AHIMA CDIP (CERTIFIED DOCUMENTATION
INTEGRITY PRACTITIONER) EXAM Complete
Test Bank — Questions with Correct Answers &
Detailed Rationales Updated for 2025/2026 | Aligned
with AHIMA CDIP Exam Content Outline
Question 1
A patient is admitted for chemotherapy for lung cancer. The patient develops
neutropenia during the admission. How should the coder sequence these
diagnoses?
A. Lung cancer as principal; neutropenia as secondary
B. Lung cancer as principal; neutropenia as secondary
C. Chemotherapy as principal
D. Both as principal
Correct Answer: B — Lung cancer as principal; neutropenia as secondary
Rationale: When a patient is admitted for chemotherapy and develops a
complication such as neutropenia, the cancer remains the principal diagnosis
(reason for admission). The neutropenia is coded as a secondary diagnosis. The
chemotherapy is coded as a procedure, not a diagnosis. This follows ICD-10-CM
guideline I.C.2.e, which states that complications of treatment are coded as
secondary diagnoses when the reason for admission is treatment of the underlying
condition.
Question 2
Which of the following best describes the correct use of "with" in ICD-10-CM
coding?
A. "With" indicates a causal relationship between two conditions
B. "With" indicates the conditions are unrelated
C. "With" indicates the conditions occurred at different times
D. "With" indicates the conditions are mutually exclusive
,Correct Answer: A — "With" indicates a causal relationship between two
conditions
Rationale: In ICD-10-CM, the word "with" in a code title or in the Alphabetic
Index indicates a causal relationship between two conditions. For example,
"diabetes with neuropathy" means the diabetes caused the neuropathy. Coders
should not assume a causal relationship unless documented by the physician. This
is explicitly stated in ICD-10-CM guideline I.A.15.
Question 3
A patient is admitted with sepsis due to a urinary tract infection (UTI). According
to ICD-10-CM guidelines, how should these diagnoses be coded?
A. Sepsis as principal; UTI as secondary
B. UTI as principal; sepsis as secondary
C. Both as principal
D. Combine into a single code for sepsis due to UTI
Correct Answer: A — Sepsis as principal; UTI as secondary
Rationale: When sepsis is present and is due to a localized infection, the sepsis is
coded as the principal diagnosis, and the underlying infection is coded as a
secondary diagnosis. This follows the ICD-10-CM guideline I.C.1.d.1.b, which
states that sepsis is the systemic response to infection and takes precedence over
the localized infection. A combination code is not available for sepsis due to UTI.
Question 4
A patient is admitted with pneumonia and is found to have dehydration. The
dehydration is treated during the admission. Which diagnosis should be sequenced
as principal?
A. Pneumonia
B. Dehydration
C. Both as principal
D. The condition that was present on admission
Correct Answer: A — Pneumonia
,Rationale: The principal diagnosis is the condition established after study to be
chiefly responsible for occasioning the admission. In this case, the patient was
admitted with pneumonia, which is the reason for admission. The dehydration,
although treated, is a secondary diagnosis. According to ICD-10-CM guideline
II.B.1, the principal diagnosis is the condition chiefly responsible for the
admission.
Question 5
A patient is admitted for sickle cell crisis with acute chest syndrome. How should
this be coded?
A. Sickle cell crisis as principal
B. Acute chest syndrome as principal
C. Sickle cell disease with crisis as principal
D. Sickle cell disease with acute chest syndrome as principal
Correct Answer: D — Sickle cell disease with acute chest syndrome as
principal
Rationale: ICD-10-CM guideline I.C.2.a.3.d states that for patients with sickle cell
crisis with acute chest syndrome, assign code D57.01 (Sickle-cell disease with
acute chest syndrome) as the principal diagnosis. The acute chest syndrome is a
manifestation of the sickle cell crisis and is included in the combination code. A
secondary code should not be assigned for the acute chest syndrome separately.
Question 6
A patient is admitted with a cerebrovascular accident (CVA) due to atrial
fibrillation. How should these diagnoses be sequenced?
A. CVA as principal; atrial fibrillation as secondary
B. Atrial fibrillation as principal; CVA as secondary
C. Both as principal
D. Combine into a single code
Correct Answer: A — CVA as principal; atrial fibrillation as secondary
, Rationale: The CVA is the condition chiefly responsible for the admission and
should be sequenced as principal. The atrial fibrillation is a contributing condition
and is coded as a secondary diagnosis. ICD-10-CM guidelines indicate that when a
patient is admitted with a condition caused by another condition, the manifestation
(CVA) is coded as principal and the etiology (atrial fibrillation) is coded as
secondary, unless a combination code exists.
Question 7
A patient is admitted with diabetic ketoacidosis (DKA) and type 2 diabetes
mellitus. How should these diagnoses be coded?
A. Type 2 diabetes as principal; DKA as secondary
B. DKA as principal; type 2 diabetes as secondary
C. Both as principal
D. Type 2 diabetes with DKA as a combination code
Correct Answer: B — DKA as principal; type 2 diabetes as secondary
Rationale: DKA is an acute complication of diabetes and may be the reason for
admission. ICD-10-CM guideline I.C.2.a.1 states that when a patient is admitted
with diabetic ketoacidosis, the DKA is coded as the principal diagnosis and the
type of diabetes is coded as secondary. However, if the patient is admitted for
treatment of the diabetes and develops DKA, the type of diabetes would be
principal.
Question 8
Which of the following is TRUE regarding "code first" notes in ICD-10-CM?
A. "Code first" notes mean the code is optional
B. "Code first" notes require sequencing the underlying condition first
C. "Code first" notes mean the code should not be used
D. "Code first" notes indicate the condition is not reportable
Correct Answer: B — "Code first" notes require sequencing the underlying
condition first
INTEGRITY PRACTITIONER) EXAM Complete
Test Bank — Questions with Correct Answers &
Detailed Rationales Updated for 2025/2026 | Aligned
with AHIMA CDIP Exam Content Outline
Question 1
A patient is admitted for chemotherapy for lung cancer. The patient develops
neutropenia during the admission. How should the coder sequence these
diagnoses?
A. Lung cancer as principal; neutropenia as secondary
B. Lung cancer as principal; neutropenia as secondary
C. Chemotherapy as principal
D. Both as principal
Correct Answer: B — Lung cancer as principal; neutropenia as secondary
Rationale: When a patient is admitted for chemotherapy and develops a
complication such as neutropenia, the cancer remains the principal diagnosis
(reason for admission). The neutropenia is coded as a secondary diagnosis. The
chemotherapy is coded as a procedure, not a diagnosis. This follows ICD-10-CM
guideline I.C.2.e, which states that complications of treatment are coded as
secondary diagnoses when the reason for admission is treatment of the underlying
condition.
Question 2
Which of the following best describes the correct use of "with" in ICD-10-CM
coding?
A. "With" indicates a causal relationship between two conditions
B. "With" indicates the conditions are unrelated
C. "With" indicates the conditions occurred at different times
D. "With" indicates the conditions are mutually exclusive
,Correct Answer: A — "With" indicates a causal relationship between two
conditions
Rationale: In ICD-10-CM, the word "with" in a code title or in the Alphabetic
Index indicates a causal relationship between two conditions. For example,
"diabetes with neuropathy" means the diabetes caused the neuropathy. Coders
should not assume a causal relationship unless documented by the physician. This
is explicitly stated in ICD-10-CM guideline I.A.15.
Question 3
A patient is admitted with sepsis due to a urinary tract infection (UTI). According
to ICD-10-CM guidelines, how should these diagnoses be coded?
A. Sepsis as principal; UTI as secondary
B. UTI as principal; sepsis as secondary
C. Both as principal
D. Combine into a single code for sepsis due to UTI
Correct Answer: A — Sepsis as principal; UTI as secondary
Rationale: When sepsis is present and is due to a localized infection, the sepsis is
coded as the principal diagnosis, and the underlying infection is coded as a
secondary diagnosis. This follows the ICD-10-CM guideline I.C.1.d.1.b, which
states that sepsis is the systemic response to infection and takes precedence over
the localized infection. A combination code is not available for sepsis due to UTI.
Question 4
A patient is admitted with pneumonia and is found to have dehydration. The
dehydration is treated during the admission. Which diagnosis should be sequenced
as principal?
A. Pneumonia
B. Dehydration
C. Both as principal
D. The condition that was present on admission
Correct Answer: A — Pneumonia
,Rationale: The principal diagnosis is the condition established after study to be
chiefly responsible for occasioning the admission. In this case, the patient was
admitted with pneumonia, which is the reason for admission. The dehydration,
although treated, is a secondary diagnosis. According to ICD-10-CM guideline
II.B.1, the principal diagnosis is the condition chiefly responsible for the
admission.
Question 5
A patient is admitted for sickle cell crisis with acute chest syndrome. How should
this be coded?
A. Sickle cell crisis as principal
B. Acute chest syndrome as principal
C. Sickle cell disease with crisis as principal
D. Sickle cell disease with acute chest syndrome as principal
Correct Answer: D — Sickle cell disease with acute chest syndrome as
principal
Rationale: ICD-10-CM guideline I.C.2.a.3.d states that for patients with sickle cell
crisis with acute chest syndrome, assign code D57.01 (Sickle-cell disease with
acute chest syndrome) as the principal diagnosis. The acute chest syndrome is a
manifestation of the sickle cell crisis and is included in the combination code. A
secondary code should not be assigned for the acute chest syndrome separately.
Question 6
A patient is admitted with a cerebrovascular accident (CVA) due to atrial
fibrillation. How should these diagnoses be sequenced?
A. CVA as principal; atrial fibrillation as secondary
B. Atrial fibrillation as principal; CVA as secondary
C. Both as principal
D. Combine into a single code
Correct Answer: A — CVA as principal; atrial fibrillation as secondary
, Rationale: The CVA is the condition chiefly responsible for the admission and
should be sequenced as principal. The atrial fibrillation is a contributing condition
and is coded as a secondary diagnosis. ICD-10-CM guidelines indicate that when a
patient is admitted with a condition caused by another condition, the manifestation
(CVA) is coded as principal and the etiology (atrial fibrillation) is coded as
secondary, unless a combination code exists.
Question 7
A patient is admitted with diabetic ketoacidosis (DKA) and type 2 diabetes
mellitus. How should these diagnoses be coded?
A. Type 2 diabetes as principal; DKA as secondary
B. DKA as principal; type 2 diabetes as secondary
C. Both as principal
D. Type 2 diabetes with DKA as a combination code
Correct Answer: B — DKA as principal; type 2 diabetes as secondary
Rationale: DKA is an acute complication of diabetes and may be the reason for
admission. ICD-10-CM guideline I.C.2.a.1 states that when a patient is admitted
with diabetic ketoacidosis, the DKA is coded as the principal diagnosis and the
type of diabetes is coded as secondary. However, if the patient is admitted for
treatment of the diabetes and develops DKA, the type of diabetes would be
principal.
Question 8
Which of the following is TRUE regarding "code first" notes in ICD-10-CM?
A. "Code first" notes mean the code is optional
B. "Code first" notes require sequencing the underlying condition first
C. "Code first" notes mean the code should not be used
D. "Code first" notes indicate the condition is not reportable
Correct Answer: B — "Code first" notes require sequencing the underlying
condition first
