Medical Coding Practice Questions, Exams of Nursing

Download Medical Coding Practice Questions and more Exams Nursing in PDF only on Docsity!

CCS Exam Final Year 2024/2025 Edition

with Correct Answers.

1.The medical record states the patient has chronic renal failure and has now been admitted with acute renal failure. Which represents the correct sequence? A. N18.9, N17. B. N17.9, N18. C. N19, N17. D. Either A or B - Correct Ans: ✔✔B. N17.9, N18.

2. A 4-year-old patient presents to the ED with her mother. The patient is an asthmatic with dyspnea and is in obvious distress. The mother states that the child's asthma was in good control until later in the day, when she began to develop problems breathing. For the last 4 hours, the mother had administered the child's albuterol inhalant with no marked improvement. The ED physician directed administration of a nebulizer treatment of albuterol, 3 mL of 0.083%. The documentation indicates asthma with an acute exacerbation. After the initial treatment, the patient began to rapidly improve and was discharged.

J45.22 Mild intermittent asthma with status asthmaticus J45.901 Unspecified asthma with acute exacerbation J44.9 Chronic obstructive pulmonary disease J45.21 Mild intermittent asthma with acute exacerbation A. J45.22, 99283 B. J45.901, 99284 C. J44.9, 99285 D. J45.21, 99284 - Correct Ans: ✔✔B. J45.901. The diagnosis is with acute exacerbation, as documented in the report.

3. A patient presents to the emergency department with the chief complaint of nausea and recurrent vomiting with dehydration. The

nausea with vomiting is listed first in the final diagnoses section of the report. Upon reviewing the medical record, the coder notes that the patient was described as having dehydration secondary to viral pharyngitis with possible ketoacidosis and received infusion therapy. The patient is a type 1 diabetic who has had no complaints with diabetes for the past 6 years, until perhaps now. The patient also has asthma that is stable at this time. The patient was discharged home. The diagnosis(es) would be: E10.9 Diabetes mellitus without mention of complication, type I (juvenile type), not stated as uncontrolled E10.10 Diabetes with ketoacidosis, type I (insulin dependent type) (juvenile type), uncontrolled E86.9 Volume depletion E86.0 Dehydration J02.9 Acute pharyngitis

J45.909 Asthma, - Correct Ans: ✔✔A. E86.0, R11.2, J02.9, E10.9, J45.909. E86.0 reports the dehydration, R11. reports the nausea with vomiting, J02.9 reports the pharyngitis, E10. reports the type I diabetes, J45.09 reports the asthma. The patient's dehydration was the focus on the ER visit so is the first-listed diagnosis

4. A 42-year-old female presents to the emergency room stating that she has significant abdominal discomfort and is supposed to have an upper gastrointestinal series at 8 AM tomorrow morning. She has a gastric ulcer, and the abdominal pain is due to this ulcer. The emergency department physician assesses the patient and orders an abdominal x-ray. The patient's physician is in the hospital for rounds and is called to the ED to assume the care of this patient. R10.9 Abdominal pain, unspecified site R10.84 Abdominal pain, generalized K25.9 Gastric ulcer, unspecified as acute or chronic, without mention of hemorrhage, perforation, or obstruction K25.4 Gastric ulcer, chronic or unspecified with hemorrhage without mention of obstruction or perforation

A. K25.

B. K25.

C. R10.9, K25.

D. R10.84, K25.9 - Correct Ans: ✔✔A. K25.9. The ED physician assessed the patient and K25. reports a gastric ulcer that was not specified as acute or chronic and had no mention of hemorrhage, perforation, or obstruction.

5. According to the ICD- 9 - CM Official Guidelines for Coding and Reporting Section I.B.12., regarding reporting late effects indicate that residual is sequenced _________and the late effect code is sequenced _________. A. second, first B. first, second

C. first or second, first or second D. none of the above - Correct Ans: ✔✔B. first, second. According to the guidelines, the condition or nature of the late effect (the residual) is sequenced first, and the late effect code is sequenced second.

6. Hospital outpatient surgery The surgeon performed a split-thickness autograft, both thighs to the abdomen measuring 45 × 21 cm because of the patient's nonhealing surgical wound (skin and subcutaneous tissue). Which codes would you use to report the facility services? 15100 Split-thickness autograft, trunk, arms, legs; first 100 sq cm or less, or one percent of body area of infants and children (except 15050) 15101; each additional 100 sq cm, or each additional one percent of body area of infants and children, or part there of (List separately in addition to code for primary procedure) T81.4XXA Infected postoperative wound L76.82 Other postprocedural complication of skin

T81.89XA Other specified complications of a procedure A. 15100 × 10, T81.4XXA B. 15100, 15101 × 9, T81.89XA C. 15100, 15101 × 8, L76. D. 15100, T81.89XA, L76.82 - Correct Ans: ✔✔B. 15100 is the correct code for the first 100 sq cm or less, and 15101 × 9 for the remaining 845 sq cm (in this case, 45 × 21 = 945 sq cm). The code T81.89XA describes a nonhealing surgical wound (skin) which is the reason for the procedure (see Coding Clinic).

7. A 59-year-old female is brought to the ED by ambulance with tachycardia and acute alcohol intoxication. The patient has been seen in the ED on several previous occasions with significant intoxication and has had multiple admissions for acute intoxication. She is an episodic alcoholic. She has a medical history that includes fairly well controlled hypertension and current tobacco abuse (cigarettes) with questionable COPD. The patient is placed on cardiac monitoring. The ED physician assesses the condition of the patient and administers an intravenous solution of 1 liter of 5% dextrose and 0.45% sodium chloride, 2 g of magnesium sulfate, 1 mg of folate, and 100 mg of thiamine. Intramuscular Ativan is also administered. The physician reassesses the

patient several times over the next 3 hours. The patient's heart rate returns to normal, and the patient is discharged. F10.229 Acute alcoholism, episodic, uncomplicated - Correct Ans: ✔✔D. R00.0, F10.229, I10, F17.210. R00.0 (tachycardia) is the first- listed diagnosis. It is the primary reason for services that were rendered in the ED (refer to ICD- 10 - CM Official Guidelines for Coding and Reporting, Section IV, H). The acute alcoholism is reported for the acute alcohol intoxication with F10.229, because although it is a major consideration in the care of this patient, the patient was not brought to the ED because she was intoxicated, but because she was experiencing tachycardia. The third-listed diagnosis is the "fairly well controlled hypertension," reported as unspecified I10. F17.210 reports the current abuse of tobacco. Questionable COPD is not coded as this is an outpatient encounter and questionable COPD would be considered an uncertain diagnosis (not coded in outpatient encounters per the Official Coding Rules & Guidelines).

8. The patient presents to the same-day surgery center for cryosurgery of a primary malignant lesion on the genitalia (vulva). The lesion measures 1.6 cm, including margins, and local anesthesia is used. 11602 Excision, malignant lesion including margins, trunk, arms, or legs; excised diameter 1.1 to 2.0 cm

11420 Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter 0.5 cm or less 11622 Excision, malignant lesion including margins, scalp, neck, hands, feet, genitalia; excised diameter 1.1 to 2.0 cm 17272 Destruction, malignant lesion (e.g., laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm C51.9 Malignant neoplasm, vulva, primary C57.7 Malignant neoplasm, other sites of female genital organs, primary C79.82 Malignant neoplasm, g - Correct Ans: ✔✔A. 17272 identifies the destruction by cryosurgery of a malignant lesion of the genitalia, lesion diameter 1.1 to 2.0 cm. Code C51.9 is the correct code for malignant neoplasm of the vulva and the reason for the procedure.

9. Carl Ostrick, 21-year-old male, slipped on a patch of ice on his sidewalk while shoveling snow. When he fell, his left hand was wedged under his body and his index finger was dislocated. After manipulating the joint back into normal alignment, the surgeon fixed the dislocation

by placing a wire percutaneously through the carpometacarpal joint to maintain alignment. 26608 Percutaneous skeletal fixation of metacarpal fracture, each bone 26650 Percutaneous skeletal fixation of carpometacarpal fracture dislocation, thumb (Bennett fracture), with manipulation 26706 Percutaneous skeletal fixation of metacarpophalangeal dislocation, single, with manipulation 26676 Percutaneous skeletal fixation of carpometacarpal dislocation, other than thumb, with manipulation, each joint

• F1 Left Index Finger
• F6 Right Index Finger S63.055A Dislocation carpometacarpal, joint, closed

S62.601A Dislocation carpometacarpal with f - Correct Ans: ✔✔D. 26676 - F1 reports the percutaneous skeletal fixation of the finger (carpometacarpal) with manipulation. The modifier - LT indicates the left hand. Some payers may require modifier F1, left hand, second digit. The S63.055A4 describes the closed dislocation and the reason for the procedure.

10. The following appear in the Index of the ICD- 9 - CM: Complications vaccination T88. meningitis G03. Meningitis influenzal G00. Adverse effect Influenza vaccine initial encounter T50.B95A The patient record indicates a diagnosis of meningitis as an adverse effect of influenza vaccination. Which would be the correct sequence of codes? A. G03.8, T88.

B. G03.8, T50.B95A

C. G00.0, T50.B95A

D. T88.1, G03.8 - Correct Ans: ✔✔B. G03.8, T50.B95A. G03.8 identifies the meningitis due to a vaccine and the T50.B95A describes this as an adverse effect of the influenza vaccine.

11. The surgeon performed an open left pyeloplasty, gastrojejunal resection with gastrectectomy and a vagotomy during the same surgical session on this inpatient. 43865 Revision of gastrojejunal anastomosis (gastrojejunostomy) with reconstruction, with or without partial gastrectomy or intestine resection; with vagotomy 50400 Pyeloplasty (Foley Y-pyeloplasty), plastic operation on renal pelvis, with or without plastic operation on ureter, nephropexy, nephrostomy, pyelostomy, or ureteral splinting; simple 43635 Vagotomy when performed with partial distal gastrectomy (List separately in

addition to code(s) for primary procedure) 0DT60ZZ Resection of stomach, open approach 008Q0ZZ Open division of vagus nerve 0DQ60ZZ Repair of stomach, open approach 0TQ40ZZ Repair of left kidney pelvis, open approach A. 43865 B. 0DQ60ZZ, 0DT60ZZ C. 50400, 43635 D. 0DQ60ZZ, 0DT60ZZ, 008Q0ZZ - Correct Ans: ✔✔D. 0DQ60ZZ, 0TQ40ZZ, 008Q0ZZ. This choice correctly reports the inpatient procedures of 0DQ60ZZ gastrojejunal revision (resection), 0T140ZZ pyeloplasty and 008Q0ZZ vagotomy.

12. Darin was a passenger in an automobile rollover accident and was not wearing a seat belt at the time. He was thrown from the

automobile and was pinned under the rear of the overturned automobile. He sustained Lefort III craniofacial separation that required complicated internal and external fixation using an open approach to repair the extensive damage to right side of his face as an inpatient. A halo device was used to hold the head immobile. 21435 Open treatment of craniofacial separation (LeFort III type); complicated, utilizing internal and/or external fixation techniques (e.g., head cap, halo device, and/or intermaxillary fixation) 20661 Application of halo, including removal; cranial 21432 Open treatment of craniofacial separation (LeFort III type); with wiring and/or internal fixation 21436 Open treatment of craniofacial separation (LeFort III type); complicated, multiple surgical approaches, internal f - Correct Ans: ✔✔B. 0NSR04Z, 0NST041, 0NH0047, S02413Acorrectly reports the procedures of an open reduction of a maxillary fracture (0nSR04Z), open reduction of mandibular fracture (0NS5041), and insertion of a halo device (0NH0047). S02413A is the code for a LeFort III fracture

13. Which codes would you use to report the percutaneous insertion of a permanent dual-chamber pacemaker by means of the subclavian vein in a patient with sick sinus syndrome?

33249 Insertion or repositioning of electrode lead(s) for single- or dual- chamber pacing cardioverter-defibrillator and insertion of pulse generator 33217 Insertion of 2 transvenous electrodes; dual-chamber (two electrodes) permanent pacemaker or pacing cardioverter-defibrillator 33208 Insertion or replacement of permanent pacemaker with transvenous electrode(s); atrial and ventricular 33240 Insertion of single- or dual-chamber pacing cardioverter- defibrillator pulse generator I47.2 Paroxysmal ventricular tachycardia I49.5 Sick sinus syndrome R00.1 Bradycardia A. 33249, I47.

B. 33217, I49.

C. 33208, I49.

D. 33240, R00.1 - Correct Ans: ✔✔C. 33208 reports insertion of a permanent dual-chamber pacemaker with transvenous (by means of a vein) electrode placement. Code I49.5, sick sinus syndrome, is the reason for the procedure. In addition, from the Coders Desk Reference; 33217 would not be used because this is the description for 33217 - The physician inserts a single transvenous electrode in 33216 and two transvenous electrodes in 33217 when there is a malfunction or complication with the electrode wire of a permanent pacemaker or implantable defibrillator. In this case, there is no malfunction documented. The generator is removed and the wire is tested. When the wire is found defective, another transvenous electrode is inserted. Access to the central caval veins is obtained through the subclavian vein or jugular vein. The vein is penetrated with a large needle and a wire is passed through it. Fluoroscopy is used to guide the wire into position. The wire is connected to the generator and the wound is closed. Various head and body positions are tested again to ensure adequate pacing.

14. The patient is brought to the ED with burns of the back. The notes indicate that the burns were over 10% of the body surface, with 50% of the burns being 3rd degree and the other 50% being 2nd degree. What would be the sequencing of codes to report this burn?

A. Code for 2nd degree, code for 3rd degree, code for body area involved. B. Code for 3rd degree, code for 2nd degree, code for body area involved. C. Code for body area, code for 3rd degree, code for 2nd degree. D. Code for 3rd degree, code for body area - Correct Ans: ✔✔D. Code for 3rd degree, code for body area. According to the ICD- 10 - CM Official Guidelines for Coding and Reporting, Section I.19,1, the code that reflects the highest degree of burn is to be sequenced first, and burns of the same local site but of different degrees are identified by the highest degree of burn recorded. In this case, there was only one area of burn (back). Even though there were 2nd and 3rd degree burns, only the 3rd degree burn is reported. No code is reported for the 2nd degree burn. The code for the total body surface area involved in the burn is sequenced second (ICD- 10 - CM Official Guidelines for Coding and Reporting, Section I.C.19.c.6).

15. A patient with end-stage renal disease and acute renal failure is admitted to the hospital for hemodialysis. Z49.31 Encounter for adequacy testing for hemodialysis

Z99.2 Extracorporeal dialysis N17.9 Acute renal failure N18.6 End-stage renal disease or chronic kidney disease requiring dialysis N18.9 Chronic renal failure, NOS A. Z49.31, N17. B. Z99.2, N17. C. N17.9, N18. D. N18.9, Z99.2 - Correct Ans: ✔✔C.N17.9 is correct for acute renal failure and N18.6 is correct for end-stage renal disease requiring dialysis, listed in this order, as the reason for the encounter is acute renal failure and is listed as principal diagnosis since this is the reason for the encounter.

16. This 52-year-old male has undergone several attempts at extubation, all of which failed. He also has morbid obesity and significant subcutaneous fat in his neck. The patient is now in for a tracheostomy because of upcoming surgery for esophageal cancer. 0B110F4 Tracheostomy 0BW10FZ Revision of tracheostomy C15.3 Malignant neoplasm, upper third of esophagus, primary C15.5 Malignant neoplasm, lower third of esophagus, primary C15.9 Malignant neoplasm, esophagus, unspecified, primary E66.9 Obesity E66.01 Morbid obesity A. C15.3, E66.9, 0B110F B. C15.5, 0B110F

C. C15.9, E66.01, 0B110F

D. C15.9, E66.01, 0BW10FZ - Correct Ans: ✔✔C. C15.9, E66.01, 0B110F4. The C15.9 esophageal cancer with upcoming surgery is the reason for the trach. Code E66.01 describes this patient's morbid obesity and the 0B110F4 describes the tracheostomy.

17. Which code would be used to report a surgical debridement of a non-healing abdominal surgical wound infection by a physician, including skin and subcutaneous tissue? 11000 Debridement of extensive eczematous or infected skin; up to 10% of body surface 11010 Debridement including removal of foreign material associated with open fracture(s) and/or dislocation(s); skin and subcutaneous tissues 11042 Debridement; skin, and subcutaneous tissue 11043 Debridement; skin, subcutaneous tissue, and muscle

T81.40XA Infected postoperative wound, unspecified T81.41XA Infected postoperative wound, skin & subcutaneous L76.882 Other post procedural complications of skin and subcutaneous tissue T8189XA Other specified complication of a procedure A. T8A.40XA, 11000 B. T81.41XA, 11042 C. L76.882, 11043 D. L76.882, 11042 - Correct Ans: ✔✔B. T81.41XA, 11042 identifies the debridement of the skin and subcutaneous tissue. Code T81.41XA identifies the non-healing surgical wound infection of the skin & subcutaneous tissue which is the reason for the procedure (See Infection - Post operative by type)

18. The radiologist, an employee of the hospital, performed preoperative placement of a needle localization wire of a single lesion

of the breast for a woman visiting the U.S. from Australia who has a primary malignant lesion of the right breast which was excised. Ultrasonic guidance was used, and the radiologist also provided that portion of the service. This service was provided at the hospital, by the hospital's radiologist, using the hospital's equipment. The patient planned to undergo surgery when she returned to her home. Code the hospital service(s). 19083 Preoperative placement of needle localization wire with biopsy of breast; 19125 Excision of breast lesion identified by preoperative placement of radiological marker, open; single lesion 19084 Image guided placement, localization, percutaneous, during breast biopsy/aspiration (List separately in addition to code for primary procedure) 77031 Stereotactic - Correct Ans: ✔✔C. The diagnosis was primary malignant neoplasm of the right breast (C50.911). 191 25 - RT identifies the placement of one wire (marker) preoperatively by a radiologist. The radiologist also provided the ultrasonic guidance, reported with 76942.

19. The patient presents to the ED with a chief complaint of fever and cough. The ED physician orders a chest x-ray with an indication that this x-ray is for fever and cough. The hospital's radiologist reviews the x-ray

and indicates that the diagnosis is pneumonia. Which diagnosis would you report for the radiologist's service? A. cough and fever B. fever and cough C. pneumonia, cough, and fever D. pneumonia - Correct Ans: ✔✔D. pneumonia. The most definitive diagnosis is to be reported, and that is pneumonia as this is an outpatient service. Signs and symptoms that are secondary to a confirmed diagnosis are not reported separately per the ICD- 10 - CM Official Guidelines for Coding and Reporting, Section IV, Diagnostic Coding and Reporting Guidelines, D. Also, according to Coding Clinic 1st Q 2002 page 4, in the outpatient setting it is acceptable to assign codes based on a radiologist's interpretation.

20. A charge description master is used to determine: A. the fee charged for a specific code or supply B. a description of a service

C. a corresponding CPT or HCPCS code and revenue code D. all of the above - Correct Ans: ✔✔D. All of the above. A charge description master is an inventory of all services, procedures, supplies, and drugs with their corresponding CPT or HCPCS codes, revenue codes, descriptions, and assigned charges billed. It can be used to assist in the analysis of charges and trends within a facility or practice.

21. A patient presents to the outpatient surgical department for removal of two sigmoid polyps. The surgeon removes the polyps by means of snare technique using a flexible sigmoidoscopy scope. 45320 Proctosigmoidoscopy, rigid; with ablation of tumor(s), polyp(s), or other lesion(s) not amenable to removal by hot biopsy forceps, bipolar cautery or snare technique (e.g., laser) 45383 Colonoscopy, flexible, proximal to splenic flexure; with ablation of tumor(s),polyp(s), or other lesion(s) not amenable to removal by hot biopsy forceps 45309 Proctosigmoidoscopy, rigid; with removal of single tumor, polyp, or other lesion by snare technique

45338 Sigmoidoscopy, flexible; with removal of tumor(s), polyp(s), or other lesion(s) by snare technique D12.5 Neoplasm, colon, benign D12.8 Neoplasm, rectum, benign D13.9 Neoplasm, other and unspecified site (digestive system NOS), benign A. D13.9, 45320 B. D12.5, 45383 - Correct Ans: ✔✔D. D12.5, 45338 identifies the flexible sigmoidoscope with the removal of the polyps using snare technique. Code D12.5 identifies the polyp in the sigmoid colon which was the reason for the procedure.

22. The delivering physician takes the newborn male, immediately after delivery, to the nursery to perform a clamp circumcision. Report the facility service for the circumcision.