CCS STUDY GUIDE CORE EXAM QUESTIONS WITH
ANSWERS 2025/2026 GRADED A+
65yo pt adm w/pain and loosening of left total hip prosthesis along with the loosening of
the acetabular component which has become painful. Pt ad for open
removal/replacement of acetabular component of left hip prosthesis, so what is the
correct coding for admission? - T84.031A (mechanical loosening of int lt hip prosth jt,
initial enc
0SPB0JZ (removal synthetic sub fro lt hip jt, open approach
0SRE0JZ (replacement lt hip jt, acetabular surface w/synthetic sub, open approach)
Maternity pt adm in labor at 43 wks and has normal delivery with vacuum extraction to
facilitate baby's delivery. What is the PD? - O48.1 (prolonged pg)
With regard to implementation of ICD-10-CM, all of these are correct: - ICD-10-CM was
developed by NCHS; it was implemented on 10/1/15; was already being used by death
certificate coding in US; the process of adopting ICD-10-CM is specified in HIPAA
What does NCHS stand for? - National Center for Health Statistics
75yo female was adm for AMI and underwent a diagnostic cardiac cath. Following the
cath, pt dev a thrombophlebitis documented as due to the catheter in the common
femoral artery. The thrombophlebitis would be coded as: - T81.718A, complication of
other artery following a procedure, NEC, initial enc
Pt adm to ED w/chest pain, and dx w/abort MI w/acute myocardial ischemia with no
prior cardiac surgery, and normal cardiac enzymes. What is coding for this case? - I24.0
(acute coronary thrombosis not resulting in MI) Pts w/acute ischemic heart disease or
acute myocardial ischemia do not always indicate an infarction and it is often possible to
prevent infarction by means of surgery or use of thrombolytic agents if tx promptly
Pt has nausea, vomiting, abdominal pain due to acute cholecystitis. Phys doc the
following on DS: Acute cholecystitis, nausea, vomiting, and abdominal pain. What is
correct coding? - Acute cholecystitis
Pt adm bc of CHF, and also found to have elevated liver function tests. Phys worked up
ELF test but able to determine dx, so the following dx is assigned: - CHF and abnormal
liver function tests
Pt adm with hypotension due to dobutamine taken and prescribed correctly. How is this
coded? - I95.2, Hypotension due to drugs
T44.5X5A, adverse effects of dobutamine
,Pt adm 2 wks after laminectomy for spinal stenosis w/headache (headache due to tear
in dura accidentally occurred during prior laminectomy surgery). Pt taken to OR for
repair of dura. How is this case coded? - G97.41, Accidental puncture or laceration of
dura during procedure
Pt adm w/SOB, CHF, and subsequently dev resp fail. Pt undergoes intubation
w/ventilator mgmt. Correct seq of dx would be: - CHF and resp failure
Pt adm w/pneumococcal pneumonia and pneumococcal sepsis, so the coder should: -
Assign code for sepsis, pneumonia, and severe sepsis. Pt w/pneumococcal sepsis and
pneumococcal pneumonia also has severe sepsis and Guidelines provide info related to
coding, seq of sepsis, severe sepsis, and localized infection, such as pneumonia
Pt adm w/ESRD following kidney transplant, who also had angina and COPD, so dx
would be seq as: - ESRD; status post kidney transplant; COPD; angina
Pt adm to hosp due to fracture of rt hip and scheduled for open reduction with int fix, but
pt dev cardiac arrhythmia which results in an inability to do planned surgery. Assign
code for PD: - Rt hip fracture (cond after study that occasioned adm should be seq first
even if the plan of tx was not carried out due to unforeseen circumstances)
What is not part of a facility coding compliance plan? - Coding audits performed by
payers (while this has value, payers are considered external reviewing)
What are various parts of a facility coding compliance plan? - Regular internal audits,
audits performed by objective external reviewers, sharing/discussing results with coding
staff
In CPT, unlisted codes are reported only if: - There is a not a HCPCS level II or a
current CPT level III code available
A virtual screening colonoscopy would be coded as: - 74263: Computed tomographic
(CT) colonography, screening including image postprocessing
Pt underwent excision of malignant lesion of chest measuring 1.0cm with 0.2cm margin,
and based on 2015 CPT codes, which code is used for this procedure? - 11602,
Excision malignant lesion of trunk; excised diameter 1.1-2.0cm
Pt dx w/L4-5 lumbar neuropathy and discogenic pain. Pt underwent percutaneous
intradiscal electrothermal annuloplasty (IDET) in radiology suite. What ICD-10-PCS
code should be used? - 0S523ZZ, Destruction, lumbar vertebral disc, percutaneous
(IDET is done w/thermal energy, or heat, directed into the outer disc wall, or annulus,
and inner disc contents, or nucleus, via a heating coil, decreasing pressure inside the
disc
,Laparoscopic tubal ligation with Falope ring is completed, so what is correct CPT code
assignment? - 58671, Laparoscopy, surgical; with occlusion of oviducts by device
(band, clip, or Falope ring)
Carcinoma of multiple overlapping sites of the bladder, so dx cystoscopy and
transurethral fulguration of bladder lesions (1.9cm, 6.0 cm) are undertaken. The
appropriate CPT code(s) would be: - 52240, Cystourethroscopy, with fulguration
(including cryosurgery or laser surgery) and/or resection of lg bladder tumor(s)
Pt presents to facility for upper endoscopy implant of material into muscle of lower
esophageal sphincter, so what is correct coding, seq of pt's record? - 43236, Upper
gastrointestinal endoscopy including esophagus, stomach, and either the duodenum
and/or jejunum as appropriate; diagnostic, with or without collection of specimen(s) by
brushing or washing (separate procedure) with directed submucosal injection(s), any
substance
Pt undergoes colposcopy with endometrial biopsy, so how many codes does is this
case req? - Two codes would be used in accordance with 2015 CPT code revisions
Pt present to outpt surgical area for cystoscopy with mult biopsies of the bladder, and
pt's presenting symptom is hematuria, so what is the correct code assignment this
procedure? - 52204, Cystourethroscopy with biopsy(s)
If pt has excision of malignant lesion of the skin, the CPT code is determined by the
body area from which the excision occurs and the: - Diameter of lesion as well as
margins excised as described in Op Report
When coding arthrocentesis, the code assignment is determined by: - Size of the jt
since arthrocentesis codes are based on whether jt is small, intermediate, or major
Assign correct code for open total cholecystectomy with exploration of common bile
duct and removal of common bile duct stone: - 0FT40ZZ, resection gallbladder, open
approach
0FC90ZZ, removal, common bile duct stone, open
Assign correct code for total laparoscopic cholecystectomy with percutaneous removal
of common bile duct stone: - 0FT44ZZ, Resection, gallbladder, Resection of gallbladder,
percutaneous endoscopic approach
0FC94ZZ, Removal, common bile duct stones, laparoscopic
Assign correct code for total open cholecystectomy with intraoperative cholangiogram
(done w/plain radiography with low osmolar contrast): - 0FC94ZZ, Removal, common
bile duct stones, laparoscopic
0FT40ZZ, Resection, gallbladder, open approach
, Removal of the entire body part and removal of an entire lobe of the liver is what root
operation? - Resection
Inpt procedures are code with: - ICD-10-CM
Pt adm to hosp for pain due to displacement of pacemaker electrode and pt also has
hypothyroidism due to partial thyroidectomy 7 yrs ago and a breast cyst. Pacemaker
electrode was relocated and synthroid was given during hosp stay. The dx codes
(excluding Ext Cause codes) assigned are: - T82.120A, Displacement of cardiac
electrode, initial encounter
E89.0, Postsurgical hypothyroidism
Assign code(s) for mammographic guidance for bilateral breast needle localization for
lesion placement with fine needle aspiration: - 19081-50, Biopsy, breast, with placement
of localization device(s) (clip, metallic pellet) when performed, and imaging of biopsy
specimen, percutaneous; first lesion incl stereotactic guidance, bilateral procedure
10022-50, Fine needle aspiration, with imaging guidance, bilateral procedure
Doc in record reveals pt is adm w/acute exacerbation of COPD (MS-DRG 192). Higher-
paying DRG may be appropriate if doc is present in record at the time the decision was
made to admit pt that confirms dx associated with: - Blood gases of pO2 of 58, pCO2 of
55, pH of 7.32 upon adm and treated w/intubation and mechanical vent for 23 hours
since this would bump to MS-DRG 208
Female pt dx w/CHF, but what would incr MS-DRG weight if POA? - Stage III pressure
ulcer would optimize DRG. CHF alone, with atrial fib, with blood loss anemia, and with
coronary artery disease all remain the same weight.
If PD is initial episode of anterior wall myocardial infarction, which procedure will result
in highest DRG? - Transbronchial lung biopsy would optimize DRG. Myocardial
infarction alone, with insertion of central venous catheter are a lower weight, and
myocardial infarction with mechanical ventilator is also a lower weight.
Pt adm with hemorrhage due to placenta previa w/twin pgs. Pt had 2 prior C-section
deliveries. Emergency C-Section was performed due to hemorrhage. Assign PD: -
Placenta previa with hemorrhage
Pt adm w/spotting, fever, and found to have been tx for miscarriage which was resolved
2 wks prior to this adm. She is tx w/aspiration D&C and POC are found, along w/her
being septic. What is the PD? - Sepsis following incomplete spontaneous abortion
ANSWERS 2025/2026 GRADED A+
65yo pt adm w/pain and loosening of left total hip prosthesis along with the loosening of
the acetabular component which has become painful. Pt ad for open
removal/replacement of acetabular component of left hip prosthesis, so what is the
correct coding for admission? - T84.031A (mechanical loosening of int lt hip prosth jt,
initial enc
0SPB0JZ (removal synthetic sub fro lt hip jt, open approach
0SRE0JZ (replacement lt hip jt, acetabular surface w/synthetic sub, open approach)
Maternity pt adm in labor at 43 wks and has normal delivery with vacuum extraction to
facilitate baby's delivery. What is the PD? - O48.1 (prolonged pg)
With regard to implementation of ICD-10-CM, all of these are correct: - ICD-10-CM was
developed by NCHS; it was implemented on 10/1/15; was already being used by death
certificate coding in US; the process of adopting ICD-10-CM is specified in HIPAA
What does NCHS stand for? - National Center for Health Statistics
75yo female was adm for AMI and underwent a diagnostic cardiac cath. Following the
cath, pt dev a thrombophlebitis documented as due to the catheter in the common
femoral artery. The thrombophlebitis would be coded as: - T81.718A, complication of
other artery following a procedure, NEC, initial enc
Pt adm to ED w/chest pain, and dx w/abort MI w/acute myocardial ischemia with no
prior cardiac surgery, and normal cardiac enzymes. What is coding for this case? - I24.0
(acute coronary thrombosis not resulting in MI) Pts w/acute ischemic heart disease or
acute myocardial ischemia do not always indicate an infarction and it is often possible to
prevent infarction by means of surgery or use of thrombolytic agents if tx promptly
Pt has nausea, vomiting, abdominal pain due to acute cholecystitis. Phys doc the
following on DS: Acute cholecystitis, nausea, vomiting, and abdominal pain. What is
correct coding? - Acute cholecystitis
Pt adm bc of CHF, and also found to have elevated liver function tests. Phys worked up
ELF test but able to determine dx, so the following dx is assigned: - CHF and abnormal
liver function tests
Pt adm with hypotension due to dobutamine taken and prescribed correctly. How is this
coded? - I95.2, Hypotension due to drugs
T44.5X5A, adverse effects of dobutamine
,Pt adm 2 wks after laminectomy for spinal stenosis w/headache (headache due to tear
in dura accidentally occurred during prior laminectomy surgery). Pt taken to OR for
repair of dura. How is this case coded? - G97.41, Accidental puncture or laceration of
dura during procedure
Pt adm w/SOB, CHF, and subsequently dev resp fail. Pt undergoes intubation
w/ventilator mgmt. Correct seq of dx would be: - CHF and resp failure
Pt adm w/pneumococcal pneumonia and pneumococcal sepsis, so the coder should: -
Assign code for sepsis, pneumonia, and severe sepsis. Pt w/pneumococcal sepsis and
pneumococcal pneumonia also has severe sepsis and Guidelines provide info related to
coding, seq of sepsis, severe sepsis, and localized infection, such as pneumonia
Pt adm w/ESRD following kidney transplant, who also had angina and COPD, so dx
would be seq as: - ESRD; status post kidney transplant; COPD; angina
Pt adm to hosp due to fracture of rt hip and scheduled for open reduction with int fix, but
pt dev cardiac arrhythmia which results in an inability to do planned surgery. Assign
code for PD: - Rt hip fracture (cond after study that occasioned adm should be seq first
even if the plan of tx was not carried out due to unforeseen circumstances)
What is not part of a facility coding compliance plan? - Coding audits performed by
payers (while this has value, payers are considered external reviewing)
What are various parts of a facility coding compliance plan? - Regular internal audits,
audits performed by objective external reviewers, sharing/discussing results with coding
staff
In CPT, unlisted codes are reported only if: - There is a not a HCPCS level II or a
current CPT level III code available
A virtual screening colonoscopy would be coded as: - 74263: Computed tomographic
(CT) colonography, screening including image postprocessing
Pt underwent excision of malignant lesion of chest measuring 1.0cm with 0.2cm margin,
and based on 2015 CPT codes, which code is used for this procedure? - 11602,
Excision malignant lesion of trunk; excised diameter 1.1-2.0cm
Pt dx w/L4-5 lumbar neuropathy and discogenic pain. Pt underwent percutaneous
intradiscal electrothermal annuloplasty (IDET) in radiology suite. What ICD-10-PCS
code should be used? - 0S523ZZ, Destruction, lumbar vertebral disc, percutaneous
(IDET is done w/thermal energy, or heat, directed into the outer disc wall, or annulus,
and inner disc contents, or nucleus, via a heating coil, decreasing pressure inside the
disc
,Laparoscopic tubal ligation with Falope ring is completed, so what is correct CPT code
assignment? - 58671, Laparoscopy, surgical; with occlusion of oviducts by device
(band, clip, or Falope ring)
Carcinoma of multiple overlapping sites of the bladder, so dx cystoscopy and
transurethral fulguration of bladder lesions (1.9cm, 6.0 cm) are undertaken. The
appropriate CPT code(s) would be: - 52240, Cystourethroscopy, with fulguration
(including cryosurgery or laser surgery) and/or resection of lg bladder tumor(s)
Pt presents to facility for upper endoscopy implant of material into muscle of lower
esophageal sphincter, so what is correct coding, seq of pt's record? - 43236, Upper
gastrointestinal endoscopy including esophagus, stomach, and either the duodenum
and/or jejunum as appropriate; diagnostic, with or without collection of specimen(s) by
brushing or washing (separate procedure) with directed submucosal injection(s), any
substance
Pt undergoes colposcopy with endometrial biopsy, so how many codes does is this
case req? - Two codes would be used in accordance with 2015 CPT code revisions
Pt present to outpt surgical area for cystoscopy with mult biopsies of the bladder, and
pt's presenting symptom is hematuria, so what is the correct code assignment this
procedure? - 52204, Cystourethroscopy with biopsy(s)
If pt has excision of malignant lesion of the skin, the CPT code is determined by the
body area from which the excision occurs and the: - Diameter of lesion as well as
margins excised as described in Op Report
When coding arthrocentesis, the code assignment is determined by: - Size of the jt
since arthrocentesis codes are based on whether jt is small, intermediate, or major
Assign correct code for open total cholecystectomy with exploration of common bile
duct and removal of common bile duct stone: - 0FT40ZZ, resection gallbladder, open
approach
0FC90ZZ, removal, common bile duct stone, open
Assign correct code for total laparoscopic cholecystectomy with percutaneous removal
of common bile duct stone: - 0FT44ZZ, Resection, gallbladder, Resection of gallbladder,
percutaneous endoscopic approach
0FC94ZZ, Removal, common bile duct stones, laparoscopic
Assign correct code for total open cholecystectomy with intraoperative cholangiogram
(done w/plain radiography with low osmolar contrast): - 0FC94ZZ, Removal, common
bile duct stones, laparoscopic
0FT40ZZ, Resection, gallbladder, open approach
, Removal of the entire body part and removal of an entire lobe of the liver is what root
operation? - Resection
Inpt procedures are code with: - ICD-10-CM
Pt adm to hosp for pain due to displacement of pacemaker electrode and pt also has
hypothyroidism due to partial thyroidectomy 7 yrs ago and a breast cyst. Pacemaker
electrode was relocated and synthroid was given during hosp stay. The dx codes
(excluding Ext Cause codes) assigned are: - T82.120A, Displacement of cardiac
electrode, initial encounter
E89.0, Postsurgical hypothyroidism
Assign code(s) for mammographic guidance for bilateral breast needle localization for
lesion placement with fine needle aspiration: - 19081-50, Biopsy, breast, with placement
of localization device(s) (clip, metallic pellet) when performed, and imaging of biopsy
specimen, percutaneous; first lesion incl stereotactic guidance, bilateral procedure
10022-50, Fine needle aspiration, with imaging guidance, bilateral procedure
Doc in record reveals pt is adm w/acute exacerbation of COPD (MS-DRG 192). Higher-
paying DRG may be appropriate if doc is present in record at the time the decision was
made to admit pt that confirms dx associated with: - Blood gases of pO2 of 58, pCO2 of
55, pH of 7.32 upon adm and treated w/intubation and mechanical vent for 23 hours
since this would bump to MS-DRG 208
Female pt dx w/CHF, but what would incr MS-DRG weight if POA? - Stage III pressure
ulcer would optimize DRG. CHF alone, with atrial fib, with blood loss anemia, and with
coronary artery disease all remain the same weight.
If PD is initial episode of anterior wall myocardial infarction, which procedure will result
in highest DRG? - Transbronchial lung biopsy would optimize DRG. Myocardial
infarction alone, with insertion of central venous catheter are a lower weight, and
myocardial infarction with mechanical ventilator is also a lower weight.
Pt adm with hemorrhage due to placenta previa w/twin pgs. Pt had 2 prior C-section
deliveries. Emergency C-Section was performed due to hemorrhage. Assign PD: -
Placenta previa with hemorrhage
Pt adm w/spotting, fever, and found to have been tx for miscarriage which was resolved
2 wks prior to this adm. She is tx w/aspiration D&C and POC are found, along w/her
being septic. What is the PD? - Sepsis following incomplete spontaneous abortion
