CCA MOCK TEST 2026/2027 | Verified Edition Questions and
Answers | Certified Coding Associate Practice Exam | Pass
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Section 1: ICD-10-CM Diagnosis Coding (Questions 1-35)
Q1: A patient is admitted with severe sepsis due to methicillin-sensitive Staphylococcus
aureus (MSSA) bacteremia. The patient develops acute kidney injury (AKI) stage 2.
What is the correct principal diagnosis sequence according to the ICD-10-CM Official
Guidelines for Coding and Reporting?
A. A41.9, R65.20, N17.9
B. R65.20, A41.2, N17.1
C. A41.2, R65.20, N17.1 [CORRECT]
D. N17.1, A41.2, R65.20
Correct Answer: C
Rationale: The ICD-10-CM Official Guidelines I.C.1.d state that for severe sepsis, the
underlying systemic infection (A41.2) is sequenced first, followed by the severe sepsis
code (R65.20), and then any organ dysfunction code (N17.1 for stage 2 AKI). Option A
uses an unspecified sepsis code despite the documented organism, and Option D
incorrectly sequences the AKI first. CCA Mock Test Tip: Always sequence the
underlying systemic infection first in severe sepsis, and never use unspecified codes if a
specific organism is documented.
Q2: A patient with type 2 diabetes mellitus (T2DM) and chronic kidney disease (CKD)
stage 4 is admitted for hyperglycemia. The physician documents "T2DM with CKD stage
4." How should this be coded?
A. E11.9, N18.4
B. E11.22, N18.4 [CORRECT]
C. N18.4, E11.22
D. E11.65, N18.4
Correct Answer: B
Rationale: Per ICD-10-CM Guidelines I.C.4.a.1, the correct sequencing is to code the
diabetes with its complication (E11.22 for T2DM with diabetic chronic kidney disease)
first, followed by the CKD code (N18.4). Code E11.65 is incorrect because it requires
documentation of both CKD and the use of insulin; if insulin use is not explicitly
documented as "on insulin," E11.22 is the correct default. CCA Mock Test Tip:
Memorize the "diabetes first, CKD second" sequencing rule, and avoid assuming insulin
use just because it is T2DM.
,Q3: A coder notes an Excludes1 note under code J84 (Other interstitial pulmonary
diseases with fibrosis) for code J67 (Hypersensitivity pneumonitis). The patient's final
diagnosis is documented as "Hypersensitivity pneumonitis due to bird droppings." What
action should the coder take?
A. Code J84 because the Excludes1 note means the conditions cannot occur together.
B. Code J67.2 because the Excludes1 note means the two conditions are mutually
exclusive. [CORRECT]
C. Code both J84 and J67.2 to fully capture the interstitial fibrosis and the cause.
D. Query the physician to determine if the patient actually has interstitial pulmonary
disease.
Correct Answer: B
Rationale: An Excludes1 note means "not coded together" because the two conditions
cannot occur together; in this case, J67 is a specific type of pneumonitis that is
excluded from the generic J84 category. The correct code is J67.2 (Hypersensitivity
pneumonitis due to bird droppings). Coding both would violate the Excludes1
convention. CCA Mock Test Tip: Never ignore an Excludes1 note; it is a strict prohibition
against coding the two conditions together, unlike an Excludes2 note.
Q4: An inpatient is admitted for hypertensive crisis. The discharge summary states:
"Hypertensive heart disease with heart failure and stage 3 chronic kidney disease."
What are the correct codes and sequence?
A. I11.0, I50.9, N18.3
B. I13.0, I50.9, N18.3 [CORRECT]
C. I10, I50.9, N18.3
D. I13.10, N18.3
Correct Answer: B
Rationale: Per ICD-10-CM Guidelines I.C.9.a, when a patient has hypertension, heart
disease, and CKD, a code from category I13 (Hypertensive heart and chronic kidney
disease) should be used. I13.0 combines hypertensive heart disease with heart failure
and CKD. An additional code for the specific type of heart failure (I50.9) and the CKD
stage (N18.3) are required as secondary codes. I11.0 is incorrect because it ignores the
CKD. CCA Mock Test Tip: When hypertension, heart disease, and CKD are all present,
bypass I11 and I12 and go directly to the I13 combination codes.
Q5: A patient presents to the emergency department after falling off a ladder at work
and sustains a displaced fracture of the midshaft of the right tibia. The fracture is closed.
This is the initial encounter for the fracture. What is the correct ICD-10-CM code?
A. S82.201A
B. S82.201D
C. S82.211A [CORRECT]
D. S82.211D
,Correct Answer: C
Rationale: The correct code is S82.211A. "S82" identifies the tibia fracture, ".2" identifies
the midshaft, ".1" identifies it as displaced (closed), and "A" identifies the initial
encounter. Option A is incorrect because it uses the "0" for nondisplaced. Option D uses
"D" for subsequent encounter. CCA Mock Test Tip: Pay strict attention to the 7th
character requirements for fractures (A, D, S) and the specific 4th/5th character
extensions for displacement and location.
Q6: A 55-year-old female patient is seen for her annual well-woman exam, which
includes a screening mammogram and a Pap smear. The results are normal. What Z
code(s) should be assigned as the primary diagnosis?
A. Z00.00, Z12.31, Z12.72
B. Z12.31, Z12.72
C. Z00.00 [CORRECT]
D. Z01.419
Correct Answer: C
Rationale: Per ICD-10-CM Guidelines I.C.21.c.4, when a screening exam is the reason
for the encounter, and other abnormal findings or symptoms are not present, the
appropriate Z code for the general screening examination (Z00.00) is sequenced first.
The specific screening codes (Z12.31 for mammogram, Z12.72 for Pap smear) can be
assigned as secondary codes. Z01.419 is for an encounter for a gynecological exam
with abnormal findings, which is not the case here. CCA Mock Test Tip: General
screening exams (Z00) are sequenced before specific screening tests (Z12) unless the
specific test is the sole reason for the visit.
Q7: A patient is brought to the ED after being struck by a motor vehicle while crossing
the street. The patient suffers a fractured pelvis. What external cause code is used to
identify the place of occurrence?
A. Y92.019 (Home)
B. Y92.410 (Street and highway) [CORRECT]
C. Y92.890 (Unknown place)
D. Y92.19 (School)
Correct Answer: B
Rationale: External cause codes from category Y92 identify the place of occurrence of
the injury. Since the patient was struck while crossing the street, Y92.410 (Street and
highway as the place of occurrence of the external cause) is the correct code. CCA
Mock Test Tip: External cause coding requires assigning separate codes for the
mechanism (e.g., V03.10), place (Y92), and activity (Y93).
, Q8: A patient with COPD is admitted with acute bronchitis and an acute exacerbation of
COPD. The physician documents: "Acute bronchitis with acute exacerbation of COPD."
How should this be coded?
A. J44.1, J20.9
B. J44.0 [CORRECT]
C. J20.9, J44.1
D. J44.9, J20.9
Correct Answer: B
Rationale: ICD-10-CM Guidelines I.C.8.a.2 state that when a patient has acute
bronchitis and an acute exacerbation of COPD, only the code for the acute exacerbation
of COPD (J44.0) is assigned. The acute bronchitis is not coded separately because it is
considered an inherent part of the COPD exacerbation per coding guidance. CCA Mock
Test Tip: Know the specific coding exclusions within the COPD guidelines; acute
bronchitis is swallowed by J44.0, whereas lower respiratory infections like pneumonia
are coded separately with J44.0.
Q9: A patient is admitted for a right total hip replacement due to osteoarthritis. On
post-op day 2, the patient develops a hospital-acquired catheter-associated urinary tract
infection (CAUTI). What is the correct POA indicator for the CAUTI?
A. Y
B. N [CORRECT]
C. U
D. W
Correct Answer: B
Rationale: The POA indicator "N" means the condition was not present at the time of
inpatient admission. Since the CAUTI developed on post-op day 2, it is a
hospital-acquired condition and must be assigned an "N". "Y" is for present on
admission, "U" is for undocumented/unknown, and "W" is for clinically undetermined
(rarely used). CCA Mock Test Tip: Hospital-acquired conditions like CAUTI, falls, and
pressure ulcers always receive an "N" POA indicator; never assume they were present
on admission.
Q10: A pathology report reveals a malignant neoplasm of the ascending colon. The
patient is admitted for a right hemicolectomy. The operative report notes no metastasis.
What is the correct primary malignancy code?
A. C78.0
B. C18.0 [CORRECT]
C. C18.9
D. D12.6
Correct Answer: B
Answers | Certified Coding Associate Practice Exam | Pass
Guaranteed - A+ Graded
Section 1: ICD-10-CM Diagnosis Coding (Questions 1-35)
Q1: A patient is admitted with severe sepsis due to methicillin-sensitive Staphylococcus
aureus (MSSA) bacteremia. The patient develops acute kidney injury (AKI) stage 2.
What is the correct principal diagnosis sequence according to the ICD-10-CM Official
Guidelines for Coding and Reporting?
A. A41.9, R65.20, N17.9
B. R65.20, A41.2, N17.1
C. A41.2, R65.20, N17.1 [CORRECT]
D. N17.1, A41.2, R65.20
Correct Answer: C
Rationale: The ICD-10-CM Official Guidelines I.C.1.d state that for severe sepsis, the
underlying systemic infection (A41.2) is sequenced first, followed by the severe sepsis
code (R65.20), and then any organ dysfunction code (N17.1 for stage 2 AKI). Option A
uses an unspecified sepsis code despite the documented organism, and Option D
incorrectly sequences the AKI first. CCA Mock Test Tip: Always sequence the
underlying systemic infection first in severe sepsis, and never use unspecified codes if a
specific organism is documented.
Q2: A patient with type 2 diabetes mellitus (T2DM) and chronic kidney disease (CKD)
stage 4 is admitted for hyperglycemia. The physician documents "T2DM with CKD stage
4." How should this be coded?
A. E11.9, N18.4
B. E11.22, N18.4 [CORRECT]
C. N18.4, E11.22
D. E11.65, N18.4
Correct Answer: B
Rationale: Per ICD-10-CM Guidelines I.C.4.a.1, the correct sequencing is to code the
diabetes with its complication (E11.22 for T2DM with diabetic chronic kidney disease)
first, followed by the CKD code (N18.4). Code E11.65 is incorrect because it requires
documentation of both CKD and the use of insulin; if insulin use is not explicitly
documented as "on insulin," E11.22 is the correct default. CCA Mock Test Tip:
Memorize the "diabetes first, CKD second" sequencing rule, and avoid assuming insulin
use just because it is T2DM.
,Q3: A coder notes an Excludes1 note under code J84 (Other interstitial pulmonary
diseases with fibrosis) for code J67 (Hypersensitivity pneumonitis). The patient's final
diagnosis is documented as "Hypersensitivity pneumonitis due to bird droppings." What
action should the coder take?
A. Code J84 because the Excludes1 note means the conditions cannot occur together.
B. Code J67.2 because the Excludes1 note means the two conditions are mutually
exclusive. [CORRECT]
C. Code both J84 and J67.2 to fully capture the interstitial fibrosis and the cause.
D. Query the physician to determine if the patient actually has interstitial pulmonary
disease.
Correct Answer: B
Rationale: An Excludes1 note means "not coded together" because the two conditions
cannot occur together; in this case, J67 is a specific type of pneumonitis that is
excluded from the generic J84 category. The correct code is J67.2 (Hypersensitivity
pneumonitis due to bird droppings). Coding both would violate the Excludes1
convention. CCA Mock Test Tip: Never ignore an Excludes1 note; it is a strict prohibition
against coding the two conditions together, unlike an Excludes2 note.
Q4: An inpatient is admitted for hypertensive crisis. The discharge summary states:
"Hypertensive heart disease with heart failure and stage 3 chronic kidney disease."
What are the correct codes and sequence?
A. I11.0, I50.9, N18.3
B. I13.0, I50.9, N18.3 [CORRECT]
C. I10, I50.9, N18.3
D. I13.10, N18.3
Correct Answer: B
Rationale: Per ICD-10-CM Guidelines I.C.9.a, when a patient has hypertension, heart
disease, and CKD, a code from category I13 (Hypertensive heart and chronic kidney
disease) should be used. I13.0 combines hypertensive heart disease with heart failure
and CKD. An additional code for the specific type of heart failure (I50.9) and the CKD
stage (N18.3) are required as secondary codes. I11.0 is incorrect because it ignores the
CKD. CCA Mock Test Tip: When hypertension, heart disease, and CKD are all present,
bypass I11 and I12 and go directly to the I13 combination codes.
Q5: A patient presents to the emergency department after falling off a ladder at work
and sustains a displaced fracture of the midshaft of the right tibia. The fracture is closed.
This is the initial encounter for the fracture. What is the correct ICD-10-CM code?
A. S82.201A
B. S82.201D
C. S82.211A [CORRECT]
D. S82.211D
,Correct Answer: C
Rationale: The correct code is S82.211A. "S82" identifies the tibia fracture, ".2" identifies
the midshaft, ".1" identifies it as displaced (closed), and "A" identifies the initial
encounter. Option A is incorrect because it uses the "0" for nondisplaced. Option D uses
"D" for subsequent encounter. CCA Mock Test Tip: Pay strict attention to the 7th
character requirements for fractures (A, D, S) and the specific 4th/5th character
extensions for displacement and location.
Q6: A 55-year-old female patient is seen for her annual well-woman exam, which
includes a screening mammogram and a Pap smear. The results are normal. What Z
code(s) should be assigned as the primary diagnosis?
A. Z00.00, Z12.31, Z12.72
B. Z12.31, Z12.72
C. Z00.00 [CORRECT]
D. Z01.419
Correct Answer: C
Rationale: Per ICD-10-CM Guidelines I.C.21.c.4, when a screening exam is the reason
for the encounter, and other abnormal findings or symptoms are not present, the
appropriate Z code for the general screening examination (Z00.00) is sequenced first.
The specific screening codes (Z12.31 for mammogram, Z12.72 for Pap smear) can be
assigned as secondary codes. Z01.419 is for an encounter for a gynecological exam
with abnormal findings, which is not the case here. CCA Mock Test Tip: General
screening exams (Z00) are sequenced before specific screening tests (Z12) unless the
specific test is the sole reason for the visit.
Q7: A patient is brought to the ED after being struck by a motor vehicle while crossing
the street. The patient suffers a fractured pelvis. What external cause code is used to
identify the place of occurrence?
A. Y92.019 (Home)
B. Y92.410 (Street and highway) [CORRECT]
C. Y92.890 (Unknown place)
D. Y92.19 (School)
Correct Answer: B
Rationale: External cause codes from category Y92 identify the place of occurrence of
the injury. Since the patient was struck while crossing the street, Y92.410 (Street and
highway as the place of occurrence of the external cause) is the correct code. CCA
Mock Test Tip: External cause coding requires assigning separate codes for the
mechanism (e.g., V03.10), place (Y92), and activity (Y93).
, Q8: A patient with COPD is admitted with acute bronchitis and an acute exacerbation of
COPD. The physician documents: "Acute bronchitis with acute exacerbation of COPD."
How should this be coded?
A. J44.1, J20.9
B. J44.0 [CORRECT]
C. J20.9, J44.1
D. J44.9, J20.9
Correct Answer: B
Rationale: ICD-10-CM Guidelines I.C.8.a.2 state that when a patient has acute
bronchitis and an acute exacerbation of COPD, only the code for the acute exacerbation
of COPD (J44.0) is assigned. The acute bronchitis is not coded separately because it is
considered an inherent part of the COPD exacerbation per coding guidance. CCA Mock
Test Tip: Know the specific coding exclusions within the COPD guidelines; acute
bronchitis is swallowed by J44.0, whereas lower respiratory infections like pneumonia
are coded separately with J44.0.
Q9: A patient is admitted for a right total hip replacement due to osteoarthritis. On
post-op day 2, the patient develops a hospital-acquired catheter-associated urinary tract
infection (CAUTI). What is the correct POA indicator for the CAUTI?
A. Y
B. N [CORRECT]
C. U
D. W
Correct Answer: B
Rationale: The POA indicator "N" means the condition was not present at the time of
inpatient admission. Since the CAUTI developed on post-op day 2, it is a
hospital-acquired condition and must be assigned an "N". "Y" is for present on
admission, "U" is for undocumented/unknown, and "W" is for clinically undetermined
(rarely used). CCA Mock Test Tip: Hospital-acquired conditions like CAUTI, falls, and
pressure ulcers always receive an "N" POA indicator; never assume they were present
on admission.
Q10: A pathology report reveals a malignant neoplasm of the ascending colon. The
patient is admitted for a right hemicolectomy. The operative report notes no metastasis.
What is the correct primary malignancy code?
A. C78.0
B. C18.0 [CORRECT]
C. C18.9
D. D12.6
Correct Answer: B
