Certified Inpatient Coder (CIC®) Exam Prep 2026
Updated Practice Questions – Comprehensive Inpatient
Coding Review Detailed Explanations – Verified Answers
– Success Workbook
SECTION 1: CODING CASES – ICD-10-CM & ICD-10-PCS (65% of Exam)
Question 1
A 68-year-old male is admitted with sepsis due to a urinary tract infection
(UTI) caused by E. coli. The patient develops acute kidney injury during the
admission. The physician documents the final diagnoses as: Sepsis due to E.
coli, UTI, and acute kidney injury. What is the correct principal diagnosis ?
A) N39.0 – Urinary tract infection, site not specified
B) N17.9 – Acute kidney injury, unspecified
C) A41.51 – Sepsis due to Escherichia coli (E. coli)
D) R65.20 – Severe sepsis without septic shock
Rationale: The principal diagnosis is the condition established after study to
be chiefly responsible for the admission. Sepsis is the overarching reason for
admission in this case. The UTI is the cause of the sepsis, and the acute kidney
injury is a manifestation of the sepsis. ICD-10-CM guidelines state that when
sepsis is present, the sepsis code should be sequenced as the principal
diagnosis, followed by the code for the underlying infection (UTI) and any
manifestations (acute kidney injury).
Question 2
A patient undergoes a laparoscopic cholecystectomy for acute cholecystitis.
The surgeon documents the procedure as "laparoscopic cholecystectomy with
intraoperative cholangiogram." What is the correct ICD-10-PCS code for
the root operation ?
A) Resection
B) Excision
,C) Removal
D) Destruction
Rationale: In ICD-10-PCS, the root operation Excision is defined as cutting
out or off, without replacement, a portion of a body part. A cholecystectomy
involves the removal of the gallbladder, which is a portion of the biliary
system. Resection would be used if the entire body part (e.g., the entire
biliary system) were removed. The presence of the cholangiogram does not
change the root operation for the cholecystectomy; it is captured in the device
or approach values.
Question 3
A patient is admitted with acute exacerbation of COPD and pneumonia. The
physician documents both conditions as equally contributing to the
admission. What is the correct sequencing of the principal diagnosis?
A) J44.1 – COPD with (acute) exacerbation
B) J44.0 – COPD with acute lower respiratory infection
C) J18.9 – Pneumonia, unspecified organism
D) J44.9 – COPD, unspecified
Rationale: When a patient with COPD has an acute exacerbation and
pneumonia, ICD-10-CM guidelines state that the combination
code J44.0 (Chronic obstructive pulmonary disease with acute lower
respiratory infection) should be used. This combination code captures both
the COPD exacerbation and the pneumonia. The pneumonia is a lower
respiratory infection. Sequencing the individual codes separately would be
incorrect when a combination code exists.
Question 4
A patient undergoes a coronary artery bypass graft (CABG) with four
bypasses using saphenous vein grafts from the left leg. The surgeon
performs a left internal mammary artery (LIMA) graft to the left anterior
descending (LAD) artery and three saphenous vein grafts to the circumflex
and right coronary arteries. What is the correct ICD-10-PCS code assignment?
,A) 021209W – Bypass coronary artery, one site, with autologous venous
tissue, open approach
B) 021209W, 02100Z9, 02100Z9, 02100Z9 – Multiple bypass codes
C) 02120Z9 – Bypass coronary artery, one site, with autologous arterial tissue,
open approach
D) 021109W – Bypass coronary artery, one site, with autologous venous
tissue, percutaneous approach
Rationale: ICD-10-PCS requires a separate code for each coronary artery
bypass. The LIMA graft is a bypass using autologous arterial tissue, while the
saphenous vein grafts use autologous venous tissue. Each bypass is coded
separately with the appropriate body part (coronary artery), device
(autologous venous or arterial tissue), and approach (open). A single code
would not capture the multiple bypasses.
Question 5
A 72-year-old female is admitted with acute ST-elevation myocardial
infarction (STEMI) of the anterior wall. During the admission, she
undergoes percutaneous coronary intervention (PCI) with drug-eluting
stent placement in the left anterior descending (LAD) artery. What is the
correct principal diagnosis?
A) I21.09 – STEMI involving other coronary artery of anterior wall
B) I21.02 – STEMI involving left anterior descending coronary artery
C) Z95.5 – Presence of coronary angioplasty implant and graft
D) I25.10 – Atherosclerotic heart disease of native coronary artery
Rationale: The principal diagnosis is the acute STEMI, which is the reason for
the admission. I21.02 is the specific code for STEMI involving the LAD artery.
The PCI with stent placement is a procedure performed during the admission
and is coded separately with ICD-10-PCS codes. The presence of the stent
(Z95.5) is not the principal diagnosis.
Question 6
, A patient is admitted for total knee arthroplasty (TKA) of the left knee. The
surgeon performs a cemented total knee replacement with a polyethylene
insert. What is the correct ICD-10-PCS root operation?
A) Excision
B) Replacement
C) Repair
D) Fusion
Rationale: The root operation Replacement is defined as putting in or on a
biological or synthetic material that physically takes the place and/or function
of all or a portion of a body part. A total knee arthroplasty involves replacing
the diseased knee joint with prosthetic components, making Replacement the
correct root operation. Excision is for removal of a portion without
replacement. Fusion is for joining body parts.
Question 7
A patient is admitted with cerebral infarction (stroke). The physician
documents "acute ischemic stroke, left middle cerebral artery (MCA)
territory." What is the correct ICD-10-CM code for the principal diagnosis?
A) I63.9 – Cerebral infarction, unspecified
B) I63.512 – Cerebral infarction due to unspecified occlusion or stenosis
of left middle cerebral artery
C) I63.511 – Cerebral infarction due to unspecified occlusion or stenosis of
right middle cerebral artery
D) I69.30 – Late effects of cerebral infarction
Rationale: ICD-10-CM requires specificity for the artery and laterality.
I63.512 is the code for cerebral infarction due to unspecified occlusion or
stenosis of the left middle cerebral artery. I63.511 is for the right MCA. I63.9 is
unspecified and would not capture the documented artery. I69.30 is for late
effects, which is not appropriate for an acute stroke.
Question 8
Updated Practice Questions – Comprehensive Inpatient
Coding Review Detailed Explanations – Verified Answers
– Success Workbook
SECTION 1: CODING CASES – ICD-10-CM & ICD-10-PCS (65% of Exam)
Question 1
A 68-year-old male is admitted with sepsis due to a urinary tract infection
(UTI) caused by E. coli. The patient develops acute kidney injury during the
admission. The physician documents the final diagnoses as: Sepsis due to E.
coli, UTI, and acute kidney injury. What is the correct principal diagnosis ?
A) N39.0 – Urinary tract infection, site not specified
B) N17.9 – Acute kidney injury, unspecified
C) A41.51 – Sepsis due to Escherichia coli (E. coli)
D) R65.20 – Severe sepsis without septic shock
Rationale: The principal diagnosis is the condition established after study to
be chiefly responsible for the admission. Sepsis is the overarching reason for
admission in this case. The UTI is the cause of the sepsis, and the acute kidney
injury is a manifestation of the sepsis. ICD-10-CM guidelines state that when
sepsis is present, the sepsis code should be sequenced as the principal
diagnosis, followed by the code for the underlying infection (UTI) and any
manifestations (acute kidney injury).
Question 2
A patient undergoes a laparoscopic cholecystectomy for acute cholecystitis.
The surgeon documents the procedure as "laparoscopic cholecystectomy with
intraoperative cholangiogram." What is the correct ICD-10-PCS code for
the root operation ?
A) Resection
B) Excision
,C) Removal
D) Destruction
Rationale: In ICD-10-PCS, the root operation Excision is defined as cutting
out or off, without replacement, a portion of a body part. A cholecystectomy
involves the removal of the gallbladder, which is a portion of the biliary
system. Resection would be used if the entire body part (e.g., the entire
biliary system) were removed. The presence of the cholangiogram does not
change the root operation for the cholecystectomy; it is captured in the device
or approach values.
Question 3
A patient is admitted with acute exacerbation of COPD and pneumonia. The
physician documents both conditions as equally contributing to the
admission. What is the correct sequencing of the principal diagnosis?
A) J44.1 – COPD with (acute) exacerbation
B) J44.0 – COPD with acute lower respiratory infection
C) J18.9 – Pneumonia, unspecified organism
D) J44.9 – COPD, unspecified
Rationale: When a patient with COPD has an acute exacerbation and
pneumonia, ICD-10-CM guidelines state that the combination
code J44.0 (Chronic obstructive pulmonary disease with acute lower
respiratory infection) should be used. This combination code captures both
the COPD exacerbation and the pneumonia. The pneumonia is a lower
respiratory infection. Sequencing the individual codes separately would be
incorrect when a combination code exists.
Question 4
A patient undergoes a coronary artery bypass graft (CABG) with four
bypasses using saphenous vein grafts from the left leg. The surgeon
performs a left internal mammary artery (LIMA) graft to the left anterior
descending (LAD) artery and three saphenous vein grafts to the circumflex
and right coronary arteries. What is the correct ICD-10-PCS code assignment?
,A) 021209W – Bypass coronary artery, one site, with autologous venous
tissue, open approach
B) 021209W, 02100Z9, 02100Z9, 02100Z9 – Multiple bypass codes
C) 02120Z9 – Bypass coronary artery, one site, with autologous arterial tissue,
open approach
D) 021109W – Bypass coronary artery, one site, with autologous venous
tissue, percutaneous approach
Rationale: ICD-10-PCS requires a separate code for each coronary artery
bypass. The LIMA graft is a bypass using autologous arterial tissue, while the
saphenous vein grafts use autologous venous tissue. Each bypass is coded
separately with the appropriate body part (coronary artery), device
(autologous venous or arterial tissue), and approach (open). A single code
would not capture the multiple bypasses.
Question 5
A 72-year-old female is admitted with acute ST-elevation myocardial
infarction (STEMI) of the anterior wall. During the admission, she
undergoes percutaneous coronary intervention (PCI) with drug-eluting
stent placement in the left anterior descending (LAD) artery. What is the
correct principal diagnosis?
A) I21.09 – STEMI involving other coronary artery of anterior wall
B) I21.02 – STEMI involving left anterior descending coronary artery
C) Z95.5 – Presence of coronary angioplasty implant and graft
D) I25.10 – Atherosclerotic heart disease of native coronary artery
Rationale: The principal diagnosis is the acute STEMI, which is the reason for
the admission. I21.02 is the specific code for STEMI involving the LAD artery.
The PCI with stent placement is a procedure performed during the admission
and is coded separately with ICD-10-PCS codes. The presence of the stent
(Z95.5) is not the principal diagnosis.
Question 6
, A patient is admitted for total knee arthroplasty (TKA) of the left knee. The
surgeon performs a cemented total knee replacement with a polyethylene
insert. What is the correct ICD-10-PCS root operation?
A) Excision
B) Replacement
C) Repair
D) Fusion
Rationale: The root operation Replacement is defined as putting in or on a
biological or synthetic material that physically takes the place and/or function
of all or a portion of a body part. A total knee arthroplasty involves replacing
the diseased knee joint with prosthetic components, making Replacement the
correct root operation. Excision is for removal of a portion without
replacement. Fusion is for joining body parts.
Question 7
A patient is admitted with cerebral infarction (stroke). The physician
documents "acute ischemic stroke, left middle cerebral artery (MCA)
territory." What is the correct ICD-10-CM code for the principal diagnosis?
A) I63.9 – Cerebral infarction, unspecified
B) I63.512 – Cerebral infarction due to unspecified occlusion or stenosis
of left middle cerebral artery
C) I63.511 – Cerebral infarction due to unspecified occlusion or stenosis of
right middle cerebral artery
D) I69.30 – Late effects of cerebral infarction
Rationale: ICD-10-CM requires specificity for the artery and laterality.
I63.512 is the code for cerebral infarction due to unspecified occlusion or
stenosis of the left middle cerebral artery. I63.511 is for the right MCA. I63.9 is
unspecified and would not capture the documented artery. I69.30 is for late
effects, which is not appropriate for an acute stroke.
Question 8
