CCA CERTIFICATION EXAM PREP 2026 Latest
Comprehensive Study Guide — Certified Coding Associate
Review Healthcare Coding • Detailed Rationales • Verified
Answers • Success Workbook
DOMAIN 1: CLINICAL CLASSIFICATION SYSTEMS (Questions 1–34)
Question 1
A patient is admitted with chest pain and shortness of breath. The physician
documents "acute anterolateral ST elevation myocardial infarction (STEMI)" with
onset of symptoms 4 hours prior to admission. What is the correct ICD-10-CM
code?
A) I21.09
B) I21.3
C) I21.4
D) I21.9
Rationale: I21.09 is the correct code for ST elevation (STEMI) myocardial
infarction of other coronary artery (anterolateral wall). I21.3 is STEMI of
unspecified site. I21.4 is non-ST elevation myocardial infarction. I21.9 is acute
myocardial infarction, unspecified. Since the specific site is documented, the more
specific code is required.
Question 2
A patient undergoes a laparoscopic cholecystectomy. During the procedure, the
surgeon converts to an open approach due to extensive adhesions. What is the
correct ICD-10-PCS code?
A) 0FT44ZZ
B) 0FT43ZZ
C) 0FT40ZZ
D) 0FT47ZZ
,Rationale: When a laparoscopic procedure is converted to open, the approach
should reflect the open approach. 0FT44ZZ represents: 0 (Medical and Surgical), F
(Hepatobiliary System), T (Resection), 4 (Gallbladder), 4 (Percutaneous
Endoscopic), Z (No Device), Z (No Qualifier). However, for a converted
procedure, the open approach (0) is used: 0FT40ZZ.
Question 3
A patient is diagnosed with sepsis due to a urinary tract infection caused by E. coli.
The patient does not have organ dysfunction. What code should be sequenced first?
A) N39.0
B) A41.51
C) B96.20
D) R65.20
Rationale: A41.51 (Sepsis due to Escherichia coli [E. coli]) should be sequenced
first when sepsis is the reason for admission. The UTI (N39.0) and the organism
code (B96.20) are coded as secondary diagnoses. R65.20 (Severe sepsis) is only
coded when organ dysfunction is present.
Question 4
A patient is admitted for an open reduction and internal fixation (ORIF) of a
fractured left femoral neck. What is the correct ICD-10-PCS code?
A) 0QH704Z
B) 0QH73ZZ
C) 0QS704Z
D) 0QH70ZZ
Rationale: 0QH704Z represents: 0 (Medical and Surgical), Q (Lower Bones), H
(Insertion), 7 (Femoral Neck, Left), 0 (Open), 4 (Internal Fixation Device), Z (No
Qualifier). The root operation "Insertion" is used for putting in a fixation device.
Question 5
A diabetic patient with type 2 diabetes is admitted for an infected diabetic foot
,ulcer of the left heel. The physician documents the ulcer as stage 3 with cellulitis.
What is the correct ICD-10-CM code assignment?
A) E11.621
B) E11.621, L97.323
C) L97.323, E11.621
D) E11.62
Rationale: E11.621 (Type 2 diabetes mellitus with foot ulcer) is sequenced first as
the underlying condition. L97.323 (Non-pressure chronic ulcer of left heel and
midfoot with necrosis of muscle) follows as the manifestation. The combination
code E11.621 captures both diabetes and the ulcer.
Question 6
A patient is diagnosed with acute bronchitis due to COVID-19. What is the correct
ICD-10-CM code assignment?
A) J20.8
B) U07.1
C) U07.1, J20.8
D) J20.8, U07.1
Rationale: U07.1 (COVID-19) should be sequenced first as the primary diagnosis,
followed by J20.8 (Acute bronchitis due to other specified organisms). COVID-19
should be coded as the principal diagnosis when it is the reason for the encounter.
Question 7
A patient undergoes a percutaneous transluminal coronary angioplasty (PTCA)
with a drug-eluting stent placement in the left anterior descending (LAD) artery.
What is the correct ICD-10-PCS code?
A) 02703DZ
B) 02703ZZ
C) 02703DZ
D) 02703ZZ
Rationale: 02703DZ represents: 0 (Medical and Surgical), 2 (Heart and Great
Vessels), 7 (Dilation), 0 (Coronary Artery, One), 3 (Percutaneous), D (Intraluminal
, Device, Drug-eluting), Z (No Qualifier). If a bare metal stent is used, the code
would be 02703ZZ.
Question 8
A patient is admitted with acute pancreatitis due to gallstones. What is the correct
ICD-10-CM code?
A) K85.0
B) K85.1
C) K85.9
D) K80.0
Rationale: K85.1 is the code for acute pancreatitis due to gallstones (biliary acute
pancreatitis). K85.0 is idiopathic acute pancreatitis, K85.9 is unspecified, and
K80.0 is cholelithiasis with acute cholecystitis. The cause is documented, so the
specific code is required.
Question 9
A patient undergoes a total abdominal hysterectomy with bilateral salpingo-
oophorectomy (TAH-BSO) for uterine fibroids. What is the ICD-10-PCS code for
the hysterectomy?
A) 0UT94ZZ
B) 0UT90ZZ
C) 0UT70ZZ
D) 0UT20ZZ
Rationale: 0UT90ZZ represents: 0 (Medical and Surgical), U (Female
Reproductive System), T (Resection), 9 (Uterus), 0 (Open), Z (No Device), Z (No
Qualifier). The BSO is coded separately (0UT20ZZ for ovaries and 0UT70ZZ for
fallopian tubes).
Question 10
A patient is diagnosed with community-acquired pneumonia caused by
Streptococcus pneumoniae. What is the correct ICD-10-CM code?
Comprehensive Study Guide — Certified Coding Associate
Review Healthcare Coding • Detailed Rationales • Verified
Answers • Success Workbook
DOMAIN 1: CLINICAL CLASSIFICATION SYSTEMS (Questions 1–34)
Question 1
A patient is admitted with chest pain and shortness of breath. The physician
documents "acute anterolateral ST elevation myocardial infarction (STEMI)" with
onset of symptoms 4 hours prior to admission. What is the correct ICD-10-CM
code?
A) I21.09
B) I21.3
C) I21.4
D) I21.9
Rationale: I21.09 is the correct code for ST elevation (STEMI) myocardial
infarction of other coronary artery (anterolateral wall). I21.3 is STEMI of
unspecified site. I21.4 is non-ST elevation myocardial infarction. I21.9 is acute
myocardial infarction, unspecified. Since the specific site is documented, the more
specific code is required.
Question 2
A patient undergoes a laparoscopic cholecystectomy. During the procedure, the
surgeon converts to an open approach due to extensive adhesions. What is the
correct ICD-10-PCS code?
A) 0FT44ZZ
B) 0FT43ZZ
C) 0FT40ZZ
D) 0FT47ZZ
,Rationale: When a laparoscopic procedure is converted to open, the approach
should reflect the open approach. 0FT44ZZ represents: 0 (Medical and Surgical), F
(Hepatobiliary System), T (Resection), 4 (Gallbladder), 4 (Percutaneous
Endoscopic), Z (No Device), Z (No Qualifier). However, for a converted
procedure, the open approach (0) is used: 0FT40ZZ.
Question 3
A patient is diagnosed with sepsis due to a urinary tract infection caused by E. coli.
The patient does not have organ dysfunction. What code should be sequenced first?
A) N39.0
B) A41.51
C) B96.20
D) R65.20
Rationale: A41.51 (Sepsis due to Escherichia coli [E. coli]) should be sequenced
first when sepsis is the reason for admission. The UTI (N39.0) and the organism
code (B96.20) are coded as secondary diagnoses. R65.20 (Severe sepsis) is only
coded when organ dysfunction is present.
Question 4
A patient is admitted for an open reduction and internal fixation (ORIF) of a
fractured left femoral neck. What is the correct ICD-10-PCS code?
A) 0QH704Z
B) 0QH73ZZ
C) 0QS704Z
D) 0QH70ZZ
Rationale: 0QH704Z represents: 0 (Medical and Surgical), Q (Lower Bones), H
(Insertion), 7 (Femoral Neck, Left), 0 (Open), 4 (Internal Fixation Device), Z (No
Qualifier). The root operation "Insertion" is used for putting in a fixation device.
Question 5
A diabetic patient with type 2 diabetes is admitted for an infected diabetic foot
,ulcer of the left heel. The physician documents the ulcer as stage 3 with cellulitis.
What is the correct ICD-10-CM code assignment?
A) E11.621
B) E11.621, L97.323
C) L97.323, E11.621
D) E11.62
Rationale: E11.621 (Type 2 diabetes mellitus with foot ulcer) is sequenced first as
the underlying condition. L97.323 (Non-pressure chronic ulcer of left heel and
midfoot with necrosis of muscle) follows as the manifestation. The combination
code E11.621 captures both diabetes and the ulcer.
Question 6
A patient is diagnosed with acute bronchitis due to COVID-19. What is the correct
ICD-10-CM code assignment?
A) J20.8
B) U07.1
C) U07.1, J20.8
D) J20.8, U07.1
Rationale: U07.1 (COVID-19) should be sequenced first as the primary diagnosis,
followed by J20.8 (Acute bronchitis due to other specified organisms). COVID-19
should be coded as the principal diagnosis when it is the reason for the encounter.
Question 7
A patient undergoes a percutaneous transluminal coronary angioplasty (PTCA)
with a drug-eluting stent placement in the left anterior descending (LAD) artery.
What is the correct ICD-10-PCS code?
A) 02703DZ
B) 02703ZZ
C) 02703DZ
D) 02703ZZ
Rationale: 02703DZ represents: 0 (Medical and Surgical), 2 (Heart and Great
Vessels), 7 (Dilation), 0 (Coronary Artery, One), 3 (Percutaneous), D (Intraluminal
, Device, Drug-eluting), Z (No Qualifier). If a bare metal stent is used, the code
would be 02703ZZ.
Question 8
A patient is admitted with acute pancreatitis due to gallstones. What is the correct
ICD-10-CM code?
A) K85.0
B) K85.1
C) K85.9
D) K80.0
Rationale: K85.1 is the code for acute pancreatitis due to gallstones (biliary acute
pancreatitis). K85.0 is idiopathic acute pancreatitis, K85.9 is unspecified, and
K80.0 is cholelithiasis with acute cholecystitis. The cause is documented, so the
specific code is required.
Question 9
A patient undergoes a total abdominal hysterectomy with bilateral salpingo-
oophorectomy (TAH-BSO) for uterine fibroids. What is the ICD-10-PCS code for
the hysterectomy?
A) 0UT94ZZ
B) 0UT90ZZ
C) 0UT70ZZ
D) 0UT20ZZ
Rationale: 0UT90ZZ represents: 0 (Medical and Surgical), U (Female
Reproductive System), T (Resection), 9 (Uterus), 0 (Open), Z (No Device), Z (No
Qualifier). The BSO is coded separately (0UT20ZZ for ovaries and 0UT70ZZ for
fallopian tubes).
Question 10
A patient is diagnosed with community-acquired pneumonia caused by
Streptococcus pneumoniae. What is the correct ICD-10-CM code?
