ADVANCED MEDICAL CODING AND
CASE STUDY ABSTRACTION
PRACTICUM QUESTIONS WITH
VERIFIED ANSWERS 2026/2027
1. When abstracting a medical record for a patient with sepsis due to a localized infection,
what is the correct sequencing priority according to ICD-10-CM guidelines?
A. The localized infection should be sequenced first, followed by sepsis.
B. The underlying condition causing the localized infection is always sequenced first.
C. The systemic infection (sepsis) should be sequenced first, followed by the localized
infection.
D. Only the sepsis code is reported; the localized infection is inherent.
Answer: C
Conceptual Explanation: Per ICD-10-CM guidelines, if sepsis is present on admission and
is related to a localized infection, the systemic infection (sepsis) code should be sequenced
first, followed by the code for the localized infection.
2. In CPT coding, which modifier is most appropriate for a physician who performs a
procedure that is significantly more complex than typically required?
A. Modifier 59
,B. Modifier 51
C. Modifier 22
D. Modifier 25
Answer: C
Conceptual Explanation: Modifier 22 (Increased Procedural Services) is used when the
work required to provide a service is substantially greater than typically required,
necessitating extensive documentation.
3. When a patient is admitted for treatment of a complication resulting from a previous
surgery, how is the principal diagnosis determined?
A. The original condition that necessitated the surgery is coded as principal.
B. The principal diagnosis is the condition that resulted in the original admission.
C. A Z-code for post-operative follow-up is sequenced first.
D. The specific complication is sequenced as the principal diagnosis.
Answer: D
Conceptual Explanation: According to official guidelines, when a patient is admitted for
treatment of a complication of surgery, the complication is sequenced as the principal
diagnosis.
4. Which ICD-10-PCS root operation is used when a physician performs a total mastectomy?
A. Excision
, B. Resection
C. Extraction
D. Destruction
Answer: B
Conceptual Explanation: Resection is defined as cutting out or off, without replacement,
all of a body part. A total mastectomy involves the entire body part (breast), fitting the
definition of Resection.
5. A patient is seen for a follow-up visit for a fracture that is now in the ‘delayed union’
phase. What is the correct seventh character for the ICD-10-CM code?
A. A - Initial encounter
B. D - Subsequent encounter
C. S - Sequela
D. G - Subsequent encounter for fracture with delayed union
Answer: D
Conceptual Explanation: The seventh character ‘G’ is specifically used for subsequent
encounters for fractures with delayed union.
6. Which of the following is true regarding ‘Excludes1’ notes in ICD-10-CM?
A. It means ‘Not coded here’ and indicates that the codes should never be used together.
B. The code and the excluded code can be used together if supported by documentation.
CASE STUDY ABSTRACTION
PRACTICUM QUESTIONS WITH
VERIFIED ANSWERS 2026/2027
1. When abstracting a medical record for a patient with sepsis due to a localized infection,
what is the correct sequencing priority according to ICD-10-CM guidelines?
A. The localized infection should be sequenced first, followed by sepsis.
B. The underlying condition causing the localized infection is always sequenced first.
C. The systemic infection (sepsis) should be sequenced first, followed by the localized
infection.
D. Only the sepsis code is reported; the localized infection is inherent.
Answer: C
Conceptual Explanation: Per ICD-10-CM guidelines, if sepsis is present on admission and
is related to a localized infection, the systemic infection (sepsis) code should be sequenced
first, followed by the code for the localized infection.
2. In CPT coding, which modifier is most appropriate for a physician who performs a
procedure that is significantly more complex than typically required?
A. Modifier 59
,B. Modifier 51
C. Modifier 22
D. Modifier 25
Answer: C
Conceptual Explanation: Modifier 22 (Increased Procedural Services) is used when the
work required to provide a service is substantially greater than typically required,
necessitating extensive documentation.
3. When a patient is admitted for treatment of a complication resulting from a previous
surgery, how is the principal diagnosis determined?
A. The original condition that necessitated the surgery is coded as principal.
B. The principal diagnosis is the condition that resulted in the original admission.
C. A Z-code for post-operative follow-up is sequenced first.
D. The specific complication is sequenced as the principal diagnosis.
Answer: D
Conceptual Explanation: According to official guidelines, when a patient is admitted for
treatment of a complication of surgery, the complication is sequenced as the principal
diagnosis.
4. Which ICD-10-PCS root operation is used when a physician performs a total mastectomy?
A. Excision
, B. Resection
C. Extraction
D. Destruction
Answer: B
Conceptual Explanation: Resection is defined as cutting out or off, without replacement,
all of a body part. A total mastectomy involves the entire body part (breast), fitting the
definition of Resection.
5. A patient is seen for a follow-up visit for a fracture that is now in the ‘delayed union’
phase. What is the correct seventh character for the ICD-10-CM code?
A. A - Initial encounter
B. D - Subsequent encounter
C. S - Sequela
D. G - Subsequent encounter for fracture with delayed union
Answer: D
Conceptual Explanation: The seventh character ‘G’ is specifically used for subsequent
encounters for fractures with delayed union.
6. Which of the following is true regarding ‘Excludes1’ notes in ICD-10-CM?
A. It means ‘Not coded here’ and indicates that the codes should never be used together.
B. The code and the excluded code can be used together if supported by documentation.
