1. A patient is admitted with chest pain, elevated CPKs and MB enzymes, and nonspecific ST
changes on EKG. What is the most likely diagnosis?
a. Unstable angina
b. Myocardial infarction
c. Congestive heart failure
d. Mitral valve stenosis
*Rationale: Elevated CPK-MB and ST changes indicate myocardial infarction (Leon-Chisen
2013, 386-387
2. Discharge diagnosis: Escherichia coli urinary tract infection. How should diagnoses be
sequenced?
a. Fever, urinary burning, urosepsis
b. Fever, urinary burning, sepsis
c. Escherichia coli, urinary tract infection
d. Urinary tract infection, Escherichia coli
Rationale: Symptoms not coded when definitive diagnosis present; organism is additional code
(HHS 2014, Section II.A., 98).
3. A patient is admitted with heart failure one week after a heart transplant. The coder suspects
transplant rejection. What action is most appropriate?
a. Query the physician
,b. Assign codes for postoperative transplant rejection
c. Assign only code for transplant rejection
d. Assign only code for heart failure
Rationale: Query when documentation is unclear about a potential complication (HHS 2014,
Section I.B.16, 16).
4. A patient has loss of interest, weight gain, fatigue, and difficulty making decisions most days
for a month. What diagnosis fits best?
a. Insomnia
b. Major depression
c. Reye's syndrome
d. Bipolar disorder
*Rationale: Symptoms are indicative of a depressive disorder (Leon-Chisen 2013, 175).*
5. Inpatient with AIDS, asymptomatic due to medication, admitted for right indirect inguinal
herniorrhaphy. Correct ICD-10-CM codes?
a. B20, K40.90
b. K40.90, Z21
c. K40.90, B20
d. Z21, K40.90
*Rationale: Code AIDS (B20) even if asymptomatic; hernia is principal diagnosis
(Schraffenberger 2013, 82-84,252).*
6. A 75-year-old from nursing home with dehydration and dysphagia due to previous stroke.
Correct ICD-10-CM codes?
a. E86.0, I69.391
,b. I69.391, E86.0
c. E86.0, I63.9
d. E86.0, I69.391
*Rationale: Dehydration principal; dysphagia due to stroke with code for late effect
(Schraffenberger 2013, 131, 209-210).*
7. Patient admitted for alcohol and barbiturate detox with chronic alcoholism, barbiturate abuse,
and alcoholic cirrhosis. Correct ICD-10-CM codes?
a. F10.229, F13.129, K70.30
b. F10.229, F13.129, K70.30
c. F10.229, K70.30, F13.129
d. F13.129, F10.229, K70.30
*Rationale: Codes for alcohol dependence, barbiturate abuse, and alcoholic cirrhosis
(Schraffenberger 2013, 140-143).*
8. A patient with recurrent epileptic seizures and tic douloureux. Correct ICD-10-CM codes?
a. G40.909, G50.0
b. G40.909, G50.0
c. G50.0, G40.909
d. G40.909 only
*Rationale: Both conditions coded; tic douloureux is trigeminal neuralgia (Schraffenberger
2013,158-159).*
9. Patient with fever, atrial fibrillation, and pneumonia treated with IV antibiotics and oral
antiarrhythmics. Which diagnosis is principal?
a. Pneumonia
, b. Atrial fibrillation
c. Fever
d. Both equally
Rationale: Pneumonia had greater resource utilization (IV antibiotics) (HHS 2014, Section II,
C).
10. Laparoscopic cholecystectomy converted to open due to adhesions. Correct ICD-10-PCS
codes?
a. OFT44ZZ only
b. OFT40ZZ only
c. OFT44ZZ, OFJ44ZZ
d. OFT40ZZ, OFJ44ZZ
*Rationale: Open cholecystectomy (OFT40ZZ) and open lysis of adhesions (OFJ44ZZ) (Leon-
Chisen 2014, 250).*
11. Patient admitted with hydronephrosis and staghorn calculus of right kidney, underwent
ureteroscopy with stent placement and calculus removal. Correct ICD-10-PCS?
a. OT788DZ, OTC08ZZ
b. OT788DZ, OTC08ZZ
c. OT788DZ only
d. OTC08ZZ only
*Rationale: Ureteroscopy with stent (OT788DZ) and removal of calculus (OTC08ZZ) (Leon-
Chisen 2013, 269).*
12. A 77-year-old with stage 3 decubitus ulcer of right heel treated with excisional debridement
in OR. Correct ICD-10-PCS?
changes on EKG. What is the most likely diagnosis?
a. Unstable angina
b. Myocardial infarction
c. Congestive heart failure
d. Mitral valve stenosis
*Rationale: Elevated CPK-MB and ST changes indicate myocardial infarction (Leon-Chisen
2013, 386-387
2. Discharge diagnosis: Escherichia coli urinary tract infection. How should diagnoses be
sequenced?
a. Fever, urinary burning, urosepsis
b. Fever, urinary burning, sepsis
c. Escherichia coli, urinary tract infection
d. Urinary tract infection, Escherichia coli
Rationale: Symptoms not coded when definitive diagnosis present; organism is additional code
(HHS 2014, Section II.A., 98).
3. A patient is admitted with heart failure one week after a heart transplant. The coder suspects
transplant rejection. What action is most appropriate?
a. Query the physician
,b. Assign codes for postoperative transplant rejection
c. Assign only code for transplant rejection
d. Assign only code for heart failure
Rationale: Query when documentation is unclear about a potential complication (HHS 2014,
Section I.B.16, 16).
4. A patient has loss of interest, weight gain, fatigue, and difficulty making decisions most days
for a month. What diagnosis fits best?
a. Insomnia
b. Major depression
c. Reye's syndrome
d. Bipolar disorder
*Rationale: Symptoms are indicative of a depressive disorder (Leon-Chisen 2013, 175).*
5. Inpatient with AIDS, asymptomatic due to medication, admitted for right indirect inguinal
herniorrhaphy. Correct ICD-10-CM codes?
a. B20, K40.90
b. K40.90, Z21
c. K40.90, B20
d. Z21, K40.90
*Rationale: Code AIDS (B20) even if asymptomatic; hernia is principal diagnosis
(Schraffenberger 2013, 82-84,252).*
6. A 75-year-old from nursing home with dehydration and dysphagia due to previous stroke.
Correct ICD-10-CM codes?
a. E86.0, I69.391
,b. I69.391, E86.0
c. E86.0, I63.9
d. E86.0, I69.391
*Rationale: Dehydration principal; dysphagia due to stroke with code for late effect
(Schraffenberger 2013, 131, 209-210).*
7. Patient admitted for alcohol and barbiturate detox with chronic alcoholism, barbiturate abuse,
and alcoholic cirrhosis. Correct ICD-10-CM codes?
a. F10.229, F13.129, K70.30
b. F10.229, F13.129, K70.30
c. F10.229, K70.30, F13.129
d. F13.129, F10.229, K70.30
*Rationale: Codes for alcohol dependence, barbiturate abuse, and alcoholic cirrhosis
(Schraffenberger 2013, 140-143).*
8. A patient with recurrent epileptic seizures and tic douloureux. Correct ICD-10-CM codes?
a. G40.909, G50.0
b. G40.909, G50.0
c. G50.0, G40.909
d. G40.909 only
*Rationale: Both conditions coded; tic douloureux is trigeminal neuralgia (Schraffenberger
2013,158-159).*
9. Patient with fever, atrial fibrillation, and pneumonia treated with IV antibiotics and oral
antiarrhythmics. Which diagnosis is principal?
a. Pneumonia
, b. Atrial fibrillation
c. Fever
d. Both equally
Rationale: Pneumonia had greater resource utilization (IV antibiotics) (HHS 2014, Section II,
C).
10. Laparoscopic cholecystectomy converted to open due to adhesions. Correct ICD-10-PCS
codes?
a. OFT44ZZ only
b. OFT40ZZ only
c. OFT44ZZ, OFJ44ZZ
d. OFT40ZZ, OFJ44ZZ
*Rationale: Open cholecystectomy (OFT40ZZ) and open lysis of adhesions (OFJ44ZZ) (Leon-
Chisen 2014, 250).*
11. Patient admitted with hydronephrosis and staghorn calculus of right kidney, underwent
ureteroscopy with stent placement and calculus removal. Correct ICD-10-PCS?
a. OT788DZ, OTC08ZZ
b. OT788DZ, OTC08ZZ
c. OT788DZ only
d. OTC08ZZ only
*Rationale: Ureteroscopy with stent (OT788DZ) and removal of calculus (OTC08ZZ) (Leon-
Chisen 2013, 269).*
12. A 77-year-old with stage 3 decubitus ulcer of right heel treated with excisional debridement
in OR. Correct ICD-10-PCS?
