Certified Coding Specialist (CCS) Exam Prep Questions with Verified Answers -AHIMA 8th Edi, Exams of Medicine

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Certified Coding Specialist (CCS) Exam Prep

Questions with Verified Answers -AHIMA 8th

Edition

Carcinoma in situ - Ans; Tumor cells that are undergoing malignant changes but are still confined to the point of origin without invasion of the surrounding normal tissue Examples of carcinoma in situ - Ans; Intraepithelial infiltrating The patient was admitted from the emergency department because of chest pain. Following blood work, it was determined that the patient had elevated CPKs and MB enzymes. The EKG shows nonspecific ST changes. What type of diagnosis might this indicate? a. Unstable angina b. Myocardial infarction c. Congestive heart failure d. Mitral valve stenosis - Ans; b The CPK elevation with MB enzymes elevated and the EKG ST changes denote a possible Ml (Leon-Chisen 2013, 386-387). A patient is admitted and diagnosed with fever and urinary burning. The discharge diagnosis· is Escherichia coli, urinary tract infection. Which of the following represents the correct diagnoses and appropriate sequence of those conditions? a. Fever, urinary burning, urosepsis b. Fever, urinary burning, sepsis c. Escherichia coli, urinary tract infection d. Urinary tract infection, Escherichia coli - Ans; d Symptoms are not coded when a definitive diagnosis is present on discharge. The patient discharge diagnosis of urinary tract infection. The organism (E. coli) is coded with a seco diagnosis code (B96.20) which is to be added as an additional code to identify the bacterial agent (HHS 2014, Section II.A., 98). A patient was admitted with heart failure within one week of a heart transplant. Due to the timing, the coder thought that it may represent a postoperative transplant rejection following heart transplant. What action(s) should the coding staff take? a. Query the physician. b. Assign the codes for the postoperative transplant rejection. c. Assign only the code for the transplant rejection. d. Assign only the code for heart failure. - Ans; a

When the documentation is not clear regarding a potential complication, it is appropriate query the physician (HHS 2014, Section I.B.16, 16; Leon-Chisen 2013, 43-44). A patient is admitted to a psychiatric unit of an acute-care facility. The patient experienced the following symptoms almost every day for the last month: loss of interest or pleasure in most or all activities, which is a change from her prior level of functioning. She has also gained 15 lbs, has difficulty falling asleep, feels fatigued, and has difficulty making decisions. What potential diagnosis most closely fits the patient's overall symptoms? a. Insomnia b. Major depression c. Reye's syndrome d. Bipolar disorder - Ans; b The symptoms provided are indicative of a depressive disorder (Leon-Chisen 2013, 175). Inpatient: Admission for inguinal hernia repair. This 30-year-old patient has acquired immunodeficiency syndrome (AIDS) but is not symptomatic at this time due to medication regimen. The procedure performed was a right indirect inguinal herniorrhaphy via open approach. - Ans; ICD-10-CM: K40.90, B20, ICD-10-PCS: OYQ50ZZ (Schraffenberger 2013, 82-84,252) Inpatient: A 75-year-old male patient was admitted from a nursing home with dehydration and dysphagia due to a previous stroke. During hospitalization the patient was rehydrated and transferred back to the nursing home. - Ans; ICD-10-CM: E86.0, I69. (Schraffenberger 2013, 131, 209-210). Stroke= cerebral infarction Inpatient: A patient is admitted to an acute care facility for detoxification from alcohol and barbiturate intoxication with chronic alcoholism and barbiturate abuse. The patient also has cirrhosis of the liver due to alcoholism. - Ans; ICD-10-CM: F10.229, F13.129, K70.30, (Schraffenberger 2013, 140-143.) ICD-10-PCS HZ2ZZZZ

(Leon-Chisen 2014, 186). Inpatient: A 30-year-old patient was seen in the emergency department for recurrent epileptic seizures. The patient also had tic douloureux. - Ans; ICD-10-CM: G40.909, G50. (Schraffenberger 2013,158-159). Inpatient: A patient was admitted to an acute care facility with a temperature of 102 and atrial fibrillation. The chest x-ray reveals pneumonia with subsequent documentation by the physician of pneumonia in the progress notes and discharge summary. The patient was treated with oral antiarrhythmia medications and IV antibiotics. - Ans; ICD-10-CM: J18.9, 148.91- In accordance with the UHDDS, both conditions are not equally treated. The pneumonia was treated with IV antibiotics. This diagnosis had greater utilization of resources of medications and staff time compared with the atrial fibrillation, which was treated with oral medication. Because of this, the pneumonia is sequenced first (HHS 2014, Section II, C). Inpatient: A patient with chronic cholecystitis and gallbladder stones underwent a laparoscopic cholecystectomy in an acute care facility. However, due to extensive gallbladder adhesions the procedure was converted to an open cholecystectomy. - Ans; ICD-10- CM: K80.10, K82.8 (Schraffenberger 2013, 249-250, 454); HHS 2011, Section I, 18. d, 14), ICD-10-PCS: OFT40ZZ, OFJ44ZZ (Leon-Chisen 2014, 250). Inpatient: A patient is admitted to the inpatient setting with hydronephrosis and a staghorn calculus of the right kidney. The patient underwent an uretetoscopy with placement of bilateral ureteral stents for dilation purposes and removal of calculus of right kidney. - Ans; ICD-10-CM: N13.2, ICD-10-PCS: OT788DZ, OTC08ZZ (Leon-Chisen 2013, 269). Inpatient: A 77-year-old nursing home patient was admitted to the acute care setting for excisional debridement of decubitus stage 3 ulcer of the right heel via surgical excision in the OR.

The patient also has degenerative joint disease of both knees. - Ans; ICD-10-CM: L89.613, M17.0, ICD-10-PCS: OJBQOZZ (Schraffenberger 2013, 265-266, 278, 282-284). Inpatient: 45-year-old woman was admitted to the inpatient setting for a displacement of a lumbar intervertebral disk. This was treated with a laminectomy and diskectomy. - Ans; ICD- 10-CM: M51.26, ICD-10-PCS: OSB20ZZ, OQBOOZZ (Schraffenberger 2013,279, 282-284). Inpatient: A 34-year-old woman delivered a live born, term baby boy (39 weeks) with macrosomia. She had a hemorrhage following an episiotomy with a low forceps delivery but prior to expulsion of the placenta. - Ans; ICD-10-CM: 067.9, 033.7, Z37.0, Z3A.39, ICD-10- PCS: 10D07Z3, OW8NXZZ- The patient had a hemorrhage that occurred after delivery but before the expulsion of the placenta. This hemorrhage, by definition, occurred in the third stage of labor (Schraffenberger 2013, 270, 278-283, 313). Inpatient: A single, newborn, term live-born baby boy, born in hospital via vaginal delivery. - Ans; ICD-10-CM: Z38. (Schraffenberger 2013, 340). Inpatient: Twin newborns, both born prematurely at 32 weeks via cesarean section, 1,002 g was the birth weight of the first twin, whose mate was stillborn. The baby was admitted to the nursery from the delivery room. The baby also was treated for jaundice due to ABO incompatibility. - Ans; ICD-10-CM: Z38.31, P07.14, P07.35, P55. (Schraffenberger 2013, 337). Inpatient: A patient is admitted to the acute care facility with chest pain. The patient was awakened from sleep; this was ;:he patient's first experience with chest pain. The

patient was given two nitroglycerin tablets in the emergency department. The chest pain was not relieved, resulting in the diagnosis of new onset unstable angina. Serial CPK was normal. Following a left cardiac catheterization with angiogram of multiple coronary arteries with low osmolar contrast, the patient is found to have arteriosclerotic coronary artery disease. - Ans; ICD-10-CM: 125.110, ICD-10-PCS: 4A023N7, B2111ZZ (Schraffenberger 2013, 202-204). Inpatient: This is the first admission for a patient with adenocarcinoma of the right lower lung who was also found with metastasis to the brain. The patient underwent a right lower lung lobectomy via laparotomy. - Ans; ICD-10-CM: C34.31, C79.31, ICD-10-PCS: OBTFOZZ (Schraffenberger 2013, Chapter 5, 99). Inpatient: A patient has metastatic adenocarcinoma of bone. - Ans; ICD-10-CM: C80.1, C79. (Schraffenberger 2013, 99). Inpatient: A patient is admitted with metastatic carcinoma from breast to liver with previous bilateral mastectomy and no reoccurrence at the primary site. - Ans; ICD-10-CM: C78.7, Z85.3, Z90. (Schraffenberger 2013, 478). Inpatient: A young woman was admitted after a car hit her from behind while she waited for a bus on the sidewalk. She sustained a fractured fibula shaft and patella on the left leg with a break in the skin at the midcalf. The patient required an open reduction of the left fibula fracture. - Ans; ICD-10-CM: S82.402A, S82.002A, T14.8, Y92.480, V03.10XA, ICD-10-PCS: OQSKOZZ (Schraffenberger 2013, 380-381, 443, 428).

Inpatient: Syncope; bradycardia ruled out; due to taking Valium as prescribed by a physician. Patient also took an antihistamine as directed on the package without consulting a healthcare provider. - Ans; ICD-10-CM: T42.4X1A, T45.0X1A, R55-The patient took over-the-counter medications with a prescription medication without consulting the prescribing physician. This is a poisoning. Per the Official ICD-10-CM Guidelines for Coding and Reporting, I.C.19.e.5.b.: Nonprescribed drug taken with correctly prescribed and properly administered drug: If a nonprescribed drug or medicinal agent was taken in combination jVith a correctly prescribed and properly administered drug, any drug toxicity or other reaction resulting from the interaction of the two drugs would be classified as a poisoning (HHS 2014, Section I, 19, e, Sa; Schraffenberger 2013, 406-407). Inpatient: Sepsis due to the presence of an indwelling urinary catheter with a positive blood culture reflected in the progress notes of Staphylococcus aureus sepsis. - Ans; ICD-10- CM: T83.51XA, A41. (Leon-Chisen 2013, 150, 154, 535). Inpatient: Respiratory distress syndrome, 26-day-old baby, temporary tracheostomy completed. - Ans; ICD-10-CM: P22.0, ICD-10-PCS: OB110F (Schraffenberger 2013, 339; Coding Clinic 1986 Nov.-Dec., 6; 1" Quarter 1989, 10) Ambulatory/Outpatient Noncardiac chest pain, esophageal acid reflux test. - Ans; ICD-10-CM: R07.89; CPT: 91034 (Schraffenberger 2013, 362-363; CPT Assistant May 2005,3) Ambulatory/Outpatient Annual screening mammogram. - Ans; ICD-10-CM: Z12. CPT: (Schraffenberger 2013, 462; CPT Assistant March 2007, 7)

Ambulatory/Outpatient Excision of basal cell carcinoma, 1.9-cm lesion left upper eyelid. - Ans; ICD-10-CM: C44.119; CPT: 11642 (Schraffenberger 2013, 99-100; CPT Assistant Fa11199-. _ May 1996, 11; Feb. 2008, 8; Feb. 2010, 3; CPT Changes: An Insider's View 2003). Ambulatory/Outpatient Hallux valgus repair with resection of the joint with implant in the first left toe proximal phalanx. - Ans; CD-10-CM: M20.12; CPT: 28293-TA (Schraffenberger 2013, 305; CPT Assistant Dec. 1996. 6; CPT Assistant Jan. 2007, 31). Ambulatory/Outpatient Metastatic ovarian cancer to the pleura. Thoracoscopic pleurodesis. - Ans; ICD-10-CM: C78.2, C56.9; CPT: 32650 (Schraffenberger 2013, 100-101; CPT Assistant F 1994, 1, 6; CPT Changes: An Insider's View 2002). Ambulatory/Outpatient Symptomatic bradycardia due to sick sinus syndrome with replacement of dual chamber pacemaker generator with removal of old generator. - Ans; ICD-10-CM: 149.5; CPT: 33228 (Schraffenberger 2013, 206, 362-363; CPT Changes: An In-sider's View 2003; CPT Assistant Summer 1994, 10, 19; CPT Assistant Nov. 1999, 16; CPT CHANGES 200, Ambulatory/Outpatient Esophagogastroduodenoscopy with sclerotherapy of esophageal varices. - Ans; ICD- 10-CM: 185.00; CPT: 43243 Leon-Chisen 2013, 246; Smith 2015, 115; CPT assistant Spring 1994, 4). Ambulatory/Outpatient

Transurethral resection of the prostate for benign prostatic hypertrophy with electrocautery. - Ans; ICD-10-CM: N40.0; CPT: 52601 ( Schraffenberger 2013, 294-295; Smith 2015, 134; CPT Assistant Nov. 1997, 20; CPT Assistant April2001, 4; CPT Assistant June 2003, 6). Ambulatory/Outpatient Cryosurgical destruction of simple papilloma of the penis. - Ans; ICD-10-CM: D29.0; CPT: 54056 (Schraffenberger 2013, 103; Smith 2015, 134). Ambulatory/Outpatient Dysfunctional uterine bleeding for which hysteroscopy with endometrial ablation was undertaken. - Ans; CD-10-CM: N93.8; CPT: 58563 (Schraffenberger 2013, 296; CPT Assistant Nov. 1999,2 : March 2000, 10; March 2002, 11; CPT Changes: An Insider's View 2000, 2002). Ambulatory/Outpatient Incompetent cervix in second trimester with removal of cervical cerclage under spinal anesthesia in a pregnant woman. - Ans; ICD-10-CM: 034.32; CPT: 59871 (Leon-Chisen 2013, 343; CPT Assistant Nov. 1997, 2 CPT Assistant Nov. 2006, 21; CPT Assistant Feb. 2007, 10) A patient is admitted to the hospital complaining of abdominal pain. Following evaluation, it was determined that the patient had an intestinal obstruction of the left colon due to adhesions from a prior abdominal surgery. The patient underwent an exploratory laparotomy with lysis of adhesions. What conditions should be coded? a. Abdominal pain, abdominal adhesions, abdominal obstruction, laparotomy, lysis of adhesions b. Abdominal adhesions, abdominal obstruction, postoperative complications of the digestive system, laparotomy, lysis of adhesions c. Abdominal adhesions with obstruction, lysis of adhesions

d. Abdominal adhesions and abdominal obstruction, postoperative complications of the digestive system, lysis of adhesions - Ans; c The patient has abdominal adhesions with obstruction, and lysis of adhesions was performed. The abdominal pain is not coded as it is a symptom (HHS 2014, Section I.B.4, 13; Leon-Chisen 2013,140) A patient has a principal diagnosis of pneumonia (118.9) (MS-DRG 195). Which of the following may legitimately change the coding of the pneumonia in accordance with the UHDDS and relevant clinical documentation? a. Sputum culture reflects growth of normal flora. b. Patient has a positive gram stain. c. Patient is found to have dysphagia with aspiration. d. Patient has nonproductive sputum. - Ans; c Patient is found to have dysphagia with aspiration is the correct answer because it changes the coding to aspiration pneumonia and would result in MS-DRG 179 RESPIRATORY INFECTIONS & INFLAMMATIONS W/0 CC/MCC, which has a weight of 0.9718 (Medicare Grouper Version Used: 31). This is in comparison to MS-DRG 0195, SIMPLE PNEUMONIA & PLEURISY W/0 CC/MCC MDC: 04 which has a DRG weight of 0.6978 (Medicare Grouper Version Used: 31). A patient is diagnosed with infertility due to endometriosis and undergoes an outpatient laparoscopic laser destruction of pelvic endometriosis. In order to code this encounter accurately, what steps must the coder take? a. Review the operative report to determine what procedure codes to use and also to determine the site or sites of endometriosis so codes with the highest specificity may be assigned, and use infertility as a principal diagnosis. b. Review the operative report to determine where the laser was used in the pelvis so the site or sites of endometriosis can be specified, and assign a principal diagnosis of infertility. c. Review the operative report to determine where the laser was used in the pelvis so the site or sites of endometriosis can be specified as principal, and assign a secondary diagnosis of infertility. d. Review the operative report to determine what procedure codes to use and also - Ans; d

There may be endometrial implants throughout the pelvic cavity which may attach to various anatomic structures such as the fallopian tube, ovary, and omentum. These locations should be identified so that the appropriate diagnostic codes can be assigned and the appropriate procedure codes can be assigned based on the destruction of the endometrial implants. Therefore, the correct answer is to review the operative report to determine what procedure codes to use and determine the site or sites of endometriosis so that codes with the highest specificity may be assigned. Also, use the diagnosis of infertility as a secondary condition (Schraffenberger 2013, 296; Leon-Chisen 2013, 33, 271). In order to establish the adequacy of documentation in the medical record the following must be reflected: a. Decisions of patient's caregivers b. Quantitative analysis of the number of pages c. Ancillary forms and consents d. Care rendered to the patient and the patient's response - Ans; d The care rendered to the patient and the patient's response must be documented in the medical record (LaTour and Eichenwald Maki 2013, 264; Sayles 2013, 70). Authentication of health record entries means to: a. Create facsimiles of documents b. Prove authorship of documents c. Develop documents d. Use a rubber stamp on random sets of documents - Ans; b Authentication is the act of verifying a claim of identity (Sayles 2013, 381). In order to prove authorship of documents they are required to be authenticated by a signature (LaTour and Eichenwald Maki 2013, 264). The requirements for documentation and record completion (documents such as history and physicals, discharge summaries, and consultations) as well as penalties for non- adherence must be specified in: a. Hospital rules and regulations b. Conditions of nonparticipation

c. Medical staff bylaws d. Nursing staff policies - Ans; c The medical staff bylaws are required by accreditation and regulatory organizations to refer to the timeline required for completion (LaTour and Eichenwald Maki 2013, 240; Sayles 2014, 353). A patient was admitted to the emergency department for abdominal pain with diarrhea and was diagnosed with infectious gastroenteritis. The patient also had angina and chronic obstructive pulmonary disease. List the diagnoses that would be coded in the order of sequence. a. Abdominal pain, infectious gastroenteritis, chronic obstructive pulmonary disease, angina b. Infectious gastroenteritis, chronic obstructive pulmonary disease, angina c. Gastroenteritis, abdominal pain, angina d. Diarrhea, chronic obstructive pulmonary disease, angina - Ans; b The abdominal pain and diarrhea are not coded as they are symptoms integral to the diagnosis of infectious gastroenteritis. Review Coding Guideline II.A, 98 for additional information on coding of symptoms, signs, and ill-defined conditions. A patient was admitted to the endoscopy unit for a screening colonoscopy. During the colonoscopy, polyps of the colon were found and a polypectomy was performed. What diagnostic codes should be used and how should they be sequenced? Z12.11 Encounter for screening for malignant neoplasm of colon D12.6 Benign neoplasm of colon, unspecified a. Z12. b. Dl2.6 Encounter for screening for malignant neoplasm of colon Benign neoplasm of colon, unspecified c. Zl2.ll,Dl2. d. D12.6, Z12.11 - Ans; c

The circumstances of the encounter are for a screening colonoscopy. Because of this the screening, colonoscopy is listed first, followed by a code for the polyps (HHS 2014, Section I.C.21.c.5, 88). 023-Other benign neoplasms of skin Includes: Benign neoplasm of hair follicles Benign neoplasm of sebaceous glands Benign neoplasm of sweat glands Excludes 1: benign lipomatous neoplasms of skin (017.0-017.3) melanocytic nevi (022.-) When coding benign neoplasm of the skin, the section noted above directs the coder to: a. Use category D23 for benign neoplasm of sweat glands b. Use category D23 for melanocytic nevi c. Use category D23 for benign lipomatous neoplasms of skin d. Use category D23 for malignant neoplasm of the skin - Ans; a Excludes note 1 is defined as never code here (HHS 2014, I.A.12.a, 10). 023-Other benign neoplasms of skin Includes: Benign neoplasm of hair follicles Benign neoplasm of sebaceous glands Benign neoplasm of sweat glands Excludes 1: benign lipomatous neoplasms of skin (017.0-017.3) melanocytic nevi (022.-) When coding benign lipomatous neoplasms of skin, the section noted above directs the coder to: a. Use category D b. Use a code from D17.0-D17. c. Use code E88. d. Use category D22 - Ans; b Excludes note 1 is defined as never code here (HHS 2014, I.A.12.a, 10). A patient was discharged from the same-day-surgery unit with the following diagnoses: posterior subcapsular mature incipient senile cataract right eye, diabetes mellitus, hypertension, and was treated for mild acute renal failure. Which codes are correct? E11.9 -Type 2 diabetes mellitus without complications E11.29 -Type 2 diabetes mellitus with other diabetic kidney complication H25.9 - Unspecified age-related cataract H25.21 -Age-related cataract, morgagnian type, right eye H25.041 -Posterior subcapsular polar age-related cataract, right eye

I10-Essential hypertension 112.9 -Hypertensive chronic kidney disease with stage 1 through stage 4, or unspecified chronic kidney disease N17.9 -Acute kidney failure, unspecified a. H25.21, E11.29, 112.9, N17. b. H25.041, E11.9, 110, N17. c. H25.9, E11.29, 112.9, N17. d. H25.041, E11.9, !12.9 - Ans; b The patient has posterior subcapsular mature incipient senile cataract right eye, diabetes mellitus (with no designated causal relationship to the cataracts), hypertension, acute renal failure. The hypertension is not related to the renal failure as it is acute and not chronic. Because of this, a combination code for hypertension and chronic renal failure is not coded (HHS 2014, Section I.B.9, 14). d Acute exacerbation of COPD is coded as J44.1. The hypertension is present with the chronic renal disease. Because of this, a combination code for hypertension and chronic renal disease is coded. In addition, the stage of the kidney disease is also coded (HHS 2014, Section I.B.9, 14). - Ans;