ADVANCED MEDICAL CODING AND
ABSTRACTING CASE STUDIES
PRACTICUM QUESTIONS WITH
VERIFIED ANSWERS 2026/2027
1. A patient is admitted for the purpose of receiving chemotherapy for secondary liver cancer,
with the primary site being the colon, which was previously resected. How should this
encounter be sequenced?
A. C78.7, C18.9, Z51.11
B. Z51.11, C18.9, C78.7
C. C18.9, C78.7, Z51.11
D. Z51.11, C78.7, Z85.038
Answer: D
Conceptual Explanation: Per ICD-10-CM guidelines, if a patient is admitted for
chemotherapy, the Z51.11 code is sequenced first. Since the primary colon cancer was
resected, it is coded as personal history (Z85.038).
2. A patient presents with acute respiratory failure and is also diagnosed with sepsis due to
MRSA. Both are present on admission. What is the appropriate sequencing?
A. A41.02 is always principal diagnosis regardless of respiratory failure.
,B. J96.00 is always principal diagnosis.
C. A41.02 followed by B95.62.
D. Either may be sequenced first if both meet the definition of principal diagnosis.
Answer: D
Conceptual Explanation: Per Guideline I.C.1.d.4, if sepsis and a localized infection (like
respiratory failure) are both present on admission, either may be sequenced as principal
unless guidelines for a specific site state otherwise.
3. In the CPT manual, when a physician performs a procedure that is ‘separate’ but integral to
another major procedure performed at the same session, how should it be coded?
A. Code only the major procedure; the separate procedure is bundled.
B. Code both and append modifier -59 to the separate procedure.
C. Code both with no modifiers.
D. Code only the separate procedure if it was more complex.
Answer: A
Conceptual Explanation: CPT guidelines state that codes designated as ‘separate
procedures’ are not reported when performed as part of a more comprehensive procedure
in the same area.
, 4. A patient with Type 2 Diabetes is admitted with a stage 4 pressure ulcer of the sacrum. The
physician documents diabetic ‘skin complications.’ What is the correct sequencing?
A. L89.154, E11.622
B. E11.622, L89.154
C. E11.9, L89.154
D. E11.621, L89.154
Answer: B
Conceptual Explanation: Category E11.622 covers Type 2 diabetes with skin ulcer. Per
ICD-10-CM guidelines, the diabetes code is sequenced first, followed by a code from
category L89 to identify the site and stage of the ulcer.
5. Which modifier should be appended to an E/M code when a physician performs a
significant, separately identifiable evaluation and management service on the same day as a
minor surgical procedure?
A. -57
B. -51
C. -24
D. -25
Answer: D
ABSTRACTING CASE STUDIES
PRACTICUM QUESTIONS WITH
VERIFIED ANSWERS 2026/2027
1. A patient is admitted for the purpose of receiving chemotherapy for secondary liver cancer,
with the primary site being the colon, which was previously resected. How should this
encounter be sequenced?
A. C78.7, C18.9, Z51.11
B. Z51.11, C18.9, C78.7
C. C18.9, C78.7, Z51.11
D. Z51.11, C78.7, Z85.038
Answer: D
Conceptual Explanation: Per ICD-10-CM guidelines, if a patient is admitted for
chemotherapy, the Z51.11 code is sequenced first. Since the primary colon cancer was
resected, it is coded as personal history (Z85.038).
2. A patient presents with acute respiratory failure and is also diagnosed with sepsis due to
MRSA. Both are present on admission. What is the appropriate sequencing?
A. A41.02 is always principal diagnosis regardless of respiratory failure.
,B. J96.00 is always principal diagnosis.
C. A41.02 followed by B95.62.
D. Either may be sequenced first if both meet the definition of principal diagnosis.
Answer: D
Conceptual Explanation: Per Guideline I.C.1.d.4, if sepsis and a localized infection (like
respiratory failure) are both present on admission, either may be sequenced as principal
unless guidelines for a specific site state otherwise.
3. In the CPT manual, when a physician performs a procedure that is ‘separate’ but integral to
another major procedure performed at the same session, how should it be coded?
A. Code only the major procedure; the separate procedure is bundled.
B. Code both and append modifier -59 to the separate procedure.
C. Code both with no modifiers.
D. Code only the separate procedure if it was more complex.
Answer: A
Conceptual Explanation: CPT guidelines state that codes designated as ‘separate
procedures’ are not reported when performed as part of a more comprehensive procedure
in the same area.
, 4. A patient with Type 2 Diabetes is admitted with a stage 4 pressure ulcer of the sacrum. The
physician documents diabetic ‘skin complications.’ What is the correct sequencing?
A. L89.154, E11.622
B. E11.622, L89.154
C. E11.9, L89.154
D. E11.621, L89.154
Answer: B
Conceptual Explanation: Category E11.622 covers Type 2 diabetes with skin ulcer. Per
ICD-10-CM guidelines, the diabetes code is sequenced first, followed by a code from
category L89 to identify the site and stage of the ulcer.
5. Which modifier should be appended to an E/M code when a physician performs a
significant, separately identifiable evaluation and management service on the same day as a
minor surgical procedure?
A. -57
B. -51
C. -24
D. -25
Answer: D
