CCA EXAM PREPARATION 2026/2027 | Verified Edition
Questions and Answers | Certified Coding Associate Study
Guide | Pass Guaranteed - A+ Graded
Section 1: ICD-10-CM Diagnosis Coding (Questions 1-50)
Q1: A patient is admitted to the hospital with chest pain. After workup, the physician documents,
"Acute myocardial infarction ruled out." According to the ICD-10-CM Official Guidelines for
Coding and Reporting, how should this be coded?
A. Code only the chest pain
B. Code the acute myocardial infarction as if it were confirmed
C. Code both chest pain and acute myocardial infarction
D. Code a Z-code for observation
Correct Answer: A
Rationale: The ICD-10-CM Official Guidelines Section II.H state that if the diagnosis
documented at the time of discharge is qualified as "probable," "suspected," "likely,"
"questionable," "rule out," or "compatible with," the code for the condition should not be
assigned. Only the signs and symptoms (chest pain) are coded. CCA Exam Preparation Tip:
The CCA exam frequently tests the "rule out" guideline for inpatient encounters; remember that
this rule applies only to inpatient admissions, not outpatient encounters.
Q2: A patient with Type 2 diabetes mellitus is admitted for diabetic ketoacidosis. The physician
documents "Type 2 diabetes mellitus with diabetic ketoacidosis." How should this be
sequenced?
A. E11.10, E11.65
B. E11.65
C. E11.10
D. E13.10
Correct Answer: B
Rationale: ICD-10-CM assumes a cause-and-effect relationship between diabetes and certain
complications. Diabetic ketoacidosis is a direct manifestation of diabetes, requiring a
combination code (E11.65, Type 2 diabetes mellitus with hyperglycemia, or the specific
ketoacidosis code depending on the index, but per guidelines, the manifestation is not coded
,separately if a combination code exists). E11.10 is for diabetes without complications. E13 is for
other specified diabetes. CCA Exam Preparation Tip: Always use the Alphabetic Index to find
the specific combination code for diabetes with its manifestations rather than coding them
separately.
Q3: In the ICD-10-CM Tabular List, a code has an Excludes1 note. What does this indicate?
A. The condition is not included here but can be coded together if documented
B. The two conditions cannot occur together
C. The code is not to be used as a principal diagnosis
D. The code requires an additional code to fully define the condition
Correct Answer: B
Rationale: An Excludes1 note means "Not coded here." It indicates that the two conditions are
mutually exclusive; they cannot occur together. If a patient has both conditions, only one can be
coded, typically the underlying condition. An Excludes2 note means "Not included here,"
indicating the conditions can occur together and both may be coded. CCA Exam Preparation
Tip: Distinguishing between Excludes1 and Excludes2 is a fundamental recall question on the
CCA exam; Excludes1 means "mutually exclusive," while Excludes2 means "not included here."
Q4: A patient has essential hypertension and hypertensive heart disease with heart failure. The
physician documents both conditions. Which code is sequenced first?
A. I11.0
B. I11.9
C. I50.9
D. I10
Correct Answer: A
Rationale: Per ICD-10-CM guidelines, when a patient has both hypertensive heart disease and
heart failure, a combination code (I11.0, Hypertensive heart disease with heart failure) is
assigned. Hypertension is inherently included in this code and is not coded separately using I10.
Heart failure is also included in the combination code. CCA Exam Preparation Tip: Memorize
the hypertension combination codes (I11.0, I11.9, I12.0, I13.0, I13.2) as the CCA exam
frequently presents scenarios where separate coding for hypertension and the organ damage is
incorrect.
,Q5: A patient is admitted with severe sepsis due to a methicillin-sensitive Staphylococcus
aureus (MSSA) wound infection and septic shock. How should this be coded?
A. A41.2, T81.4XXA, R65.20
B. A41.2, T81.4XXA, R65.21
C. R65.21, A41.2, T81.4XXA
D. A41.2, R65.21
Correct Answer: B
Rationale: The sequencing for severe sepsis requires the underlying systemic infection code
(A41.2) sequenced first, followed by the severe sepsis code (R65.20) if no organ dysfunction is
specified, or the septic shock code (R65.21) if shock is present. The code for the localized
infection (T81.4XXA, postprocedural wound infection) is also assigned as an additional code.
Septic shock cannot be assigned without a code for severe sepsis, but R65.21 encompasses
both severe sepsis and septic shock. CCA Exam Preparation Tip: Septic shock coding is heavily
tested; remember that R65.21 replaces R65.20 when shock is present, and the underlying
infection is always sequenced first.
Q6: A patient presents to the emergency department after falling off a ladder and sustaining a
displaced fracture of the right femur. The fracture is treated with open reduction and internal
fixation. What 7th character is used for the initial encounter?
A. A
B. B
C. D
D. S
Correct Answer: B
Rationale: For fractures, the 7th character extensions are used to identify the episode of care.
"A" represents initial encounter for a closed fracture, and "B" represents initial encounter for an
open fracture. Since this is an open fracture (treated with ORIF), "B" is the correct character. "D"
is for subsequent encounters, and "S" is for sequela. CCA Exam Preparation Tip: Do not
confuse the 7th character with the type of treatment; "initial encounter" does not mean "only
when seen in the ED," it means while the patient is receiving active treatment for the fracture.
Q7: A patient is seen for a routine prenatal visit for her first pregnancy. She has no
complications. What is the correct ICD-10-CM code?
A. Z34.00
B. Z34.81
C. O09.00
, D. Z00.00
Correct Answer: A
Rationale: Z34.00 is the correct code for a routine prenatal visit for a first pregnancy with no
complications. The 7th character in the Z34 category denotes the number of previous
pregnancies (0 for none). O09 is used for supervision of high-risk pregnancies. Z00.00 is a
general adult exam. CCA Exam Preparation Tip: Pay close attention to the 7th character
extensions in the Z34 category, which indicate the trimester and the number of previous
pregnancies, not the number of fetuses.
Q8: A patient is brought to the ER after being intentionally struck by another person, resulting in
a contusion of the left shoulder. Which external cause code accurately reflects the intent?
A. W50.0XXA
B. Y04.0XXA
C. X92.XXXA
D. V04.10XA
Correct Answer: B
Rationale: External cause codes in the Y00-Y09 range denote assault. Y04.0XXA specifically
represents being struck by another person, initial encounter. W50 codes are for accidental
striking against or being struck by objects. X92 is for assault by cut/pierce. V04 is a transport
accident. CCA Exam Preparation Tip: The CCA exam tests your ability to identify the correct
intent (accidental, assault, self-harm, undetermined) within the V00-Y99 external cause code
range.
Q9: An inpatient admission note lists "History of COPD" in the past medical history. The patient
is admitted for pneumonia. The physician does not document any treatment for COPD during
this stay. How is the COPD coded?
A. Code J44.9 as a secondary diagnosis with a POA indicator of N
B. Code Z87.09 as a secondary diagnosis with a POA indicator of N
C. Do not code the COPD
D. Code J44.9 as a secondary diagnosis with a POA indicator of Y
Correct Answer: B
Rationale: Per ICD-10-CM guidelines, history codes (Z80-Z87) explain a patient's past medical
history that may impact current care or be relevant to the encounter. Since the COPD is not
being treated and is strictly historical, Z87.09 (Personal history of other diseases of the
respiratory system) is assigned. The POA indicator is "N" (No) because it is a history code. CCA
Questions and Answers | Certified Coding Associate Study
Guide | Pass Guaranteed - A+ Graded
Section 1: ICD-10-CM Diagnosis Coding (Questions 1-50)
Q1: A patient is admitted to the hospital with chest pain. After workup, the physician documents,
"Acute myocardial infarction ruled out." According to the ICD-10-CM Official Guidelines for
Coding and Reporting, how should this be coded?
A. Code only the chest pain
B. Code the acute myocardial infarction as if it were confirmed
C. Code both chest pain and acute myocardial infarction
D. Code a Z-code for observation
Correct Answer: A
Rationale: The ICD-10-CM Official Guidelines Section II.H state that if the diagnosis
documented at the time of discharge is qualified as "probable," "suspected," "likely,"
"questionable," "rule out," or "compatible with," the code for the condition should not be
assigned. Only the signs and symptoms (chest pain) are coded. CCA Exam Preparation Tip:
The CCA exam frequently tests the "rule out" guideline for inpatient encounters; remember that
this rule applies only to inpatient admissions, not outpatient encounters.
Q2: A patient with Type 2 diabetes mellitus is admitted for diabetic ketoacidosis. The physician
documents "Type 2 diabetes mellitus with diabetic ketoacidosis." How should this be
sequenced?
A. E11.10, E11.65
B. E11.65
C. E11.10
D. E13.10
Correct Answer: B
Rationale: ICD-10-CM assumes a cause-and-effect relationship between diabetes and certain
complications. Diabetic ketoacidosis is a direct manifestation of diabetes, requiring a
combination code (E11.65, Type 2 diabetes mellitus with hyperglycemia, or the specific
ketoacidosis code depending on the index, but per guidelines, the manifestation is not coded
,separately if a combination code exists). E11.10 is for diabetes without complications. E13 is for
other specified diabetes. CCA Exam Preparation Tip: Always use the Alphabetic Index to find
the specific combination code for diabetes with its manifestations rather than coding them
separately.
Q3: In the ICD-10-CM Tabular List, a code has an Excludes1 note. What does this indicate?
A. The condition is not included here but can be coded together if documented
B. The two conditions cannot occur together
C. The code is not to be used as a principal diagnosis
D. The code requires an additional code to fully define the condition
Correct Answer: B
Rationale: An Excludes1 note means "Not coded here." It indicates that the two conditions are
mutually exclusive; they cannot occur together. If a patient has both conditions, only one can be
coded, typically the underlying condition. An Excludes2 note means "Not included here,"
indicating the conditions can occur together and both may be coded. CCA Exam Preparation
Tip: Distinguishing between Excludes1 and Excludes2 is a fundamental recall question on the
CCA exam; Excludes1 means "mutually exclusive," while Excludes2 means "not included here."
Q4: A patient has essential hypertension and hypertensive heart disease with heart failure. The
physician documents both conditions. Which code is sequenced first?
A. I11.0
B. I11.9
C. I50.9
D. I10
Correct Answer: A
Rationale: Per ICD-10-CM guidelines, when a patient has both hypertensive heart disease and
heart failure, a combination code (I11.0, Hypertensive heart disease with heart failure) is
assigned. Hypertension is inherently included in this code and is not coded separately using I10.
Heart failure is also included in the combination code. CCA Exam Preparation Tip: Memorize
the hypertension combination codes (I11.0, I11.9, I12.0, I13.0, I13.2) as the CCA exam
frequently presents scenarios where separate coding for hypertension and the organ damage is
incorrect.
,Q5: A patient is admitted with severe sepsis due to a methicillin-sensitive Staphylococcus
aureus (MSSA) wound infection and septic shock. How should this be coded?
A. A41.2, T81.4XXA, R65.20
B. A41.2, T81.4XXA, R65.21
C. R65.21, A41.2, T81.4XXA
D. A41.2, R65.21
Correct Answer: B
Rationale: The sequencing for severe sepsis requires the underlying systemic infection code
(A41.2) sequenced first, followed by the severe sepsis code (R65.20) if no organ dysfunction is
specified, or the septic shock code (R65.21) if shock is present. The code for the localized
infection (T81.4XXA, postprocedural wound infection) is also assigned as an additional code.
Septic shock cannot be assigned without a code for severe sepsis, but R65.21 encompasses
both severe sepsis and septic shock. CCA Exam Preparation Tip: Septic shock coding is heavily
tested; remember that R65.21 replaces R65.20 when shock is present, and the underlying
infection is always sequenced first.
Q6: A patient presents to the emergency department after falling off a ladder and sustaining a
displaced fracture of the right femur. The fracture is treated with open reduction and internal
fixation. What 7th character is used for the initial encounter?
A. A
B. B
C. D
D. S
Correct Answer: B
Rationale: For fractures, the 7th character extensions are used to identify the episode of care.
"A" represents initial encounter for a closed fracture, and "B" represents initial encounter for an
open fracture. Since this is an open fracture (treated with ORIF), "B" is the correct character. "D"
is for subsequent encounters, and "S" is for sequela. CCA Exam Preparation Tip: Do not
confuse the 7th character with the type of treatment; "initial encounter" does not mean "only
when seen in the ED," it means while the patient is receiving active treatment for the fracture.
Q7: A patient is seen for a routine prenatal visit for her first pregnancy. She has no
complications. What is the correct ICD-10-CM code?
A. Z34.00
B. Z34.81
C. O09.00
, D. Z00.00
Correct Answer: A
Rationale: Z34.00 is the correct code for a routine prenatal visit for a first pregnancy with no
complications. The 7th character in the Z34 category denotes the number of previous
pregnancies (0 for none). O09 is used for supervision of high-risk pregnancies. Z00.00 is a
general adult exam. CCA Exam Preparation Tip: Pay close attention to the 7th character
extensions in the Z34 category, which indicate the trimester and the number of previous
pregnancies, not the number of fetuses.
Q8: A patient is brought to the ER after being intentionally struck by another person, resulting in
a contusion of the left shoulder. Which external cause code accurately reflects the intent?
A. W50.0XXA
B. Y04.0XXA
C. X92.XXXA
D. V04.10XA
Correct Answer: B
Rationale: External cause codes in the Y00-Y09 range denote assault. Y04.0XXA specifically
represents being struck by another person, initial encounter. W50 codes are for accidental
striking against or being struck by objects. X92 is for assault by cut/pierce. V04 is a transport
accident. CCA Exam Preparation Tip: The CCA exam tests your ability to identify the correct
intent (accidental, assault, self-harm, undetermined) within the V00-Y99 external cause code
range.
Q9: An inpatient admission note lists "History of COPD" in the past medical history. The patient
is admitted for pneumonia. The physician does not document any treatment for COPD during
this stay. How is the COPD coded?
A. Code J44.9 as a secondary diagnosis with a POA indicator of N
B. Code Z87.09 as a secondary diagnosis with a POA indicator of N
C. Do not code the COPD
D. Code J44.9 as a secondary diagnosis with a POA indicator of Y
Correct Answer: B
Rationale: Per ICD-10-CM guidelines, history codes (Z80-Z87) explain a patient's past medical
history that may impact current care or be relevant to the encounter. Since the COPD is not
being treated and is strictly historical, Z87.09 (Personal history of other diseases of the
respiratory system) is assigned. The POA indicator is "N" (No) because it is a history code. CCA
