)

Correct answer: Modifier 50

Modifier 50 indicates that an identical procedure was performed on both sides of the body during the same operative session.

Question 54: Blue Cross Blue Shield plans often use which concept to bundle related gynecologic services performed on the same day, preventing separate billing?

Medically Unlikely Edits (MUEs)
Mutually exclusive edits (MUEs)
Claim bundling or 'same-day surgery' bundling policies (Correct answer)
Advance Beneficiary Notices (ABNs)

Correct answer: Claim bundling or 'same-day surgery' bundling policies

BCBS and other commercial payers apply claim bundling policies that combine multiple related procedures performed on the same day into a single allowable, preventing double-billing.

Question 55: The ovarian follicle that releases a mature egg during ovulation is called the:

Primordial follicle
Corpus luteum
Graafian follicle (Correct answer)
Corpus albicans

Correct answer: Graafian follicle

The Graafian (mature) follicle is the dominant follicle that ruptures at ovulation to release the secondary oocyte.

Question 56: A patient at 30 weeks is diagnosed with gestational hypertension WITHOUT significant proteinuria. Which ICD-10-CM code category applies?

O11
O10
O14
O13 (Correct answer)

Correct answer: O13

O13 (Gestational hypertension without significant proteinuria) is used for pregnancy-induced hypertension that does not meet criteria for preeclampsia.

Question 57: According to ICD-10-CM general coding guidelines, when a condition qualifies for both a Chapter 15 (obstetric) code and a code from another chapter, the sequencing rule is:

Chapter 21 (Z codes) takes priority for preventive and supervision encounters
Chapter 15 codes have sequencing priority and are used as the principal or first-listed diagnosis (Correct answer)
The non-obstetric chapter code takes priority and is sequenced as principal diagnosis
Both codes are sequenced equally with no official priority rule specified

Correct answer: Chapter 15 codes have sequencing priority and are used as the principal or first-listed diagnosis

ICD-10-CM guidelines explicitly state that Chapter 15 codes have sequencing priority over codes from other chapters when the patient is pregnant and the condition relates to or complicates the pregnancy.

Question 58: Which modifier indicates a procedure was performed on the left side only?

Modifier RT
Modifier 50
Modifier LT (Correct answer)
Modifier 51

Correct answer: Modifier LT

HCPCS modifier LT (Left Side) indicates a bilateral procedure was performed on the left side only.

Question 59: A patient undergoes laparoscopic cystectomy of a right ovarian cyst. The cyst ruptures during removal. How does this affect coding?

No change; code the procedure as planned (Correct answer)
Use an unlisted laparoscopy code
Add modifier 22 for increased complexity
Downcode to a lesser procedure

Correct answer: No change; code the procedure as planned

Intraoperative complications like cyst rupture do not change the procedure code; the surgeon's intended and completed procedure determines the code.

Question 60: A physician provided antepartum-only care for 5 visits and will not perform the delivery. Which CPT code is appropriate?

59426
59400
99215
59425 (Correct answer)

Correct answer: 59425

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

Question 61: What is the global period for most major gynecologic surgical procedures under Medicare guidelines?

0 days
10 days
30 days
90 days (Correct answer)

Correct answer: 90 days

Major gynecologic surgeries typically carry a 90-day global period under Medicare, during which routine postoperative care is bundled.

Question 62: When a physician provides antepartum care only (4-6 visits) because another provider will perform the delivery, which CPT code is used?

59426
59430
59400
59425 (Correct answer)

Correct answer: 59425

CPT 59425 reports antepartum care only when the provider sees the patient for 4 to 6 visits but does not perform the delivery.

Question 63: Assisted embryo hatching is performed by microtechnique to facilitate implantation. Which CPT code is used?

89253 (Correct answer)
89255
89268
89272

Correct answer: 89253

CPT 89253 covers assisted embryo hatching using microtechniques (any method), a laboratory procedure used to facilitate embryo implantation.

Question 64: What is the fee schedule used for Medicare OB/GYN reimbursement?

A flat rate for all services
No fee schedule exists
Negotiated rates like commercial insurance
The Medicare Physician Fee Schedule based on the Resource-Based Relative Value Scale (RBRVS) (Correct answer)

Correct answer: The Medicare Physician Fee Schedule based on the Resource-Based Relative Value Scale (RBRVS)

Medicare uses the RBRVS system to assign relative values to services based on work, practice expense, and malpractice cost.

Question 65: Estrogen biosynthesis in the ovarian follicle primarily occurs through which cellular mechanism?

Granulosa cells aromatize theca-derived androgens into estrogen (Correct answer)
Stromal cells convert FSH into estrogen
Theca cells directly secrete estrogen
Cumulus cells produce estrogen from progesterone

Correct answer: Granulosa cells aromatize theca-derived androgens into estrogen

Theca cells produce androgens (androstenedione, testosterone) under LH stimulation; granulosa cells then aromatize these androgens to estradiol under FSH stimulation (the two-cell theory).

Question 66: What does the suffix '-rrhea' mean in OB/GYN terminology?

Inflammation
Flow or discharge (Correct answer)
Surgical removal
Rupture

Correct answer: Flow or discharge

'-rrhea' means flow or discharge, as seen in terms like menorrhea (menstrual flow) and leukorrhea (white vaginal discharge).

Question 67: A patient undergoes a cesarean section due to a breech-presenting fetus at 39 weeks with no other documented complications. What is the principal ICD-10-CM diagnosis?

O80 – Encounter for full-term uncomplicated delivery
O82 – Encounter for cesarean delivery without indication
O32.1XX0 – Maternal care for breech presentation, single fetus (Correct answer)
O34.219 – Maternal care for unspecified scar from previous cesarean delivery

Correct answer: O32.1XX0 – Maternal care for breech presentation, single fetus

The indication for the cesarean (breech presentation, O32.1XX0) is sequenced as principal diagnosis; O82 is reserved for cesarean deliveries with no documented clinical indication.

Question 68: Which Z37 code represents the delivery of twins, both liveborn?

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

Correct answer: Z37.2

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

Question 69: When a commercial payer's allowed amount is less than the patient's deductible, what amount is the patient responsible for?

The difference between billed charge and deductible
Nothing, as the payer absorbs the deductible
The payer's allowed (contracted) amount (Correct answer)
The provider's full billed charge

Correct answer: The payer's allowed (contracted) amount

Under a contracted fee schedule, the patient's financial responsibility is limited to the payer's allowed amount (not the billed charge), which is applied toward their deductible.

Question 70: Which modifier indicates that only postpartum care was provided by the reporting physician?

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

Correct answer: Modifier 55

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

Question 71: How are antepartum visits counted for global OB coding?

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
All visits are coded separately

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 72: How are multiple gestations coded?

Same as singleton pregnancy
Multiple gestations cannot be coded
Only one baby is coded
Using specific codes for twin, triplet, or higher-order pregnancies with appropriate identifiers (Correct answer)

Correct answer: Using specific codes for twin, triplet, or higher-order pregnancies with appropriate identifiers

Multiple gestation coding specifies the number of fetuses and their individual outcomes.

Question 73: Which modifier is appended to indicate a procedure was performed on the left side when a bilateral code does not exist?

Modifier RT
Modifier 52
Modifier LT (Correct answer)
Modifier 50

Correct answer: Modifier LT

Modifier LT (Left side) is used to identify procedures performed on the left side of the body when no bilateral-specific code exists.

Question 74: A fetal non-stress test (NST) is performed in the physician's office at 36 weeks gestation. Which CPT code reports this service?

59030
59025 (Correct answer)
76816
76801

Correct answer: 59025

CPT 59025 is used to report the fetal non-stress test, which monitors fetal heart rate patterns in response to fetal movement.

Question 75: How is a cesarean delivery coded?

Same code as vaginal delivery
Only by adding a modifier
No specific code exists
Using specific CPT codes for C-section that differ from vaginal delivery codes (Correct answer)

Correct answer: Using specific CPT codes for C-section that differ from vaginal delivery codes

C-section has its own CPT codes distinct from vaginal delivery, reflecting the surgical procedure.

Question 76: Which CPT code is used when thawing cryopreserved embryos prior to a frozen embryo transfer (FET)?

89352
89356
89353
89354 (Correct answer)

Correct answer: 89354

CPT 89354 covers thawing of cryopreserved embryo(s) per aliquot, which is reported before performing a frozen embryo transfer.

Question 77: Which of the following is NOT a recognized component of the 'Risk of Complications and/or Morbidity or Mortality' element in 2021 MDM?

Diagnosis or treatment significantly limited by social determinants of health
Documenting the patient's blood pressure reading (Correct answer)
Prescription drug management
Elective major surgery with identified patient risk factors

Correct answer: Documenting the patient's blood pressure reading

Documenting vital signs such as blood pressure is a clinical task but is not a risk factor element within MDM; recognized risk elements include drug management, surgical risk, and social determinants affecting treatment.

Question 78: 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?

99203
99215
99205 (Correct answer)
99204

Correct answer: 99205

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

Question 79: What is the difference between new and established patient E/M codes?

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)
Only the first visit is a new patient visit

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

Fee-for-service payments for each individual CPT code rendered
A single predetermined payment covering all prenatal, delivery, and postpartum care for the episode (Correct answer)
Cost-plus reimbursement based on actual expenses
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 81: 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
Wait for the payer to request a refund before acting
Conduct a self-disclosure, correct the record, and refund any overpayment (Correct answer)
Submit a new claim with the correct code without notifying the payer

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

Examination
Removal (Correct answer)
Study of
Inflammation

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 83: According to ICD-10-CM guidelines, a code from category Z3A (Weeks of gestation) should be assigned:

As a principal diagnosis when gestational age is the primary reason for the encounter
As an additional code whenever applicable to provide the specific gestational age (Correct answer)
Only for high-risk pregnancies requiring special monitoring
Only when the patient is in the third trimester and at risk for preterm delivery

Correct answer: As an additional code whenever applicable to provide the specific gestational age

Z3A codes are always secondary/additional codes used to specify the number of completed weeks of gestation; they are never sequenced as principal diagnosis.

Question 84: Eclampsia occurring during the postpartum (puerperal) period is coded as:

O15.03 – Eclampsia in the third trimester
O90.4 – Postpartum acute kidney failure
O15.9 – Eclampsia, unspecified as to time period
O15.2 – Eclampsia in the puerperium (Correct answer)

Correct answer: O15.2 – Eclampsia in the puerperium

O15.2 specifically identifies eclampsia occurring in the puerperium (postpartum period), distinct from eclampsia in pregnancy or labor.

Question 85: An embryo transfer (CPT 58974) is initiated but cannot be completed due to cervical stenosis preventing catheter passage. Which modifier should be appended?

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

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 86: How are preventive visit codes used in gynecology?

They replace all other codes
Preventive codes are not used in gynecology
Only for patients under 40
For annual well-woman exams including breast and pelvic examinations, separate from problem-oriented visits (Correct answer)

Correct answer: For annual well-woman exams including breast and pelvic examinations, separate from problem-oriented visits

Preventive visit codes cover routine wellness exams; if a problem is also addressed, a separate E/M code with modifier 25 may be added.

Question 87: A gynecology patient signs a Notice of Privacy Practices (NPP) acknowledgment. What does this document legally confirm?

The patient authorizes release of records to her insurer
The patient was provided the opportunity to review the practice's HIPAA privacy policies (Correct answer)
The patient consents to all uses and disclosures of her PHI
The patient waives her right to access her medical records

Correct answer: The patient was provided the opportunity to review the practice's HIPAA privacy policies

The NPP acknowledgment documents that the patient was given the opportunity to review the notice; it is not consent to all PHI disclosures.

Question 88: Which CPT code describes sperm isolation using a complex preparation method such as Percoll gradient?

89264
89257
89260
89261 (Correct answer)

Correct answer: 89261

CPT 89261 describes complex sperm isolation preparation such as Percoll gradient or albumin gradient, used when more sophisticated processing is required.

Question 89: Which prefix means 'before' or 'in front of' in OB/GYN terms such as 'antepartum'?

Ante- (Correct answer)
Post-
Retro-
Peri-

Correct answer: Ante-

'Ante-' means before, as in antepartum (before delivery) and antecubital (in front of the elbow).

Question 90: Under the 2021 CPT E&M revisions, a new patient visit supported by Straightforward MDM maps to which office visit code?

99204
99201
99202 (Correct answer)
99203

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 91: Which ICD-10-CM category covers obstructed labor due to fetal malpresentation?

O70
O62
O64 (Correct answer)
O60

Correct answer: O64

Category O64 (Obstructed labor due to malposition and malpresentation of fetus) covers presentations such as face, brow, or transverse lie causing obstruction.

Question 92: What are the key components of E/M coding for OB/GYN visits?

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

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 93: What is coding for high-risk pregnancy?

No additional codes needed
Additional codes for conditions like gestational diabetes, preeclampsia, or multiple gestation (Correct answer)
Only ICD codes change
Same codes as normal pregnancy

Correct answer: Additional codes for conditions like gestational diabetes, preeclampsia, or multiple gestation

High-risk conditions require additional diagnosis and procedure codes beyond the routine OB package.

Question 94: 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 95: Which document serves as the primary compliance roadmap outlining an OB/GYN practice's commitment to ethical billing and coding standards?

The compliance plan (Correct answer)
The superbill
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 96: The prefix 'retro-' in 'retroversion' means:

Lateral
Below
Forward
Backward or behind (Correct answer)

Correct answer: Backward or behind

'Retro-' means backward or behind; retroversion of the uterus describes the uterus tipping backward toward the rectum instead of forward.

Question 97: Which part of the female reproductive system is also known as the birth canal?

Uterus
Ovaries
Vagina (Correct answer)
Fallopian Tubes

Correct answer: Vagina

The vagina is a muscular, elastic canal that extends from the cervix to the outside of the body. It is commonly known as the birth canal because it serves as the passageway through which a baby travels during a vaginal delivery. It also plays a role in menstruation and sexual intercourse.

Question 98: What are bundled payments in OB/GYN?

A single payment covering all services related to a specific episode of care (Correct answer)
Paying for each service separately
A type of discount
Only hospital fees

Correct answer: A single payment covering all services related to a specific episode of care

Bundled payments combine multiple related services into one payment, requiring accurate tracking of included and excluded services.

Question 99: Which CPT code is used for insertion of an intrauterine device (IUD)?

58300 (Correct answer)
58305
58301
58310

Correct answer: 58300

CPT 58300 is the code for IUD insertion; the corresponding removal code is 58301.

Question 100: Under ICD-10-CM guidelines, the postpartum period is defined as:

The first 10 days following delivery
The first 28 days following delivery
The first 3 months following delivery
The first 6 weeks (42 days) following delivery (Correct answer)

Correct answer: The first 6 weeks (42 days) following delivery

ICD-10-CM defines the postpartum (puerperium) period as the first 6 weeks (42 days) following delivery.

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%

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