ADVANCED MEDICAL CODING AND
CASE STUDY ABSTRACTING (9TH
EDITION) QUESTIONS WITH VERIFIED
ANSWERS 2026/2027
1. When abstracting an inpatient medical record, how is the ‘Principal Diagnosis’ defined
according to the Uniform Hospital Discharge Data Set (UHDDS)?
A. The condition established after study to be chiefly responsible for occasioning the
admission of the patient to the hospital.
B. The most serious condition diagnosed during the hospital stay regardless of the reason
for admission.
C. The condition that consumed the most resources during the patient’s hospitalization.
D. The first diagnosis listed by the physician on the discharge summary.
Answer: A
Conceptual Explanation: The UHDDS defines the principal diagnosis as the condition
established after study to be chiefly responsible for occasioning the admission of the
patient to the hospital.
,2. In the context of ICD-10-CM coding, which of the following is true regarding ‘Excludes1’
notes?
A. It indicates that the excluded code can be used as a secondary diagnosis if the patient has
both conditions.
B. It is a ‘pure’ exclusion note indicating that the code excluded should never be used at the
same time as the code above it.
C. It means ‘not included here’ and allows both codes to be reported if supported by
documentation.
D. It applies only to outpatient coding and is ignored in inpatient settings.
Answer: B
Conceptual Explanation: An Excludes1 note is a ‘pure’ exclusion, meaning the two
conditions cannot occur together (e.g., congenital vs. acquired versions of the same
condition).
3. A patient is admitted with acute respiratory failure due to an exacerbation of chronic
obstructive pulmonary disease (COPD). According to ICD-10-CM sequencing rules, which code
is sequenced first?
A. The code for acute respiratory failure.
B. The code for COPD exacerbation.
C. Either can be principal depending on which was most resource-intensive.
D. A combined code that includes both conditions.
, Answer: A
Conceptual Explanation: When a patient is admitted in respiratory failure due to another
acute or chronic condition, the respiratory failure is typically sequenced as the principal
diagnosis unless the coding guidelines for the specific underlying condition state otherwise.
4. In ICD-10-PCS, what is the correct root operation when a physician performs a total
mastectomy?
A. Excision
B. Resection
C. Destruction
D. Extraction
Answer: B
Conceptual Explanation: Resection is defined as cutting out or off, without replacement,
all of a body part. Since a total mastectomy removes the entire body part (the breast),
Resection is the correct root operation.
5. When abstracting an operative report, the coder notices the ‘Preoperative Diagnosis’ is
‘Abdominal Pain’ and the ‘Postoperative Diagnosis’ is ‘Acute Appendicitis’. Which diagnosis
should be coded?
A. Acute Appendicitis only
B. Abdominal Pain only
CASE STUDY ABSTRACTING (9TH
EDITION) QUESTIONS WITH VERIFIED
ANSWERS 2026/2027
1. When abstracting an inpatient medical record, how is the ‘Principal Diagnosis’ defined
according to the Uniform Hospital Discharge Data Set (UHDDS)?
A. The condition established after study to be chiefly responsible for occasioning the
admission of the patient to the hospital.
B. The most serious condition diagnosed during the hospital stay regardless of the reason
for admission.
C. The condition that consumed the most resources during the patient’s hospitalization.
D. The first diagnosis listed by the physician on the discharge summary.
Answer: A
Conceptual Explanation: The UHDDS defines the principal diagnosis as the condition
established after study to be chiefly responsible for occasioning the admission of the
patient to the hospital.
,2. In the context of ICD-10-CM coding, which of the following is true regarding ‘Excludes1’
notes?
A. It indicates that the excluded code can be used as a secondary diagnosis if the patient has
both conditions.
B. It is a ‘pure’ exclusion note indicating that the code excluded should never be used at the
same time as the code above it.
C. It means ‘not included here’ and allows both codes to be reported if supported by
documentation.
D. It applies only to outpatient coding and is ignored in inpatient settings.
Answer: B
Conceptual Explanation: An Excludes1 note is a ‘pure’ exclusion, meaning the two
conditions cannot occur together (e.g., congenital vs. acquired versions of the same
condition).
3. A patient is admitted with acute respiratory failure due to an exacerbation of chronic
obstructive pulmonary disease (COPD). According to ICD-10-CM sequencing rules, which code
is sequenced first?
A. The code for acute respiratory failure.
B. The code for COPD exacerbation.
C. Either can be principal depending on which was most resource-intensive.
D. A combined code that includes both conditions.
, Answer: A
Conceptual Explanation: When a patient is admitted in respiratory failure due to another
acute or chronic condition, the respiratory failure is typically sequenced as the principal
diagnosis unless the coding guidelines for the specific underlying condition state otherwise.
4. In ICD-10-PCS, what is the correct root operation when a physician performs a total
mastectomy?
A. Excision
B. Resection
C. Destruction
D. Extraction
Answer: B
Conceptual Explanation: Resection is defined as cutting out or off, without replacement,
all of a body part. Since a total mastectomy removes the entire body part (the breast),
Resection is the correct root operation.
5. When abstracting an operative report, the coder notices the ‘Preoperative Diagnosis’ is
‘Abdominal Pain’ and the ‘Postoperative Diagnosis’ is ‘Acute Appendicitis’. Which diagnosis
should be coded?
A. Acute Appendicitis only
B. Abdominal Pain only
