CCS Exam 1: Practice Questions & Key
Concepts
The patient is seen in the pain clinic for chronic neoplasm-related pain that was known to be caused
by the metastatic bone carcinoma of the vertebra that has spread from carcinoma of the left main
bronchus of the lung. How should this be coded?
a. C34.02, Malignant neoplasm of left main bronchus
b. G89.3, Neoplasm related pain (acute) (chronic)
c. G89.3, Neoplasm related pain (acute) (chronic); C79.51, Secondary malignant neoplasm of bone;
C34.02, Malignant neoplasm of left main bronchus
d. C79.51, Secondary malignant neoplasm of bone; G89.3, Neoplasm related pain (acute) (chronic)
Correct Answer: C
Code G89.3 is assigned to pain documented as being related, associated, or due to cancer, primary or
secondary malignancy, or tumor. This code is assigned regardless of whether the pain is acute or
chronic. Code G89.3 may be sequenced as the primary diagnosis when the reason for the encounter is
specifically for pain management. An additional code(s) is assigned for the underlying neoplastic disease
(CMS 2020a, Section I.C.6.b.5., 44).
A patient underwent excision of a malignant lesion of the skin of the chest that measured 1.0 cm, and
there was a 0.2-cm margin on both sides. Based on the 2020 CPT codes, which code would be used for
the procedure?
a. 11401, Excision, benign lesion including margins, except skin tag (unless listed elsewhere), trunk,
arms or legs; exciseddiameter 0.6 to 1.0 cm
b. 11601, Excision, malignant lesion including margins, trunk, arms, or legs; excised diameter 0.6 to 1.0
cm
c. 11602, Excision, malignant lesion including margins, trunk, arms, or legs; excised diameter 1.1 to 2.0
cm
d. 11402, Excision, benign lesion including margins, except skin tag (unless listed elsewhere), trunk,
arms or legs; exciseddiameter 1.1 to 2.0 cm
,Correct Answer: C
The size of the lesion plus the margins are included in coding the excision. Excised diameter: 1.0 cm + 0.2
cm + 0.2 cm = 1.4 cm (AMA CPT Professional Edition 2020, 86).
A laparoscopic tubal ligation with Falope ring is completed. What is the correct CPT code assignment?
49321Laparoscopy, surgical; with biopsy (single or multiple)
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. 58662
b. 58670
c. 58671
d. 49321
Correct Answer: C
For tubal ligation, which may be performed by ligation, transection, or other occlusion of the fallopian
tubes, the coder should refer to codes 58600-58615 for abdominal or vaginal approaches. For
laparoscopic tubal ligation with the use of Falope rings, code 58671 is assigned (Kuehn 2020, 176).
A patient is admitted to the hospital for pain due to displacement of pacemaker electrode. The
patient also has hypothyroidism due to partial thyroidectomy seven years ago and a breast cyst. Using
a guide wire, the pacemaker electrode was relocated and Synthroid was given during hospitalization.
The codes (excluding External Cause codes) that should be assigned are:
T82.110ABreakdown (mechanical) of cardiac electrode, initial encounter
T82.110DBreakdown (mechanical) of cardiac electrode, subsequent encounter
T82.120ADisplacement of cardiac electrode, initial encounter
T82.120SDisplacement of cardiac electrode, sequela
N60.09Solitary cyst of unspecified breast
E89.0Postsurgical hypothyroidism
02WA3MZRevision of cardiac lead in heart, percutaneous approach
02WA4MZRevision of cardiac lead in heart, percutaneous endoscopic approach
02WA0MZRevision of cardiac lead in heart, open approach
a. T82.110A, E89.0, 02WA3MZ
b. T82.110D, E89.0, N60.09, 02WA4MZ
c. T82.120A, E89.0, 02WA3MZ
d. T82.120S, E89.0, N60.09, 02WA0MZ
Correct Answer: C
02WA3MZ, Revision of device in, Heart, percutaneous, cardiac lead, no qualifier. Code T82.110A
pertains to mechanical complications and would not be used. In this case, there is pain due to the
displacement of the electrode. The breast cyst (N60.09) would not be coded because it does not meet
the criteria of the UHDDS as a secondary condition; it is an incidental finding and does not have any
, bearing on the current hospital stay. Review the Alphabetic Index under Absence, thyroid, with
hypothyroidism, which directs the coder to code E89.0 (CMS 2020a, Section III, 110-112).
A maternity patient is admitted in labor at 43 weeks. She has a spontaneous delivery with vacuum
extraction to facilitate the baby's delivery. Which of the following would be the principal diagnosis?
O80Encounter for full-term uncomplicated delivery
O48.0Post-term pregnancy
O48.1Prolonged pregnancy
O66.5Attempted application of vacuum extractor and forceps
a. O48.0
b. O48.1
c. O80
d. O66.5
Correct Answer: B
When an admission involves delivery, the principal diagnosis should identify the main circumstance or
complication of the delivery. The code for normal delivery cannot be used because there is a
complication of pregnancy, that it is prolonged at 43 weeks. Prolonged pregnancy is pregnancy that
extends beyond 42 weeks of gestation (CMS 2020a, Section I.C.15.b., 62).
A patient is admitted to the hospital due to a fracture of the right hip and is scheduled for an open
reduction with internal fixation. The patient developed cardiac arrhythmia which results in an inability
to do the planned surgery. What is the principal diagnosis?
a. Status post fracture
b. Cardiac arrhythmia
c. Right hip fracture
d. Cancelled procedure
Correct Answer: C
The condition after study that occasioned the admission should be sequenced first even if the plan of
treatment was not carried out due to unforeseen circumstances (CMS 2020a, Section II.F., 108).
Patient admitted with hemorrhage due to placenta previa with twin pregnancy. This patient had two
prior (cesarean section) deliveries. Emergency C-section was performed due to the hemorrhage. The
appropriate principal diagnosis would be:
a. Prior cesarean sections
b. Placenta previa without hemorrhage
c. Twin gestation
d. Placenta previa with hemorrhage
Correct Answer: D
The principal diagnosis should be the condition established after study that was responsible for the
patient's admission. If the patient was admitted with a condition that resulted in the performance of a
Concepts
The patient is seen in the pain clinic for chronic neoplasm-related pain that was known to be caused
by the metastatic bone carcinoma of the vertebra that has spread from carcinoma of the left main
bronchus of the lung. How should this be coded?
a. C34.02, Malignant neoplasm of left main bronchus
b. G89.3, Neoplasm related pain (acute) (chronic)
c. G89.3, Neoplasm related pain (acute) (chronic); C79.51, Secondary malignant neoplasm of bone;
C34.02, Malignant neoplasm of left main bronchus
d. C79.51, Secondary malignant neoplasm of bone; G89.3, Neoplasm related pain (acute) (chronic)
Correct Answer: C
Code G89.3 is assigned to pain documented as being related, associated, or due to cancer, primary or
secondary malignancy, or tumor. This code is assigned regardless of whether the pain is acute or
chronic. Code G89.3 may be sequenced as the primary diagnosis when the reason for the encounter is
specifically for pain management. An additional code(s) is assigned for the underlying neoplastic disease
(CMS 2020a, Section I.C.6.b.5., 44).
A patient underwent excision of a malignant lesion of the skin of the chest that measured 1.0 cm, and
there was a 0.2-cm margin on both sides. Based on the 2020 CPT codes, which code would be used for
the procedure?
a. 11401, Excision, benign lesion including margins, except skin tag (unless listed elsewhere), trunk,
arms or legs; exciseddiameter 0.6 to 1.0 cm
b. 11601, Excision, malignant lesion including margins, trunk, arms, or legs; excised diameter 0.6 to 1.0
cm
c. 11602, Excision, malignant lesion including margins, trunk, arms, or legs; excised diameter 1.1 to 2.0
cm
d. 11402, Excision, benign lesion including margins, except skin tag (unless listed elsewhere), trunk,
arms or legs; exciseddiameter 1.1 to 2.0 cm
,Correct Answer: C
The size of the lesion plus the margins are included in coding the excision. Excised diameter: 1.0 cm + 0.2
cm + 0.2 cm = 1.4 cm (AMA CPT Professional Edition 2020, 86).
A laparoscopic tubal ligation with Falope ring is completed. What is the correct CPT code assignment?
49321Laparoscopy, surgical; with biopsy (single or multiple)
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. 58662
b. 58670
c. 58671
d. 49321
Correct Answer: C
For tubal ligation, which may be performed by ligation, transection, or other occlusion of the fallopian
tubes, the coder should refer to codes 58600-58615 for abdominal or vaginal approaches. For
laparoscopic tubal ligation with the use of Falope rings, code 58671 is assigned (Kuehn 2020, 176).
A patient is admitted to the hospital for pain due to displacement of pacemaker electrode. The
patient also has hypothyroidism due to partial thyroidectomy seven years ago and a breast cyst. Using
a guide wire, the pacemaker electrode was relocated and Synthroid was given during hospitalization.
The codes (excluding External Cause codes) that should be assigned are:
T82.110ABreakdown (mechanical) of cardiac electrode, initial encounter
T82.110DBreakdown (mechanical) of cardiac electrode, subsequent encounter
T82.120ADisplacement of cardiac electrode, initial encounter
T82.120SDisplacement of cardiac electrode, sequela
N60.09Solitary cyst of unspecified breast
E89.0Postsurgical hypothyroidism
02WA3MZRevision of cardiac lead in heart, percutaneous approach
02WA4MZRevision of cardiac lead in heart, percutaneous endoscopic approach
02WA0MZRevision of cardiac lead in heart, open approach
a. T82.110A, E89.0, 02WA3MZ
b. T82.110D, E89.0, N60.09, 02WA4MZ
c. T82.120A, E89.0, 02WA3MZ
d. T82.120S, E89.0, N60.09, 02WA0MZ
Correct Answer: C
02WA3MZ, Revision of device in, Heart, percutaneous, cardiac lead, no qualifier. Code T82.110A
pertains to mechanical complications and would not be used. In this case, there is pain due to the
displacement of the electrode. The breast cyst (N60.09) would not be coded because it does not meet
the criteria of the UHDDS as a secondary condition; it is an incidental finding and does not have any
, bearing on the current hospital stay. Review the Alphabetic Index under Absence, thyroid, with
hypothyroidism, which directs the coder to code E89.0 (CMS 2020a, Section III, 110-112).
A maternity patient is admitted in labor at 43 weeks. She has a spontaneous delivery with vacuum
extraction to facilitate the baby's delivery. Which of the following would be the principal diagnosis?
O80Encounter for full-term uncomplicated delivery
O48.0Post-term pregnancy
O48.1Prolonged pregnancy
O66.5Attempted application of vacuum extractor and forceps
a. O48.0
b. O48.1
c. O80
d. O66.5
Correct Answer: B
When an admission involves delivery, the principal diagnosis should identify the main circumstance or
complication of the delivery. The code for normal delivery cannot be used because there is a
complication of pregnancy, that it is prolonged at 43 weeks. Prolonged pregnancy is pregnancy that
extends beyond 42 weeks of gestation (CMS 2020a, Section I.C.15.b., 62).
A patient is admitted to the hospital due to a fracture of the right hip and is scheduled for an open
reduction with internal fixation. The patient developed cardiac arrhythmia which results in an inability
to do the planned surgery. What is the principal diagnosis?
a. Status post fracture
b. Cardiac arrhythmia
c. Right hip fracture
d. Cancelled procedure
Correct Answer: C
The condition after study that occasioned the admission should be sequenced first even if the plan of
treatment was not carried out due to unforeseen circumstances (CMS 2020a, Section II.F., 108).
Patient admitted with hemorrhage due to placenta previa with twin pregnancy. This patient had two
prior (cesarean section) deliveries. Emergency C-section was performed due to the hemorrhage. The
appropriate principal diagnosis would be:
a. Prior cesarean sections
b. Placenta previa without hemorrhage
c. Twin gestation
d. Placenta previa with hemorrhage
Correct Answer: D
The principal diagnosis should be the condition established after study that was responsible for the
patient's admission. If the patient was admitted with a condition that resulted in the performance of a
