CCS PRACTICE EXAM QUESTIONS
AND 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 laparoscopic tubal ligation is completed. What is the correct CPT code assignment?
49320Laparoscopy, abdomen, peritoneum, and omentum, diagnostic, with or without
collection of specimen(s) by brushing or washing (separate procedure)
58662Laparoscopy, surgical; with fulguration or excision of lesions of the ovary, pelvic
viscera, or peritoneal surface by any method
58670Laparoscopy, surgical; with fulguration of oviducts (with or without transection)
,58671Laparoscopy, surgical; with occlusion of oviducts by device (eg, band, clip, or
Falope ring)
a. 49320, 58662
b. 58670
c. 58671
d. 49320 - Correct Answers -Correct Answer: B
The code that best reports the tubal ligation is 58670 Laparoscopy, surgical; with
fulguration of oviducts because there are no clips or excision of lesion completed during
the procedure (CPT Assistant Nov. 1999, 29; March 2000, 10).
Normal twin delivery at 30 weeks. Both babies were delivered vaginally and were
liveborn. What conditions should have codes assigned?
O30.003Twin pregnancy, unspecified number of placenta and unspecified number of
amniotic sacs, third trimester
O30.009Twin pregnancy, unspecified number of placenta and unspecified number of
amniotic sacs, unspecified trimester
O60.14X0Preterm labor third trimester with preterm delivery third trimester, not
applicable or unspecified
O60.14X1 Preterm labor third trimester with preterm delivery third trimester, fetus 1
O60.14X2Preterm labor third trimester with preterm delivery third trimester, fetus
2O80Encounter for full-term uncomplicated delivery
Z3A.3030 weeks gestation of pregnancy
Z37.0Single live birth
Z37.2Twins, both liveborn
a. O80, Z3A.30, Z37.0
b. O30.003, O60.14X0, Z3A.30, Z37.2
c. O60.14X1, O60.14X2 O30.003, Z3A.30, Z37.2
d. O80, O30.009, Z3A.30, Z37.2 - Correct Answers -Correct Answer: C
A code for preterm labor and delivery is assigned for each fetus since both babies were
born preterm as noted in Coding Clinic. Additionally, a code from category O30, Multiple
gestations, must be assigned (Leon-Chisen 2020, 325; AHA Coding Clinic 2016 2nd
Quarter, 10-11).
A patient with acute respiratory failure, hypertension, and congestive heart failure is
admitted for intubation and ventilation. The patient's heart failure is stable on current
medications. What are the correct diagnosis codes and sequencing?
I10Essential hypertension
I11.0Hypertensive heart with heart failure
I50.9Heart failure, unspecified
J96.00Acute respiratory failure, unspecified whether with hypoxia or hypercapnia
J96.20Acute and chronic respiratory failure, unspecified whether with hypoxia or
hypercapnia
a. J96.00, I11.0, I50.9
, b. I50.9, J96.00, I10
c. J96.20, I10, I50.9
d. I50.9, J96.20, I11.0 - Correct Answers -Correct Answer: A
The patient was admitted and treated for respiratory failure. The other conditions
present are also coded. The classification presumes a causal relationship between
hypertension and congestive heart failure unless the physician documents otherwise
(Leon-Chisen 2020, 228-231; CMS 2020a, Section I.C.10.b., 53, Section I.C.9.a, 46;
AHA Coding Clinic 2017 1st Quarter, 47).
a. Only the names of patients who are admitted to the hospital for continuation of care
could be provided.
b. A full list of names could be provided.
c. No information can be obtained under any circumstances.
d. A list of patients may be available after consultation with the medical director. -
Correct Answers -Correct Answer: A
Only records that are required for care or authorized by the patient can be released by
the urgent-care facility to the acute-care facility (Rinehart-Thompson 2017a, 216-217;
Rinehart- Thompson 2020a, 272-277).
The patient was admitted for breast carcinoma in the right breast at two o'clock. This
was removed via lumpectomy. An axillary lymph node dissection, performed along with
the lumpectomy, identified 1 of 7 lymph nodes positive for carcinoma. One of the
patient's neighbors, who works at the hospital, called the coding department to get the
patient's diagnosis because she is a cancer survivor herself. The coder should:
a. Discuss the case with the coworker
b. Report the incident to hospital security
c. Give the caller false information
d. Explain that discussing the case would violate the patient's right to privacy - Correct
Answers -Correct Answer: D
Disclosing information without the patient's written consent violates the patient's right to
privacy (Rinehart-Thompson 2017a, 221-230; Hamilton 2020, 669-670).
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).
AND 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 laparoscopic tubal ligation is completed. What is the correct CPT code assignment?
49320Laparoscopy, abdomen, peritoneum, and omentum, diagnostic, with or without
collection of specimen(s) by brushing or washing (separate procedure)
58662Laparoscopy, surgical; with fulguration or excision of lesions of the ovary, pelvic
viscera, or peritoneal surface by any method
58670Laparoscopy, surgical; with fulguration of oviducts (with or without transection)
,58671Laparoscopy, surgical; with occlusion of oviducts by device (eg, band, clip, or
Falope ring)
a. 49320, 58662
b. 58670
c. 58671
d. 49320 - Correct Answers -Correct Answer: B
The code that best reports the tubal ligation is 58670 Laparoscopy, surgical; with
fulguration of oviducts because there are no clips or excision of lesion completed during
the procedure (CPT Assistant Nov. 1999, 29; March 2000, 10).
Normal twin delivery at 30 weeks. Both babies were delivered vaginally and were
liveborn. What conditions should have codes assigned?
O30.003Twin pregnancy, unspecified number of placenta and unspecified number of
amniotic sacs, third trimester
O30.009Twin pregnancy, unspecified number of placenta and unspecified number of
amniotic sacs, unspecified trimester
O60.14X0Preterm labor third trimester with preterm delivery third trimester, not
applicable or unspecified
O60.14X1 Preterm labor third trimester with preterm delivery third trimester, fetus 1
O60.14X2Preterm labor third trimester with preterm delivery third trimester, fetus
2O80Encounter for full-term uncomplicated delivery
Z3A.3030 weeks gestation of pregnancy
Z37.0Single live birth
Z37.2Twins, both liveborn
a. O80, Z3A.30, Z37.0
b. O30.003, O60.14X0, Z3A.30, Z37.2
c. O60.14X1, O60.14X2 O30.003, Z3A.30, Z37.2
d. O80, O30.009, Z3A.30, Z37.2 - Correct Answers -Correct Answer: C
A code for preterm labor and delivery is assigned for each fetus since both babies were
born preterm as noted in Coding Clinic. Additionally, a code from category O30, Multiple
gestations, must be assigned (Leon-Chisen 2020, 325; AHA Coding Clinic 2016 2nd
Quarter, 10-11).
A patient with acute respiratory failure, hypertension, and congestive heart failure is
admitted for intubation and ventilation. The patient's heart failure is stable on current
medications. What are the correct diagnosis codes and sequencing?
I10Essential hypertension
I11.0Hypertensive heart with heart failure
I50.9Heart failure, unspecified
J96.00Acute respiratory failure, unspecified whether with hypoxia or hypercapnia
J96.20Acute and chronic respiratory failure, unspecified whether with hypoxia or
hypercapnia
a. J96.00, I11.0, I50.9
, b. I50.9, J96.00, I10
c. J96.20, I10, I50.9
d. I50.9, J96.20, I11.0 - Correct Answers -Correct Answer: A
The patient was admitted and treated for respiratory failure. The other conditions
present are also coded. The classification presumes a causal relationship between
hypertension and congestive heart failure unless the physician documents otherwise
(Leon-Chisen 2020, 228-231; CMS 2020a, Section I.C.10.b., 53, Section I.C.9.a, 46;
AHA Coding Clinic 2017 1st Quarter, 47).
a. Only the names of patients who are admitted to the hospital for continuation of care
could be provided.
b. A full list of names could be provided.
c. No information can be obtained under any circumstances.
d. A list of patients may be available after consultation with the medical director. -
Correct Answers -Correct Answer: A
Only records that are required for care or authorized by the patient can be released by
the urgent-care facility to the acute-care facility (Rinehart-Thompson 2017a, 216-217;
Rinehart- Thompson 2020a, 272-277).
The patient was admitted for breast carcinoma in the right breast at two o'clock. This
was removed via lumpectomy. An axillary lymph node dissection, performed along with
the lumpectomy, identified 1 of 7 lymph nodes positive for carcinoma. One of the
patient's neighbors, who works at the hospital, called the coding department to get the
patient's diagnosis because she is a cancer survivor herself. The coder should:
a. Discuss the case with the coworker
b. Report the incident to hospital security
c. Give the caller false information
d. Explain that discussing the case would violate the patient's right to privacy - Correct
Answers -Correct Answer: D
Disclosing information without the patient's written consent violates the patient's right to
privacy (Rinehart-Thompson 2017a, 221-230; Hamilton 2020, 669-670).
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).
