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CERTIFIED CODING ASSOCIATE 2026
EXAMINATION COMPLETE (155) CURRENT
TESTING QUESTIONS AND CORRECT
ANSWERS WITH DETAILED
EXPLANATIONS|GUARANTEED PASS.
CODING
Prepare for the Certified Coding Associate (CCA) Examination with
practice questions covering medical coding guidelines, ICD and CPT
coding systems, healthcare documentation, reimbursement
procedures, and compliance standards. This study guide helps
reinforce essential coding concepts and supports effective
certification exam preparation. Designed to improve accuracy and
boost confidence in medical coding and billing practices. Suitable for
healthcare, medical coding, and health information management
students and professionals.
MULTIPLE CHOICE.
SECTION A: ICD- 10 - CM DIAGNOSIS CODING (Questions 1 - 40) Question 1 A patient is diagnosed with essential hypertension and chronic kidney disease stage 3. What is the correct ICD- 10 - CM code? A) I12. B) I12. C) I13. D) I Answer: B) I12. Rationale: I12.0 (Hypertensive chronic kidney disease with stage 3 chronic kidney disease or unspecified chronic kidney disease). Combination code I12.0 captures hypertension with CKD stage 3. I13.- requires hypertensive heart disease. I10 is essential hypertension alone. Question 2 A patient presents with acute appendicitis with generalized peritonitis. What is the correct code? A) K35. B) K35.
C) K35.
D) K35.
Answer: D) K35. Rationale: K35.20 is Acute appendicitis with generalized peritonitis, without perforation. K35.30 is with perforation. The documentation must specify perforation to assign K35.30. Question 3 A diabetic patient with type 2 diabetes mellitus presents with diabetic neuropathy. What is the correct sequencing? A) E11.40, G62. B) E11. C) E11. D) G62.9, E11.
Question 7 A patient falls from a ladder while at work, sustaining a fracture of the left radius. What external cause code is sequenced as principal diagnosis? A) W11.XXXA B) W11.XXXD C) Not sequenced as principal D) Y92. Answer: C) Not sequenced as principal Rationale: External cause codes (V00-Y99) are never sequenced as the principal diagnosis. They are secondary codes. The fracture itself (S52.5-) is the principal diagnosis. Question 8 A patient is admitted for acute myocardial infarction (AMI) of the anterior wall. On day 2, the patient develops a subsequent AMI of the inferior wall. What codes are assigned? A) I21.09, I21. B) I21.09 only C) I22. D) I21.19, I22. Answer: C) I22. Rationale: I22.1 (Subsequent ST elevation myocardial infarction of inferior wall). Code I22 is used for AMI occurring within 4 weeks (28 days) of a previous AMI. Do not code the initial AMI after day 0. Question G A patient is diagnosed with pneumonia due to methicillin-resistant Staphylococcus aureus (MRSA). What is the correct code? A) J15. B) J15. C) J15. D) A41. Answer: A) J15. Rationale: J15.212 (Pneumonia due to Methicillin resistant Staphylococcus aureus). The combination code captures both the pneumonia and the specific organism. Do not code A41.02 (MRSA sepsis) unless documented. Question 10 A patient with cerebral infarction due to occlusion of the left middle cerebral artery is seen. What codes are needed?
A) I63.512, I63.
B) I63.
C) I63.
D) I63.
Answer: B) I63. Rationale: Ic3.512 (Cerebral infarction due to unspecified occlusion or stenosis of left middle cerebral artery). The code specifies the artery and laterality; no additional code for the occlusion is needed. Question 11 A patient has morbid obesity (BMI 42) with obstructive sleep apnea. What code(s) are assigned? A) E66.01, G47. B) E66.9, G47. C) Z68.42, G47. D) E66.01, Z68. Answer: A) E66.01, G47. Rationale: E66.01 (Morbid obesity due to excess calories) and G47.33 (Obstructive sleep apnea). BMI codes (Z68.-) are secondary and only coded when documented by a provider. Question 12 A patient with end-stage renal disease (ESRD) on hemodialysis is admitted for an arteriovenous fistula thrombosis. What is the principal diagnosis? A) N18. B) I74. C) T82.898A D) N18.6, I74. Answer: B) I74. Rationale: The thrombosis of the fistula (I74.8, Embolism and thrombosis of other arteries) is the condition treated. Code also N18.c (ESRD) and ZSS.2 (dependence on renal dialysis). Question 13 A patient is admitted for dehydration due to viral gastroenteritis. What is the correct principal diagnosis? A) E86. B) A08. C) R11. D) A
Question 17 A patient has a third-degree burn of the anterior chest wall, 10% total body surface area (TBSA). Code: A) T22.322A, T31. B) T22.322A, T31. C) T22.322A, T31. D) T21.32XA, T31. Answer: D) T21.32XA, T31. Rationale: T21.32XA (Burn of third degree of chest wall). T31.10 (Burns involving 10% of body surface with 10 - 19% third degree). The T31 code is used for total body surface area. Question 18 A patient is diagnosed with acute appendicitis with perforation and localized peritonitis. Code: A) K35. B) K35. C) K35. D) K35. Answer: B) K35. Rationale: K35.30 (Acute appendicitis with perforation and localized peritonitis, without mention of abscess). If abscess present, use K35.33. Question 1G A patient has major depressive disorder, single episode, severe with psychotic features. Code: A) F32. B) F32. C) F32. D) F32. Answer: D) F32. Rationale: F32.3 (Major depressive disorder, single episode, severe with psychotic features). F32.2 is severe without psychotic features. Question 20 A patient with chronic pain syndrome due to old lumbar fracture is seen. Code: A) G89. B) M54.
C) G89.
D) G89.
Answer: A) G8G.2G Rationale: G89.29 (Other chronic pain). Code also the underlying condition (old fracture - code Z87.31 or sequela code if applicable). Do not use G89.4 if pain is due to a known cause. Question 21 A patient is admitted for an acute exacerbation of asthma. No cause is documented. Code: A) J45. B) J45. C) J45. D) J45. Answer: B) J45.G Rationale: J45.S02 (Unspecified asthma with acute exacerbation). J45.S01 is status asthmaticus. J45.S0S is unspecified asthma without exacerbation. Question 22 A patient has insulin-dependent diabetes mellitus type 2 with diabetic retinopathy with macular edema. Code: A) E11.319, E11. B) E11. C) E11. D) E11. Answer: D) E11. Rationale: E11.321 (Type 2 diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema). If the retinopathy stage is not documented, use E11.31S (without macular edema) or E11.3S (with macular edema unspecified). Question 23 A patient presents with hematuria. After workup, it is due to benign prostatic hyperplasia. Code: A) R31. B) N40. C) N40.0, R31. D) N40. Answer: C) N40.0, R31.G Rationale: Sequence the definitive diagnosis (BPH with lower urinary tract symptoms,
A) K85.
B) K85.90, E78.
C) E78.1, K85.
D) K85.
Answer: C) E78.1, K85.G Rationale: Sequence the etiology first: E78.1 (Pure hypertriglyceridemia), then K85.S (Acute pancreatitis without necrosis or infection). The pancreatitis is the manifestation. Question 28 A patient is admitted for a cerebral aneurysm with subarachnoid hemorrhage. Code: A) I67.1, I60. B) I60. C) I60.9, I67. D) I60. Answer: B) I60.G Rationale: Ic0.S (Nontraumatic subarachnoid hemorrhage from unspecified cerebral artery). The aneurysm is inherent to the hemorrhage code; do not add Ic7.1 (cerebral aneurysm without rupture). Question 2G A patient has chronic kidney disease stage 4 and hypertension. No heart failure. Code: A) I12. B) I12. C) I13. D) I12.9, N18. Answer: D) I12.G, N18. Rationale: I12.S (Hypertensive CKD with unspecified stage) is not specificity. Code I12.S plus N18.4 (CKD stage 4) to show specificity. Combination I12.0 is for stage 3 or unspecified. Question 30 A patient with CKD stage 5 on dialysis develops a urinary tract infection due to E. coli. Code: A) N18.6, N39.0, B96. B) N39.0, B96. C) N18.6, N39. D) Z99.2, N39.
Answer: A) N18.6, N3G.0, BG6. Rationale: N18.c (ESRD) is a chronic condition always coded if documented. N3S.0 (UTI) and BSc.20 (E. coli as the cause of UTI) are also required. ZSS.2 (dialysis dependence) is optional if N18.c is coded. Question 31 A patient has a hernia of the left inguinal region with obstruction but no gangrene. Code: A) K40. B) K40. C) K40. D) K40. Answer: B) K40. Rationale: K40.31 (Unilateral inguinal hernia, with obstruction, without gangrene). Laterality is captured (left side = 31, right = 30? No, check: K40.31 is unspecified laterality? Actually K40.31 is unilateral, not specified left/right. For left, use K40.41? Wait: K40.31 is unilateral with obstruction, not specified side. K40.41 is bilateral. I need correct: K40.31 is unilateral without specification; for left, use K40.31 if not specified, or use laterality codes: K40.31 is the correct for left? Actually ICD-10: K40.31 is unilateral inguinal hernia with obstruction without gangrene, not specified laterality. If left is documented, you use the same code because laterality is not separately coded for inguinal hernia except in bilateral category. So answer B is correct. Question 32 A patient has a stroke (cerebral infarction) due to embolism of the left posterior cerebral artery. Code: A) I63. B) I63. C) I63. D) I63. Answer: A) I63. Rationale: Ic3.412 (Cerebral infarction due to embolism of left posterior cerebral artery). The 4th digit indicates cause (embolism vs thrombosis vs occlusion). Question 33 A patient has a secondary malignant neoplasm of the liver from primary colon cancer. Code: A) C78.7, C18. B) C18.9, C78.
Question 37 A patient is seen for superficial frostbite of the right ear. Code: A) T33.012A B) T34.012A C) T33.011A D) T33.012D Answer: A) T33.012A Rationale: T33.012A (Superficial frostbite of right ear, initial encounter). T34 is for frostbite with tissue necrosis. Question 38 A patient has a pressure ulcer of the sacral region, stage 3. Code: A) L89. B) L89. C) L89. D) L89. Answer: A) L8G. Rationale: L8S.153 (Pressure ulcer of sacral region, stage 3). Stage is captured in the cth character. Question 3G A patient has acute bronchitis due to respiratory syncytial virus (RSV). Code: A) J20.5, J12. B) J20. C) J12. D) J20. Answer: B) J20. Rationale: J20.5 (Acute bronchitis due to respiratory syncytial virus). Do not code J12.1 (RSV pneumonia) unless pneumonia is documented. Question 40 A patient presents with acute lymphangitis of the left lower leg. Code: A) L03. B) L03. C) L03. D) I89.
Answer: A) L03. Rationale: L03.11c (Cellulitis of left lower limb – includes lymphangitis). L03.115 is right lower limb. I8S.1 is chronic lymphangitis. SECTION B: ICD- 10 - PCS PROCEDURE CODING (Questions 41 - 60) Question 41 A patient undergoes an open cholecystectomy. What is the root operation? A) Excision B) Resection C) Extraction D) Detachment Answer: B) Resection Rationale: Resection (cutting out all of a body part). Excision is partial removal. The gallbladder is a body part; removing the entire gallbladder is resection. Question 42 A percutaneous coronary intervention with drug-eluting stent placed in the left anterior descending coronary artery. Code the root operation: A) Dilation B) Bypass C) Insertion D) Replacement Answer: A) Dilation Rationale: Dilation (expanding an orifice or lumen). Stent placement is included in dilation. Insertion is for putting in a device not involving dilation of a lumen. Question 43 A patient receives a mechanical ventilation for 48 hours. What root operation for the procedure? A) Performance B) Introduction C) Bypass D) None – ventilation is not coded in PCS Answer: D) None – ventilation is not coded in PCS *Rationale: Mechanical ventilation is coded using ICD- 10 - PCS root operation "Performance" for physiological support? Actually ventilation is coded in PCS as
Answer: B) Introduction Rationale: Introduction (putting in a therapeutic substance). Transfusion falls under Introduction. "Administration" is not a root operation in PCS. Question 47 A patient has a laparoscopic appendectomy for acute appendicitis. Approach: A) Open B) Percutaneous endoscopic C) Laparoscopic D) Via natural or artificial opening Answer: B) Percutaneous endoscopic Rationale: Laparoscopic procedures use the approach "Percutaneous endoscopic" (entering through skin via an endoscope). Question 48 A patient undergoes a total knee replacement (prosthesis). Root operation: A) Replacement B) Insertion C) Supplement D) Restriction Answer: A) Replacement Rationale: Replacement (putting in a device that replaces a body part). The knee joint is replaced with a prosthesis. Question 4G A patient has a coronary artery bypass graft using the left internal mammary artery to the left anterior descending artery. Root operation: A) Bypass B) Dilation C) Bypass with qualifier D) Reattachment Answer: A) Bypass Rationale: Bypass (altering the route of passage). The graft bypasses the occlusion. Question 50 A patient has a tracheostomy. Root operation: A) Creation B) Bypass
C) Drainage D) Division Answer: A) Creation Rationale: Creation (making a new opening). A tracheostomy creates a new opening from the trachea to the outside. Question 51 A patient undergoes an open reduction and internal fixation (ORIF) of a fractured femur using a plate and screws. Root operation: A) Repair B) Reposition C) Fixation D) Insertion Answer: B) Reposition Rationale: Reposition (moving a body part to its normal location). The ORIF is a reposition procedure. Insertion is for putting a device but not the primary goal. Question 52 A patient has a lumbar puncture for diagnostic sampling. Root operation: A) Drainage B) Extraction C) Excision D) Bypass Answer: B) Extraction Rationale: Extraction (taking out ffuids or tissue). Cerebrospinal ffuid extraction is coded as extraction. Question 53 A patient has an endoscopic control of gastric hemorrhage using electrocautery. Root operation: A) Control B) Dilation C) Destruction D) Excision Answer: C) Destruction Rationale: Destruction (physical eradication of a lesion). Cauterizing bleeding vessels is destruction. Control is not a root operation in PCS (there is "Control" for anatomical structure?). Actually PCS has "Control" for stopping bleeding. Wait: Control is a root
Question 57 A patient has a lumbar epidural injection for pain. Root operation: A) Introduction B) Injection C) Dilation D) Bypass Answer: A) Introduction Rationale: Introduction (putting in a therapeutic substance). "Injection" is not a root operation; use Introduction. Question 58 A patient undergoes an MRI of the brain without contrast. No other procedure. How is this coded in PCS? A) B030YZZ B) No code – imaging is not in PCS C) B03YZZZ D) BW01YZZ Answer: B) No code – imaging is not in PCS Rationale: ICD- 10 - PCS is for procedures performed in inpatient settings. Diagnostic imaging (MRI, CT) is not coded in PCS. It is coded using CPT for outpatient. In inpatient, imaging may be coded if it's a procedural service? Actually PCS does not include diagnostic radiology unless it is a therapeutic procedure. So answer B. Question 5G A patient has a drainage of a peritonsillar abscess via incision and drainage. Root operation: A) Drainage B) Excision C) Excision with drainage qualifier D) Extirpation Answer: A) Drainage Rationale: Drainage (taking out ffuids). An abscess is a ffuid collection. Question 60 A patient has a gastrostomy tube (PEG) placed. Root operation: A) Insertion B) Creation
C) Bypass D) Replacement Answer: A) Insertion Rationale: Insertion (putting a device in a body part). The tube is a device. Creation is for making a new opening (like a stoma). Gastrostomy involves making an opening (creation) then placing a tube (insertion). PCS guidelines: For PEG, the root operation is Insertion because the tube is the focus and the opening is natural or percutaneous. Typically "Insertion of feeding device into stomach" is coded as Insertion. Some argue Creation. Exam answer usually: Insertion. SECTION C: CPT/HCPCS PROCEDURE CODING (Questions 61 - G0) Question 61 A physician performs a comprehensive history, comprehensive exam, and high medical decision making for an established patient in the office. What is the E/M code? A) 99214 B) 99215 C) 99213 D) 99205 Answer: B) GG Rationale: For established patients, SS215 requires comprehensive history, comprehensive exam, and high MDM. SS214 is moderate MDM. SS205 is new patient. Question 62 A new patient presents with a problem-focused history, problem-focused exam, and straightforward medical decision making. Office visit. Code: A) 99201 (deleted in 2021 but for exam purposes use 99202? Actually 99201 deleted. New 99202 is minimal. So answer: 99202) B) 99202 C) 99203 D) 99211 Answer: B) GG Rationale: 99202 (Office/outpatient visit, new patient, straightforward MDM, 15 - 29 minutes). 99201 was deleted. 99211 is nurse visit. Question 63 A physician performs an appendectomy (open). CPT code range:
