CCS EXAM ONLINE PRACTICE
COMPREHENSIVE CODING EXAM (2026/2027 EDITION)
650 Multiple-Choice Questions - Complete Online Practice Exam
Independent-Study Disclaimer
This practice examination is an independent study aid and is not affiliated with, endorsed by, or sponsored by the
American Health Information Management Association (AHIMA) or any other testing organization. It is provided for
educational and self-assessment purposes only and is not a substitute for official AHIMA CCS materials, the current
coding manuals, or professional guidance. Code sets and guidelines are subject to change; always consult the
current ICD-10-CM, ICD-10-PCS, CPT, and HCPCS Level II manuals and the Official Guidelines for Coding and
Reporting.
,Section 1: ICD-10-CM Coding – Diagnosis Coding, Guidelines, and
Conventions (150 questions)
Q1: In ICD-10-CM, the 'principal diagnosis' for an inpatient is defined as the condition:
A. Established after study to be chiefly responsible for the admission [CORRECT]
B. That is the most severe regardless of reason
C. That pays the highest DRG
D. Listed first alphabetically
Correct Answer: A
Rationale: The principal diagnosis is the condition chiefly responsible for admission after study. It is not severity-, payment-,
or alphabet-based.
Q2: Which symbol in ICD-10-CM indicates a code that is not used as a principal diagnosis?
A. The 'dx' note or manifest-code restriction conventions [CORRECT]
B. A plus sign
C. The exclamation point
D. The asterisk only
Correct Answer: A
Rationale: Codes with 'manifestation' or 'use additional code' restrictions may be excluded as principal diagnoses. The other
symbols are not the convention.
Q3: In ICD-10-CM, the 'use additional code' instructional note indicates that:
A. No other code is needed
B. The code is invalid
C. A procedure code is required
D. Another code should be assigned to fully describe the condition [CORRECT]
Correct Answer: D
Rationale: 'Use additional code' means an additional diagnosis code is needed to fully describe the condition. It does not
invalidate the code.
Q4: Which ICD-10-CM convention means 'code first the underlying condition'?
A. 'Use additional code'
B. The excludes note
C. 'Code first' instructional note (etiology/manifestation) [CORRECT]
D. The includes note
Correct Answer: C
Rationale: A 'code first' note indicates the underlying (etiology) condition is coded first, followed by the manifestation. The
others are different conventions.
Q5: The 'Excludes1' note in ICD-10-CM indicates that:
A. Two conditions cannot be reported together (mutually exclusive) [CORRECT]
B. Two conditions can be reported together
C. The code is a combination code
D. A procedure is needed
Correct Answer: A
Rationale: Excludes1 means the excluded conditions are mutually exclusive and should not be reported together. Excludes2
allows both.
CCS Exam Online Practice - 2026/2027 Edition Page 2
,Q6: The 'Excludes2' note in ICD-10-CM indicates that:
A. The two conditions may be reported together if both exist [CORRECT]
B. The codes are mutually exclusive
C. The code is invalid
D. No code applies
Correct Answer: A
Rationale: Excludes2 means both conditions may be reported together when they coexist. Excludes1 means they cannot.
Q7: In ICD-10-CM, a 'combination code' is:
A. Two separate codes
B. A procedure code
C. A single code that classifies two diagnoses or a diagnosis with an associated manifestation [CORRECT]
D. An invalid code
Correct Answer: C
Rationale: A combination code classifies two diagnoses or a diagnosis with an associated manifestation in a single code. It is
not a procedure code.
Q8: Which of the following is a valid ICD-10-CM coding principle?
A. Code only the first word of a diagnosis
B. Code the highest level of specificity documented [CORRECT]
C. Assign unsupported codes from billing data
D. Use unspecified codes whenever possible
Correct Answer: B
Rationale: Coders assign the most specific code supported by documentation. Unspecified codes are avoided when a
specific code is documented.
Q9: An ICD-10-CM code is reported as 'unspecified' when:
A. The provider documents the condition without specifying the type [CORRECT]
B. A more specific code is always available
C. The condition is well-defined
D. The coder prefers it
Correct Answer: A
Rationale: Unspecified codes are used when the provider does not document enough detail to assign a more specific code.
They are not preferred.
Q10: Which of the following is the correct sequencing rule for the principal diagnosis?
A. The least severe condition is first
B. The condition chiefly responsible for the encounter/admission is listed first [CORRECT]
C. Conditions are listed alphabetically
D. The coder chooses arbitrarily
Correct Answer: B
Rationale: The condition chiefly responsible for the encounter is listed first as the principal/first-listed diagnosis. The others
are incorrect.
CCS Exam Online Practice - 2026/2027 Edition Page 3
, Q11: For outpatient encounters, the first-listed diagnosis is:
A. The most severe condition
B. The reason for the encounter as documented [CORRECT]
C. A screening result
D. The highest-paying code
Correct Answer: B
Rationale: For outpatients, the first-listed diagnosis is the reason for the encounter. It is not severity- or payment-based.
Q12: Which of the following is TRUE about coding signs and symptoms?
A. Only the definitive diagnosis is coded
B. Symptoms are never coded
C. Signs and symptoms may be coded when a definitive diagnosis is not established [CORRECT]
D. Signs are always ignored
Correct Answer: C
Rationale: Signs and symptoms may be coded when no definitive diagnosis is established. When a definitive diagnosis
exists, it is coded.
Q13: In ICD-10-CM, coding of 'present on admission' (POA) applies to:
A. All outpatient conditions
B. Conditions present at the time of admission, reported on the claim [CORRECT]
C. Procedure codes
D. Medicare Part B only
Correct Answer: B
Rationale: POA reporting identifies conditions present at admission on inpatient claims. It is not for outpatient or procedures.
Q14: Which of the following is a valid POA indicator?
A. A, B, C
B. 1, 2, 3
C. Y (present), N (not present), U (unknown), W (clinically undetermined) [CORRECT]
D. None
Correct Answer: C
Rationale: POA indicators include Y, N, U, W (and others). The other options are not valid POA indicators.
Q15: The ICD-10-CM code for essential hypertension is found in which chapter/category?
A. Chapter 9 (Diseases of the circulatory system), I10 [CORRECT]
B. Chapter 4
C. Chapter 7
D. Chapter 12
Correct Answer: A
Rationale: Essential (primary) hypertension is coded I10 in Chapter 9 (circulatory). The other chapters are incorrect.
CCS Exam Online Practice - 2026/2027 Edition Page 4
COMPREHENSIVE CODING EXAM (2026/2027 EDITION)
650 Multiple-Choice Questions - Complete Online Practice Exam
Independent-Study Disclaimer
This practice examination is an independent study aid and is not affiliated with, endorsed by, or sponsored by the
American Health Information Management Association (AHIMA) or any other testing organization. It is provided for
educational and self-assessment purposes only and is not a substitute for official AHIMA CCS materials, the current
coding manuals, or professional guidance. Code sets and guidelines are subject to change; always consult the
current ICD-10-CM, ICD-10-PCS, CPT, and HCPCS Level II manuals and the Official Guidelines for Coding and
Reporting.
,Section 1: ICD-10-CM Coding – Diagnosis Coding, Guidelines, and
Conventions (150 questions)
Q1: In ICD-10-CM, the 'principal diagnosis' for an inpatient is defined as the condition:
A. Established after study to be chiefly responsible for the admission [CORRECT]
B. That is the most severe regardless of reason
C. That pays the highest DRG
D. Listed first alphabetically
Correct Answer: A
Rationale: The principal diagnosis is the condition chiefly responsible for admission after study. It is not severity-, payment-,
or alphabet-based.
Q2: Which symbol in ICD-10-CM indicates a code that is not used as a principal diagnosis?
A. The 'dx' note or manifest-code restriction conventions [CORRECT]
B. A plus sign
C. The exclamation point
D. The asterisk only
Correct Answer: A
Rationale: Codes with 'manifestation' or 'use additional code' restrictions may be excluded as principal diagnoses. The other
symbols are not the convention.
Q3: In ICD-10-CM, the 'use additional code' instructional note indicates that:
A. No other code is needed
B. The code is invalid
C. A procedure code is required
D. Another code should be assigned to fully describe the condition [CORRECT]
Correct Answer: D
Rationale: 'Use additional code' means an additional diagnosis code is needed to fully describe the condition. It does not
invalidate the code.
Q4: Which ICD-10-CM convention means 'code first the underlying condition'?
A. 'Use additional code'
B. The excludes note
C. 'Code first' instructional note (etiology/manifestation) [CORRECT]
D. The includes note
Correct Answer: C
Rationale: A 'code first' note indicates the underlying (etiology) condition is coded first, followed by the manifestation. The
others are different conventions.
Q5: The 'Excludes1' note in ICD-10-CM indicates that:
A. Two conditions cannot be reported together (mutually exclusive) [CORRECT]
B. Two conditions can be reported together
C. The code is a combination code
D. A procedure is needed
Correct Answer: A
Rationale: Excludes1 means the excluded conditions are mutually exclusive and should not be reported together. Excludes2
allows both.
CCS Exam Online Practice - 2026/2027 Edition Page 2
,Q6: The 'Excludes2' note in ICD-10-CM indicates that:
A. The two conditions may be reported together if both exist [CORRECT]
B. The codes are mutually exclusive
C. The code is invalid
D. No code applies
Correct Answer: A
Rationale: Excludes2 means both conditions may be reported together when they coexist. Excludes1 means they cannot.
Q7: In ICD-10-CM, a 'combination code' is:
A. Two separate codes
B. A procedure code
C. A single code that classifies two diagnoses or a diagnosis with an associated manifestation [CORRECT]
D. An invalid code
Correct Answer: C
Rationale: A combination code classifies two diagnoses or a diagnosis with an associated manifestation in a single code. It is
not a procedure code.
Q8: Which of the following is a valid ICD-10-CM coding principle?
A. Code only the first word of a diagnosis
B. Code the highest level of specificity documented [CORRECT]
C. Assign unsupported codes from billing data
D. Use unspecified codes whenever possible
Correct Answer: B
Rationale: Coders assign the most specific code supported by documentation. Unspecified codes are avoided when a
specific code is documented.
Q9: An ICD-10-CM code is reported as 'unspecified' when:
A. The provider documents the condition without specifying the type [CORRECT]
B. A more specific code is always available
C. The condition is well-defined
D. The coder prefers it
Correct Answer: A
Rationale: Unspecified codes are used when the provider does not document enough detail to assign a more specific code.
They are not preferred.
Q10: Which of the following is the correct sequencing rule for the principal diagnosis?
A. The least severe condition is first
B. The condition chiefly responsible for the encounter/admission is listed first [CORRECT]
C. Conditions are listed alphabetically
D. The coder chooses arbitrarily
Correct Answer: B
Rationale: The condition chiefly responsible for the encounter is listed first as the principal/first-listed diagnosis. The others
are incorrect.
CCS Exam Online Practice - 2026/2027 Edition Page 3
, Q11: For outpatient encounters, the first-listed diagnosis is:
A. The most severe condition
B. The reason for the encounter as documented [CORRECT]
C. A screening result
D. The highest-paying code
Correct Answer: B
Rationale: For outpatients, the first-listed diagnosis is the reason for the encounter. It is not severity- or payment-based.
Q12: Which of the following is TRUE about coding signs and symptoms?
A. Only the definitive diagnosis is coded
B. Symptoms are never coded
C. Signs and symptoms may be coded when a definitive diagnosis is not established [CORRECT]
D. Signs are always ignored
Correct Answer: C
Rationale: Signs and symptoms may be coded when no definitive diagnosis is established. When a definitive diagnosis
exists, it is coded.
Q13: In ICD-10-CM, coding of 'present on admission' (POA) applies to:
A. All outpatient conditions
B. Conditions present at the time of admission, reported on the claim [CORRECT]
C. Procedure codes
D. Medicare Part B only
Correct Answer: B
Rationale: POA reporting identifies conditions present at admission on inpatient claims. It is not for outpatient or procedures.
Q14: Which of the following is a valid POA indicator?
A. A, B, C
B. 1, 2, 3
C. Y (present), N (not present), U (unknown), W (clinically undetermined) [CORRECT]
D. None
Correct Answer: C
Rationale: POA indicators include Y, N, U, W (and others). The other options are not valid POA indicators.
Q15: The ICD-10-CM code for essential hypertension is found in which chapter/category?
A. Chapter 9 (Diseases of the circulatory system), I10 [CORRECT]
B. Chapter 4
C. Chapter 7
D. Chapter 12
Correct Answer: A
Rationale: Essential (primary) hypertension is coded I10 in Chapter 9 (circulatory). The other chapters are incorrect.
CCS Exam Online Practice - 2026/2027 Edition Page 4
