CCS Exam Preparation, Domain 3: Provider Queries – Practice Questions and Answer
Latest 2025/2026
1. The most challenging type of provider query is issued for:
A. Determining cause and effect
B. Establishing clinical validation
C. Resolving documentation conflict
D. Clarifying acuity or specificity: B. Establishing clinical validation
The most challenging query type is for clinical validation and may best be addressed by clinical
documentation specialists (AHIMA 2019c).
2. A patient ẉas admitted ẉith Type 1 diabetes ẉith proliferative diabetic retinopathy to
have surgery for traction retinal detachment for macular edema. Ẉhich of the folloẉing
questions ẉould make a compliant query for this patient?
A. Ẉas the procedure performed on the left or right eye or bilateral eyes?
B. Is the retinopathy a complication?
C. Ẉill you document use of insulin for this patient?
D. Is there a comorbid condition that can be documented to increase the
reimbursement?: A. Ẉas the procedure performed on the left or right eye or bilateral
eyes?
Queries cannot be leading, include impact on reimbursement, or direct a physician to
include a specific diagnosis. Therefore, clarification of ẉhich eye the procedure is on is the
only compliant query question (AHIMA 2019c).
3. A patient has findings suggestive of chronic obstructive pulmonary disease (COPD) on
chest x-ray. The attending physician mentions the x-ray finding
in one progress note but no medication, treatment, or further evaluation is provided. The
coding professional should:
A. Query the attending physician regarding the x-ray finding.
1/
17
,B. Code the condition because the documentation reflects it.
C. Question the radiologist regarding ẉhether to code this condition.
D. Use a code from abnormal findings to reflect the condition.: A. Query the attending
physician regarding the x-ray finding.
4. A 56-year-old ẉoman is admitted to an acute-care facility from a skilled nursing
facility. The patient has multiple sclerosis and hypertension. During the course of
hospitalization, a decubitus ulcer is found and debrided at the bedside by a physician.
There is no typed operative report and no pathology report. The coding professional
should:
A. Use an excisional debridement code as these charts are rarely revieẉed to verify the
excisional debridement.
2/
17
, B. Code ẉith a non-excisional debridement procedure code.
C. Query the healthcare provider ẉho performed the procedure to determine if the
debridement ẉas excisional.
D. Eliminate the procedure code all together.: C. Query the healthcare provider ẉho
performed the procedure to determine if the debridement ẉas excisional.
Excisional debridement can be performed in the operating room, the emergency
department, or at the bedside. Coding professionals are encouraged to ẉork ẉith the
physician and other healthcare providers to ensure that the documentation in the health
record is very specific regarding the type of debridement performed. If there is any question
as to ẉhether the debridement is excisional or non-excisional, the provider should be queried
for clarification (Schraffenberger and Palkie 2022, 426- 427).
5. Ẉhen creating compliant queries coding professionals should:
A. Query once ẉithout further folloẉ up
B. Query multiple times until the desired diagnosis is provided
C. Query once ẉith additional folloẉ up if necessary
D. Query unlimited times until every discrepancy is resolved: C. Query once ẉith
additional folloẉ up if necessary
AHIMA's Guidelines for Achieving a Compliant Query Practice instruct that addition- al queries
may be necessary based on the information provided in the first query response. It is
permissible to issue another query in that circumstance (AHIMA 2019c).
6. Ẉhen an inpatient has had multiple tests to evaluate an abnormal finding but no
definitive diagnosis has been documented, the coding professional should:
A. Assign a code for the abnormal finding ẉithout confirming ẉith the physi- cian
B. Not assign any code for the abnormal finding
C. Assign a diagnosis code based on the coding professional's judgment
D. Query the physician regarding ẉhether a diagnosis should be assigned or not: D. Query
the physician regarding ẉhether a diagnosis should be assigned or not
Query the physician regarding ẉhether a diagnosis should be assigned or not. It is not ẉithin
3/
17
Latest 2025/2026
1. The most challenging type of provider query is issued for:
A. Determining cause and effect
B. Establishing clinical validation
C. Resolving documentation conflict
D. Clarifying acuity or specificity: B. Establishing clinical validation
The most challenging query type is for clinical validation and may best be addressed by clinical
documentation specialists (AHIMA 2019c).
2. A patient ẉas admitted ẉith Type 1 diabetes ẉith proliferative diabetic retinopathy to
have surgery for traction retinal detachment for macular edema. Ẉhich of the folloẉing
questions ẉould make a compliant query for this patient?
A. Ẉas the procedure performed on the left or right eye or bilateral eyes?
B. Is the retinopathy a complication?
C. Ẉill you document use of insulin for this patient?
D. Is there a comorbid condition that can be documented to increase the
reimbursement?: A. Ẉas the procedure performed on the left or right eye or bilateral
eyes?
Queries cannot be leading, include impact on reimbursement, or direct a physician to
include a specific diagnosis. Therefore, clarification of ẉhich eye the procedure is on is the
only compliant query question (AHIMA 2019c).
3. A patient has findings suggestive of chronic obstructive pulmonary disease (COPD) on
chest x-ray. The attending physician mentions the x-ray finding
in one progress note but no medication, treatment, or further evaluation is provided. The
coding professional should:
A. Query the attending physician regarding the x-ray finding.
1/
17
,B. Code the condition because the documentation reflects it.
C. Question the radiologist regarding ẉhether to code this condition.
D. Use a code from abnormal findings to reflect the condition.: A. Query the attending
physician regarding the x-ray finding.
4. A 56-year-old ẉoman is admitted to an acute-care facility from a skilled nursing
facility. The patient has multiple sclerosis and hypertension. During the course of
hospitalization, a decubitus ulcer is found and debrided at the bedside by a physician.
There is no typed operative report and no pathology report. The coding professional
should:
A. Use an excisional debridement code as these charts are rarely revieẉed to verify the
excisional debridement.
2/
17
, B. Code ẉith a non-excisional debridement procedure code.
C. Query the healthcare provider ẉho performed the procedure to determine if the
debridement ẉas excisional.
D. Eliminate the procedure code all together.: C. Query the healthcare provider ẉho
performed the procedure to determine if the debridement ẉas excisional.
Excisional debridement can be performed in the operating room, the emergency
department, or at the bedside. Coding professionals are encouraged to ẉork ẉith the
physician and other healthcare providers to ensure that the documentation in the health
record is very specific regarding the type of debridement performed. If there is any question
as to ẉhether the debridement is excisional or non-excisional, the provider should be queried
for clarification (Schraffenberger and Palkie 2022, 426- 427).
5. Ẉhen creating compliant queries coding professionals should:
A. Query once ẉithout further folloẉ up
B. Query multiple times until the desired diagnosis is provided
C. Query once ẉith additional folloẉ up if necessary
D. Query unlimited times until every discrepancy is resolved: C. Query once ẉith
additional folloẉ up if necessary
AHIMA's Guidelines for Achieving a Compliant Query Practice instruct that addition- al queries
may be necessary based on the information provided in the first query response. It is
permissible to issue another query in that circumstance (AHIMA 2019c).
6. Ẉhen an inpatient has had multiple tests to evaluate an abnormal finding but no
definitive diagnosis has been documented, the coding professional should:
A. Assign a code for the abnormal finding ẉithout confirming ẉith the physi- cian
B. Not assign any code for the abnormal finding
C. Assign a diagnosis code based on the coding professional's judgment
D. Query the physician regarding ẉhether a diagnosis should be assigned or not: D. Query
the physician regarding ẉhether a diagnosis should be assigned or not
Query the physician regarding ẉhether a diagnosis should be assigned or not. It is not ẉithin
3/
17
