CCS Practice Exam test with correct
answers
A 12-year-old boy was seen in an ambulatory surgical center for pain in his right arm.
The x-ray showed fracture of ulna. Patient underwent closed reduction of fracture right
proximal ulna and an elbow-to-finger cast was applied. What diagnostic and procedure
codes should be assigned?
S52.101AUnspecified fracture of upper end of right radius, initial encounter for closed
fracture
S52.101BUnspecified fracture of upper end of right radius, initial encounter for open
fracture
S52.001AUnspecified fracture of upper end of right ulna, initial encounter for closed
fracture
S52.001BUnspecified fracture of upper end of right ulna, initial encounter for open
fracture
0PSH0ZZReposition right radius, open approach
0PSK0ZZReposition right ulna, open approach
24670Closed treatment of ulnar fracture, proximal end (eg, olecranon or coronoid
process(es) ); without manipulation
24675Closed treatment of ulnar fracture, proximal end (eg - CORRECT ANSWERS-
Correct Answer: D
The patient has a fracture of the right proximal ulna and closed reduction is necessary.
In the ICD-10-CM Code Book, under Fracture, ulna, proximal, the coder is referred to
Fracture, ulna, upper end. The term "manipulation" is used to indicate reduction in CPT.
According to CPT guidelines, cast application or strapping (including removal) is only
reported as a replacement procedure or when the cast application or strapping is an
initial service performed without a restorative treatment or procedure (AMA CPT
Professional Edition 2020, 182). (Note: Since this is an ambulatory surgery center case,
CPT codes are assigned rather than ICD-10-PCS codes.)
A 64-year-old female is admitted to the hospital with nausea, vomiting, and edema. Lab
values indicate the patient has dehydration. The patient takes Lisinopril as prescribed
along with Levothyroxine for hypothyroidism. On the discharge summary, the final
diagnoses of acute renal failure, hypothyroidism and dehydration are documented.
What discrepancy should a coding professional note in this documentation?
,a. There is not enough detail in the documentation to assign the dehydration.
b. There is no explanation for the patient's vomiting.
c. There is no correlating diagnosis for the Lisinopril.
d. The nausea, vomiting, and edema are indicative of chronic renal failure not acute. -
CORRECT ANSWERS-Correct Answer: C
The patient should have a diagnosis related to taking the medication Lisinopril, which is
usually hypertension (Brinda 2020, 186-187).
A 64-year-old female was discharged with the final diagnosis of acute renal failure and
hypertension. What coding guideline applies?
a. Use combination code of hypertension and chronic renal failure.
b. Use separate codes for hypertension and chronic renal failure.
c. Use separate codes for hypertension and acute renal failure.
d. Use combination code for hypertension and acute renal failure. - CORRECT
ANSWERS-Correct Answer: C
There is not a combination code for acute renal failure and hypertension. Acute kidney
failure is not the same as chronic kidney disease (CMS 2020a, Section I.C.9. 2-3, 46-
47; Leon-Chisen 2020, 262).
A 75-year-old patient is admitted for a complex, ventral hernia repair. While in the
hospital, the patient slips and falls, suffering a left hip fracture. Will the hip fracture be
identified as part of the facility's patient safety indicators (PSI)? Why or why not?
a. No, the hip fracture is the principal diagnosis and will not be part of the PSI
b. Yes, the hip fracture is the principal diagnosis and would still be part of the PSI
c. No, the hip fracture is a secondary diagnosis and therefore, will not be part of the PSI
d. Yes, the hip fracture is a secondary diagnosis and will be part of the PSI - CORRECT
ANSWERS-Correct Answer: D
Patient safety indicators are designed to capture adverse effects following surgery,
procedures, or childbirth. Therefore, it is a secondary diagnosis of hip fracture that will
necessitate capture of the PSI (CMS 2020d).
A bronchoscopy with multiple biopsies of the left bronchus was completed and revealed
adenocarcinoma. What, if any, modifier should be added to the procedure code billed by
the facility?
a. -59, Distinct procedural service
b. -51, Multiple procedures
c. -76, Repeat procedure or service by same physician
d. No modifiers should be reported - CORRECT ANSWERS-Correct Answer: D
The procedure is reported with code 31625, the description of which indicates biopsy of
single or multiple sites. When reporting this code, it is not necessary to indicate multiple
procedures as the code itself does that (AMA CPT Professional Edition 2020, Appendix
A).
, A coder reviews a medical record and determines that a code Medicare has designated
as "unacceptable principal diagnosis" is the correct code to assign. What should the
coder do?
a. Assign another code from the history and physical as the principal diagnosis
b. Assign the code even though the insurer may not pay the claim
c. Use a comorbidity as the principal diagnosis
d. Assign a code from the outpatient visit prior to admission - CORRECT ANSWERS-
Correct Answer: B
While Medicare may specify that a given condition is not acceptable, if that condition is
what is documented, the coder has no other option but to code what is documented
even though the insurer may not pay the claim (Leon-Chisen 2020, 33).
A condition is considered present on admission when it is:
a. The principal diagnosis
b. In accordance with medical staff bylaws
c. A condition that occurs prior to an inpatient admission
d. Present within three days after admission - CORRECT ANSWERS-Correct Answer:
C
It is important to understand the time frame for assigning a status code specifying that a
condition is present on admission. A condition is present on admission when it occurs
prior to inpatient admission (CMS 2020a, Appendix I, 117-121).
A facility recently implemented a computer-assisted coding (CAC) program to assist
their coding staff. Since that time, the coding manager has found that one coder, who
previously struggled to meet productivity, is now leading the coding staff in productivity.
A review shows that he is accepting all CAC suggested codes without validation. Is
there an ethical issue here?
a. Yes, the coding professional is required to utilize CAC as a tool, but not without
validating the code choices.
b. Yes, CAC codes can be assigned only after a coder has independently arrived at the
same codes by using a code book.
c. No, CAC codes are populated based on provider documentation and do not require
validation.
d. No, CAC programs are built by coding professionals, so the auto-suggested codes
can automatically be assigned. - CORRECT ANSWERS-Correct Answer: A
The Standards of Ethical Coding from AHIMA state that CAC programs should be used
as a tool, but require coding professionals to use their knowledge in order to assign the
correct codes (AHIMA House of Delegates 2016).
A facility's coding policy states that inpatients who undergo open reduction and internal
fixation of a fractured femur should be routinely coded with blood loss anemia when
there is intraoperative blood loss of 500 cc or more documented in the operative report
and the patient has low hemoglobin. Is this correct or incorrect and why?
a. It is correct to code blood loss anemia because the policy requires it.
b. It is correct because the clinical signs are documented in the record.
answers
A 12-year-old boy was seen in an ambulatory surgical center for pain in his right arm.
The x-ray showed fracture of ulna. Patient underwent closed reduction of fracture right
proximal ulna and an elbow-to-finger cast was applied. What diagnostic and procedure
codes should be assigned?
S52.101AUnspecified fracture of upper end of right radius, initial encounter for closed
fracture
S52.101BUnspecified fracture of upper end of right radius, initial encounter for open
fracture
S52.001AUnspecified fracture of upper end of right ulna, initial encounter for closed
fracture
S52.001BUnspecified fracture of upper end of right ulna, initial encounter for open
fracture
0PSH0ZZReposition right radius, open approach
0PSK0ZZReposition right ulna, open approach
24670Closed treatment of ulnar fracture, proximal end (eg, olecranon or coronoid
process(es) ); without manipulation
24675Closed treatment of ulnar fracture, proximal end (eg - CORRECT ANSWERS-
Correct Answer: D
The patient has a fracture of the right proximal ulna and closed reduction is necessary.
In the ICD-10-CM Code Book, under Fracture, ulna, proximal, the coder is referred to
Fracture, ulna, upper end. The term "manipulation" is used to indicate reduction in CPT.
According to CPT guidelines, cast application or strapping (including removal) is only
reported as a replacement procedure or when the cast application or strapping is an
initial service performed without a restorative treatment or procedure (AMA CPT
Professional Edition 2020, 182). (Note: Since this is an ambulatory surgery center case,
CPT codes are assigned rather than ICD-10-PCS codes.)
A 64-year-old female is admitted to the hospital with nausea, vomiting, and edema. Lab
values indicate the patient has dehydration. The patient takes Lisinopril as prescribed
along with Levothyroxine for hypothyroidism. On the discharge summary, the final
diagnoses of acute renal failure, hypothyroidism and dehydration are documented.
What discrepancy should a coding professional note in this documentation?
,a. There is not enough detail in the documentation to assign the dehydration.
b. There is no explanation for the patient's vomiting.
c. There is no correlating diagnosis for the Lisinopril.
d. The nausea, vomiting, and edema are indicative of chronic renal failure not acute. -
CORRECT ANSWERS-Correct Answer: C
The patient should have a diagnosis related to taking the medication Lisinopril, which is
usually hypertension (Brinda 2020, 186-187).
A 64-year-old female was discharged with the final diagnosis of acute renal failure and
hypertension. What coding guideline applies?
a. Use combination code of hypertension and chronic renal failure.
b. Use separate codes for hypertension and chronic renal failure.
c. Use separate codes for hypertension and acute renal failure.
d. Use combination code for hypertension and acute renal failure. - CORRECT
ANSWERS-Correct Answer: C
There is not a combination code for acute renal failure and hypertension. Acute kidney
failure is not the same as chronic kidney disease (CMS 2020a, Section I.C.9. 2-3, 46-
47; Leon-Chisen 2020, 262).
A 75-year-old patient is admitted for a complex, ventral hernia repair. While in the
hospital, the patient slips and falls, suffering a left hip fracture. Will the hip fracture be
identified as part of the facility's patient safety indicators (PSI)? Why or why not?
a. No, the hip fracture is the principal diagnosis and will not be part of the PSI
b. Yes, the hip fracture is the principal diagnosis and would still be part of the PSI
c. No, the hip fracture is a secondary diagnosis and therefore, will not be part of the PSI
d. Yes, the hip fracture is a secondary diagnosis and will be part of the PSI - CORRECT
ANSWERS-Correct Answer: D
Patient safety indicators are designed to capture adverse effects following surgery,
procedures, or childbirth. Therefore, it is a secondary diagnosis of hip fracture that will
necessitate capture of the PSI (CMS 2020d).
A bronchoscopy with multiple biopsies of the left bronchus was completed and revealed
adenocarcinoma. What, if any, modifier should be added to the procedure code billed by
the facility?
a. -59, Distinct procedural service
b. -51, Multiple procedures
c. -76, Repeat procedure or service by same physician
d. No modifiers should be reported - CORRECT ANSWERS-Correct Answer: D
The procedure is reported with code 31625, the description of which indicates biopsy of
single or multiple sites. When reporting this code, it is not necessary to indicate multiple
procedures as the code itself does that (AMA CPT Professional Edition 2020, Appendix
A).
, A coder reviews a medical record and determines that a code Medicare has designated
as "unacceptable principal diagnosis" is the correct code to assign. What should the
coder do?
a. Assign another code from the history and physical as the principal diagnosis
b. Assign the code even though the insurer may not pay the claim
c. Use a comorbidity as the principal diagnosis
d. Assign a code from the outpatient visit prior to admission - CORRECT ANSWERS-
Correct Answer: B
While Medicare may specify that a given condition is not acceptable, if that condition is
what is documented, the coder has no other option but to code what is documented
even though the insurer may not pay the claim (Leon-Chisen 2020, 33).
A condition is considered present on admission when it is:
a. The principal diagnosis
b. In accordance with medical staff bylaws
c. A condition that occurs prior to an inpatient admission
d. Present within three days after admission - CORRECT ANSWERS-Correct Answer:
C
It is important to understand the time frame for assigning a status code specifying that a
condition is present on admission. A condition is present on admission when it occurs
prior to inpatient admission (CMS 2020a, Appendix I, 117-121).
A facility recently implemented a computer-assisted coding (CAC) program to assist
their coding staff. Since that time, the coding manager has found that one coder, who
previously struggled to meet productivity, is now leading the coding staff in productivity.
A review shows that he is accepting all CAC suggested codes without validation. Is
there an ethical issue here?
a. Yes, the coding professional is required to utilize CAC as a tool, but not without
validating the code choices.
b. Yes, CAC codes can be assigned only after a coder has independently arrived at the
same codes by using a code book.
c. No, CAC codes are populated based on provider documentation and do not require
validation.
d. No, CAC programs are built by coding professionals, so the auto-suggested codes
can automatically be assigned. - CORRECT ANSWERS-Correct Answer: A
The Standards of Ethical Coding from AHIMA state that CAC programs should be used
as a tool, but require coding professionals to use their knowledge in order to assign the
correct codes (AHIMA House of Delegates 2016).
A facility's coding policy states that inpatients who undergo open reduction and internal
fixation of a fractured femur should be routinely coded with blood loss anemia when
there is intraoperative blood loss of 500 cc or more documented in the operative report
and the patient has low hemoglobin. Is this correct or incorrect and why?
a. It is correct to code blood loss anemia because the policy requires it.
b. It is correct because the clinical signs are documented in the record.
