Certified Professional Coder (CPC) Coding Guidelines
COMPLETE EXAM LATEST VERSION 2026-2027
QUESTIONS AND ANSWERS
When coding sequela should the code for the acute phase of an illness or injury that led to the
sequela be used? - answer>>No
When coding conditions described as "impending" or "threatened", what should be reported if
it did occur? - answer>>Code as a confirmed diagnosis
How many times can each unique ICD-10-CM diagnosis code be reported per encounter? -
answer>>Once.
This applies to bilateral conditions when there are no distinct codes identifying laterality or
two different conditions classified to the same ICD-10-CM code
If no bilateral code is provided and the condition is bilateral, how should the encounter be
coded? - answer>>Assign separate codes for both the left and right side. If the side is not
identified in the MR assign the code for the unspecified side
Which physician should be the one responsible for documenting BMI, non-pressure ulcers, and
pressure ulcer stages? - answer>>Patient's primary provider
When should BMI codes be reported as first listed diagnosis?? - answer>>Never
How should we code syndromes using ICD-10-CM guidelines - answer>>Follow the alphabetic
index guidance
,When coding syndromes and the alphabetic index does not proving any guidance, how should
the encounter be coded? - answer>>Assign codes for the documented manifestations of the
syndrome
Additional codes for manifestations that are not an integral part of the disease process may
also be assigned when the condition does not have a unique code
When is it appropriate to assign codes for complications of care? - answer>>There must be a
cause and effect relationship between the care provided and the condition, and an indication
in the documentation that it is a complication
If the provider documents "borderline" diagnosis at the time of discharge, how is the diagnosis
coded? - answer>>Diagnosis is coded as confirmed unless the classification provides a specific
entry (e.g., borderline diabetes)
If a definitive diagnosis has not been established by the end of the encounter, it is appropriate
to report codes for __________________ in lieu of a definitive diagnosis. - answer>>Sign(s0
and/or symptom(s)
When sufficient clinical information isn't known or available about a particular health
condition to assign a more specific code, how should the encounter be coded? - answer>>It is
acceptable to report the appropriate unspecified code
When it is appropriate to code HIV infection/illness(es)?? - answer>>Code only confirmed
cases of HIV/illness
Does HIV confirmation required documentation of positive serology or culture for HIV? -
answer>>No. The provider's diagnostic statement that the patient is HIV positive, or has an
HIV-related illness is sufficient
If a patient is admitted for an HIV-related condition, what should the principal diagnosis be? -
answer>>B20; followed by additional diagnosis codes for all reported HIV-related conditions
, If a patient with HIV disease is admitted for an unrelated condition, what should be coded as
the principal diagnosis? - answer>>The code for the unrelated condition should be the
principal diagnosis; other diagnoses would be B20 followed by additional diagnosis codes for
all reported HIV related conditions
When should Z21 asymptomatic HIV infection status be applied? - answer>>When the patient
without any documentation of symptoms is listed as being "HIV positive", "known HIV", "HIV
test positive" or similar terminology
When should we not apply Z21 asymptomatic HIV infection? - answer>>If the term "AIDS" is
used or if the patient is treated for any HIV-related illness or is described as having any
conditions resulting from his/her HIV positive status, use B20 in these cases
What code should be applied for patients with inconclusive HIV serology, but no definitive
diagnosis or manifestations of the illness?? - answer>>B20
Once a patient has developed an HIV-related illness, the patient should always be assigned
____________ on every subsequent admission/encounter. - answer>>R75 Z21
During pregnancy, childbirth or the puerperium, a patient admitted because of an HIV-related
illness should receive a principal diagnosis code of? - answer>>O98.7-, followed by B20 and
then the codes for the HIV-related illness(es)
What code(s) should patients with asymptomatic HIV infection status admitted during
pregnancy, childbirth, or the puerperium receive? - answer>>O98.7- followed by Z21 If a
patient is being seen to determine his/her HIV status, how should this encounter be coded? -
answer>>Z11.4 Encounter for Screening for HIV; also use additional codes for any high risk
behavior
COMPLETE EXAM LATEST VERSION 2026-2027
QUESTIONS AND ANSWERS
When coding sequela should the code for the acute phase of an illness or injury that led to the
sequela be used? - answer>>No
When coding conditions described as "impending" or "threatened", what should be reported if
it did occur? - answer>>Code as a confirmed diagnosis
How many times can each unique ICD-10-CM diagnosis code be reported per encounter? -
answer>>Once.
This applies to bilateral conditions when there are no distinct codes identifying laterality or
two different conditions classified to the same ICD-10-CM code
If no bilateral code is provided and the condition is bilateral, how should the encounter be
coded? - answer>>Assign separate codes for both the left and right side. If the side is not
identified in the MR assign the code for the unspecified side
Which physician should be the one responsible for documenting BMI, non-pressure ulcers, and
pressure ulcer stages? - answer>>Patient's primary provider
When should BMI codes be reported as first listed diagnosis?? - answer>>Never
How should we code syndromes using ICD-10-CM guidelines - answer>>Follow the alphabetic
index guidance
,When coding syndromes and the alphabetic index does not proving any guidance, how should
the encounter be coded? - answer>>Assign codes for the documented manifestations of the
syndrome
Additional codes for manifestations that are not an integral part of the disease process may
also be assigned when the condition does not have a unique code
When is it appropriate to assign codes for complications of care? - answer>>There must be a
cause and effect relationship between the care provided and the condition, and an indication
in the documentation that it is a complication
If the provider documents "borderline" diagnosis at the time of discharge, how is the diagnosis
coded? - answer>>Diagnosis is coded as confirmed unless the classification provides a specific
entry (e.g., borderline diabetes)
If a definitive diagnosis has not been established by the end of the encounter, it is appropriate
to report codes for __________________ in lieu of a definitive diagnosis. - answer>>Sign(s0
and/or symptom(s)
When sufficient clinical information isn't known or available about a particular health
condition to assign a more specific code, how should the encounter be coded? - answer>>It is
acceptable to report the appropriate unspecified code
When it is appropriate to code HIV infection/illness(es)?? - answer>>Code only confirmed
cases of HIV/illness
Does HIV confirmation required documentation of positive serology or culture for HIV? -
answer>>No. The provider's diagnostic statement that the patient is HIV positive, or has an
HIV-related illness is sufficient
If a patient is admitted for an HIV-related condition, what should the principal diagnosis be? -
answer>>B20; followed by additional diagnosis codes for all reported HIV-related conditions
, If a patient with HIV disease is admitted for an unrelated condition, what should be coded as
the principal diagnosis? - answer>>The code for the unrelated condition should be the
principal diagnosis; other diagnoses would be B20 followed by additional diagnosis codes for
all reported HIV related conditions
When should Z21 asymptomatic HIV infection status be applied? - answer>>When the patient
without any documentation of symptoms is listed as being "HIV positive", "known HIV", "HIV
test positive" or similar terminology
When should we not apply Z21 asymptomatic HIV infection? - answer>>If the term "AIDS" is
used or if the patient is treated for any HIV-related illness or is described as having any
conditions resulting from his/her HIV positive status, use B20 in these cases
What code should be applied for patients with inconclusive HIV serology, but no definitive
diagnosis or manifestations of the illness?? - answer>>B20
Once a patient has developed an HIV-related illness, the patient should always be assigned
____________ on every subsequent admission/encounter. - answer>>R75 Z21
During pregnancy, childbirth or the puerperium, a patient admitted because of an HIV-related
illness should receive a principal diagnosis code of? - answer>>O98.7-, followed by B20 and
then the codes for the HIV-related illness(es)
What code(s) should patients with asymptomatic HIV infection status admitted during
pregnancy, childbirth, or the puerperium receive? - answer>>O98.7- followed by Z21 If a
patient is being seen to determine his/her HIV status, how should this encounter be coded? -
answer>>Z11.4 Encounter for Screening for HIV; also use additional codes for any high risk
behavior
