CCS Exam 2: Questions With In-Depth Solutions
Assign code(s) for the following diagnosis: Congestive heart failure due to
hypertension.
I10Essential (primary) hypertension
I11.0Hypertensive heart disease with heart failure
I50.9Heart failure, unspecified
I50.23Acute on chronic systolic (congestive) heart failure
a. I10, I50.9
b. I11.0
c. I50.23, I10
d. I11.0, I50.9 Correct Answer - D
Heart failure is assigned a combination code when a causal relationship is
stated (due to hypertension) or implied (hypertensive). Use an additional
code to identify the type of heart failure in those patients with heart failure
(CMS 2020a, Section I.C.9.a.1, 46-47).
A patient is seen for evaluation of a right orbital roof fracture. How should this
be coded?
S02.121AFracture of orbital roof, right side, initial encounter for closed
fracture
S02.31XAFracture of orbital floor, right side, initial encounter for closed
fracture
S02.92XAUnspecified fracture of facial bones, initial encounter for closed
fracture
S02.91XAUnspecified fracture of skull, initial encounter for closed fracture
a. S02.121A
b. S02.31XA
c. S02.92XA
d. S02.91XA Correct Answer - A
Alphabetic Index for fracture, traumatic; orbit, orbital; roof guides the coder
to S02.12. Evaluation of a fracture is an example of active treatment which is
reported with 7th character "A" (Schraffenberger and Palkie 2020, 580-584).
,Patient presents in the ER with thrombosis of a loop PTFE hemodialysis fistula
without mechanical complications. The physician performed a percutaneous
thrombectomy of the left brachial vein. Assign a facility code for this
outpatient procedure.
05CA3ZZExtirpation of matter from left brachial vein, percutaneous approach
36904Percutaneous transluminal mechanical thrombectomy and/or infusion
for thrombolysis, dialysis circuit, any method, including all imaging and
radiological supervision and interpretation, diagnostic angiography,
fluoroscopic guidance, catheter placement(s), and intraprocedural
pharmacological thrombolytic injection(s)
36832Revision, open, arteriovenous fistula; without thrombectomy,
autogenous or nonautogenous dialysis graft (separate procedure)
37184Primary percutaneous transluminal mechanical thrombectomy,
noncoronary, arterial or arterial bypass graft, including fluoroscopic guidance
and intrapro Correct Answer - B
This episode of care occurs in the ER which is an outpatient setting, therefore,
a CPT code should be used. CPT code 36904 correctly identifies the
thrombectomy procedure because it specifies the site of the thrombectomy as
"dialysis circuit." 36904 includes imaging guidance, diagnostic angiography,
catheter placement, and intraprocedural pharmacological thrombolytic
injections" (Kirchoff 2009, 203).
Patient admitted for laparoscopic repair of right diaphragmatic hernia. Assign
the ICD-10-PCS procedure code for this surgery.
0BQT4ZZRepair diaphragm, percutaneous endoscopic approach
0BQT3ZZRepair diaphragm, percutaneous approach
0WQF4ZZRepair abdominal wall, percutaneous endoscopic approach
0BQT0ZZRepair diaphragm, open approach
a. 0BQT4ZZ
b. 0BQT3ZZ
c. 0WQF4ZZ
d. 0BQT0ZZ Correct Answer - A
ICD-10-PCS code 0BQT4ZZ is the correct code based on the values for the
body part and approach. The correct body part is diaphragm and laparoscopy
is reported as a percutaneous endoscopic method of approach (Leon-Chisen
2020, 250-251).
,A 23-year-old female is admitted for vaginal bleeding following a miscarriage
two weeks prior to this admission. She is afebrile at this time and is treated
with an aspiration dilation and curettage. Products of conception are found.
Which of the following should be the principal diagnosis?
a. O03.1, Delayed or excessive hemorrhage following incomplete spontaneous
abortion
b. O08.1, Delayed or excessive hemorrhage following ectopic and molar
pregnancy
c. O03.6, Delayed or excessive hemorrhage following complete or unspecified
spontaneous abortion
d. O07.1, Delayed or excessive hemorrhage following failed attempted
termination of pregnancy Correct Answer - A
A miscarriage is a spontaneous abortion. If the readmission is for the purpose
of dealing with retained products of conception, the spontaneous abortion is
incomplete; use a code from the O03 category (CMS 2020a, Section I.C.15.q.,
68).
A patient presents to the emergency department with a fractured arm
secondary to a fall precipitated by syncope and ataxia. The patient undergoes
a closed reduction of the fracture in the emergency department and is then
admitted for work up for metastatic carcinoma secondary to ataxia and
syncope in a patient with recent history of lung cancer. The patient's work-up
confirms recurrent lung carcinoma metastatic to the brain.The principal
diagnosis should be:
a. Fractured arm
b. Syncope
c. Metastatic carcinoma of the brain
d. Carcinoma of the lung Correct Answer - C
According to the UHDDS definition, the principal diagnosis is "that condition
established after study to be chiefly responsible for occasioning the admission
of the patient to the hospital for care." In this case, metastatic carcinoma of the
brain is responsible for the patient's ataxia and syncope, which led to the fall
(CMS 2020a, Section II, 107).
A female patient with hematochezia presents to the hospital outpatient
surgery department for a colonoscopy but the procedure was not performed
due to elevated blood pressure. What is the firstlisted diagnosis for this
encounter?
a. Elevated blood pressure
, b. Hematochezia
c. Procedure not performed due to contraindication
d. Procedure not performed for other reason Correct Answer - B
When a patient presents for outpatient surgery, code the reason for the
surgery as the firstlisted diagnosis (reason for the encounter) even if the
surgery is not performed due to a contraindication (CMS 2020a, Section
IV.A.1., 113).
A 55-year-old patient with AIDS admitted after being struck by car while
walking in a parking lot. She has a comminuted, right femoral shaft fracture
and a contusion of both hands and right elbow abrasion. The principal
diagnosis should be the:
a. AIDS
b. Fractured femur
c. Abrasion elbow
d. Contusion hand Correct Answer - B
If a patient with HIV disease is admitted for an unrelated condition (such as a
traumatic injury), the code for the unrelated condition (for example, the
nature of injury code) should be the principal diagnosis. The most severe
injury should be sequenced first. Other diagnoses would be B20 followed by
additional diagnosis codes for all reported HIV-related conditions (CMS
2020a, Section I.C.1.a.2.b., 21).
A patient takes Coumadin as prescribed and correctly administered. However,
the patient develops hematuria secondary to the Coumadin use. The correct
coding assignment for this case would be:
a. Poisoning due to Coumadin
b. Unspecified adverse reaction to Coumadin
c. Hematuria, poisoning due to Coumadin
d. Hematuria, adverse reaction to Coumadin Correct Answer - D
An adverse reaction can occur when a drug was correctly prescribed and
administered. In the case of an adverse reaction, the manifestation is coded
first (Hematuria) followed by a T code for the medication (Coumadin) (CMS
2020a, Section I.C.19.e.5(a), 81).
A patient with human immunodeficiency virus (HIV) with methicillin
susceptible pneumonia due to Staphylococcus aureus was discharged from
the acute-care setting. The physician documented that the pneumonia was
Assign code(s) for the following diagnosis: Congestive heart failure due to
hypertension.
I10Essential (primary) hypertension
I11.0Hypertensive heart disease with heart failure
I50.9Heart failure, unspecified
I50.23Acute on chronic systolic (congestive) heart failure
a. I10, I50.9
b. I11.0
c. I50.23, I10
d. I11.0, I50.9 Correct Answer - D
Heart failure is assigned a combination code when a causal relationship is
stated (due to hypertension) or implied (hypertensive). Use an additional
code to identify the type of heart failure in those patients with heart failure
(CMS 2020a, Section I.C.9.a.1, 46-47).
A patient is seen for evaluation of a right orbital roof fracture. How should this
be coded?
S02.121AFracture of orbital roof, right side, initial encounter for closed
fracture
S02.31XAFracture of orbital floor, right side, initial encounter for closed
fracture
S02.92XAUnspecified fracture of facial bones, initial encounter for closed
fracture
S02.91XAUnspecified fracture of skull, initial encounter for closed fracture
a. S02.121A
b. S02.31XA
c. S02.92XA
d. S02.91XA Correct Answer - A
Alphabetic Index for fracture, traumatic; orbit, orbital; roof guides the coder
to S02.12. Evaluation of a fracture is an example of active treatment which is
reported with 7th character "A" (Schraffenberger and Palkie 2020, 580-584).
,Patient presents in the ER with thrombosis of a loop PTFE hemodialysis fistula
without mechanical complications. The physician performed a percutaneous
thrombectomy of the left brachial vein. Assign a facility code for this
outpatient procedure.
05CA3ZZExtirpation of matter from left brachial vein, percutaneous approach
36904Percutaneous transluminal mechanical thrombectomy and/or infusion
for thrombolysis, dialysis circuit, any method, including all imaging and
radiological supervision and interpretation, diagnostic angiography,
fluoroscopic guidance, catheter placement(s), and intraprocedural
pharmacological thrombolytic injection(s)
36832Revision, open, arteriovenous fistula; without thrombectomy,
autogenous or nonautogenous dialysis graft (separate procedure)
37184Primary percutaneous transluminal mechanical thrombectomy,
noncoronary, arterial or arterial bypass graft, including fluoroscopic guidance
and intrapro Correct Answer - B
This episode of care occurs in the ER which is an outpatient setting, therefore,
a CPT code should be used. CPT code 36904 correctly identifies the
thrombectomy procedure because it specifies the site of the thrombectomy as
"dialysis circuit." 36904 includes imaging guidance, diagnostic angiography,
catheter placement, and intraprocedural pharmacological thrombolytic
injections" (Kirchoff 2009, 203).
Patient admitted for laparoscopic repair of right diaphragmatic hernia. Assign
the ICD-10-PCS procedure code for this surgery.
0BQT4ZZRepair diaphragm, percutaneous endoscopic approach
0BQT3ZZRepair diaphragm, percutaneous approach
0WQF4ZZRepair abdominal wall, percutaneous endoscopic approach
0BQT0ZZRepair diaphragm, open approach
a. 0BQT4ZZ
b. 0BQT3ZZ
c. 0WQF4ZZ
d. 0BQT0ZZ Correct Answer - A
ICD-10-PCS code 0BQT4ZZ is the correct code based on the values for the
body part and approach. The correct body part is diaphragm and laparoscopy
is reported as a percutaneous endoscopic method of approach (Leon-Chisen
2020, 250-251).
,A 23-year-old female is admitted for vaginal bleeding following a miscarriage
two weeks prior to this admission. She is afebrile at this time and is treated
with an aspiration dilation and curettage. Products of conception are found.
Which of the following should be the principal diagnosis?
a. O03.1, Delayed or excessive hemorrhage following incomplete spontaneous
abortion
b. O08.1, Delayed or excessive hemorrhage following ectopic and molar
pregnancy
c. O03.6, Delayed or excessive hemorrhage following complete or unspecified
spontaneous abortion
d. O07.1, Delayed or excessive hemorrhage following failed attempted
termination of pregnancy Correct Answer - A
A miscarriage is a spontaneous abortion. If the readmission is for the purpose
of dealing with retained products of conception, the spontaneous abortion is
incomplete; use a code from the O03 category (CMS 2020a, Section I.C.15.q.,
68).
A patient presents to the emergency department with a fractured arm
secondary to a fall precipitated by syncope and ataxia. The patient undergoes
a closed reduction of the fracture in the emergency department and is then
admitted for work up for metastatic carcinoma secondary to ataxia and
syncope in a patient with recent history of lung cancer. The patient's work-up
confirms recurrent lung carcinoma metastatic to the brain.The principal
diagnosis should be:
a. Fractured arm
b. Syncope
c. Metastatic carcinoma of the brain
d. Carcinoma of the lung Correct Answer - C
According to the UHDDS definition, the principal diagnosis is "that condition
established after study to be chiefly responsible for occasioning the admission
of the patient to the hospital for care." In this case, metastatic carcinoma of the
brain is responsible for the patient's ataxia and syncope, which led to the fall
(CMS 2020a, Section II, 107).
A female patient with hematochezia presents to the hospital outpatient
surgery department for a colonoscopy but the procedure was not performed
due to elevated blood pressure. What is the firstlisted diagnosis for this
encounter?
a. Elevated blood pressure
, b. Hematochezia
c. Procedure not performed due to contraindication
d. Procedure not performed for other reason Correct Answer - B
When a patient presents for outpatient surgery, code the reason for the
surgery as the firstlisted diagnosis (reason for the encounter) even if the
surgery is not performed due to a contraindication (CMS 2020a, Section
IV.A.1., 113).
A 55-year-old patient with AIDS admitted after being struck by car while
walking in a parking lot. She has a comminuted, right femoral shaft fracture
and a contusion of both hands and right elbow abrasion. The principal
diagnosis should be the:
a. AIDS
b. Fractured femur
c. Abrasion elbow
d. Contusion hand Correct Answer - B
If a patient with HIV disease is admitted for an unrelated condition (such as a
traumatic injury), the code for the unrelated condition (for example, the
nature of injury code) should be the principal diagnosis. The most severe
injury should be sequenced first. Other diagnoses would be B20 followed by
additional diagnosis codes for all reported HIV-related conditions (CMS
2020a, Section I.C.1.a.2.b., 21).
A patient takes Coumadin as prescribed and correctly administered. However,
the patient develops hematuria secondary to the Coumadin use. The correct
coding assignment for this case would be:
a. Poisoning due to Coumadin
b. Unspecified adverse reaction to Coumadin
c. Hematuria, poisoning due to Coumadin
d. Hematuria, adverse reaction to Coumadin Correct Answer - D
An adverse reaction can occur when a drug was correctly prescribed and
administered. In the case of an adverse reaction, the manifestation is coded
first (Hematuria) followed by a T code for the medication (Coumadin) (CMS
2020a, Section I.C.19.e.5(a), 81).
A patient with human immunodeficiency virus (HIV) with methicillin
susceptible pneumonia due to Staphylococcus aureus was discharged from
the acute-care setting. The physician documented that the pneumonia was
