AHIMA CCA CASE STUDIES 2026/2027 – CERTIFIED CODING ASSOCIATE CODING
PRACTICE & EXAM REVIEW
CASE INSTRUCTIONS:
To view this health record:
Click on the tabs above.
Scroll to the bottom of each document.
For your reference, the Coding Guidelines tab includes information from your codebooks.
To answer the questions in this case:
Enter the appropriate codes in the boxes on the right.
Enter a DX code in every box.
Any necessary decimal point must be present and correctly placed.
Do not include spaces with your answer.
----------
CODING GUIDELINES
*Candidates will need to click on each tab to review the reports. Candidates will be instructed on exactly
how many codes are required. The key will be displayed as to which codes are required, meaning
Diagnosis or Procedure and how many. In this sample question, the case requires 1 Diagnosis code and 1
Procedure code. If the candidate gets both codes correct they will receive two (2) points. If they get one
(1) correct and one (1) incorrect they will receive 1 poi - ✔✔Case Studies
PDX 337.22 Reflex sympathetic dystrophy of the lower limb
PP1 64520-LT Injection, anesthetic agent; lumbar or thoracic (paravertebral sympathetic)
PR2 77003 Fluoroscopic guidance and localization of needle or catheter tip for spine or paraspinous
diagnostic or therapeutic injection procedures (epidural or subarachnoid)
Notes for Practice Outpatient Case—Patient 3
337.22 The diagnostic code is needed to establish the medical necessity for the procedure and a pain
management code is not appropriate because the underlying condition is being treated (Brown 2012,
163).64520-LT When coding paravertebral spinal nerves and branches, it is appropriate to use the
modifiers to note the laterality (CPT Assistant July 1998, 10; April 2005, 13).
77003 Fluoroscopic guidance is not included in the 64520 code; hence, it is therefore appropriate to
code a second code (CPT Assistant March 2007, 7; July 2008, 9; February 2010, 12).
(Garvin 2013, 55, 251.)
AMBULATORY RECORD
DATE: 8/12/20XX
SURGERY RECORD:
, PATIENT HISTORY: This patient is seen today to insert an intrathecal pump for pain management due to
ductal carcinoma of the left upper breast metastatic to the spine. She previously underwent modified
radical mastectomy with general anesthesia and had no adverse effects. No other surgical history is
given. No known allergies, no current medications. Review of systems is normal ASA = 2.
Following preoperative evaluation and discussion with the patient, local anesthesia was used to implant
an intrathecal programmable pump surgically placed and attached to a previously placed catheter. The
patient tolerated the procedure well. There were no adverse effects of anesthesia.
-----------
Enter three diagnosis codes and one procedure code.
PDX
DX2
DX3
PP1 - ✔✔Case Studies
PDX 338.3 Neoplasm-related pain (acute) (chronic)
DX2 174.8 Malignant neoplasm of female breast, other specified sites
DX3 198.5 Secondary malignant neoplasm of bone and bone marrow
PP1 62362 Implantation or replacement of device for intrathecal or epidural drug infusion;
programmable pump, including preparation of pump, with or without programming
Notes for Practice Outpatient Case—Patient 2
338.3 The patient is admitted for pain management due to metastatic cancer. If the admission is for pain
control related to, associated with, or due to, a malignancy, code 338.3 (Brown 2012, 163; Coding Clinic
2nd Quarter 2007, 13-14).
174.8, 198.5 The primary site and metastatic (secondary) sites should be coded (Brown 2012, 378-382).
62362 The reservoir is surgically placed and attached to a previously placed catheter (CPT Assistant
March 1997, 11).
(Garvin 2013, 54, 250.)
EMERGENCY DEPARTMENT RECORD
DATE OF ADMISSION: 8/19 DATE OF DISCHARGE: 8/19
HISTORY (Problem Focused):
ADMISSION HISTORY: This is a 13-year-old African-American male. He became short of breath, used his
inhaler as described but continued to have wheezing and shortness of breath.
ALLERGIES: None
CHRONIC MEDICATIONS: Albuterol inhaler
PRACTICE & EXAM REVIEW
CASE INSTRUCTIONS:
To view this health record:
Click on the tabs above.
Scroll to the bottom of each document.
For your reference, the Coding Guidelines tab includes information from your codebooks.
To answer the questions in this case:
Enter the appropriate codes in the boxes on the right.
Enter a DX code in every box.
Any necessary decimal point must be present and correctly placed.
Do not include spaces with your answer.
----------
CODING GUIDELINES
*Candidates will need to click on each tab to review the reports. Candidates will be instructed on exactly
how many codes are required. The key will be displayed as to which codes are required, meaning
Diagnosis or Procedure and how many. In this sample question, the case requires 1 Diagnosis code and 1
Procedure code. If the candidate gets both codes correct they will receive two (2) points. If they get one
(1) correct and one (1) incorrect they will receive 1 poi - ✔✔Case Studies
PDX 337.22 Reflex sympathetic dystrophy of the lower limb
PP1 64520-LT Injection, anesthetic agent; lumbar or thoracic (paravertebral sympathetic)
PR2 77003 Fluoroscopic guidance and localization of needle or catheter tip for spine or paraspinous
diagnostic or therapeutic injection procedures (epidural or subarachnoid)
Notes for Practice Outpatient Case—Patient 3
337.22 The diagnostic code is needed to establish the medical necessity for the procedure and a pain
management code is not appropriate because the underlying condition is being treated (Brown 2012,
163).64520-LT When coding paravertebral spinal nerves and branches, it is appropriate to use the
modifiers to note the laterality (CPT Assistant July 1998, 10; April 2005, 13).
77003 Fluoroscopic guidance is not included in the 64520 code; hence, it is therefore appropriate to
code a second code (CPT Assistant March 2007, 7; July 2008, 9; February 2010, 12).
(Garvin 2013, 55, 251.)
AMBULATORY RECORD
DATE: 8/12/20XX
SURGERY RECORD:
, PATIENT HISTORY: This patient is seen today to insert an intrathecal pump for pain management due to
ductal carcinoma of the left upper breast metastatic to the spine. She previously underwent modified
radical mastectomy with general anesthesia and had no adverse effects. No other surgical history is
given. No known allergies, no current medications. Review of systems is normal ASA = 2.
Following preoperative evaluation and discussion with the patient, local anesthesia was used to implant
an intrathecal programmable pump surgically placed and attached to a previously placed catheter. The
patient tolerated the procedure well. There were no adverse effects of anesthesia.
-----------
Enter three diagnosis codes and one procedure code.
PDX
DX2
DX3
PP1 - ✔✔Case Studies
PDX 338.3 Neoplasm-related pain (acute) (chronic)
DX2 174.8 Malignant neoplasm of female breast, other specified sites
DX3 198.5 Secondary malignant neoplasm of bone and bone marrow
PP1 62362 Implantation or replacement of device for intrathecal or epidural drug infusion;
programmable pump, including preparation of pump, with or without programming
Notes for Practice Outpatient Case—Patient 2
338.3 The patient is admitted for pain management due to metastatic cancer. If the admission is for pain
control related to, associated with, or due to, a malignancy, code 338.3 (Brown 2012, 163; Coding Clinic
2nd Quarter 2007, 13-14).
174.8, 198.5 The primary site and metastatic (secondary) sites should be coded (Brown 2012, 378-382).
62362 The reservoir is surgically placed and attached to a previously placed catheter (CPT Assistant
March 1997, 11).
(Garvin 2013, 54, 250.)
EMERGENCY DEPARTMENT RECORD
DATE OF ADMISSION: 8/19 DATE OF DISCHARGE: 8/19
HISTORY (Problem Focused):
ADMISSION HISTORY: This is a 13-year-old African-American male. He became short of breath, used his
inhaler as described but continued to have wheezing and shortness of breath.
ALLERGIES: None
CHRONIC MEDICATIONS: Albuterol inhaler
