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Question 1. Which section of the ICD‑ 10 ‑CM manual contains the Alphabetic Index? A) Chapter 1 B) Volume 1 C) Volume 2 D) Volume 3 Answer: B Explanation: Volume 2 of ICD‑ 10 ‑CM houses the Alphabetic Index, which is used to locate the main code for a diagnosis. Question 2. In the ICD‑ 10 ‑CM code structure, what does the third character most commonly represent? A) Subcategory B) Laterality C) Extension for encounter type D) Placeholder “X” Answer: A Explanation: The third character defines the subcategory, providing more detail about the condition within the category. Question 3. When should the placeholder “X” be used in an ICD‑ 10 ‑CM code? A) When a code has no seventh character extension B) To indicate an unspecified side C) To fill empty positions for future expansion D) Only for external cause codes Answer: C Explanation: “X” is inserted as a placeholder to maintain the 7‑character format and allow future code expansion.
Question 4. Which seventh‑character extension indicates an initial encounter for a fracture? A) A B) D C) G D) S Answer: A Explanation: “A” denotes the initial encounter for a traumatic injury, such as a fracture. Question 5. “Excludes1” in the Alphabetic Index means: A) The code is not to be used in any circumstance B) The condition is included elsewhere in the index C) The condition is not coded here but elsewhere in the tabular list D) The code is optional Answer: C Explanation: “Excludes1” indicates that the condition is excluded from that code and must be coded elsewhere. Question 6. “Excludes2” in the Alphabetic Index means: A) The condition is never coded with the listed code B) The condition may be coded together with the listed code when appropriate C) The code is obsolete D) The condition is a manifestation of the listed disease Answer: B Explanation: “Excludes2” signals that the two conditions can be coded together if clinically appropriate.
Explanation: Laterality codes use “1” for right, “2” for left, “3” for bilateral, and “9” for unspecified. Question 10. A patient presents with cough and fever but no definitive diagnosis. Which type of code is appropriate? A) Symptom code (R05) only B) Definitive diagnosis code only C) Both symptom and diagnosis codes D) No code until diagnosis is confirmed Answer: A Explanation: When only symptoms are documented, symptom codes from Chapter 18 (R00‑R99) are used. Question 11. Which code would you assign for a confirmed diagnosis of acute myocardial infarction of the anterior wall, initial encounter? A) I21. B) I21. C) I21. D) I21. Answer: D Explanation: I21.01 specifies ST elevation (STEMI) of the anterior wall, initial encounter. Question 12. For a patient with type 2 diabetes mellitus with diabetic retinopathy, which code combination is correct? A) E11.9, H36. B) E11.321, H36. C) E11.321, H36.0 (with “with”)
D) E11.321 only Answer: C Explanation: Use the diabetes code with “with” to link the complication (E11.321) and add the specific retinopathy code (H36.0). Question 13. Which ICD‑ 10 ‑CM chapter contains the Z‑codes? A) Chapter 14 B) Chapter 20 C) Chapter 21 D) Chapter 22 Answer: C Explanation: Z‑codes are located in Chapter 21 (Factors influencing health status and contact with health services). Question 14. A pregnant woman at 30 weeks gestation is admitted for pre‑eclampsia. Which code takes sequencing priority? A) O14.0 (pre‑eclampsia) B) O13.2 (mild pre‑eclampsia) C) O24.41 (gestational diabetes) D) Any maternal condition takes priority over pregnancy codes Answer: A Explanation: Pregnancy‑related codes (Chapter 15) are sequenced before other conditions when both are present. Question 15. In the Tabular List, what does the “–” (dash) indicate? A) The code is not used B) A range of codes
D) Uncertain behavior Answer: B Explanation: Benign neoplasms are coded using the “Benign” column entries. Question 19. Which code indicates a subsequent encounter for a healing fracture of the right femur? A) S72.001A B) S72.001D C) S72.001G D) S72.001S Answer: C Explanation: “G” denotes a subsequent encounter for routine healing. Question 20. When coding HIV infection with no symptoms, which code is appropriate? A) B20.0 – HIV disease resulting in infectious and parasitic diseases B) B20.9 – HIV disease, unspecified C) Z21 – Asymptomatic HIV infection status D) R75 – Laboratory evidence of HIV Answer: C Explanation: Z21 is used for an asymptomatic HIV infection status when no disease manifestations are present. Question 21. For a patient with chronic obstructive pulmonary disease (COPD) exacerbation, which seventh‑character extension is required? A) A – Initial encounter B) D – Subsequent encounter C) G – Routine healing
D) S – Sequela Answer: A Explanation: An acute exacerbation is considered an initial encounter for the COPD episode. Question 22. In the context of external cause codes, what does the “E” prefix represent? A) Environmental factors B) External cause of injury C) Encounter type D) Etiology Answer: B Explanation: “E” codes (now V00‑Y99) describe external causes of morbidity and mortality. Question 23. Which of the following is a correct way to code a patient with a documented “history of myocardial infarction”? A) I21.9 – Acute myocardial infarction, unspecified B) Z86.74 – Personal history of myocardial infarction C) I25.2 – Old myocardial infarction D) Both B and C are acceptable Answer: B Explanation: Z86.74 specifically captures a personal history of MI without indicating current disease activity. Question 24. A newborn is diagnosed with congenital diaphragmatic hernia. Which chapter contains the appropriate code? A) Chapter 17 – Congenital malformations, deformations, and chromosomal abnormalities B) Chapter 12 – Diseases of the skin and subcutaneous tissue C) Chapter 9 – Diseases of the circulatory system
C) 2 – Left D) 3 – Bilateral Answer: C Explanation: “2” indicates left side involvement. Question 28. A patient receives a vaccination for influenza. Which Z‑code is appropriate? A) Z23 – Encounter for immunization B) Z20.2 – Contact with and exposure to influenza C) Z71.1 – Person with feared health complaint D) Z00.0 – General medical examination Answer: A Explanation: Z23 is used for encounters for immunization. Question 29. Which ICD‑ 10 ‑CM code would you assign for “unspecified fracture of the left radius, initial encounter for closed fracture”? A) S52.501A B) S52.501D C) S52.502A D) S52.502D Answer: A Explanation: S52.501A denotes an unspecified fracture of the left radius, initial encounter, closed fracture. Question 30. In the tabular list, a code ending in “‑ 0 ” often indicates: A) Unspecified laterality B) Unspecified severity C) Unspecified encounter type
D) Unspecified manifestation Answer: A Explanation: The “‑ 0 ” suffix typically represents “unspecified” laterality (right/left/bilateral). Question 31. Which code correctly identifies “chronic kidney disease, stage 3, unspecified”? A) N18.3 – Chronic kidney disease, stage 3 B) N18.30 – Chronic kidney disease, stage 3, unspecified C) N18.31 – Chronic kidney disease, stage 3, with proteinuria D) N18.39 – Chronic kidney disease, stage 3, other Answer: B Explanation: N18.30 specifies stage 3 CKD without additional descriptors. Question 32. A patient is diagnosed with “acute appendicitis, with peritonitis.” Which code is most accurate? A) K35.80 – Acute appendicitis without peritonitis B) K35.2 – Acute appendicitis with generalized peritonitis C) K35.3 – Acute appendicitis with localized peritonitis D) K36.0 – Other appendicitis Answer: B Explanation: K35.2 indicates acute appendicitis with generalized peritonitis. Question 33. Which of the following is an example of a “use additional code” instruction? A) “Exclude this code” B) “Code first” C) “Apply seventh character” D) “Use additional code for type of infection”
Answer: B Explanation: Z85.3 captures a personal history of breast cancer without current disease activity. Question 37. Which code represents “unspecified acute renal failure”? A) N17.9 – Acute kidney failure, unspecified B) N18.9 – Chronic kidney disease, unspecified C) R34.0 – Anuria and oliguria D) Z99.2 – Dependence on renal dialysis Answer: A Explanation: N17.9 is the code for unspecified acute kidney failure. Question 38. In ICD‑ 10 ‑CM, what does the “U” chapter (U00‑U85) represent? A) Special codes for clinical trials B) Codes for emergency use of new diseases (e.g., COVID‑19) C) Unused codes reserved for future updates D) Codes for uncommon infections Answer: B Explanation: Chapter U contains temporary codes for emerging infectious diseases, such as U07.1 for COVID‑19. Question 39. A patient suffers a “self‑inflicted gunshot wound to the abdomen.” Which external cause code is correct? A) X71.0XXA – Intentional self‑harm by discharge of a firearm, initial encounter B) Y22.4XXA – Assault by firearm, initial encounter C) X71.0XXD – Intentional self‑harm by discharge of a firearm, subsequent encounter D) V45.2 – Encounter for adjustment and management of personal health care Answer: A
Explanation: X71.0XXA captures intentional self‑harm (suicide attempt) by firearm, initial encounter. Question 40. Which of the following is a correct use of “laterality” for a bilateral condition? A) 1 – Right only B) 2 – Left only C) 3 – Bilateral D) 9 – Unspecified Answer: C Explanation: “3” is the laterality digit for bilateral involvement. Question 41. A patient with “acute exacerbation of chronic bronchitis” should be coded using which primary diagnosis code? A) J40 – Bronchitis, not specified as acute or chronic B) J44.1 – Chronic obstructive pulmonary disease with acute exacerbation C) J41.0 – Simple chronic bronchitis D) J45.901 – Unspecified asthma with (acute) exacerbation Answer: B Explanation: J44.1 specifically denotes COPD with an acute exacerbation, which includes chronic bronchitis. Question 42. Which code best describes “unspecified viral hepatitis without hepatic coma”? A) B19.10 – Unspecified viral hepatitis with hepatic coma B) B19.9 – Unspecified viral hepatitis, unspecified C) B19.10 – Unspecified viral hepatitis without hepatic coma D) B19.0 – Acute hepatitis A
C) 2 – Left D) 3 – Bilateral Answer: B Explanation: “1” denotes right‑side involvement. Question 46. A patient is seen for “screening for colorectal cancer.” Which Z‑code should be assigned? A) Z12.11 – Encounter for screening for malignant neoplasm of colon B) Z85.51 – Personal history of malignant neoplasm of colon C) Z13.9 – Encounter for other screening, unspecified D) Z71.3 – Dietary counseling and surveillance Answer: A Explanation: Z12.11 is the specific code for colorectal cancer screening. Question 47. Which code represents “acute pancreatitis, unspecified”? A) K85.9 – Acute pancreatitis, unspecified B) K86.0 – Alcoholic chronic pancreatitis C) K85.0 – Idiopathic acute pancreatitis D) R10.2 – Pelvic and perineal pain Answer: A Explanation: K85.9 is used for acute pancreatitis when the etiology is not specified. Question 48. A patient with “chronic sinusitis, allergic type” should be coded with which code? A) J32.0 – Chronic sinusitis, unspecified B) J30.1 – Allergic rhinitis due to pollen C) J32.8 – Other chronic sinusitis
D) J31.0 – Chronic rhinitis Answer: A Explanation: J32.0 captures chronic sinusitis without further specification; allergic type is not separately coded. Question 49. For a “first‑time encounter for chemotherapy for malignant neoplasm of breast,” which seventh‑character extension is required? A) A – Initial encounter B) D – Subsequent encounter C) G – Routine healing D) S – Sequela Answer: A Explanation: Chemotherapy administration is considered an initial encounter for the malignant neoplasm. Question 50. Which code is appropriate for “unspecified disorder of the thyroid”? A) E03.9 – Hypothyroidism, unspecified B) E04.9 – Nontoxic goiter, unspecified C) E07.9 – Disorder of thyroid, unspecified D) E06.9 – Thyroiditis, unspecified Answer: C Explanation: E07.9 is the generic “Disorder of thyroid, unspecified.” Question 51. A patient with “cerebral infarction due to embolism” should be coded with which primary diagnosis code? A) I63.9 – Cerebral infarction, unspecified B) I63.5 – Cerebral infarction due to embolism of unspecified artery
B) N49.9 – Disorder of male genital organs, unspecified C) N50.9 – Disorder of prostate, unspecified D) N51.9 – Disorder of testis, unspecified Answer: B Explanation: N49.9 captures unspecified disorders of male genital organs. Question 55. A patient is seen for “routine immunization against hepatitis B.” Which Z‑code applies? A) Z23 – Encounter for immunization B) Z71.1 – Person with feared health complaint C) Z20.6 – Contact with and exposure to hepatitis B virus D) Z72.0 – Tobacco use, current Answer: A Explanation: Z23 is the generic code for any immunization encounter. Question 56. Which code indicates “unspecified malignant neoplasm of the pancreas”? A) C25.9 – Malignant neoplasm of pancreas, unspecified B) C25.0 – Malignant neoplasm of head of pancreas C) C25.1 – Malignant neoplasm of body of pancreas D) C25.2 – Malignant neoplasm of tail of pancreas Answer: A Explanation: C25.9 is used when the pancreatic malignancy location is not specified. Question 57. For “chronic hepatitis B, carrier” which code is appropriate? A) B18.0 – Chronic viral hepatitis B without delta‑virus B) B18.1 – Chronic viral hepatitis B with delta‑virus
C) B18.2 – Chronic viral hepatitis C D) B19.9 – Unspecified viral hepatitis Answer: A Explanation: B18.0 captures chronic hepatitis B infection without co‑infection. Question 58. A patient presents with “acute otitis media, unilateral, left ear.” Which code is correct? A) H66.001 – Acute otitis media, unspecified ear, initial encounter B) H66.001A – Acute otitis media, left ear, initial encounter C) H66.001D – Acute otitis media, left ear, subsequent encounter D) H66.001S – Acute otitis media, left ear, sequela Answer: B Explanation: H66.001A specifies left ear involvement and initial encounter. Question 59. Which of the following is a “use additional code” instruction for “pneumonia due to Streptococcus pneumoniae”? A) Code the organism only. B) Use additional code for the type of pneumonia (e.g., lobar). C) Use additional code for the causative organism (J13). D) No additional code needed. Answer: C Explanation: The instruction directs coders to add the organism code J13 for Streptococcus pneumoniae. Question 60. A patient with “unspecified anemia” should be coded as: A) D50.9 – Iron deficiency anemia, unspecified B) D64.9 – Anemia, unspecified
