Certified Coding Associate (CCA®) Exam Prep 2026
Updated Practice Questions — Comprehensive Medical
Coding Associate Review Detailed Explanations, Verified
Answers, Complete Success Workbook
DOMAIN 1: CLINICAL CLASSIFICATION SYSTEMS (36%)
ICD-10-CM Diagnosis Coding
Question 1
A 45-year-old patient is admitted with chest pain and shortness of breath. The
physician documents "rule out myocardial infarction" and "possible unstable
angina." After evaluation, the final diagnosis is unstable angina. What is the correct
principal diagnosis code?
A) R07.9 (Chest pain, unspecified)
B) I20.0 (Unstable angina)
C) I21.9 (Acute myocardial infarction, unspecified)
D) R06.02 (Shortness of breath)
Rationale: The principal diagnosis is the condition established after study to be
chiefly responsible for the admission. "Rule out" or "possible" diagnoses
should not be coded as if they exist. When the final diagnosis is established as
unstable angina (I20.0), that is the correct code. Chest pain (R07.9) and shortness
of breath (R06.02) are symptoms that are integral to the definitive diagnosis and
should not be coded separately.
Question 2
A patient with hypertensive heart disease and chronic kidney disease is admitted
for evaluation. The physician documents a cause-and-effect relationship between
the hypertension and both conditions. What is the correct coding approach?
A) I11.9 (Hypertensive heart disease without heart failure)
B) I13.10 (Hypertensive heart and chronic kidney disease without heart
failure or chronic kidney disease)
C) I10 (Essential hypertension)
D) I12.9 (Hypertensive chronic kidney disease)
,Rationale: When a patient has both hypertensive heart disease and chronic
kidney disease with a documented cause-and-effect relationship, the correct code
is from category I13 (Hypertensive heart and chronic kidney disease). The
combination code reflects the relationship between all three conditions. Coding
only one condition would inaccurately represent the patient's clinical picture.
Question 3
A patient is admitted with acute appendicitis with generalized peritonitis. What is
the correct ICD-10-CM code?
A) K35.2 (Acute appendicitis with generalized peritonitis)
B) K35.3 (Acute appendicitis with generalized peritonitis)
C) K35.89 (Other acute appendicitis)
D) K35.80 (Unspecified acute appendicitis)
Rationale: K35.3 is the correct code for acute appendicitis with generalized
peritonitis. K35.2 is used for acute appendicitis with perforation or abscess (but
without peritonitis). The distinction between peritonitis and perforation/abscess is
clinically significant and affects code selection.
Question 4
A patient with type 2 diabetes mellitus is admitted with diabetic neuropathy. The
physician documents that the neuropathy is due to the diabetes. What is the correct
coding sequence?
A) E11.40 (Type 2 diabetes mellitus with diabetic neuropathy, unspecified)
B) E11.40 (Type 2 diabetes mellitus with diabetic neuropathy, unspecified)
C) E11.9 (Type 2 diabetes mellitus without complications)
D) G62.9 (Polyneuropathy, unspecified)
Rationale: When diabetes is the cause of a condition (such as neuropathy),
the diabetes code with the manifestation is used as the primary code. E11.40 is
the correct code for type 2 diabetes with diabetic neuropathy. Coding only the
neuropathy (G62.9) would miss the underlying etiology.
,Question 5
A patient is admitted for chemotherapy for lung cancer. The patient also has
hypertension and depression. What is the correct principal diagnosis?
A) J44.9 (Chronic obstructive pulmonary disease, unspecified)
B) Z51.11 (Encounter for antineoplastic chemotherapy)
C) Z51.0 (Encounter for radiotherapy)
D) Z51.81 (Encounter for therapeutic drug level monitoring)
Rationale: When a patient is admitted solely for chemotherapy, the encounter is
coded with Z51.11 as the principal diagnosis. The cancer diagnosis is coded as a
secondary diagnosis. This tests understanding of reason for encounter coding
rather than the underlying disease itself.
Question 6
A 45-year-old patient is seen in the emergency department for a severe headache.
The physician documents "migraine with aura" and "tension headache." The final
diagnosis is migraine with aura. What is the correct code?
A) G44.2 (Tension-type headache)
B) G43.109 (Migraine with aura, not intractable, without status migrainosus)
C) R51 (Headache)
D) G44.89 (Other headache syndromes)
Rationale: The final diagnosis of migraine with aura (G43.109) is the correct
code. "Rule out" diagnoses should not be coded. When the physician documents a
definitive diagnosis, that diagnosis takes precedence over symptom codes (R51) or
less specific diagnoses.
Question 7
A patient is admitted with community-acquired pneumonia due to Streptococcus
pneumoniae. What is the correct code?
A) J15.4 (Pneumonia due to Streptococcus)
B) J15.4 (Pneumonia due to Streptococcus)
C) J18.9 (Pneumonia, unspecified organism)
D) B95.3 (Streptococcus pneumoniae as the cause of diseases classified elsewhere)
, Rationale: When the organism causing pneumonia is documented, the code
for pneumonia due to the specific organism (J15.4) is used. An additional code
for the organism (B95.3) is not needed as the combination code already identifies
the organism.
Question 8
A patient is admitted with severe sepsis due to a urinary tract infection. What is the
correct coding approach?
A) N39.0 (Urinary tract infection, site not specified)
B) R65.20 (Severe sepsis without septic shock) and N39.0 (Urinary tract
infection)
C) A41.9 (Sepsis, unspecified organism)
D) R65.21 (Severe sepsis with septic shock)
Rationale: For severe sepsis, the sepsis code (R65.20 or R65.21) is sequenced
first, followed by the code for the underlying infection (N39.0). The sepsis code
indicates the severity of the systemic response. Coding only the UTI would miss
the severe sepsis diagnosis.
Question 9
A patient is admitted with acute respiratory failure due to chronic obstructive
pulmonary disease (COPD) exacerbation. What is the correct principal diagnosis?
A) J44.1 (Chronic obstructive pulmonary disease with acute exacerbation)
B) J96.00 (Acute respiratory failure, unspecified whether with hypoxia or
hypercapnia)
C) J44.9 (Chronic obstructive pulmonary disease, unspecified)
D) J96.90 (Respiratory failure, unspecified)
Rationale: When a patient is admitted with acute respiratory failure due to
COPD exacerbation, the acute respiratory failure is coded first (J96.00), followed
by the COPD code (J44.1). The respiratory failure is the more acute condition that
prompted the admission.
Updated Practice Questions — Comprehensive Medical
Coding Associate Review Detailed Explanations, Verified
Answers, Complete Success Workbook
DOMAIN 1: CLINICAL CLASSIFICATION SYSTEMS (36%)
ICD-10-CM Diagnosis Coding
Question 1
A 45-year-old patient is admitted with chest pain and shortness of breath. The
physician documents "rule out myocardial infarction" and "possible unstable
angina." After evaluation, the final diagnosis is unstable angina. What is the correct
principal diagnosis code?
A) R07.9 (Chest pain, unspecified)
B) I20.0 (Unstable angina)
C) I21.9 (Acute myocardial infarction, unspecified)
D) R06.02 (Shortness of breath)
Rationale: The principal diagnosis is the condition established after study to be
chiefly responsible for the admission. "Rule out" or "possible" diagnoses
should not be coded as if they exist. When the final diagnosis is established as
unstable angina (I20.0), that is the correct code. Chest pain (R07.9) and shortness
of breath (R06.02) are symptoms that are integral to the definitive diagnosis and
should not be coded separately.
Question 2
A patient with hypertensive heart disease and chronic kidney disease is admitted
for evaluation. The physician documents a cause-and-effect relationship between
the hypertension and both conditions. What is the correct coding approach?
A) I11.9 (Hypertensive heart disease without heart failure)
B) I13.10 (Hypertensive heart and chronic kidney disease without heart
failure or chronic kidney disease)
C) I10 (Essential hypertension)
D) I12.9 (Hypertensive chronic kidney disease)
,Rationale: When a patient has both hypertensive heart disease and chronic
kidney disease with a documented cause-and-effect relationship, the correct code
is from category I13 (Hypertensive heart and chronic kidney disease). The
combination code reflects the relationship between all three conditions. Coding
only one condition would inaccurately represent the patient's clinical picture.
Question 3
A patient is admitted with acute appendicitis with generalized peritonitis. What is
the correct ICD-10-CM code?
A) K35.2 (Acute appendicitis with generalized peritonitis)
B) K35.3 (Acute appendicitis with generalized peritonitis)
C) K35.89 (Other acute appendicitis)
D) K35.80 (Unspecified acute appendicitis)
Rationale: K35.3 is the correct code for acute appendicitis with generalized
peritonitis. K35.2 is used for acute appendicitis with perforation or abscess (but
without peritonitis). The distinction between peritonitis and perforation/abscess is
clinically significant and affects code selection.
Question 4
A patient with type 2 diabetes mellitus is admitted with diabetic neuropathy. The
physician documents that the neuropathy is due to the diabetes. What is the correct
coding sequence?
A) E11.40 (Type 2 diabetes mellitus with diabetic neuropathy, unspecified)
B) E11.40 (Type 2 diabetes mellitus with diabetic neuropathy, unspecified)
C) E11.9 (Type 2 diabetes mellitus without complications)
D) G62.9 (Polyneuropathy, unspecified)
Rationale: When diabetes is the cause of a condition (such as neuropathy),
the diabetes code with the manifestation is used as the primary code. E11.40 is
the correct code for type 2 diabetes with diabetic neuropathy. Coding only the
neuropathy (G62.9) would miss the underlying etiology.
,Question 5
A patient is admitted for chemotherapy for lung cancer. The patient also has
hypertension and depression. What is the correct principal diagnosis?
A) J44.9 (Chronic obstructive pulmonary disease, unspecified)
B) Z51.11 (Encounter for antineoplastic chemotherapy)
C) Z51.0 (Encounter for radiotherapy)
D) Z51.81 (Encounter for therapeutic drug level monitoring)
Rationale: When a patient is admitted solely for chemotherapy, the encounter is
coded with Z51.11 as the principal diagnosis. The cancer diagnosis is coded as a
secondary diagnosis. This tests understanding of reason for encounter coding
rather than the underlying disease itself.
Question 6
A 45-year-old patient is seen in the emergency department for a severe headache.
The physician documents "migraine with aura" and "tension headache." The final
diagnosis is migraine with aura. What is the correct code?
A) G44.2 (Tension-type headache)
B) G43.109 (Migraine with aura, not intractable, without status migrainosus)
C) R51 (Headache)
D) G44.89 (Other headache syndromes)
Rationale: The final diagnosis of migraine with aura (G43.109) is the correct
code. "Rule out" diagnoses should not be coded. When the physician documents a
definitive diagnosis, that diagnosis takes precedence over symptom codes (R51) or
less specific diagnoses.
Question 7
A patient is admitted with community-acquired pneumonia due to Streptococcus
pneumoniae. What is the correct code?
A) J15.4 (Pneumonia due to Streptococcus)
B) J15.4 (Pneumonia due to Streptococcus)
C) J18.9 (Pneumonia, unspecified organism)
D) B95.3 (Streptococcus pneumoniae as the cause of diseases classified elsewhere)
, Rationale: When the organism causing pneumonia is documented, the code
for pneumonia due to the specific organism (J15.4) is used. An additional code
for the organism (B95.3) is not needed as the combination code already identifies
the organism.
Question 8
A patient is admitted with severe sepsis due to a urinary tract infection. What is the
correct coding approach?
A) N39.0 (Urinary tract infection, site not specified)
B) R65.20 (Severe sepsis without septic shock) and N39.0 (Urinary tract
infection)
C) A41.9 (Sepsis, unspecified organism)
D) R65.21 (Severe sepsis with septic shock)
Rationale: For severe sepsis, the sepsis code (R65.20 or R65.21) is sequenced
first, followed by the code for the underlying infection (N39.0). The sepsis code
indicates the severity of the systemic response. Coding only the UTI would miss
the severe sepsis diagnosis.
Question 9
A patient is admitted with acute respiratory failure due to chronic obstructive
pulmonary disease (COPD) exacerbation. What is the correct principal diagnosis?
A) J44.1 (Chronic obstructive pulmonary disease with acute exacerbation)
B) J96.00 (Acute respiratory failure, unspecified whether with hypoxia or
hypercapnia)
C) J44.9 (Chronic obstructive pulmonary disease, unspecified)
D) J96.90 (Respiratory failure, unspecified)
Rationale: When a patient is admitted with acute respiratory failure due to
COPD exacerbation, the acute respiratory failure is coded first (J96.00), followed
by the COPD code (J44.1). The respiratory failure is the more acute condition that
prompted the admission.
