CCS Certification Exam Prep 2026 Updated Practice
Questions, Comprehensive Cardiovascular Pulmonary
Therapy Review, Detailed Explanations, Verified Answers,
Complete Success Workbook
DOMAIN 1: CODING KNOWLEDGE AND SKILLS (39–41%)
ICD-10-CM Diagnosis Coding, Sequencing, and Guidelines
Question 1. A 55-year-old patient is admitted with hypertensive heart disease with
congestive heart failure. What is the correct ICD-10-CM code assignment?
A. I10, I50.9
B. I11.0, I50.9
C. I50.9, I11.0
D. I15.8, I50.9
Rationale: ICD-10-CM guidelines require that when a patient has both
hypertensive heart disease and heart failure, the hypertension is classified as a
causal condition. The correct code is I11.0 (Hypertensive heart disease with heart
failure), followed by I50.9 (Heart failure, unspecified). The hypertension code I10
is incorrect because the hypertension is not stated as being unrelated to the heart
disease. I15.8 is for secondary hypertension, which is not documented here.
Question 2. A patient is admitted with acute respiratory failure. The physician
documents "acute respiratory failure" without specifying whether it is hypoxic or
hypercapnic. What code should be assigned?
A. J96.01
B. J96.00
C. J96.91
D. J96.90
Rationale: When acute respiratory failure is documented without specification of
type (hypoxic or hypercapnic), the default code is J96.00 (Acute respiratory
failure, unspecified whether with hypoxia or hypercapnia). J96.01 is used when
,hypoxic respiratory failure is specifically documented. J96.91 and J96.90 are for
chronic respiratory failure.
Question 3. A patient is admitted for chemotherapy due to a primary carcinoma of
the right transplanted kidney. What codes should be reported?
A. Z51.11, T86.19, C80.2, C64.1
B. Z51.11, T86.19, C64.1
C. Z51.11, C64.1
D. Z51.11, T86.19, C80.2
Rationale: When a patient is admitted for chemotherapy, the encounter code
Z51.11 (Encounter for antineoplastic chemotherapy) is assigned first, followed by
the code for the malignancy being treated. The transplanted kidney malignancy is
coded with T86.19 (Other complication of kidney transplant) and C64.1
(Malignant neoplasm of right kidney). C80.2 (Malignant neoplasm associated with
transplanted organ) is not the primary code when the specific site is known.
Question 4. A patient is admitted with sepsis due to streptococcal pneumonia. The
physician documents "sepsis due to Streptococcus pneumoniae." What is the
correct coding sequence?
A. A41.9, J13
B. A40.3, J13
C. J13, A40.3
D. A41.9, J15.4
Rationale: When sepsis is documented as due to a specific organism, the systemic
infection code (A40.3, Sepsis due to Streptococcus pneumoniae) is sequenced first,
followed by the code for the local infection (J13, Pneumonia due to Streptococcus
pneumoniae). A41.9 is for unspecified sepsis and is incorrect when the organism is
specified. The local infection is sequenced after the systemic infection.
Question 5. A 70-year-old patient is admitted with dehydration and acute kidney
injury. The physician documents both conditions as contributing to the admission.
What is the correct principal diagnosis?
,A. N17.9 (Acute kidney failure, unspecified)
B. E86.0 (Dehydration)
C. N17.9 and E86.0 are both principal
D. I12.9 (Hypertensive chronic kidney disease)
Rationale: The principal diagnosis is the condition established after study to be
chiefly responsible for the admission. When the physician documents both
dehydration and acute kidney injury and both are treated, the condition that is the
primary reason for admission should be sequenced first. In this case, if dehydration
is the cause of the AKI, E86.0 would be sequenced first. However, the question
does not specify causation, and coding guidelines require that when both
conditions are present on admission, the principal diagnosis is determined by the
physician's documentation of the primary reason for admission.
Question 6. A patient is diagnosed with diabetic ketoacidosis (DKA) due to Type
1 diabetes mellitus. What is the correct ICD-10-CM code assignment?
A. E10.10
B. E10.10, E87.2
C. E11.10, E87.2
D. E10.10, E87.2, E86.0
Rationale: Diabetic ketoacidosis is coded with E10.10 (Type 1 diabetes mellitus
with ketoacidosis). If acidosis (E87.2) is documented, it may also be coded.
However, DKA inherently includes acidosis, so E87.2 is not separately coded
unless specifically documented as a distinct condition. E11.10 is for Type 2
diabetes with ketoacidosis.
Question 7. Which of the following is the correct code for a patient with chronic
systolic heart failure?
A. I50.9
B. I50.22
C. I50.32
D. I50.43
, Rationale: I50.22 is the correct code for chronic systolic heart failure. I50.9 is for
unspecified heart failure, I50.32 is for chronic diastolic heart failure, and I50.43 is
for acute on chronic combined systolic and diastolic heart failure.
Question 8. A patient is admitted with a non-healing pressure ulcer of the sacrum,
stage III. What is the correct code?
A. L89.159
B. L89.152
C. L89.150
D. L89.153
Rationale: L89.152 is the correct code for pressure ulcer of the sacral region, stage
III. The ICD-10-CM code structure for pressure ulcers includes the site and stage.
L89.159 is for unspecified stage, L89.150 is for stage I, and L89.153 is for stage
IV.
Question 9. A patient is admitted for a total knee replacement due to severe
osteoarthritis of the right knee. What is the correct principal diagnosis?
A. M17.11
B. M17.12
C. Z96.651
D. M17.9
Rationale: M17.11 is the correct code for unilateral primary osteoarthritis, right
knee. The principal diagnosis for a joint replacement is the underlying condition
(osteoarthritis), not the presence of the prosthesis (Z96.651 is for the presence of a
knee joint prosthesis).
Question 10. A patient presents with chest pain. After evaluation, the physician
documents "chest pain, likely musculoskeletal in origin." What code should be
assigned?
A. R07.89
B. R07.9
Questions, Comprehensive Cardiovascular Pulmonary
Therapy Review, Detailed Explanations, Verified Answers,
Complete Success Workbook
DOMAIN 1: CODING KNOWLEDGE AND SKILLS (39–41%)
ICD-10-CM Diagnosis Coding, Sequencing, and Guidelines
Question 1. A 55-year-old patient is admitted with hypertensive heart disease with
congestive heart failure. What is the correct ICD-10-CM code assignment?
A. I10, I50.9
B. I11.0, I50.9
C. I50.9, I11.0
D. I15.8, I50.9
Rationale: ICD-10-CM guidelines require that when a patient has both
hypertensive heart disease and heart failure, the hypertension is classified as a
causal condition. The correct code is I11.0 (Hypertensive heart disease with heart
failure), followed by I50.9 (Heart failure, unspecified). The hypertension code I10
is incorrect because the hypertension is not stated as being unrelated to the heart
disease. I15.8 is for secondary hypertension, which is not documented here.
Question 2. A patient is admitted with acute respiratory failure. The physician
documents "acute respiratory failure" without specifying whether it is hypoxic or
hypercapnic. What code should be assigned?
A. J96.01
B. J96.00
C. J96.91
D. J96.90
Rationale: When acute respiratory failure is documented without specification of
type (hypoxic or hypercapnic), the default code is J96.00 (Acute respiratory
failure, unspecified whether with hypoxia or hypercapnia). J96.01 is used when
,hypoxic respiratory failure is specifically documented. J96.91 and J96.90 are for
chronic respiratory failure.
Question 3. A patient is admitted for chemotherapy due to a primary carcinoma of
the right transplanted kidney. What codes should be reported?
A. Z51.11, T86.19, C80.2, C64.1
B. Z51.11, T86.19, C64.1
C. Z51.11, C64.1
D. Z51.11, T86.19, C80.2
Rationale: When a patient is admitted for chemotherapy, the encounter code
Z51.11 (Encounter for antineoplastic chemotherapy) is assigned first, followed by
the code for the malignancy being treated. The transplanted kidney malignancy is
coded with T86.19 (Other complication of kidney transplant) and C64.1
(Malignant neoplasm of right kidney). C80.2 (Malignant neoplasm associated with
transplanted organ) is not the primary code when the specific site is known.
Question 4. A patient is admitted with sepsis due to streptococcal pneumonia. The
physician documents "sepsis due to Streptococcus pneumoniae." What is the
correct coding sequence?
A. A41.9, J13
B. A40.3, J13
C. J13, A40.3
D. A41.9, J15.4
Rationale: When sepsis is documented as due to a specific organism, the systemic
infection code (A40.3, Sepsis due to Streptococcus pneumoniae) is sequenced first,
followed by the code for the local infection (J13, Pneumonia due to Streptococcus
pneumoniae). A41.9 is for unspecified sepsis and is incorrect when the organism is
specified. The local infection is sequenced after the systemic infection.
Question 5. A 70-year-old patient is admitted with dehydration and acute kidney
injury. The physician documents both conditions as contributing to the admission.
What is the correct principal diagnosis?
,A. N17.9 (Acute kidney failure, unspecified)
B. E86.0 (Dehydration)
C. N17.9 and E86.0 are both principal
D. I12.9 (Hypertensive chronic kidney disease)
Rationale: The principal diagnosis is the condition established after study to be
chiefly responsible for the admission. When the physician documents both
dehydration and acute kidney injury and both are treated, the condition that is the
primary reason for admission should be sequenced first. In this case, if dehydration
is the cause of the AKI, E86.0 would be sequenced first. However, the question
does not specify causation, and coding guidelines require that when both
conditions are present on admission, the principal diagnosis is determined by the
physician's documentation of the primary reason for admission.
Question 6. A patient is diagnosed with diabetic ketoacidosis (DKA) due to Type
1 diabetes mellitus. What is the correct ICD-10-CM code assignment?
A. E10.10
B. E10.10, E87.2
C. E11.10, E87.2
D. E10.10, E87.2, E86.0
Rationale: Diabetic ketoacidosis is coded with E10.10 (Type 1 diabetes mellitus
with ketoacidosis). If acidosis (E87.2) is documented, it may also be coded.
However, DKA inherently includes acidosis, so E87.2 is not separately coded
unless specifically documented as a distinct condition. E11.10 is for Type 2
diabetes with ketoacidosis.
Question 7. Which of the following is the correct code for a patient with chronic
systolic heart failure?
A. I50.9
B. I50.22
C. I50.32
D. I50.43
, Rationale: I50.22 is the correct code for chronic systolic heart failure. I50.9 is for
unspecified heart failure, I50.32 is for chronic diastolic heart failure, and I50.43 is
for acute on chronic combined systolic and diastolic heart failure.
Question 8. A patient is admitted with a non-healing pressure ulcer of the sacrum,
stage III. What is the correct code?
A. L89.159
B. L89.152
C. L89.150
D. L89.153
Rationale: L89.152 is the correct code for pressure ulcer of the sacral region, stage
III. The ICD-10-CM code structure for pressure ulcers includes the site and stage.
L89.159 is for unspecified stage, L89.150 is for stage I, and L89.153 is for stage
IV.
Question 9. A patient is admitted for a total knee replacement due to severe
osteoarthritis of the right knee. What is the correct principal diagnosis?
A. M17.11
B. M17.12
C. Z96.651
D. M17.9
Rationale: M17.11 is the correct code for unilateral primary osteoarthritis, right
knee. The principal diagnosis for a joint replacement is the underlying condition
(osteoarthritis), not the presence of the prosthesis (Z96.651 is for the presence of a
knee joint prosthesis).
Question 10. A patient presents with chest pain. After evaluation, the physician
documents "chest pain, likely musculoskeletal in origin." What code should be
assigned?
A. R07.89
B. R07.9
