Certified Coding Specialist (CCS) Exam Preparation Questions and
Answers
Diagnostic-related groups (DRGs) and transbronchial needle aspiration biopsy(s),
ambulatory patient classifications (APCs) are trachea, main stem and/or lobar bronchus(i)
similar in that they are both: 31632 Bronchoscopy, rigid or flexible, including
a. Determined by HCPCS codes fluoroscopic guidance, when performed; with
b. Focused on hospital outpatients transbronchial lung biopsy(s), each additional
c. Focused on hospital inpatients lobe
d. Prospective payment systems - −50 Bilateral procedure - ANSWER -
ANSWER -d. Prospective payment
systems
Assign the code(s) for endoscopic sinusotomy
** Both are types of prospective payment with bilateral anterior ethmoidectomy.
systems (Casto and Forrestal 2015, 6). 31231 Nasal endoscopy, diagnostic, unilateral or
bilateral (separate procedure)
31254 Nasal/sinus endoscopy, surgical; with
A patient is treated for esophageal varices with ethmoidectomy, partial (anterior)
hemorrhage due to cirrhosis. The diagnostic −50 Bilateral procedurea.
codes that would be assigned are: a. 31254
b. 31254-50
I85.01 Esophageal varices with bleeding c. 31254, 31254
I85.11 Secondary esophageal varices with d. 31231 - ANSWER -b. 31254-50
bleeding 31254 Nasal/sinus endoscopy, surgical; with
K74.60 Unspecified cirrhosis of liver - ethmoidectomy, partial (anterior)
ANSWER -d. K74.60, I85.11 −50 Bilateral procedurea.
K74.60: Unspecified cirrhosis of liver ** A code for the anterior ethmoidectomy is
assigned and to denote the bilateral procedure, a
I85.11:Secondary esophageal varices with modifier of -50 is added (CPT Assistant Winter
bleeding 1993, 23; Jan. 1997, 4; Sept. 1997, 10; Oct.
1997, 5; Dec. 2001, 6; May 2003, 5). The
**The patient has cirrhosis of the liver with sinusotomy is not coded separately, as it is a
resulting bleeding esophageal varices. Cirrhosis diagnostic procedure.
of liver is sequenced first followed by the code for
the bleeding esophageal varices (HHS 2017,
Section I.A.13, 11). The most common language used for both data
definition language and data manipulation
language is:
Assign the code(s) for bronchoscopy with a. Unified modeling language
bilateral transbronchial biopsy for each lobe of b. JAVA
each lung. c. Perl
d. Structured query language - ANSWER -
31628 Bronchoscopy, rigid or flexible, including d. Structured query language
fluoroscopic guidance, when performed; with
transbronchial lung biopsy(s), single lobe ** Structured query language (SQL) is used
31629 Bronchoscopy, rigid or flexible, including commonly for data language and data definitions
fluoroscopic guidance, when performed; with (Sharp 2016, 184).
,Certified Coding Specialist (CCS) Exam Preparation Questions and
Answers
congestive heart failure is assigned based on the
"code also" note (HHS 2017, Section I.C.9.a.,
An ethmoidectomy removes infected tissue and 40).
bone in the ethmoid sinuses that blocks natural
drainage. The surgeon views your ethmoid
sinuses with an endoscope, a thin flexible tube A surgeon would like to undertake a research
with a very small camera and light at the end of study on his patients with stage II malignant
it. - ANSWER - melanoma of the back, who have undergone
wide excision of the melanoma. What work
processes and associated software could be
Documentation from the nursing or other allied used to provide this information?
health professionals' notes can be used to
establish which of the following diagnoses: a. Obtain a summary of the cases from the
cancer registry, import them into a spreadsheet,
a. Body mass index (BMI) and provide to the surgeon.
b. Malnutrition b. Obtain a summary of the cases from the chart
c. Aspiration pneumonia completion software, import them into a
d. Fatigue - ANSWER -a. Body mass index spreadsheet, and provide to the surgeon.
(BMI) c. Obtain a summary of the cases from the
master patient index, import them into a
** The physician must establish the diagnosis— spreadsheet, and provide to the surgeon.
obesity or morbid obesity—and the additional d. Obtain a summary of the cases from the
information can be pulled from ancillary transcription tracking software, import them into a
documentation to establish the correct code spreadsheet, and provide to the surgeon. -
assignment for body mass index (BMI) (Leon- ANSWER -a. Obtain a summary of the
Chisen 2017, 168). cases from the cancer registry, import them into a
spreadsheet, and provide to the surgeon.
A 55-year-old patient has hypertensive heart **The cancer registry can be used to undertake
disease with congestive heart failure. What code studies in addition to reporting cases to a central
would be assigned? registry (Sharp and Madlock-Brown 2016, 173).
a. I15.8, Other secondary hypertension
b. I11.0, Hypertensive heart disease with heart A facility located near a national park has a
failure and I50.9, Heart failure, unspecified significant number of snake bites, and patients
c. I50.9, Heart failure, unspecified and I15.0, receive treatment with antivenom in urgent-care
Renovascular hypertension settings. Sometimes a patient is admitted to the
d. N18.6, End stage renal disease - hospital after several days. Can the urgent-care
ANSWER -b. I11.0, Hypertensive heart setting provide the hospital with a list of names of
disease with heart failure and I50.9, Heart failure, patients treated with snake antivenom?
unspecified
a. Only the names of patients who are admitted
** There is a cause and effect relationship to the hospital can be requested if the physician
established between the hypertension and the needs it for continuity of care, but an entire list of
congestive heart failure. A separate code for the patients cannot be provided.
, Certified Coding Specialist (CCS) Exam Preparation Questions and
Answers
b. A list of names could be provided.
c. No information can be obtained under any **The patient has a recurrent hernia without
circumstances. obstruction and this is captured in diagnosis code
d. A list of patients may be available after K40.91 (Leon-Chisen 2017, 253; CPT Assistant
consultation with the national park ranger. - Nov. 1999, 24; March 2000, 9).
ANSWER -a. Only the names of patients
who are admitted to the hospital can be
requested if the physician needs it for continuity .In order to accurately code a cardiac
of care, but an entire list of patients cannot be catheterization, what needs to be determined
provided. based on a review of the documentation?
a. The approach and the side of the heart
**Only records that are required for care or (chambers) into which the catheter was inserted
authorized by the patient can be released by the b. The approach, the side of the heart
urgent-care facility to the acute-care facility (chambers) into which the catheter was inserted,
(Brodnik 2012, 225; Rinehart-Thompson 2016b, as well as any additional procedures performed
243-247). c. The duration of the procedure
d. If there is documentation of the procedure in
the medical record that stents are considered -
What diagnoses and procedures should be ANSWER -b. The approach, the side of the
reported for recurrent left inguinal hernia with heart (chambers) into which the catheter was
laparoscopic repair? inserted, as well as any additional procedures
performed
K40.30 Unilateral inguinal hernia, with
obstruction, without gangrene, not specified as
recurrent A condition is present on admission when:
K40.31 Unilateral inguinal hernia, with
obstruction, without gangrene, recurrent a. It is the principal diagnosis
K40.91 Unilateral inguinal hernia, without b. It is accordance with medical staff bylaws
mention of obstruction or gangrene, recurrent c. A condition that occurs prior to an inpatient
49520 Repair recurrent inguinal hernia, any age; admission
reducible d. It is present within 3 days after admission -
49521 Repair recurrent inguinal hernia, any age; ANSWER -c. A condition that occurs prior
incarcerated or strangulated to an inpatient admission
49651 Laparoscopy, surgical; repair recurrent
inguinal hernia **It is important to understand the time frame for
assigning a status code specifying that a
a. K40.91, 49520 condition is present on admission (Leon-Chisen
b. K40.31, 49521 2017, 571-574).
c. K40.91, 49651
d. K40.30, 49520 - ANSWER -c.
K40.91:Unilateral inguinal hernia, without A patient was admitted after a fall down the
mention of obstruction or gangrene, recurrent steps. The patient was unconscious for
49651:Laparoscopy, surgical; repair recurrent approximately 45 minutes and was admitted to
inguinal hernia the emergency department (ED) within 3 hours of
Answers
Diagnostic-related groups (DRGs) and transbronchial needle aspiration biopsy(s),
ambulatory patient classifications (APCs) are trachea, main stem and/or lobar bronchus(i)
similar in that they are both: 31632 Bronchoscopy, rigid or flexible, including
a. Determined by HCPCS codes fluoroscopic guidance, when performed; with
b. Focused on hospital outpatients transbronchial lung biopsy(s), each additional
c. Focused on hospital inpatients lobe
d. Prospective payment systems - −50 Bilateral procedure - ANSWER -
ANSWER -d. Prospective payment
systems
Assign the code(s) for endoscopic sinusotomy
** Both are types of prospective payment with bilateral anterior ethmoidectomy.
systems (Casto and Forrestal 2015, 6). 31231 Nasal endoscopy, diagnostic, unilateral or
bilateral (separate procedure)
31254 Nasal/sinus endoscopy, surgical; with
A patient is treated for esophageal varices with ethmoidectomy, partial (anterior)
hemorrhage due to cirrhosis. The diagnostic −50 Bilateral procedurea.
codes that would be assigned are: a. 31254
b. 31254-50
I85.01 Esophageal varices with bleeding c. 31254, 31254
I85.11 Secondary esophageal varices with d. 31231 - ANSWER -b. 31254-50
bleeding 31254 Nasal/sinus endoscopy, surgical; with
K74.60 Unspecified cirrhosis of liver - ethmoidectomy, partial (anterior)
ANSWER -d. K74.60, I85.11 −50 Bilateral procedurea.
K74.60: Unspecified cirrhosis of liver ** A code for the anterior ethmoidectomy is
assigned and to denote the bilateral procedure, a
I85.11:Secondary esophageal varices with modifier of -50 is added (CPT Assistant Winter
bleeding 1993, 23; Jan. 1997, 4; Sept. 1997, 10; Oct.
1997, 5; Dec. 2001, 6; May 2003, 5). The
**The patient has cirrhosis of the liver with sinusotomy is not coded separately, as it is a
resulting bleeding esophageal varices. Cirrhosis diagnostic procedure.
of liver is sequenced first followed by the code for
the bleeding esophageal varices (HHS 2017,
Section I.A.13, 11). The most common language used for both data
definition language and data manipulation
language is:
Assign the code(s) for bronchoscopy with a. Unified modeling language
bilateral transbronchial biopsy for each lobe of b. JAVA
each lung. c. Perl
d. Structured query language - ANSWER -
31628 Bronchoscopy, rigid or flexible, including d. Structured query language
fluoroscopic guidance, when performed; with
transbronchial lung biopsy(s), single lobe ** Structured query language (SQL) is used
31629 Bronchoscopy, rigid or flexible, including commonly for data language and data definitions
fluoroscopic guidance, when performed; with (Sharp 2016, 184).
,Certified Coding Specialist (CCS) Exam Preparation Questions and
Answers
congestive heart failure is assigned based on the
"code also" note (HHS 2017, Section I.C.9.a.,
An ethmoidectomy removes infected tissue and 40).
bone in the ethmoid sinuses that blocks natural
drainage. The surgeon views your ethmoid
sinuses with an endoscope, a thin flexible tube A surgeon would like to undertake a research
with a very small camera and light at the end of study on his patients with stage II malignant
it. - ANSWER - melanoma of the back, who have undergone
wide excision of the melanoma. What work
processes and associated software could be
Documentation from the nursing or other allied used to provide this information?
health professionals' notes can be used to
establish which of the following diagnoses: a. Obtain a summary of the cases from the
cancer registry, import them into a spreadsheet,
a. Body mass index (BMI) and provide to the surgeon.
b. Malnutrition b. Obtain a summary of the cases from the chart
c. Aspiration pneumonia completion software, import them into a
d. Fatigue - ANSWER -a. Body mass index spreadsheet, and provide to the surgeon.
(BMI) c. Obtain a summary of the cases from the
master patient index, import them into a
** The physician must establish the diagnosis— spreadsheet, and provide to the surgeon.
obesity or morbid obesity—and the additional d. Obtain a summary of the cases from the
information can be pulled from ancillary transcription tracking software, import them into a
documentation to establish the correct code spreadsheet, and provide to the surgeon. -
assignment for body mass index (BMI) (Leon- ANSWER -a. Obtain a summary of the
Chisen 2017, 168). cases from the cancer registry, import them into a
spreadsheet, and provide to the surgeon.
A 55-year-old patient has hypertensive heart **The cancer registry can be used to undertake
disease with congestive heart failure. What code studies in addition to reporting cases to a central
would be assigned? registry (Sharp and Madlock-Brown 2016, 173).
a. I15.8, Other secondary hypertension
b. I11.0, Hypertensive heart disease with heart A facility located near a national park has a
failure and I50.9, Heart failure, unspecified significant number of snake bites, and patients
c. I50.9, Heart failure, unspecified and I15.0, receive treatment with antivenom in urgent-care
Renovascular hypertension settings. Sometimes a patient is admitted to the
d. N18.6, End stage renal disease - hospital after several days. Can the urgent-care
ANSWER -b. I11.0, Hypertensive heart setting provide the hospital with a list of names of
disease with heart failure and I50.9, Heart failure, patients treated with snake antivenom?
unspecified
a. Only the names of patients who are admitted
** There is a cause and effect relationship to the hospital can be requested if the physician
established between the hypertension and the needs it for continuity of care, but an entire list of
congestive heart failure. A separate code for the patients cannot be provided.
, Certified Coding Specialist (CCS) Exam Preparation Questions and
Answers
b. A list of names could be provided.
c. No information can be obtained under any **The patient has a recurrent hernia without
circumstances. obstruction and this is captured in diagnosis code
d. A list of patients may be available after K40.91 (Leon-Chisen 2017, 253; CPT Assistant
consultation with the national park ranger. - Nov. 1999, 24; March 2000, 9).
ANSWER -a. Only the names of patients
who are admitted to the hospital can be
requested if the physician needs it for continuity .In order to accurately code a cardiac
of care, but an entire list of patients cannot be catheterization, what needs to be determined
provided. based on a review of the documentation?
a. The approach and the side of the heart
**Only records that are required for care or (chambers) into which the catheter was inserted
authorized by the patient can be released by the b. The approach, the side of the heart
urgent-care facility to the acute-care facility (chambers) into which the catheter was inserted,
(Brodnik 2012, 225; Rinehart-Thompson 2016b, as well as any additional procedures performed
243-247). c. The duration of the procedure
d. If there is documentation of the procedure in
the medical record that stents are considered -
What diagnoses and procedures should be ANSWER -b. The approach, the side of the
reported for recurrent left inguinal hernia with heart (chambers) into which the catheter was
laparoscopic repair? inserted, as well as any additional procedures
performed
K40.30 Unilateral inguinal hernia, with
obstruction, without gangrene, not specified as
recurrent A condition is present on admission when:
K40.31 Unilateral inguinal hernia, with
obstruction, without gangrene, recurrent a. It is the principal diagnosis
K40.91 Unilateral inguinal hernia, without b. It is accordance with medical staff bylaws
mention of obstruction or gangrene, recurrent c. A condition that occurs prior to an inpatient
49520 Repair recurrent inguinal hernia, any age; admission
reducible d. It is present within 3 days after admission -
49521 Repair recurrent inguinal hernia, any age; ANSWER -c. A condition that occurs prior
incarcerated or strangulated to an inpatient admission
49651 Laparoscopy, surgical; repair recurrent
inguinal hernia **It is important to understand the time frame for
assigning a status code specifying that a
a. K40.91, 49520 condition is present on admission (Leon-Chisen
b. K40.31, 49521 2017, 571-574).
c. K40.91, 49651
d. K40.30, 49520 - ANSWER -c.
K40.91:Unilateral inguinal hernia, without A patient was admitted after a fall down the
mention of obstruction or gangrene, recurrent steps. The patient was unconscious for
49651:Laparoscopy, surgical; repair recurrent approximately 45 minutes and was admitted to
inguinal hernia the emergency department (ED) within 3 hours of
