CERTIFIED CODING SPECIALIST CORRECT FINALS
ANSWERS AND QUESTIONS SET A+
✔✔What diagnoses and procedures should be reported for recurrent left inguinal hernia
with laparoscopic repair?
K40.30 Unilateral inguinal hernia, with obstruction, without gangrene, not specified as
recurrent
K40.31 Unilateral inguinal hernia, with obstruction, without gangrene, recurrent
K40.91 Unilateral inguinal hernia, without mention of obstruction or gangrene, recurrent
49520 Repair recurrent inguinal hernia, any age; reducible
49521 Repair recurrent inguinal hernia, any age; incarcerated or strangulated
49651 Laparoscopy, surgical; repair recurrent inguinal hernia
a. K40.91, 49520
b. K40.31, 49521
c. K40.91, 49651
d. K40.30, 49520 - ✔✔c. K40.91:Unilateral inguinal hernia, without mention of
obstruction or gangrene, recurrent
49651:Laparoscopy, surgical; repair recurrent inguinal hernia
**The patient has a recurrent hernia without obstruction and this is captured in diagnosis
code K40.91 (Leon-Chisen 2017, 253; CPT Assistant Nov. 1999, 24; March 2000, 9).
✔✔.In order to accurately code a cardiac catheterization, what needs to be determined
based on a review of the documentation?
a. The approach and the side of the heart (chambers) into which the catheter was
inserted
b. The approach, the side of the heart (chambers) into which the catheter was inserted,
as well as any additional procedures performed
c. The duration of the procedure
d. If there is documentation of the procedure in the medical record that stents are
considered - ✔✔b. The approach, the side of the heart (chambers) into which the
catheter was inserted, as well as any additional procedures performed
,✔✔A condition is present on admission when:
a. It is the principal diagnosis
b. It is accordance with medical staff bylaws
c. A condition that occurs prior to an inpatient admission
d. It is present within 3 days after admission - ✔✔c. A condition that occurs prior to an
inpatient admission
**It is important to understand the time frame for assigning a status code specifying that
a condition is present on admission (Leon-Chisen 2017, 571-574).
✔✔A patient was admitted after a fall down the steps. The patient was unconscious for
approximately 45 minutes and was admitted to the emergency department (ED) within 3
hours of the fall. A CT scan was performed within an hour of admission to the ED. A
cerebral contusion was diagnosed by the ED physician based on the findings in the CT
scan. What conditions should be reported on the Uniform Billing form 04 (UB-04)?
R40.0 Somnolence
S02.91XA Unspecified fracture of skull, initial encounter for closed fracture
S06.331A Contusion and laceration of cerebrum, unspecified, with loss of
consciousness of 30 minutes or less, initial encounter
S06.332A Contusion and laceration of cerebrum, unspecified, with loss of
consciousness of 31 minutes to 59 minutes, initial encounter
W10.9XXA Fall (on) (from) unspecified stairs and steps, initial encounter
a. S02.91XA, W10.9XXA
b. R40.0
c. S06.331A, W10.9XXA
d. S06.332A, W10.9XXA - ✔✔d. S06.332A:Contusion and laceration of cerebrum,
unspecified, with loss of consciousness of 31 minutes to 59 minutes, initial encounter.
W10.9XXA: Fall (on) (from) unspecified stairs and steps, initial encounter
**The code for the injury to the brain also includes the time of unconsciousness. The
external cause code is provided here as part of the review; however, no external cause
codes are used on the exam except those for poisonings and adverse effects of drugs
(Leon-Chisen 2017, 487-488).
✔✔Medicare reimbursement depends on all of the following, except:
a. The correct designation of the principal diagnosis
b. Policies and procedures of the medical staff
c. The presence or absence of additional codes that represent complications,
comorbidities, or major complications/comorbidities
d. Procedures performed - ✔✔b. Policies and procedures of the medical staff
,**Policies and procedures of the medical staff are not relevant. But the presence or
absence of additional codes that represent complications, comorbidities, or major
complications/ comorbidities are all important to determine the MS-DRG as part of
Medicare Acute Inpatient Prospective Payment System (Leon-Chisen 2017, 566;
Rinehart-Thompson 2016a, 240-241).
✔✔A 35-year-old woman has hypertension with acute renal failure and stage 3 chronic
kidney disease. What code would be assigned?
a. N17.9, Acute kidney failure, unspecified
b. I13.2, Hypertensive heart and chronic kidney disease with heart failure and with stage
5 chronic kidney disease, or end stage renal disease
c. I50.9, Heart failure, unspecified
d. N17.9, Acute kidney failure, unspecified and I12.9, Hypertensive chronic kidney
disease with stage 1 through stage 4 chronic kidney disease, or unspecified chronic
kidney disease and N18.3, Chronic kidney disease, stage 3 (moderate) - ✔✔d. N17.9,
Acute kidney failure, unspecified and I12.9, Hypertensive chronic kidney disease with
stage 1 through stage 4 chronic kidney disease, or unspecified chronic kidney disease
and N18.3, Chronic kidney disease, stage 3 (moderate)
**Code the hypertension with stage 3 chronic kidney disease. In this case, both
hypertension and chronic kidney disease are documented and a combination code is
used. Also the code for the stage 3 chronic kidney disease must be assigned due to the
"code also" note. The acute renal failure is identified with a separate code (HHS 2017,
Section I.C.9.a., 40; HHS 2017, Section I.C.14.a., 53).
✔✔A patient is diagnosed with infertility due to endometriosis and undergoes an
outpatient laparoscopic laser destruction of pelvic endometriosis. In order to code this
encounter accurately, what steps must the coder take?
a. Review the operative report to determine what procedure codes to use and also to
determine the site or sites of endometriosis so codes with the highest specificity may be
assigned, and use infertility as a principal diagnosis.
b. Review the operative report to determine where the laser was used in the pelvis so
the site or sites of endometriosis can be specified, and assign a principal diagnosis of
infertility.
c. Review the operative report to determine where the laser was used in the pelvis so
the site or sites of endometriosis can be specified as principal, and assign a secondary
diagnosis of infertility.
d. Review the operative report to determine what procedure codes to use and also to
deter - ✔✔d. Review the operative report to determine what procedure codes to use
and also to determine the site or sites of endometriosis so codes with the highest
specificity may be assigned, and use the diagnosis of infertility as a secondary
condition.
, ** There may be endometrial implants throughout the pelvic cavity which may attach to
various anatomic structures such as the fallopian tube, ovary, and omentum. These
locations should be identified so that the appropriate diagnostic codes can be assigned
and the appropriate procedure codes can be assigned based on the destruction of the
endometrial implants. Therefore, the correct answer is to review the operative report to
determine what procedure codes to use and determine the site or sites of endometriosis
so that codes with the highest specificity may be assigned. Also, use the diagnosis of
infertility as a secondary condition (Schraffenberger 2017, 455-457; Leon-Chisen 2017,
272).
✔✔A patient is admitted to a psychiatric unit of an acute-care facility. The patient
experienced the following symptoms almost every day for the last month: loss of interest
or pleasure in most or all activities, which is a change from her prior level of functioning.
She has also gained 15 lbs, has difficulty falling asleep, feels fatigued, and has difficulty
making decisions. What potential diagnosis most closely fits the patient's overall
symptoms?
a. Insomnia
b. Major depression
c. Reye's syndrome
d. Bipolar disorder - ✔✔b. Major depression
✔✔The CPT definition of a surgical package contains which of the following?
a. The surgical procedure(s)
b. Follow-up surgery
c. Preoperative tests
d. Yearly follow-up visits - ✔✔a.The surgical procedure(s)
**The surgical package refers to a combination of individual services provided during
one surgical operation (Smith 2017, 55).
✔✔A patient was admitted to the endoscopy unit for a screening colonoscopy. During
the colonoscopy, polyps of the colon were found and a polypectomy was performed.
What diagnostic codes should be used and how should they be sequenced?
Z12.11 Encounter for screening for malignant neoplasm of colon
D12.6 Benign neoplasm of colon, unspecified
a. Z12.11
b. D12.6
c. Z12.11, D12.6
d. D12.6, Z12.11 - ✔✔c. Z12.11: Encounter for screening for malignant neoplasm of
colon
D12.6:Benign neoplasm of colon, unspecified
ANSWERS AND QUESTIONS SET A+
✔✔What diagnoses and procedures should be reported for recurrent left inguinal hernia
with laparoscopic repair?
K40.30 Unilateral inguinal hernia, with obstruction, without gangrene, not specified as
recurrent
K40.31 Unilateral inguinal hernia, with obstruction, without gangrene, recurrent
K40.91 Unilateral inguinal hernia, without mention of obstruction or gangrene, recurrent
49520 Repair recurrent inguinal hernia, any age; reducible
49521 Repair recurrent inguinal hernia, any age; incarcerated or strangulated
49651 Laparoscopy, surgical; repair recurrent inguinal hernia
a. K40.91, 49520
b. K40.31, 49521
c. K40.91, 49651
d. K40.30, 49520 - ✔✔c. K40.91:Unilateral inguinal hernia, without mention of
obstruction or gangrene, recurrent
49651:Laparoscopy, surgical; repair recurrent inguinal hernia
**The patient has a recurrent hernia without obstruction and this is captured in diagnosis
code K40.91 (Leon-Chisen 2017, 253; CPT Assistant Nov. 1999, 24; March 2000, 9).
✔✔.In order to accurately code a cardiac catheterization, what needs to be determined
based on a review of the documentation?
a. The approach and the side of the heart (chambers) into which the catheter was
inserted
b. The approach, the side of the heart (chambers) into which the catheter was inserted,
as well as any additional procedures performed
c. The duration of the procedure
d. If there is documentation of the procedure in the medical record that stents are
considered - ✔✔b. The approach, the side of the heart (chambers) into which the
catheter was inserted, as well as any additional procedures performed
,✔✔A condition is present on admission when:
a. It is the principal diagnosis
b. It is accordance with medical staff bylaws
c. A condition that occurs prior to an inpatient admission
d. It is present within 3 days after admission - ✔✔c. A condition that occurs prior to an
inpatient admission
**It is important to understand the time frame for assigning a status code specifying that
a condition is present on admission (Leon-Chisen 2017, 571-574).
✔✔A patient was admitted after a fall down the steps. The patient was unconscious for
approximately 45 minutes and was admitted to the emergency department (ED) within 3
hours of the fall. A CT scan was performed within an hour of admission to the ED. A
cerebral contusion was diagnosed by the ED physician based on the findings in the CT
scan. What conditions should be reported on the Uniform Billing form 04 (UB-04)?
R40.0 Somnolence
S02.91XA Unspecified fracture of skull, initial encounter for closed fracture
S06.331A Contusion and laceration of cerebrum, unspecified, with loss of
consciousness of 30 minutes or less, initial encounter
S06.332A Contusion and laceration of cerebrum, unspecified, with loss of
consciousness of 31 minutes to 59 minutes, initial encounter
W10.9XXA Fall (on) (from) unspecified stairs and steps, initial encounter
a. S02.91XA, W10.9XXA
b. R40.0
c. S06.331A, W10.9XXA
d. S06.332A, W10.9XXA - ✔✔d. S06.332A:Contusion and laceration of cerebrum,
unspecified, with loss of consciousness of 31 minutes to 59 minutes, initial encounter.
W10.9XXA: Fall (on) (from) unspecified stairs and steps, initial encounter
**The code for the injury to the brain also includes the time of unconsciousness. The
external cause code is provided here as part of the review; however, no external cause
codes are used on the exam except those for poisonings and adverse effects of drugs
(Leon-Chisen 2017, 487-488).
✔✔Medicare reimbursement depends on all of the following, except:
a. The correct designation of the principal diagnosis
b. Policies and procedures of the medical staff
c. The presence or absence of additional codes that represent complications,
comorbidities, or major complications/comorbidities
d. Procedures performed - ✔✔b. Policies and procedures of the medical staff
,**Policies and procedures of the medical staff are not relevant. But the presence or
absence of additional codes that represent complications, comorbidities, or major
complications/ comorbidities are all important to determine the MS-DRG as part of
Medicare Acute Inpatient Prospective Payment System (Leon-Chisen 2017, 566;
Rinehart-Thompson 2016a, 240-241).
✔✔A 35-year-old woman has hypertension with acute renal failure and stage 3 chronic
kidney disease. What code would be assigned?
a. N17.9, Acute kidney failure, unspecified
b. I13.2, Hypertensive heart and chronic kidney disease with heart failure and with stage
5 chronic kidney disease, or end stage renal disease
c. I50.9, Heart failure, unspecified
d. N17.9, Acute kidney failure, unspecified and I12.9, Hypertensive chronic kidney
disease with stage 1 through stage 4 chronic kidney disease, or unspecified chronic
kidney disease and N18.3, Chronic kidney disease, stage 3 (moderate) - ✔✔d. N17.9,
Acute kidney failure, unspecified and I12.9, Hypertensive chronic kidney disease with
stage 1 through stage 4 chronic kidney disease, or unspecified chronic kidney disease
and N18.3, Chronic kidney disease, stage 3 (moderate)
**Code the hypertension with stage 3 chronic kidney disease. In this case, both
hypertension and chronic kidney disease are documented and a combination code is
used. Also the code for the stage 3 chronic kidney disease must be assigned due to the
"code also" note. The acute renal failure is identified with a separate code (HHS 2017,
Section I.C.9.a., 40; HHS 2017, Section I.C.14.a., 53).
✔✔A patient is diagnosed with infertility due to endometriosis and undergoes an
outpatient laparoscopic laser destruction of pelvic endometriosis. In order to code this
encounter accurately, what steps must the coder take?
a. Review the operative report to determine what procedure codes to use and also to
determine the site or sites of endometriosis so codes with the highest specificity may be
assigned, and use infertility as a principal diagnosis.
b. Review the operative report to determine where the laser was used in the pelvis so
the site or sites of endometriosis can be specified, and assign a principal diagnosis of
infertility.
c. Review the operative report to determine where the laser was used in the pelvis so
the site or sites of endometriosis can be specified as principal, and assign a secondary
diagnosis of infertility.
d. Review the operative report to determine what procedure codes to use and also to
deter - ✔✔d. Review the operative report to determine what procedure codes to use
and also to determine the site or sites of endometriosis so codes with the highest
specificity may be assigned, and use the diagnosis of infertility as a secondary
condition.
, ** There may be endometrial implants throughout the pelvic cavity which may attach to
various anatomic structures such as the fallopian tube, ovary, and omentum. These
locations should be identified so that the appropriate diagnostic codes can be assigned
and the appropriate procedure codes can be assigned based on the destruction of the
endometrial implants. Therefore, the correct answer is to review the operative report to
determine what procedure codes to use and determine the site or sites of endometriosis
so that codes with the highest specificity may be assigned. Also, use the diagnosis of
infertility as a secondary condition (Schraffenberger 2017, 455-457; Leon-Chisen 2017,
272).
✔✔A patient is admitted to a psychiatric unit of an acute-care facility. The patient
experienced the following symptoms almost every day for the last month: loss of interest
or pleasure in most or all activities, which is a change from her prior level of functioning.
She has also gained 15 lbs, has difficulty falling asleep, feels fatigued, and has difficulty
making decisions. What potential diagnosis most closely fits the patient's overall
symptoms?
a. Insomnia
b. Major depression
c. Reye's syndrome
d. Bipolar disorder - ✔✔b. Major depression
✔✔The CPT definition of a surgical package contains which of the following?
a. The surgical procedure(s)
b. Follow-up surgery
c. Preoperative tests
d. Yearly follow-up visits - ✔✔a.The surgical procedure(s)
**The surgical package refers to a combination of individual services provided during
one surgical operation (Smith 2017, 55).
✔✔A patient was admitted to the endoscopy unit for a screening colonoscopy. During
the colonoscopy, polyps of the colon were found and a polypectomy was performed.
What diagnostic codes should be used and how should they be sequenced?
Z12.11 Encounter for screening for malignant neoplasm of colon
D12.6 Benign neoplasm of colon, unspecified
a. Z12.11
b. D12.6
c. Z12.11, D12.6
d. D12.6, Z12.11 - ✔✔c. Z12.11: Encounter for screening for malignant neoplasm of
colon
D12.6:Benign neoplasm of colon, unspecified
