1
CCS CERTIFICATION EXAM 2026/2027 | CERTIFIED
CODING SPECIALIST | 100 VERIFIED Q&A | DETAILED
RATIONALES | PASS GUARANTEED – A+ GRADED
SECTION 1: ICD-10-CM CODING GUIDELINES - Questions 1-15
Q1: ICD-10-CM Structure
The student is reviewing ICD-10-CM coding. What is the correct structure of an ICD-10-CM diagnosis
code?
A. 3-5 characters, with the first character always a letter
B. 3-7 characters, with the first character always a letter
C. 3-7 characters, with the first character always a number
D. 3-5 characters, with the first character always a number
Correct Answer: B
Rationale: ICD-10-CM codes are 3-7 characters in length. The first character is always a letter (A-Z),
followed by numbers and possibly additional letters. The structure allows for greater specificity than
ICD-9-CM. [100% CORRECT]
Q2: Seventh Character Extensions
The student is reviewing ICD-10-CM. What is the purpose of the 7th character in ICD-10-CM?
A. To identify the severity of the condition
B. To identify the episode of care or laterality
C. To identify the anatomical site
D. To identify the causative organism
Correct Answer: B
Rationale: The 7th character is used in certain chapters (e.g., injuries, fractures, obstetric) to indicate
the episode of care (initial encounter, subsequent encounter, sequela) or laterality. It is not used for
all codes. [100% CORRECT]
Q3: Excludes1 Notes
The student is reviewing coding guidelines. What does an Excludes1 note indicate?
A. The two conditions cannot be coded together; the code excluded should never be used with the
code above it
B. The two conditions may be coded together if desired
C. The excluded code is optional
D. The excluded code is the primary diagnosis
,2
Correct Answer: A
Rationale: Excludes1 means the two conditions are mutually exclusive. The code excluded should
never be used at the same time as the code above it. Excludes2 means the two conditions may
coexist. [100% CORRECT]
Q4: Excludes2 Notes
The student is reviewing coding guidelines. What does an Excludes2 note indicate?
A. The two conditions cannot be coded together
B. The two conditions may be coded together if both are present
C. The excluded code is always the primary diagnosis
D. The excluded code is never coded
Correct Answer: B
Rationale: Excludes2 means the condition excluded is not part of the condition represented by the
code, but the patient may have both conditions at the same time. Both codes may be used if
applicable. [100% CORRECT]
Q5: Code First/Use Additional Code
The student is reviewing coding guidelines. What does "Code First" mean in ICD-10-CM?
A. The code listed after "Code First" is the primary diagnosis
B. The condition listed after "Code First" is the underlying cause and should be sequenced first
C. The code should be sequenced last
D. The code is optional
Correct Answer: B
Rationale: "Code First" indicates that the condition listed should be sequenced before the code to
which the note is attached. It identifies the underlying cause or etiology. [100% CORRECT]
Q6: Signs and Symptoms
The student is reviewing coding guidelines. When should a sign or symptom code be used?
A. When the definitive diagnosis has been established
B. When the definitive diagnosis has not been established
C. Never
D. Always as a secondary code
Correct Answer: B
Rationale: Signs and symptoms are coded when a definitive diagnosis has not been established.
Once a definitive diagnosis is made, the sign/symptom is not coded separately unless it is an integral
part of the disease. [100% CORRECT]
, 3
Q7: Acute and Chronic Conditions
The student is reviewing coding guidelines. If a patient has both acute and chronic conditions, how
are they coded?
A. Only the acute condition is coded
B. Only the chronic condition is coded
C. Both are coded, with the acute sequenced first if listed as such
D. Both are coded, with the chronic sequenced first
Correct Answer: C
Rationale: If the same condition is described as both acute and chronic, and separate subentries
exist, both codes are assigned. The acute condition is usually sequenced first if the alphabetic index
directs. [100% CORRECT]
Q8: Combination Codes
The student is reviewing ICD-10-CM. What is a combination code?
A. A code that combines two diagnoses or a diagnosis with a manifestation
B. A code that combines two procedures
C. A code that combines a diagnosis and a procedure
D. A code that combines two body sites
Correct Answer: A
Rationale: Combination codes classify two diagnoses, a diagnosis with an associated secondary
process (manifestation), or a diagnosis with an associated complication. Only one code is needed.
[100% CORRECT]
Q9: Laterality
The student is reviewing ICD-10-CM. How is laterality coded in ICD-10-CM?
A. With a 5th character
B. With a 6th character
C. With a 7th character
D. With an additional code
Correct Answer: B
Rationale: Laterality (right, left, bilateral) is typically coded in the 6th character position for many
codes. The 7th character is used for episode of care. [100% CORRECT]
Q10: Neoplasm Coding
The student is reviewing neoplasm coding. When a patient is admitted for treatment of a primary
malignancy and a secondary malignancy, which is sequenced first?
CCS CERTIFICATION EXAM 2026/2027 | CERTIFIED
CODING SPECIALIST | 100 VERIFIED Q&A | DETAILED
RATIONALES | PASS GUARANTEED – A+ GRADED
SECTION 1: ICD-10-CM CODING GUIDELINES - Questions 1-15
Q1: ICD-10-CM Structure
The student is reviewing ICD-10-CM coding. What is the correct structure of an ICD-10-CM diagnosis
code?
A. 3-5 characters, with the first character always a letter
B. 3-7 characters, with the first character always a letter
C. 3-7 characters, with the first character always a number
D. 3-5 characters, with the first character always a number
Correct Answer: B
Rationale: ICD-10-CM codes are 3-7 characters in length. The first character is always a letter (A-Z),
followed by numbers and possibly additional letters. The structure allows for greater specificity than
ICD-9-CM. [100% CORRECT]
Q2: Seventh Character Extensions
The student is reviewing ICD-10-CM. What is the purpose of the 7th character in ICD-10-CM?
A. To identify the severity of the condition
B. To identify the episode of care or laterality
C. To identify the anatomical site
D. To identify the causative organism
Correct Answer: B
Rationale: The 7th character is used in certain chapters (e.g., injuries, fractures, obstetric) to indicate
the episode of care (initial encounter, subsequent encounter, sequela) or laterality. It is not used for
all codes. [100% CORRECT]
Q3: Excludes1 Notes
The student is reviewing coding guidelines. What does an Excludes1 note indicate?
A. The two conditions cannot be coded together; the code excluded should never be used with the
code above it
B. The two conditions may be coded together if desired
C. The excluded code is optional
D. The excluded code is the primary diagnosis
,2
Correct Answer: A
Rationale: Excludes1 means the two conditions are mutually exclusive. The code excluded should
never be used at the same time as the code above it. Excludes2 means the two conditions may
coexist. [100% CORRECT]
Q4: Excludes2 Notes
The student is reviewing coding guidelines. What does an Excludes2 note indicate?
A. The two conditions cannot be coded together
B. The two conditions may be coded together if both are present
C. The excluded code is always the primary diagnosis
D. The excluded code is never coded
Correct Answer: B
Rationale: Excludes2 means the condition excluded is not part of the condition represented by the
code, but the patient may have both conditions at the same time. Both codes may be used if
applicable. [100% CORRECT]
Q5: Code First/Use Additional Code
The student is reviewing coding guidelines. What does "Code First" mean in ICD-10-CM?
A. The code listed after "Code First" is the primary diagnosis
B. The condition listed after "Code First" is the underlying cause and should be sequenced first
C. The code should be sequenced last
D. The code is optional
Correct Answer: B
Rationale: "Code First" indicates that the condition listed should be sequenced before the code to
which the note is attached. It identifies the underlying cause or etiology. [100% CORRECT]
Q6: Signs and Symptoms
The student is reviewing coding guidelines. When should a sign or symptom code be used?
A. When the definitive diagnosis has been established
B. When the definitive diagnosis has not been established
C. Never
D. Always as a secondary code
Correct Answer: B
Rationale: Signs and symptoms are coded when a definitive diagnosis has not been established.
Once a definitive diagnosis is made, the sign/symptom is not coded separately unless it is an integral
part of the disease. [100% CORRECT]
, 3
Q7: Acute and Chronic Conditions
The student is reviewing coding guidelines. If a patient has both acute and chronic conditions, how
are they coded?
A. Only the acute condition is coded
B. Only the chronic condition is coded
C. Both are coded, with the acute sequenced first if listed as such
D. Both are coded, with the chronic sequenced first
Correct Answer: C
Rationale: If the same condition is described as both acute and chronic, and separate subentries
exist, both codes are assigned. The acute condition is usually sequenced first if the alphabetic index
directs. [100% CORRECT]
Q8: Combination Codes
The student is reviewing ICD-10-CM. What is a combination code?
A. A code that combines two diagnoses or a diagnosis with a manifestation
B. A code that combines two procedures
C. A code that combines a diagnosis and a procedure
D. A code that combines two body sites
Correct Answer: A
Rationale: Combination codes classify two diagnoses, a diagnosis with an associated secondary
process (manifestation), or a diagnosis with an associated complication. Only one code is needed.
[100% CORRECT]
Q9: Laterality
The student is reviewing ICD-10-CM. How is laterality coded in ICD-10-CM?
A. With a 5th character
B. With a 6th character
C. With a 7th character
D. With an additional code
Correct Answer: B
Rationale: Laterality (right, left, bilateral) is typically coded in the 6th character position for many
codes. The 7th character is used for episode of care. [100% CORRECT]
Q10: Neoplasm Coding
The student is reviewing neoplasm coding. When a patient is admitted for treatment of a primary
malignancy and a secondary malignancy, which is sequenced first?
