MEDICAL CODING AND ABSTRACTING
- HIGH DIFFICULTY PRACTICUM
QUESTIONS WITH VERIFIED ANSWERS
2026/2027
1. When abstracting a medical record for an inpatient stay, which condition is designated as
the principal diagnosis?
A. The condition that represents the highest resource consumption during the stay.
B. The first condition listed in the discharge summary by the attending physician.
C. The most severe condition documented by the physician regardless of the reason for
admission.
D. The condition established after study to be chiefly responsible for occasioning the
admission.
Answer: D
Conceptual Explanation: According to the Official ICD-10-CM Guidelines for Coding and
Reporting, the principal diagnosis is defined as that condition established after study to be
chiefly responsible for occasioning the admission of the patient to the hospital.
2. A patient is admitted with acute respiratory failure due to an exacerbation of COPD. How
should these codes be sequenced?
A. Acute respiratory failure (J96.0x) then COPD exacerbation (J44.1).
,B. COPD exacerbation (J44.1) then Acute respiratory failure (J96.0x).
C. Either can be principal if both are present on admission and meet the definition.
D. J44.1 followed by J96.21 (Acute on chronic respiratory failure).
Answer: C
Conceptual Explanation: ICD-10-CM Guideline II.C.10 states that if both the respiratory
failure and another acute condition are present on admission and both meet the definition
of principal diagnosis, either may be sequenced first unless chapter-specific sequencing
exists.
3. In the CPT manual, which modifier is used to indicate that a procedure was discontinued
after the administration of anesthesia due to a threat to the patient’s well-being?
A. -52
B. -73
C. -53
D. -74
Answer: C
Conceptual Explanation: Modifier -53 is used for discontinued procedures due to
extenuating circumstances or those that threaten the well-being of the patient after
anesthesia has started. Modifiers -73 and -74 are specific to facility (outpatient hospital)
reporting.
, 4. When coding for a patient with Type 2 Diabetes and Stage 4 Chronic Kidney Disease (CKD),
what is the correct relationship assumption in ICD-10-CM?
A. The link must be explicitly stated as ‘due to diabetes’ by the physician.
B. Diabetes is always secondary to CKD.
C. The link is assumed unless the provider states the CKD is due to another cause.
D. The codes must be coded separately with no combination code used.
Answer: C
Conceptual Explanation: Guideline I.C.9.a.2 and I.C.4.a.3 state that the word ‘with’ or ‘in’
in the Alphabetic Index implies a causal relationship; therefore, the link between DM and
CKD is assumed unless documented otherwise.
5. A physician performs an E/M visit that is ‘level 4’ based on MDM, but the patient also
receives a minor surgical procedure. Which CPT modifier is required on the E/M code?
A. -59
B. -24
C. -57
D. -25
Answer: D
- HIGH DIFFICULTY PRACTICUM
QUESTIONS WITH VERIFIED ANSWERS
2026/2027
1. When abstracting a medical record for an inpatient stay, which condition is designated as
the principal diagnosis?
A. The condition that represents the highest resource consumption during the stay.
B. The first condition listed in the discharge summary by the attending physician.
C. The most severe condition documented by the physician regardless of the reason for
admission.
D. The condition established after study to be chiefly responsible for occasioning the
admission.
Answer: D
Conceptual Explanation: According to the Official ICD-10-CM Guidelines for Coding and
Reporting, the principal diagnosis is defined as that condition established after study to be
chiefly responsible for occasioning the admission of the patient to the hospital.
2. A patient is admitted with acute respiratory failure due to an exacerbation of COPD. How
should these codes be sequenced?
A. Acute respiratory failure (J96.0x) then COPD exacerbation (J44.1).
,B. COPD exacerbation (J44.1) then Acute respiratory failure (J96.0x).
C. Either can be principal if both are present on admission and meet the definition.
D. J44.1 followed by J96.21 (Acute on chronic respiratory failure).
Answer: C
Conceptual Explanation: ICD-10-CM Guideline II.C.10 states that if both the respiratory
failure and another acute condition are present on admission and both meet the definition
of principal diagnosis, either may be sequenced first unless chapter-specific sequencing
exists.
3. In the CPT manual, which modifier is used to indicate that a procedure was discontinued
after the administration of anesthesia due to a threat to the patient’s well-being?
A. -52
B. -73
C. -53
D. -74
Answer: C
Conceptual Explanation: Modifier -53 is used for discontinued procedures due to
extenuating circumstances or those that threaten the well-being of the patient after
anesthesia has started. Modifiers -73 and -74 are specific to facility (outpatient hospital)
reporting.
, 4. When coding for a patient with Type 2 Diabetes and Stage 4 Chronic Kidney Disease (CKD),
what is the correct relationship assumption in ICD-10-CM?
A. The link must be explicitly stated as ‘due to diabetes’ by the physician.
B. Diabetes is always secondary to CKD.
C. The link is assumed unless the provider states the CKD is due to another cause.
D. The codes must be coded separately with no combination code used.
Answer: C
Conceptual Explanation: Guideline I.C.9.a.2 and I.C.4.a.3 state that the word ‘with’ or ‘in’
in the Alphabetic Index implies a causal relationship; therefore, the link between DM and
CKD is assumed unless documented otherwise.
5. A physician performs an E/M visit that is ‘level 4’ based on MDM, but the patient also
receives a minor surgical procedure. Which CPT modifier is required on the E/M code?
A. -59
B. -24
C. -57
D. -25
Answer: D
