MEDICAL CODING AND
ABSTRACTING: ADVANCED CASE
STUDIES (CHAPTERS 1-26) QUESTIONS
WITH VERIFIED ANSWERS 2026/2027
1. When abstracting a medical record for a patient with a primary malignancy of the breast
that has metastasized to the liver, which code should be sequenced first?
A. The code for the liver metastasis
B. A code for personal history of malignancy
C. The code for the symptoms causing admission
D. The code for the primary breast malignancy
Answer: D
Conceptual Explanation: According to ICD-10-CM sequencing guidelines for neoplasms,
the primary site is sequenced first followed by secondary sites, unless the treatment is
directed solely toward the secondary site.
,2. A patient is diagnosed with ‘Acute and Chronic Respiratory Failure.’ According to the ICD-
10-CM sequencing guidelines, how should this be coded?
A. Code only the acute respiratory failure
B. Code only the chronic respiratory failure
C. Assign codes for both, sequencing the acute code first
D. Assign a single combination code for both acute and chronic
Answer: C
Conceptual Explanation: When a condition is documented as both acute and chronic and
there are separate subentries for each in the Alphabetic Index at the same indentation
level, the acute code is sequenced first.
3. In CPT coding, when a procedure is described as ‘extensive’ but the documentation does
not support the intensity, what is the most appropriate action for a coder?
A. Use an unlisted procedure code
B. Query the physician for clarification or code to the standard procedure
C. Append modifier -22 (Increased Procedural Services)
D. Automatically code the next highest level of service
Answer: B
, Conceptual Explanation: Coders must ensure documentation supports the level of
service. If ‘extensive’ is used without clinical detail, clarification from the provider is
necessary to ensure code accuracy.
4. Which of the following describes the ‘Excludes1’ note in ICD-10-CM?
A. Use this code only as a secondary diagnosis
B. Not included here; the patient may have both conditions
C. Code also the associated condition
D. Not coded here; the two conditions cannot occur together
Answer: D
Conceptual Explanation: Excludes1 indicates a ‘pure’ excludes note. It means ‘NOT
CODED HERE!’ and indicates that the code excluded should never be used at the same time
as the code above the note.
5. A patient undergoes a laparoscopic cholecystectomy that is converted to an open
procedure. How should this be coded in CPT?
A. Code both the laparoscopic and open procedures
B. Code the laparoscopic procedure with modifier -52
C. Code only the open procedure
D. Code the laparoscopic procedure with modifier -22
Answer: C
ABSTRACTING: ADVANCED CASE
STUDIES (CHAPTERS 1-26) QUESTIONS
WITH VERIFIED ANSWERS 2026/2027
1. When abstracting a medical record for a patient with a primary malignancy of the breast
that has metastasized to the liver, which code should be sequenced first?
A. The code for the liver metastasis
B. A code for personal history of malignancy
C. The code for the symptoms causing admission
D. The code for the primary breast malignancy
Answer: D
Conceptual Explanation: According to ICD-10-CM sequencing guidelines for neoplasms,
the primary site is sequenced first followed by secondary sites, unless the treatment is
directed solely toward the secondary site.
,2. A patient is diagnosed with ‘Acute and Chronic Respiratory Failure.’ According to the ICD-
10-CM sequencing guidelines, how should this be coded?
A. Code only the acute respiratory failure
B. Code only the chronic respiratory failure
C. Assign codes for both, sequencing the acute code first
D. Assign a single combination code for both acute and chronic
Answer: C
Conceptual Explanation: When a condition is documented as both acute and chronic and
there are separate subentries for each in the Alphabetic Index at the same indentation
level, the acute code is sequenced first.
3. In CPT coding, when a procedure is described as ‘extensive’ but the documentation does
not support the intensity, what is the most appropriate action for a coder?
A. Use an unlisted procedure code
B. Query the physician for clarification or code to the standard procedure
C. Append modifier -22 (Increased Procedural Services)
D. Automatically code the next highest level of service
Answer: B
, Conceptual Explanation: Coders must ensure documentation supports the level of
service. If ‘extensive’ is used without clinical detail, clarification from the provider is
necessary to ensure code accuracy.
4. Which of the following describes the ‘Excludes1’ note in ICD-10-CM?
A. Use this code only as a secondary diagnosis
B. Not included here; the patient may have both conditions
C. Code also the associated condition
D. Not coded here; the two conditions cannot occur together
Answer: D
Conceptual Explanation: Excludes1 indicates a ‘pure’ excludes note. It means ‘NOT
CODED HERE!’ and indicates that the code excluded should never be used at the same time
as the code above the note.
5. A patient undergoes a laparoscopic cholecystectomy that is converted to an open
procedure. How should this be coded in CPT?
A. Code both the laparoscopic and open procedures
B. Code the laparoscopic procedure with modifier -52
C. Code only the open procedure
D. Code the laparoscopic procedure with modifier -22
Answer: C
