HEALTH INFORMATION MANAGEMENT · CERTIFICATION PREP
WGU D521 A+
INTRODUCTION TO
MEDICAL CODING
2026/2027 Official Exam · A+ Verified Questions & Rationales
A+ 5 100%
QUESTIONS VERIFIED EXAM DOMAINS COVERED RATIONALES INCLUDED
CATEGORIES
■ 1. Coding Foundations & Medical Terminology
■ 2. ICD-10-CM Diagnosis Coding
■ 3. ICD-10-PCS Procedure Coding
■ 4. CPT / HCPCS Procedure Coding
■ 5. Ethics, Compliance, Reimbursement & Documentation
STUVIAACTUALEXAM
Passing Score: 75% · 1 Mark per Question · Application/Analysis Level
,SECTION 1: Coding Foundations & Medical Terminology
Q1. A new medical coder reviews a patient chart that lists the chief complaint as 'dyspnea on exertion' and the
assessment as 'COPD exacerbation.' The coder must determine which term represents the condition that will primarily
drive code selection for the encounter. Which statement correctly distinguishes the roles of these terms in the coding
process?
A. COPD exacerbation is the condition established after study that is chiefly responsible for the encounter and therefore the
focus of diagnosis coding, while dyspnea is a symptom that may be reported if it adds specificity.
B. Dyspnea is the definitive diagnosis and should be coded as the principal condition; COPD is only a symptom descriptor.
C. Both terms are coded equally because symptoms always take precedence over chronic disease labels in outpatient
coding.
D. The coder should query the provider to replace both terms with a single unspecified respiratory disorder code.
Correct Answer: A
Rationale: In ICD-10-CM, the condition established after study that is chiefly responsible for the encounter is the principal or first-listed
diagnosis. COPD exacerbation meets that definition; dyspnea is a symptom that supports the diagnosis but is not coded in place of it
when a definitive diagnosis is documented.
Q2. During orientation, a coding student is asked to explain why the Alphabetic Index and Tabular List must both be used
when assigning an ICD-10-CM code. The student correctly identifies which principle as the reason both resources are
required?
A. The Alphabetic Index contains the final code selection; the Tabular List is only for historical reference.
B. The Alphabetic Index guides location of a candidate code, but the Tabular List must be consulted to confirm
completeness, apply instructional notes, and verify the highest level of specificity.
C. Codes found only in the Alphabetic Index are complete and ready for reporting without further verification.
D. The Tabular List is optional once a code has been located in the Index because official guidelines prohibit additional
verification steps.
Correct Answer: B
Rationale: Official ICD-10-CM coding guidelines require that a code located in the Alphabetic Index be verified in the Tabular List. The
Tabular List contains essential instructional notes, excludes notes, and additional characters that determine the final valid code.
Q3. A hospital compliance officer is reviewing coder training materials and notices that several trainees confuse the
terms 'morbidity' and 'mortality.' Which clarification correctly differentiates these foundational concepts for coding and
statistical reporting?
A. Morbidity refers to death rates; mortality refers to the presence of disease in a population.
B. Both terms are interchangeable when reporting cause-of-death statistics to public health agencies.
C. Mortality is used only for inpatient principal diagnosis selection; morbidity applies solely to outpatient encounters.
D. Morbidity describes the state of being diseased or the incidence of disease; mortality refers to the incidence of death.
Correct Answer: D
Rationale: Morbidity is the condition of being diseased or the rate of disease in a population. Mortality is the incidence of death.
Accurate distinction is required for proper use of ICD-10-CM for both clinical and statistical purposes.
WGU D521 · Page 2
, Q4. A physician documents 'hypertension with stage 3 chronic kidney disease' in an outpatient progress note. The coder
recalls that certain conditions have a presumed causal relationship under ICD-10-CM guidelines. Which coding principle
correctly applies to this documentation?
A. Hypertension and chronic kidney disease are always coded separately with no linking instruction unless the provider
explicitly states 'due to.'
B. Only the hypertension code is reported because chronic kidney disease is considered a non-reportable comorbidity in the
outpatient setting.
C. ICD-10-CM assumes a causal relationship between hypertension and chronic kidney disease, so a combination code
from the I12 category is appropriate when both are present.
D. The coder must query for confirmation of causality before assigning any code related to either condition.
Correct Answer: C
Rationale: ICD-10-CM Official Guidelines state that a causal relationship is assumed between hypertension and chronic kidney
disease. When both conditions are documented, a combination code from category I12 is assigned rather than separate codes.
Q5. While abstracting a record, a coder encounters the abbreviation 'NEC' next to a diagnosis term in the Alphabetic
Index. The coder correctly interprets this abbreviation to mean which of the following?
A. Not Elsewhere Classified, requiring the coder to force the condition into the closest available specific code even if
documentation is incomplete.
B. No Evidence of Complication, a status indicator used only in procedure coding.
C. Necessary Extra Character, signaling that an additional digit must be appended from a different chapter.
D. Not Elsewhere Classified, indicating that a more specific code does not exist for the condition as documented.
Correct Answer: D
Rationale: NEC means 'Not Elsewhere Classified.' It is used when the Index directs the coder to a code because a more precise code
for the documented condition is not available in the classification.
Q6. A coding supervisor is explaining the difference between a 'symptom' and a 'sign' to new hires. Which statement
accurately reflects how these terms are treated in diagnosis coding?
A. Signs are always coded in addition to the definitive diagnosis; symptoms are never coded.
B. Both signs and symptoms must be coded as principal diagnoses regardless of any definitive diagnosis documented.
C. Symptoms are coded only for inpatient encounters; signs are coded only for outpatient encounters.
D. Signs and symptoms are never coded when a definitive diagnosis has been established that accounts for them.
Correct Answer: D
Rationale: Per ICD-10-CM guidelines, signs and symptoms that are integral to a definitive diagnosis are not coded separately. They
are reported only when no definitive diagnosis has been established or when they are not routinely associated with the condition.
Q7. An outpatient encounter note states 'patient presents for evaluation of possible pneumonia; chest x-ray pending.'
The coder must decide how to report the diagnosis for this visit. Which approach is consistent with outpatient coding
guidelines?
A. Code confirmed pneumonia because the provider is highly suspicious.
B. Code both the suspected pneumonia and the symptoms to maximize specificity.
C. Omit diagnosis coding until the chest x-ray result is available and then amend the claim.
D. Code the symptom or the reason for the encounter (e.g., cough or abnormal findings) rather than a suspected or rule-out
condition.
Correct Answer: D
Rationale: Outpatient coding guidelines prohibit coding diagnoses documented as 'probable,' 'suspected,' 'questionable,' or 'rule out.'
Instead, code the condition(s) to the highest degree of certainty, which is typically the symptom or the reason for the encounter.
WGU D521 · Page 3
WGU D521 A+
INTRODUCTION TO
MEDICAL CODING
2026/2027 Official Exam · A+ Verified Questions & Rationales
A+ 5 100%
QUESTIONS VERIFIED EXAM DOMAINS COVERED RATIONALES INCLUDED
CATEGORIES
■ 1. Coding Foundations & Medical Terminology
■ 2. ICD-10-CM Diagnosis Coding
■ 3. ICD-10-PCS Procedure Coding
■ 4. CPT / HCPCS Procedure Coding
■ 5. Ethics, Compliance, Reimbursement & Documentation
STUVIAACTUALEXAM
Passing Score: 75% · 1 Mark per Question · Application/Analysis Level
,SECTION 1: Coding Foundations & Medical Terminology
Q1. A new medical coder reviews a patient chart that lists the chief complaint as 'dyspnea on exertion' and the
assessment as 'COPD exacerbation.' The coder must determine which term represents the condition that will primarily
drive code selection for the encounter. Which statement correctly distinguishes the roles of these terms in the coding
process?
A. COPD exacerbation is the condition established after study that is chiefly responsible for the encounter and therefore the
focus of diagnosis coding, while dyspnea is a symptom that may be reported if it adds specificity.
B. Dyspnea is the definitive diagnosis and should be coded as the principal condition; COPD is only a symptom descriptor.
C. Both terms are coded equally because symptoms always take precedence over chronic disease labels in outpatient
coding.
D. The coder should query the provider to replace both terms with a single unspecified respiratory disorder code.
Correct Answer: A
Rationale: In ICD-10-CM, the condition established after study that is chiefly responsible for the encounter is the principal or first-listed
diagnosis. COPD exacerbation meets that definition; dyspnea is a symptom that supports the diagnosis but is not coded in place of it
when a definitive diagnosis is documented.
Q2. During orientation, a coding student is asked to explain why the Alphabetic Index and Tabular List must both be used
when assigning an ICD-10-CM code. The student correctly identifies which principle as the reason both resources are
required?
A. The Alphabetic Index contains the final code selection; the Tabular List is only for historical reference.
B. The Alphabetic Index guides location of a candidate code, but the Tabular List must be consulted to confirm
completeness, apply instructional notes, and verify the highest level of specificity.
C. Codes found only in the Alphabetic Index are complete and ready for reporting without further verification.
D. The Tabular List is optional once a code has been located in the Index because official guidelines prohibit additional
verification steps.
Correct Answer: B
Rationale: Official ICD-10-CM coding guidelines require that a code located in the Alphabetic Index be verified in the Tabular List. The
Tabular List contains essential instructional notes, excludes notes, and additional characters that determine the final valid code.
Q3. A hospital compliance officer is reviewing coder training materials and notices that several trainees confuse the
terms 'morbidity' and 'mortality.' Which clarification correctly differentiates these foundational concepts for coding and
statistical reporting?
A. Morbidity refers to death rates; mortality refers to the presence of disease in a population.
B. Both terms are interchangeable when reporting cause-of-death statistics to public health agencies.
C. Mortality is used only for inpatient principal diagnosis selection; morbidity applies solely to outpatient encounters.
D. Morbidity describes the state of being diseased or the incidence of disease; mortality refers to the incidence of death.
Correct Answer: D
Rationale: Morbidity is the condition of being diseased or the rate of disease in a population. Mortality is the incidence of death.
Accurate distinction is required for proper use of ICD-10-CM for both clinical and statistical purposes.
WGU D521 · Page 2
, Q4. A physician documents 'hypertension with stage 3 chronic kidney disease' in an outpatient progress note. The coder
recalls that certain conditions have a presumed causal relationship under ICD-10-CM guidelines. Which coding principle
correctly applies to this documentation?
A. Hypertension and chronic kidney disease are always coded separately with no linking instruction unless the provider
explicitly states 'due to.'
B. Only the hypertension code is reported because chronic kidney disease is considered a non-reportable comorbidity in the
outpatient setting.
C. ICD-10-CM assumes a causal relationship between hypertension and chronic kidney disease, so a combination code
from the I12 category is appropriate when both are present.
D. The coder must query for confirmation of causality before assigning any code related to either condition.
Correct Answer: C
Rationale: ICD-10-CM Official Guidelines state that a causal relationship is assumed between hypertension and chronic kidney
disease. When both conditions are documented, a combination code from category I12 is assigned rather than separate codes.
Q5. While abstracting a record, a coder encounters the abbreviation 'NEC' next to a diagnosis term in the Alphabetic
Index. The coder correctly interprets this abbreviation to mean which of the following?
A. Not Elsewhere Classified, requiring the coder to force the condition into the closest available specific code even if
documentation is incomplete.
B. No Evidence of Complication, a status indicator used only in procedure coding.
C. Necessary Extra Character, signaling that an additional digit must be appended from a different chapter.
D. Not Elsewhere Classified, indicating that a more specific code does not exist for the condition as documented.
Correct Answer: D
Rationale: NEC means 'Not Elsewhere Classified.' It is used when the Index directs the coder to a code because a more precise code
for the documented condition is not available in the classification.
Q6. A coding supervisor is explaining the difference between a 'symptom' and a 'sign' to new hires. Which statement
accurately reflects how these terms are treated in diagnosis coding?
A. Signs are always coded in addition to the definitive diagnosis; symptoms are never coded.
B. Both signs and symptoms must be coded as principal diagnoses regardless of any definitive diagnosis documented.
C. Symptoms are coded only for inpatient encounters; signs are coded only for outpatient encounters.
D. Signs and symptoms are never coded when a definitive diagnosis has been established that accounts for them.
Correct Answer: D
Rationale: Per ICD-10-CM guidelines, signs and symptoms that are integral to a definitive diagnosis are not coded separately. They
are reported only when no definitive diagnosis has been established or when they are not routinely associated with the condition.
Q7. An outpatient encounter note states 'patient presents for evaluation of possible pneumonia; chest x-ray pending.'
The coder must decide how to report the diagnosis for this visit. Which approach is consistent with outpatient coding
guidelines?
A. Code confirmed pneumonia because the provider is highly suspicious.
B. Code both the suspected pneumonia and the symptoms to maximize specificity.
C. Omit diagnosis coding until the chest x-ray result is available and then amend the claim.
D. Code the symptom or the reason for the encounter (e.g., cough or abnormal findings) rather than a suspected or rule-out
condition.
Correct Answer: D
Rationale: Outpatient coding guidelines prohibit coding diagnoses documented as 'probable,' 'suspected,' 'questionable,' or 'rule out.'
Instead, code the condition(s) to the highest degree of certainty, which is typically the symptom or the reason for the encounter.
WGU D521 · Page 3
