Certified Coding Specialist
(CCS®) Exam
Questions and Answers| Latest Update| Guaranteed Pass
Q1. When a patient is admitted with a condition that develops after admission (a
complication), which code is sequenced as the principal diagnosis?
A. The complication is always sequenced first regardless of circumstances
B. The condition that occasioned the admission, per the guidelines for principal
diagnosis selection
C. The most severe diagnosis documented
D. Whichever diagnosis has the highest reimbursement weight
Answer: B
Rationale: Per the Uniform Hospital Discharge Data Set (UHDDS) definition, the
principal diagnosis is the condition established after study to be chiefly responsible
for occasioning the admission to the hospital. Complications arising after admission
are coded as additional diagnoses, not as the principal diagnosis, unless they meet
specific sequencing guideline exceptions.
Q2. According to ICD-10-CM guidelines, how should 'probable,' 'suspected,' or 'rule out'
diagnoses be coded in the inpatient setting?
A. Do not code them; wait for confirmation
B. Code the condition as if it existed/was confirmed
C. Code only the presenting symptoms
D. Query the physician before any coding can occur
Answer: B
Rationale: For inpatient coding, if a diagnosis documented at the time of discharge is
qualified as 'probable,' 'suspected,' 'likely,' 'questionable,' 'possible,' or 'still to be
ruled out,' the condition is coded as if it existed or was established, per ICD-10-CM
Official Guidelines for Coding and Reporting. This differs from outpatient coding,
where uncertain diagnoses are not coded.
Q3. Which coding convention indicates that a code includes multiple conditions in its
description, and both parts must be present to assign the code?
, A. Excludes1 note
B. 'And' in a code title (interpreted as 'and/or')
C. Includes note
D. Code first note
Answer: B
Rationale: In ICD-10-CM, when the word 'and' appears in a code title, it should be
interpreted as meaning 'and/or,' allowing the code to be used when either one or
both of the conditions listed are documented, such as 'acute and chronic' conditions.
Q4. What is the correct action when an Excludes1 note appears under a code?
A. The excluded condition can be coded together with the code
B. The excluded condition can never be coded with that code, as the two conditions
cannot occur together
C. Excludes1 has no bearing on code assignment
D. Excludes1 means the code is invalid
Answer: B
Rationale: An Excludes1 note indicates 'not coded here' — the excluded condition
and the code it's listed under are mutually exclusive and represent two distinct
conditions that cannot occur together (such as a congenital versus acquired form of
the same condition), so both codes should never be assigned together for the same
encounter.
Q5. Which guideline applies to coding a patient with sepsis due to a localized infection,
such as a urinary tract infection?
A. Code only the UTI
B. Code the systemic infection (sepsis) code first, followed by the code for the
localized infection
C. Code only sepsis without identifying the source
D. Sepsis and localized infections cannot be coded together
Answer: B
Rationale: When a patient has sepsis due to a localized infection, the underlying
systemic infection code (e.g., A41.9 for sepsis, unspecified organism, or a more
specific sepsis code) is sequenced first, followed by a code for the localized infection
(e.g., N39.0 for UTI), per ICD-10-CM sepsis coding guidelines.
Q6. A patient is diagnosed with Type 2 diabetes mellitus with diabetic chronic kidney
disease. How should this be coded?
, A. Code diabetes and CKD as two entirely unrelated conditions
B. Use the combination code that links diabetes with the specified manifestation (e.g.,
E11.22)
C. Only code the CKD
D. Only code the diabetes without specifying manifestation
Answer: B
Rationale: ICD-10-CM provides combination codes for diabetes mellitus with
associated manifestations. When documentation supports a cause-and-effect
relationship between diabetes and a condition like CKD, a combination code (E11.22,
Type 2 diabetes mellitus with diabetic chronic kidney disease) is used, along with an
additional code to identify the stage of CKD.
Q7. When coding for a patient with both an acute and chronic condition, how should
the codes be sequenced when the classification provides separate subentries?
A. Chronic condition is sequenced first, then the acute
B. Acute condition is sequenced first, followed by the chronic condition
C. Only the chronic condition is coded
D. Sequencing does not matter
Answer: B
Rationale: When separate codes exist for the acute and chronic forms of a condition
and both are documented, the acute (or subacute) code is sequenced first, followed
by the code for the chronic condition, per ICD-10-CM Official Guidelines.
Q8. What is the correct approach for coding a diagnosis described as 'due to' or
'associated with' another condition, when no combination code exists and no direct
instruction is given?
A. Assume causality is never indicated unless a combination code exists
B. Code each condition separately without any specific linkage assumption unless
guidelines or an index entry specifically supports it
C. Ignore the secondary condition entirely
D. Always link them regardless of guideline support
Answer: B
Rationale: Coders should not assume a cause-and-effect relationship between two
conditions unless the classification provides a specific instructional note (such as
'code also' or a combination code), or the provider has explicitly documented the
, linkage; each condition should generally be coded separately unless guidance
supports otherwise.
Q9. Which code category is used when coding a personal history of a condition that no
longer exists and is not currently being treated, but may affect future care?
A. Z codes (personal history codes, category Z85-Z87)
B. The active disease code itself
C. A symptom code
D. An external cause code
Answer: A
Rationale: Personal history (Z85-Z87) codes are used to indicate a condition the
patient previously had that has been resolved or no longer exists but which may be
clinically significant for future care, such as personal history of malignant neoplasm
or personal history of a specific disease.
Q10. A patient is admitted for chemotherapy for a known malignancy. What is the
correct principal diagnosis assignment?
A. The malignancy code as principal diagnosis
B. The appropriate Z51 code for encounter for chemotherapy as principal diagnosis,
with the malignancy as a secondary diagnosis
C. A symptom code only
D. No diagnosis code is needed for chemotherapy encounters
Answer: B
Rationale: When a patient's sole reason for admission/encounter is to receive
chemotherapy for a malignancy, the appropriate Z51.11 (encounter for
antineoplastic chemotherapy) code is sequenced as the principal/first-listed
diagnosis, with the malignancy code(s) reported as secondary diagnoses.
Q11. Which guideline governs the coding of 'impending' or 'threatened' conditions (e.g.,
threatened miscarriage) that did not actually occur?
A. Code the condition as if it occurred
B. Reference the ICD-10-CM index under the main term 'impending' or 'threatened';
if a specific code exists, use it, otherwise code the existing underlying condition(s)
C. Never code impending or threatened conditions
D. Always code as a confirmed diagnosis without index verification
Answer: B
(CCS®) Exam
Questions and Answers| Latest Update| Guaranteed Pass
Q1. When a patient is admitted with a condition that develops after admission (a
complication), which code is sequenced as the principal diagnosis?
A. The complication is always sequenced first regardless of circumstances
B. The condition that occasioned the admission, per the guidelines for principal
diagnosis selection
C. The most severe diagnosis documented
D. Whichever diagnosis has the highest reimbursement weight
Answer: B
Rationale: Per the Uniform Hospital Discharge Data Set (UHDDS) definition, the
principal diagnosis is the condition established after study to be chiefly responsible
for occasioning the admission to the hospital. Complications arising after admission
are coded as additional diagnoses, not as the principal diagnosis, unless they meet
specific sequencing guideline exceptions.
Q2. According to ICD-10-CM guidelines, how should 'probable,' 'suspected,' or 'rule out'
diagnoses be coded in the inpatient setting?
A. Do not code them; wait for confirmation
B. Code the condition as if it existed/was confirmed
C. Code only the presenting symptoms
D. Query the physician before any coding can occur
Answer: B
Rationale: For inpatient coding, if a diagnosis documented at the time of discharge is
qualified as 'probable,' 'suspected,' 'likely,' 'questionable,' 'possible,' or 'still to be
ruled out,' the condition is coded as if it existed or was established, per ICD-10-CM
Official Guidelines for Coding and Reporting. This differs from outpatient coding,
where uncertain diagnoses are not coded.
Q3. Which coding convention indicates that a code includes multiple conditions in its
description, and both parts must be present to assign the code?
, A. Excludes1 note
B. 'And' in a code title (interpreted as 'and/or')
C. Includes note
D. Code first note
Answer: B
Rationale: In ICD-10-CM, when the word 'and' appears in a code title, it should be
interpreted as meaning 'and/or,' allowing the code to be used when either one or
both of the conditions listed are documented, such as 'acute and chronic' conditions.
Q4. What is the correct action when an Excludes1 note appears under a code?
A. The excluded condition can be coded together with the code
B. The excluded condition can never be coded with that code, as the two conditions
cannot occur together
C. Excludes1 has no bearing on code assignment
D. Excludes1 means the code is invalid
Answer: B
Rationale: An Excludes1 note indicates 'not coded here' — the excluded condition
and the code it's listed under are mutually exclusive and represent two distinct
conditions that cannot occur together (such as a congenital versus acquired form of
the same condition), so both codes should never be assigned together for the same
encounter.
Q5. Which guideline applies to coding a patient with sepsis due to a localized infection,
such as a urinary tract infection?
A. Code only the UTI
B. Code the systemic infection (sepsis) code first, followed by the code for the
localized infection
C. Code only sepsis without identifying the source
D. Sepsis and localized infections cannot be coded together
Answer: B
Rationale: When a patient has sepsis due to a localized infection, the underlying
systemic infection code (e.g., A41.9 for sepsis, unspecified organism, or a more
specific sepsis code) is sequenced first, followed by a code for the localized infection
(e.g., N39.0 for UTI), per ICD-10-CM sepsis coding guidelines.
Q6. A patient is diagnosed with Type 2 diabetes mellitus with diabetic chronic kidney
disease. How should this be coded?
, A. Code diabetes and CKD as two entirely unrelated conditions
B. Use the combination code that links diabetes with the specified manifestation (e.g.,
E11.22)
C. Only code the CKD
D. Only code the diabetes without specifying manifestation
Answer: B
Rationale: ICD-10-CM provides combination codes for diabetes mellitus with
associated manifestations. When documentation supports a cause-and-effect
relationship between diabetes and a condition like CKD, a combination code (E11.22,
Type 2 diabetes mellitus with diabetic chronic kidney disease) is used, along with an
additional code to identify the stage of CKD.
Q7. When coding for a patient with both an acute and chronic condition, how should
the codes be sequenced when the classification provides separate subentries?
A. Chronic condition is sequenced first, then the acute
B. Acute condition is sequenced first, followed by the chronic condition
C. Only the chronic condition is coded
D. Sequencing does not matter
Answer: B
Rationale: When separate codes exist for the acute and chronic forms of a condition
and both are documented, the acute (or subacute) code is sequenced first, followed
by the code for the chronic condition, per ICD-10-CM Official Guidelines.
Q8. What is the correct approach for coding a diagnosis described as 'due to' or
'associated with' another condition, when no combination code exists and no direct
instruction is given?
A. Assume causality is never indicated unless a combination code exists
B. Code each condition separately without any specific linkage assumption unless
guidelines or an index entry specifically supports it
C. Ignore the secondary condition entirely
D. Always link them regardless of guideline support
Answer: B
Rationale: Coders should not assume a cause-and-effect relationship between two
conditions unless the classification provides a specific instructional note (such as
'code also' or a combination code), or the provider has explicitly documented the
, linkage; each condition should generally be coded separately unless guidance
supports otherwise.
Q9. Which code category is used when coding a personal history of a condition that no
longer exists and is not currently being treated, but may affect future care?
A. Z codes (personal history codes, category Z85-Z87)
B. The active disease code itself
C. A symptom code
D. An external cause code
Answer: A
Rationale: Personal history (Z85-Z87) codes are used to indicate a condition the
patient previously had that has been resolved or no longer exists but which may be
clinically significant for future care, such as personal history of malignant neoplasm
or personal history of a specific disease.
Q10. A patient is admitted for chemotherapy for a known malignancy. What is the
correct principal diagnosis assignment?
A. The malignancy code as principal diagnosis
B. The appropriate Z51 code for encounter for chemotherapy as principal diagnosis,
with the malignancy as a secondary diagnosis
C. A symptom code only
D. No diagnosis code is needed for chemotherapy encounters
Answer: B
Rationale: When a patient's sole reason for admission/encounter is to receive
chemotherapy for a malignancy, the appropriate Z51.11 (encounter for
antineoplastic chemotherapy) code is sequenced as the principal/first-listed
diagnosis, with the malignancy code(s) reported as secondary diagnoses.
Q11. Which guideline governs the coding of 'impending' or 'threatened' conditions (e.g.,
threatened miscarriage) that did not actually occur?
A. Code the condition as if it occurred
B. Reference the ICD-10-CM index under the main term 'impending' or 'threatened';
if a specific code exists, use it, otherwise code the existing underlying condition(s)
C. Never code impending or threatened conditions
D. Always code as a confirmed diagnosis without index verification
Answer: B
