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Certified Coding Specialist (CCS) Exam Prep — 100 Practice Questions & Answers (2026–
2027)
Section 1: Coding Knowledge & Skills — Diagnosis Coding (Questions 1–25)
1. A 72-year-old patient is admitted with acute respiratory failure secondary to
exacerbation of chronic congestive heart failure. The patient is intubated and placed on
mechanical ventilation. What is the correct principal diagnosis?
A. I50.22 Chronic systolic heart failure
B. J96.00 Acute respiratory failure
C. I50.9 Heart failure, unspecified
D. J96.20 Acute and chronic respiratory failure
Answer: B. The principal diagnosis is the condition established after study to be chiefly
responsible for admission. The patient was admitted for acute respiratory failure requiring
intubation and ventilation. The heart failure is sequenced as a secondary diagnosis .
2. A patient is discharged with diagnoses of Type 2 diabetes mellitus and chronic kidney
disease, Stage 3. What is the correct ICD-10-CM code?
A. E11.9, N18.3
B. E11.22
C. N18.3, E11.9
D. E11.29
Answer: B. ICD-10-CM guideline I.C.4.a.2 requires a combination code for diabetes with
chronic kidney disease. E11.22 captures Type 2 diabetes mellitus with diabetic chronic
kidney disease. Separate codes are not assigned when a causal relationship is documented .
3. A patient is admitted after a fall. A pressure injury is documented by the wound nurse
six hours after admission. The physician confirms that the injury was present when the
patient arrived. Which POA concept controls the decision?
A. The diagnosis was entered after admission, so the indicator must be N
B. The condition's clinical presence at admission controls the assignment
C. Every pressure injury automatically receives Y
D. The coder should omit the diagnosis because the physician documented it late
Answer: B. POA assessment concerns whether the condition was present when the
inpatient admission occurred. The time at which the diagnosis was formally entered does
not independently decide the indicator .
4. An operative report documents substantial blood loss. Postoperative laboratory results
show a large hemoglobin decrease, and the patient receives two units of blood. No
provider documents acute blood loss anemia. What should the coder do?
A. Assign acute blood loss anemia from the clinical indicators
B. Assign unspecified anemia automatically
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C. Query the provider when the diagnosis would affect accurate code assignment
D. Ignore the laboratory results permanently
Answer: C. Coders may identify clinical indicators and recognize a potential documentation
gap, yet the diagnosis requires appropriate provider documentation. A compliant query can
present the clinical facts without directing the provider toward one answer .
5. A patient is admitted with acute inferior myocardial infarction and discharged alive.
Which condition would increase the MS-DRG weight?
A. Respiratory failure
B. Atrial fibrillation
C. Hypertension
D. History of myocardial infarction
Answer: A. Respiratory failure is a Major Complication/Comorbidity (MCC) that would
change the MS-DRG assignment. Atrial fibrillation, hypertension, and history of MI are not
MCCs for this DRG .
6. What does MS-DRG stand for?
A. Medical Standard Diagnostic Related Group
B. Medicare Severity Diagnosis Related Group
C. Major Surgical Diagnosis Reference Group
D. Medical Services Diagnostic Registry Group
Answer: B. MS-DRGs classify inpatient hospital cases into groups expected to consume
similar hospital resources. The system incorporates severity levels based on presence of
MCCs and CCs .
7. According to the UHDDS, in order to assign a code for another diagnosis, documentation
must be present that:
A. The condition is recorded in the patient record by a dietary clerk
B. The condition is present in the admission department data
C. The condition was clinically evaluated or therapeutically treated, extended the length of
hospital stay, or increased nursing care or monitoring
D. The condition was mentioned in a nursing note only
Answer: C. UHDDS defines additional diagnoses as conditions that were clinically evaluated,
therapeutically treated, extended length of stay, or increased nursing care/monitoring .
8. A patient is diagnosed with recurrent thyroglossal duct cyst. The CPT code assignment
for excision is:
A. 60280
B. 60281
C. 60282
D. 60283
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Answer: B. CPT code 60281 is accessed using index entry Cyst, thyroglossal duct, excision,
resulting in code range 60280–60281 .
9. If the type of diabetes mellitus is not documented in the medical record, what is the
default code?
A. E10 (Type 1)
B. E11 (Type 2)
C. E13 (Other specified)
D. E08 (Due to underlying condition)
Answer: B. If the type of diabetes mellitus is not documented, the default is E11, Type 2
diabetes mellitus .
10. A patient takes insulin long-term. What additional code should be assigned?
A. Z79.4
B. Z79.84
C. Z91.14
D. Z91.15
Answer: A. Code Z79.4, Long-term (current) use of insulin, should be assigned for patients
who take insulin .
11. A patient is admitted with chest pain, awakened from sleep. Nitroglycerin does not
relieve the pain. Serial CPK is normal. Cardiac catheterization reveals arteriosclerotic
coronary artery disease. What is the correct diagnosis?
A. I20.0 Unstable angina
B. I21.9 Acute myocardial infarction
C. I25.10 Atherosclerotic heart disease of native coronary artery
D. R07.9 Chest pain, unspecified
Answer: A. The documentation states "new onset unstable angina" with normal serial CPK,
ruling out myocardial infarction. I20.0 is the correct code .
12. A patient has metastatic adenocarcinoma of bone. What is the correct code?
A. C80.1
B. C79.51
C. C41.9
D. C80.0
Answer: B. C79.51 is the code for secondary malignant neoplasm of bone. C80.1 is
malignant neoplasm without specification of site .
13. A patient is admitted with metastatic carcinoma from breast to liver with previous
bilateral mastectomy and no recurrence at the primary site. What codes are assigned?
A. C78.7, Z85.3, Z90.13
B. C50.919, C78.7
Certified Coding Specialist (CCS) Exam Prep — 100 Practice Questions & Answers (2026–
2027)
Section 1: Coding Knowledge & Skills — Diagnosis Coding (Questions 1–25)
1. A 72-year-old patient is admitted with acute respiratory failure secondary to
exacerbation of chronic congestive heart failure. The patient is intubated and placed on
mechanical ventilation. What is the correct principal diagnosis?
A. I50.22 Chronic systolic heart failure
B. J96.00 Acute respiratory failure
C. I50.9 Heart failure, unspecified
D. J96.20 Acute and chronic respiratory failure
Answer: B. The principal diagnosis is the condition established after study to be chiefly
responsible for admission. The patient was admitted for acute respiratory failure requiring
intubation and ventilation. The heart failure is sequenced as a secondary diagnosis .
2. A patient is discharged with diagnoses of Type 2 diabetes mellitus and chronic kidney
disease, Stage 3. What is the correct ICD-10-CM code?
A. E11.9, N18.3
B. E11.22
C. N18.3, E11.9
D. E11.29
Answer: B. ICD-10-CM guideline I.C.4.a.2 requires a combination code for diabetes with
chronic kidney disease. E11.22 captures Type 2 diabetes mellitus with diabetic chronic
kidney disease. Separate codes are not assigned when a causal relationship is documented .
3. A patient is admitted after a fall. A pressure injury is documented by the wound nurse
six hours after admission. The physician confirms that the injury was present when the
patient arrived. Which POA concept controls the decision?
A. The diagnosis was entered after admission, so the indicator must be N
B. The condition's clinical presence at admission controls the assignment
C. Every pressure injury automatically receives Y
D. The coder should omit the diagnosis because the physician documented it late
Answer: B. POA assessment concerns whether the condition was present when the
inpatient admission occurred. The time at which the diagnosis was formally entered does
not independently decide the indicator .
4. An operative report documents substantial blood loss. Postoperative laboratory results
show a large hemoglobin decrease, and the patient receives two units of blood. No
provider documents acute blood loss anemia. What should the coder do?
A. Assign acute blood loss anemia from the clinical indicators
B. Assign unspecified anemia automatically
, 2
C. Query the provider when the diagnosis would affect accurate code assignment
D. Ignore the laboratory results permanently
Answer: C. Coders may identify clinical indicators and recognize a potential documentation
gap, yet the diagnosis requires appropriate provider documentation. A compliant query can
present the clinical facts without directing the provider toward one answer .
5. A patient is admitted with acute inferior myocardial infarction and discharged alive.
Which condition would increase the MS-DRG weight?
A. Respiratory failure
B. Atrial fibrillation
C. Hypertension
D. History of myocardial infarction
Answer: A. Respiratory failure is a Major Complication/Comorbidity (MCC) that would
change the MS-DRG assignment. Atrial fibrillation, hypertension, and history of MI are not
MCCs for this DRG .
6. What does MS-DRG stand for?
A. Medical Standard Diagnostic Related Group
B. Medicare Severity Diagnosis Related Group
C. Major Surgical Diagnosis Reference Group
D. Medical Services Diagnostic Registry Group
Answer: B. MS-DRGs classify inpatient hospital cases into groups expected to consume
similar hospital resources. The system incorporates severity levels based on presence of
MCCs and CCs .
7. According to the UHDDS, in order to assign a code for another diagnosis, documentation
must be present that:
A. The condition is recorded in the patient record by a dietary clerk
B. The condition is present in the admission department data
C. The condition was clinically evaluated or therapeutically treated, extended the length of
hospital stay, or increased nursing care or monitoring
D. The condition was mentioned in a nursing note only
Answer: C. UHDDS defines additional diagnoses as conditions that were clinically evaluated,
therapeutically treated, extended length of stay, or increased nursing care/monitoring .
8. A patient is diagnosed with recurrent thyroglossal duct cyst. The CPT code assignment
for excision is:
A. 60280
B. 60281
C. 60282
D. 60283
, 3
Answer: B. CPT code 60281 is accessed using index entry Cyst, thyroglossal duct, excision,
resulting in code range 60280–60281 .
9. If the type of diabetes mellitus is not documented in the medical record, what is the
default code?
A. E10 (Type 1)
B. E11 (Type 2)
C. E13 (Other specified)
D. E08 (Due to underlying condition)
Answer: B. If the type of diabetes mellitus is not documented, the default is E11, Type 2
diabetes mellitus .
10. A patient takes insulin long-term. What additional code should be assigned?
A. Z79.4
B. Z79.84
C. Z91.14
D. Z91.15
Answer: A. Code Z79.4, Long-term (current) use of insulin, should be assigned for patients
who take insulin .
11. A patient is admitted with chest pain, awakened from sleep. Nitroglycerin does not
relieve the pain. Serial CPK is normal. Cardiac catheterization reveals arteriosclerotic
coronary artery disease. What is the correct diagnosis?
A. I20.0 Unstable angina
B. I21.9 Acute myocardial infarction
C. I25.10 Atherosclerotic heart disease of native coronary artery
D. R07.9 Chest pain, unspecified
Answer: A. The documentation states "new onset unstable angina" with normal serial CPK,
ruling out myocardial infarction. I20.0 is the correct code .
12. A patient has metastatic adenocarcinoma of bone. What is the correct code?
A. C80.1
B. C79.51
C. C41.9
D. C80.0
Answer: B. C79.51 is the code for secondary malignant neoplasm of bone. C80.1 is
malignant neoplasm without specification of site .
13. A patient is admitted with metastatic carcinoma from breast to liver with previous
bilateral mastectomy and no recurrence at the primary site. What codes are assigned?
A. C78.7, Z85.3, Z90.13
B. C50.919, C78.7
