ADVANCED MEDICAL CODING AND
CASE STUDY ABSTRACTING (10TH
EDITION) QUESTIONS WITH VERIFIED
ANSWERS 2026/2027
1. When abstracting a case where a patient is admitted for treatment of a primary
malignancy but the treatment is directed solely at a metastatic site, what is the sequence of
ICD-10-CM codes?
A. The primary malignancy is sequenced first, followed by the secondary site.
B. The secondary site is sequenced first, followed by the primary malignancy.
C. Only the secondary site is coded; the primary site is omitted.
D. A Z-code for personal history of malignancy is used instead of the primary site.
Answer: B
Conceptual Explanation: According to ICD-10-CM Official Guidelines, if treatment is
directed solely toward the secondary site, the secondary site is designated as the principal
diagnosis, followed by the primary malignancy.
2. In CPT coding, which modifier should be used when a physician performs a procedure that
is significantly more complex than typically required?
A. -22 (Increased Procedural Services)
,B. -51 (Multiple Procedures)
C. -59 (Distinct Procedural Service)
D. -25 (Significant, Separately Identifiable E/M Service)
Answer: A
Conceptual Explanation: Modifier -22 is used when the work required to provide a
service is substantially greater than typically required, usually requiring supporting
documentation of increased time or complexity.
3. When abstracting a clinical record, which of the following takes precedence in determining
the principal diagnosis for an inpatient stay?
A. The admitting diagnosis provided by the primary care physician.
B. The condition that resulted in the highest resource consumption.
C. The most severe condition documented in the patient’s history.
D. The diagnosis established after study to be chiefly responsible for the admission.
Answer: D
Conceptual Explanation: The Uniform Hospital Discharge Data Set (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.
, 4. A patient presents with acute respiratory failure and congestive heart failure. If both are
equally responsible for the admission, what is the coding guideline?
A. The respiratory failure must always be sequenced first.
B. Either may be sequenced first as the principal diagnosis.
C. The heart failure must always be sequenced first.
D. A combination code must be found to represent both conditions.
Answer: B
Conceptual Explanation: When two or more diagnoses equally meet the criteria for
principal diagnosis as determined by the circumstances of admission, any one of the
diagnoses may be sequenced first.
5. In the 2024/2025/2026 E/M guidelines, which component is no longer used to determine
the level of service for Office or Other Outpatient visits?
A. History and Physical Examination
B. Total Time on the date of the encounter
C. Medical Decision Making (MDM)
D. Number and complexity of problems addressed
Answer: A
CASE STUDY ABSTRACTING (10TH
EDITION) QUESTIONS WITH VERIFIED
ANSWERS 2026/2027
1. When abstracting a case where a patient is admitted for treatment of a primary
malignancy but the treatment is directed solely at a metastatic site, what is the sequence of
ICD-10-CM codes?
A. The primary malignancy is sequenced first, followed by the secondary site.
B. The secondary site is sequenced first, followed by the primary malignancy.
C. Only the secondary site is coded; the primary site is omitted.
D. A Z-code for personal history of malignancy is used instead of the primary site.
Answer: B
Conceptual Explanation: According to ICD-10-CM Official Guidelines, if treatment is
directed solely toward the secondary site, the secondary site is designated as the principal
diagnosis, followed by the primary malignancy.
2. In CPT coding, which modifier should be used when a physician performs a procedure that
is significantly more complex than typically required?
A. -22 (Increased Procedural Services)
,B. -51 (Multiple Procedures)
C. -59 (Distinct Procedural Service)
D. -25 (Significant, Separately Identifiable E/M Service)
Answer: A
Conceptual Explanation: Modifier -22 is used when the work required to provide a
service is substantially greater than typically required, usually requiring supporting
documentation of increased time or complexity.
3. When abstracting a clinical record, which of the following takes precedence in determining
the principal diagnosis for an inpatient stay?
A. The admitting diagnosis provided by the primary care physician.
B. The condition that resulted in the highest resource consumption.
C. The most severe condition documented in the patient’s history.
D. The diagnosis established after study to be chiefly responsible for the admission.
Answer: D
Conceptual Explanation: The Uniform Hospital Discharge Data Set (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.
, 4. A patient presents with acute respiratory failure and congestive heart failure. If both are
equally responsible for the admission, what is the coding guideline?
A. The respiratory failure must always be sequenced first.
B. Either may be sequenced first as the principal diagnosis.
C. The heart failure must always be sequenced first.
D. A combination code must be found to represent both conditions.
Answer: B
Conceptual Explanation: When two or more diagnoses equally meet the criteria for
principal diagnosis as determined by the circumstances of admission, any one of the
diagnoses may be sequenced first.
5. In the 2024/2025/2026 E/M guidelines, which component is no longer used to determine
the level of service for Office or Other Outpatient visits?
A. History and Physical Examination
B. Total Time on the date of the encounter
C. Medical Decision Making (MDM)
D. Number and complexity of problems addressed
Answer: A
