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CCS- CERTIFIED CODING SPECIALIST EXAM
1 | (WITH RATIONALES) NEWEST ACTUAL
EXAM COMPREHENSIVE QUESTIONS AND
VERIFIED ANSWERS GRADED A+ | 100%
CORRECT | 2026 UPDATE!!
Which type of conditions are always considered present on admission? a. Obstetrical b. Congenital c. Those with an acute exacerbation d. Those that represent an injury ANSWER
Correct Answer: B
In accordance with the POA guidelines, congenital conditions are always considered POA (CMS 2020a, Appendix I, 117).
A patient is admitted with a high temperature, lethargy, hypotension, tachycardia, oliguria, and elevated WBC. The patient also has more than 100,000 organisms of Escherichia coli per cc of urine. The attending physician documents "urosepsis." What is the next step for the coder?
a. Code sepsis as the principal with a secondary diagnosis of urinary tract infection due to E. coli. b. Code urinary tract infection with sepsis as a secondary diagnosis. c. Query the physician to determine if the patient is being treated for sepsis, highlighting the clinical signs and symptoms. d. Ask the physician whether the patient had septic shock so that this may be used as the principal diagnosis. ANSWER Correct Answer: C
The term urosepsis is a nonspecific term. It has no default code in the Alphabetic Index. Should providers use this term, they must be queried for clarification (CMS 2020a, Section I.C.1.d.,
24).
When a patient goes home with an order for home health to start one week after an inpatient admission, this is categorized as a(n): a. Discharge b. Transfer c. Readmission d. Outlier ANSWER Correct Answer: A
no medication, treatment, or further evaluation is provided. The coder should: a. Query the attending physician regarding the x-ray finding b. Code the condition because the documentation reflects it c. Question the radiologist regarding whether to code this condition d. Use a code from abnormal findings to reflect the condition -
✔✔✔ Correct Answer > Correct Answer: A
Query the attending physician regarding the clinical significance of the findings and request that appropriate documentation be provided. This is an example of a circumstance where the chronic condition must be verified. All secondary conditions must meet the UHDDS definitions; it is not clear if COPD does (CMS 2020a, Section III, 111-112).
A patient is admitted for seizures. What is the appropriate POA for the external cause code of W06.XXXA assigned because the patient fell out of bed during a seizure in the emergency
department?
a. Y b. N c. U
d. W ANSWER Correct Answer: A
The patient fell out of bed prior to admission, so the POA indicator for the fall is Y for yes (CMS 2020a, Appendix I, 117).
The outpatient code editor (OCE) has all of the following types of edits except: a. Sex and procedure edits b. Valid diagnosis code edits c. Invalid revenue code edits d. Diagnosis and age edits ANSWER Correct Answer: B
The OCE has a large number of edits that a claim must go through in order to identify errors. The OCE looks at invalid diagnosis codes, but not valid ones (Casto 2018, 256-257).
Determining medical necessity for outpatient services includes all the following except:
a. Local coverage determinations (LCDs) b. National coverage determinations (NCDs) c. Diagnoses linked to procedures by claims-processing software tests ensuring that the procedure is cross-
NCCI edits apply to services billed by the same provider for the same beneficiary on the same date of service (Kuehn 2020, 377).
If the principal diagnosis is an initial anterior wall myocardial infarction, which procedure will result in the highest MS-DRG assignment?
a. Mechanical ventilator b. Insertion central venous catheter c. Right heart cardiac catheterization d. Transbronchial lung biopsy ANSWER Correct Answer: D
MS-DRG 264 (weight = 03.2481) for myocardial infarction with transbronchial lung biopsy would result in the highest reimbursement. MS-DRG 282 (weight = 00.7379) would be assigned for the myocardial infarction with insertion central venous catheter, with mechanical ventilator, or with a right heart catheterization (CMS 2019b).
Medicare payment to physicians for services rendered is made under the:
a. Outpatient Prospective Payment System b. Resource-based Relative Value Scale c. Ambulatory Payment Classification d. Conditions of Participation ANSWER Correct Answer: B
Physician payment from Medicare is based on the Resourcebased Relative Value Scale (RBRVS) (Kuehn 2020, 365).
Inpatient procedures are coded with:
a. HCPCS b. CPT c. ICD-10-PCS d. ICD-O ANSWER Correct Answer: C
The UHDDS specifies ICD-10-PCS as the code system for inpatient procedures (CMS 2020b, 1).
Under the Inpatient Prospective Payment System (IPPS), what can be used to measure the cost of care for inpatients?
a. MS-DRG assignment
The date of surgery is typically abstracted by coding professionals. While the other elements are also collected, b and c are usually gathered during the registration process, and the blood type is not normally part of the abstract process (Sayles 2020, 70)
Dr. Jones is the attending physician for a patient admitted with aspiration of a ballpoint pen cap. Dr. Westwood is the provider who performed a direct laryngoscopy with foreign body removal on the patient the afternoon of admission. Monitoring of the patient's respiratory status continued for 36 hours after the procedure as severe swelling of the larynx was noted during the laryngoscopy. On the morning of discharge, the patient was noted to have acute, suppurative otitis media of the right ear and Dr. Phillips performed a myringotomy with tube insertion under general anesthesia with assistance from Dr. Johannsen, the resident.Upon discharge, which physician will be assigned to the principal procedure that was performed?
a. Dr. Jones b. Dr. Westwood c. Dr. Johannsen d. Dr. Phillips ANSWER Correct Answer: B
The principal procedure in this scenario was the laryngoscopy to remove the foreign body performed by Dr. Westwood (Sayles 2020, 70).
Documentation in the record reveals that a patient is admitted with an acute exacerbation of COPD (MS-DRG 192). A higherpaying MS-DRG may be appropriate if documentation is present in the record at the time the decision was made to admit the patient that confirms a diagnosis associated with which of the following? a. Angina and treated with nitroglycerin prn b. Atrial fibrillation and underwent a cardioversion c. Respiratory failure treated with intubation and mechanical ventilation for 23 hours d. Anemia and was given a blood transfusion - ✔✔✔ Correct
Answer > Correct Answer: C
MS-DRG 0208 is a correct reflection of the patient's severity illness and appropriate reimbursement based on the documentation when compared to the MS-DRG associated with acute exacerbation of COPD (Leon-Chisen 2020, 225-226).
Which of the following diagnoses qualifies as MCC? a.
Coronary artery disease b. Aortic stenosis c. Type 2 myocardial infarction d. Unspecified atrial fibrillation ANSWER
Correct Answer: C
A diagnosis of type 2 MI is considered a major complication/comorbidity (Optum 360 2019, 648).
A 7-year-old patient was admitted to the emergency department for treatment of shortness of breath. The patient is given epinephrine and nebulizer treatments. The shortness of breath and wheezing are unabated following treatment. What diagnosis should be suspected? a. Acute bronchitis b. Acute bronchitis with chronic obstructive pulmonary disease c. Asthma with status asthmaticus d. Chronic obstructive asthma ANSWER Correct Answer: C
"Status asthmaticus is an acute asthmatic attack in which the degree of bronchial obstruction is not relieved by the usual treatment, such as by epinephrine or aminophylline" (Schraffenberger and Palkie 2020, 352-353).
A 23-year-old female is admitted for shock following treatment of an ectopic pregnancy. This encounter would be coded as: a. O03.81, Spontaneous abortion complicated by shock b. O08.3, Complication following ectopic and molar pregnancies c. R57.9, Shock NOS d. T81.10XA, Postoperative shock ANSWER Correct Answer: B
When a patient is readmitted because a complication has developed following discharge for a treated ectopic pregnancy, a code from category O08 is assigned as the principal diagnosis (Leon-Chisen 2020, 357-358).
A patient is discharged with a diagnosis of acute pulmonary edema due to congestive heart failure. What condition(s) should be coded? a. Acute pulmonary edema b. Congestive heart failure c. Acute pulmonary edema and congestive heart failure d. Unable to determine based on the information provided ANSWER Correct Answer: B
A patient is admitted post-back surgery with uncontrolled pain and leakage at the surgical site. Vitals show a fever of 101 with some tachycardia noted as well. The attending physician documents inflammation, with an infectious disease consultant documenting Staphylococcus aureus infection based on the lab culture. How should the coder resolve the discrepancy between the diagnoses documented? a. Code the inflammation since that is what the attending physician documented b. Code the infection since the consultant was specific regarding the type of infection c. Code the infection based on the lab culture results d. Query the attending physician to clarify the conflicting documentation ANSWER Correct Answer: D
When there is conflicting information in the patient's medical record, a query to the attending physician is warranted to ask for clarification (AHIMA 2019c).
A coder has noted that a particular nurse practitioner is sending orders for outpatient testing with the diagnosis listed as "possible" or "rule out" without any accompanying signs or symptoms or abnormal findings suggestive of the possible diagnosis. What action should the coder take?
a. Nothing, code the diagnosis as if it exists since this is an outpatient b. Use an observation code for the encounter c. Ask for outpatient CDI specialist to educate the NP on the guidelines for outpatient coding which do not permit the use of "possible" or "rule out" diagnoses
d. Report the nurse practitioner to quality management and billing as this practice is causing billing delays and increase in the discharge not final billed metric ANSWER Correct Answer: C
The NP should be educated on the outpatient coding guidelines in order to recognize the need for reporting signs/symptoms or abnormal findings rather than uncertain diagnoses in the outpatient setting (AHIMA House of Delegates 2016).
An operative report indicates the physician performed metatarsal surgery but all other information in the record points to need for metacarpal surgery. What step should the coder take upon this discovery? a. Code the metatarsal surgery as that is what is documented in the operative report
The patient reports not having chest pain, yet it is identified as a diagnosis by the provider (AHIMA Work Group 2013).
The most challenging type of provider query is issued for: a.
Determining cause and effect b. Establishing clinical validation c. Resolving documentation conflict d. Clarifying acuity or specificity ANSWER Correct Answer: B
The most challenging query type is for clinical validation and may best be addressed by clinical documentation specialists (AHIMA 2019c).
When creating a compliant query to clarify conflicting information from the surgeon and the attending physician, to whom should the query be directed? a. Surgeon b. Attending physician c. Medical staff director d. Medical records committee chairperson ANSWER Correct Answer: B
It is the responsibility of the attending physician to clarify conflicting documentation in the patient's record (AHIMA 2019c).
When a compliant query remains unanswered, what is the next step for the coder? a. Ask the HIM director to place the physician on suspension until the query is answered. b. Alert the CEO that the query is outstanding, requesting a fine until the query is answered. c. Refer to the internal escalation policy and follow the process outlined therein. d. Report the physician to the peer review committee for disciplinary measures. ANSWER Correct Answer: C
Every facility should have an internal escalation policy in place to address the process that should be followed if a query remains unanswered. This may include involving the coding supervisor or manager, the physician advisor, or administration (AHIMA 2019c).
When creating compliant queries coders should: a.
Query once without further follow up
