CCA PRACTICE EXAM 2026/2027 | Verified Edition Questions
and Answers | Certified Coding Associate Prep | Pass
Guaranteed - A+ Graded
Section 1: Clinical Classification & Coding Systems (ICD-10-CM, ICD-10-PCS,
CPT, HCPCS) (Questions 1-50)
Q1: An inpatient is admitted with chest pain. The physician documents "acute
myocardial infarction" in the discharge summary but states in the progress notes "rule
out MI." According to the ICD-10-CM Official Guidelines for Coding and Reporting, how
should this be coded?
A. Code only chest pain
B. Code acute myocardial infarction
C. Code both chest pain and acute myocardial infarction
D. Query the physician before coding
Correct Answer: B
Rationale: The ICD-10-CM Official Guidelines state that if the diagnosis documented at
the time of discharge is qualified as "probable," "suspected," "likely," "questionable,"
"possible," or "still to be determined," the condition should be coded as if it were
established for inpatient admissions. Outpatient records cannot code uncertain
diagnoses. CCA Exam Tip: Always differentiate inpatient vs. outpatient coding
guidelines for uncertain diagnoses; inpatient coders code it as if confirmed.
Q2: A patient is seen in the emergency department for a snake bite. The physician
documents "venomous snake bite, right hand." What is the correct ICD-10-CM code
assignment?
A. T63.0X1A
B. T63.0X4A
C. T63.0X1D
D. X20.0XXA
Correct Answer: B
Rationale: ICD-10-CM uses specific 7th character extensions for poisoning, adverse
effects, and underdosing. Code T63.0X4A represents the toxic effect of contact with
venomous snakes, initial encounter. Extension '1' is for accidental poisoning (e.g.,
ingesting venom), and X20 is for non-venomous snake bites. CCA Exam Tip: Memorize
the 7th character extensions: 1 (poisoning/accidental), 4 (toxic effect), and 5 (adverse
effect) for Chapter 19.
Q3: A patient with type 2 diabetes mellitus on insulin presents with diabetic chronic
kidney disease, stage 3. What are the correct ICD-10-CM codes and sequencing?
,A. E11.22, N18.3
B. E11.9, N18.3
C. N18.3, E11.22
D. E11.65, N18.3
Correct Answer: A
Rationale: Per ICD-10-CM guidelines, the code for the underlying condition (type 2
diabetes mellitus with kidney complications, E11.22) must be sequenced first, followed
by the manifestation code (chronic kidney disease, stage 3, N18.3). Code E11.65 is for
hyperglycemia. CCA Exam Tip: Always sequence the etiology (diabetes) before the
manifestation (kidney disease) and verify the correct 5th character for the specific
complication.
Q4: A patient undergoes a laparoscopic cholecystectomy. In ICD-10-PCS, what is the
approach character for a laparoscopic procedure?
A. Open
B. Percutaneous
C. Percutaneous Endoscopic
D. Via Natural or Artificial Opening Endoscopic
Correct Answer: C
Rationale: In ICD-10-PCS, a laparoscopic approach is coded as Percutaneous
Endoscopic because it involves entering the body through the skin with visualization via
a scope. "Via Natural or Artificial Opening Endoscopic" is used for procedures like
colonoscopy. CCA Exam Tip: Distinguish carefully between percutaneous endoscopic
(laparoscopy) and via natural opening endoscopic (endoscopy via mouth, anus, etc.).
Q5: A surgeon performs an excision of a benign lesion, 1.2 cm, on the patient's back.
The pathology report confirms a sebaceous cyst. How is this coded in CPT?
A. 11400
B. 11401
C. 11420
D. 10060
Correct Answer: B
Rationale: CPT code 11401 is for the excision of a benign lesion of the trunk, arms, or
legs measuring over 1.0 to 2.0 cm. Code 11400 is for lesions 0.6 to 1.0 cm. Code 11420
is for benign lesions of the face. Code 10060 is for incision and drainage of an abscess.
CCA Exam Tip: Always cross-reference the exact anatomical location and size in
centimeters provided in the operative/pathology report to select the correct CPT
excision code.
Q6: A patient with essential hypertension is admitted for treatment of malignant
hypertension. How should this be coded in ICD-10-CM?
,A. I10
B. I11.9
C. I13.0
D. I16.0
Correct Answer: D
Rationale: Malignant hypertension is classified to I16.0 (Hypertensive crisis). Essential
hypertension is coded as I10. Hypertensive heart disease without heart failure is I11.9,
and hypertensive heart and chronic kidney disease are I13.-. Malignant hypertension is
an acute, life-threatening event. CCA Exam Tip: Do not confuse chronic essential
hypertension (I10) with hypertensive emergencies/crises (I16.-).
Q7: A physician provides a comprehensive preventive medicine visit for a new
45-year-old patient. The patient also complains of a new rash on her arm, which the
physician evaluates and treats. What modifier is appended to the E/M code for the
rash?
A. Modifier -25
B. Modifier -59
C. Modifier -57
D. Modifier -50
Correct Answer: A
Rationale: Modifier -25 is added to the office/outpatient E/M service to indicate a
significant, separately identifiable evaluation and management service on the same day
as a preventive medicine visit. Modifier -57 is for decision for surgery. CCA Exam Tip:
Preventive visits and problem-oriented visits can be billed on the same day by
appending modifier -25 to the problem-oriented E/M code.
Q8: A patient receives an intravenous infusion of Rituximab, 500 mg, for rheumatoid
arthritis in the outpatient setting. How is this coded?
A. J9310
B. 96413
C. J9310, 96413
D. 96365
Correct Answer: C
Rationale: Both the drug product and the administration service must be coded. J9310
is the HCPCS code for Rituximab, 100 mg (reported as 5 units for 500 mg). 96413 is the
CPT code for intravenous infusion for therapy/diagnosis, first hour. CCA Exam Tip:
Always remember to code both the drug (HCPCS J-code) and the administration (CPT
code) for infused medications, ensuring drug units are calculated correctly.
, Q9: A patient is seen for a follow-up visit after a total knee replacement performed 6
weeks ago. The physician documents "healing well, no complications." What
ICD-10-CM code is assigned?
A. Z96.651
B. M17.11
C. Z48.815
D. No code is assigned
Correct Answer: A
Rationale: Z96.651 (Presence of right artificial knee joint) is the correct code for a
routine follow-up after joint replacement where no complication is present. The history of
osteoarthritis (M17.11) is not coded for a routine follow-up. Z48.815 is for aftercare
following joint replacement. CCA Exam Tip: Distinguish between aftercare Z codes
(used by the surgeon performing the procedure) and status Z codes (used for long-term
presence of a device).
Q10: An inpatient undergoes a total colectomy with formation of an ileostomy. In
ICD-10-PCS, what is the root operation for creating the ileostomy?
A. Bypass
B. Supplement
C. Replacement
D. Drainage
Correct Answer: A
Rationale: Creating an ileostomy involves altering the route of passage of the intestinal
contents. In ICD-10-PCS, altering the route of passage of body contents without taking
out a body part is defined as a Bypass. Drainage is taking or letting out fluids/gases.
CCA Exam Tip: Understand that creating an ostomy (colostomy, ileostomy) is coded as
a Bypass because it reroutes the physiological pathway.
Q11: A patient is admitted for chemotherapy for acute myeloid leukemia (AML). The
admission is solely for the administration of chemotherapy. What is the correct principal
diagnosis?
A. Z51.11
B. C92.0
C. Z51.11, C92.0
D. T45.1X5A
Correct Answer: A
Rationale: When a patient is admitted solely for the administration of chemotherapy, the
appropriate principal diagnosis is Z51.11 (Encounter for antineoplastic chemotherapy).
The malignancy code (C92.0) is assigned as a secondary diagnosis. CCA Exam Tip: If
the admission is solely for chemo/radiation, the Z code is principal. If admitted for a
and Answers | Certified Coding Associate Prep | Pass
Guaranteed - A+ Graded
Section 1: Clinical Classification & Coding Systems (ICD-10-CM, ICD-10-PCS,
CPT, HCPCS) (Questions 1-50)
Q1: An inpatient is admitted with chest pain. The physician documents "acute
myocardial infarction" in the discharge summary but states in the progress notes "rule
out MI." According to the ICD-10-CM Official Guidelines for Coding and Reporting, how
should this be coded?
A. Code only chest pain
B. Code acute myocardial infarction
C. Code both chest pain and acute myocardial infarction
D. Query the physician before coding
Correct Answer: B
Rationale: The ICD-10-CM Official Guidelines state that if the diagnosis documented at
the time of discharge is qualified as "probable," "suspected," "likely," "questionable,"
"possible," or "still to be determined," the condition should be coded as if it were
established for inpatient admissions. Outpatient records cannot code uncertain
diagnoses. CCA Exam Tip: Always differentiate inpatient vs. outpatient coding
guidelines for uncertain diagnoses; inpatient coders code it as if confirmed.
Q2: A patient is seen in the emergency department for a snake bite. The physician
documents "venomous snake bite, right hand." What is the correct ICD-10-CM code
assignment?
A. T63.0X1A
B. T63.0X4A
C. T63.0X1D
D. X20.0XXA
Correct Answer: B
Rationale: ICD-10-CM uses specific 7th character extensions for poisoning, adverse
effects, and underdosing. Code T63.0X4A represents the toxic effect of contact with
venomous snakes, initial encounter. Extension '1' is for accidental poisoning (e.g.,
ingesting venom), and X20 is for non-venomous snake bites. CCA Exam Tip: Memorize
the 7th character extensions: 1 (poisoning/accidental), 4 (toxic effect), and 5 (adverse
effect) for Chapter 19.
Q3: A patient with type 2 diabetes mellitus on insulin presents with diabetic chronic
kidney disease, stage 3. What are the correct ICD-10-CM codes and sequencing?
,A. E11.22, N18.3
B. E11.9, N18.3
C. N18.3, E11.22
D. E11.65, N18.3
Correct Answer: A
Rationale: Per ICD-10-CM guidelines, the code for the underlying condition (type 2
diabetes mellitus with kidney complications, E11.22) must be sequenced first, followed
by the manifestation code (chronic kidney disease, stage 3, N18.3). Code E11.65 is for
hyperglycemia. CCA Exam Tip: Always sequence the etiology (diabetes) before the
manifestation (kidney disease) and verify the correct 5th character for the specific
complication.
Q4: A patient undergoes a laparoscopic cholecystectomy. In ICD-10-PCS, what is the
approach character for a laparoscopic procedure?
A. Open
B. Percutaneous
C. Percutaneous Endoscopic
D. Via Natural or Artificial Opening Endoscopic
Correct Answer: C
Rationale: In ICD-10-PCS, a laparoscopic approach is coded as Percutaneous
Endoscopic because it involves entering the body through the skin with visualization via
a scope. "Via Natural or Artificial Opening Endoscopic" is used for procedures like
colonoscopy. CCA Exam Tip: Distinguish carefully between percutaneous endoscopic
(laparoscopy) and via natural opening endoscopic (endoscopy via mouth, anus, etc.).
Q5: A surgeon performs an excision of a benign lesion, 1.2 cm, on the patient's back.
The pathology report confirms a sebaceous cyst. How is this coded in CPT?
A. 11400
B. 11401
C. 11420
D. 10060
Correct Answer: B
Rationale: CPT code 11401 is for the excision of a benign lesion of the trunk, arms, or
legs measuring over 1.0 to 2.0 cm. Code 11400 is for lesions 0.6 to 1.0 cm. Code 11420
is for benign lesions of the face. Code 10060 is for incision and drainage of an abscess.
CCA Exam Tip: Always cross-reference the exact anatomical location and size in
centimeters provided in the operative/pathology report to select the correct CPT
excision code.
Q6: A patient with essential hypertension is admitted for treatment of malignant
hypertension. How should this be coded in ICD-10-CM?
,A. I10
B. I11.9
C. I13.0
D. I16.0
Correct Answer: D
Rationale: Malignant hypertension is classified to I16.0 (Hypertensive crisis). Essential
hypertension is coded as I10. Hypertensive heart disease without heart failure is I11.9,
and hypertensive heart and chronic kidney disease are I13.-. Malignant hypertension is
an acute, life-threatening event. CCA Exam Tip: Do not confuse chronic essential
hypertension (I10) with hypertensive emergencies/crises (I16.-).
Q7: A physician provides a comprehensive preventive medicine visit for a new
45-year-old patient. The patient also complains of a new rash on her arm, which the
physician evaluates and treats. What modifier is appended to the E/M code for the
rash?
A. Modifier -25
B. Modifier -59
C. Modifier -57
D. Modifier -50
Correct Answer: A
Rationale: Modifier -25 is added to the office/outpatient E/M service to indicate a
significant, separately identifiable evaluation and management service on the same day
as a preventive medicine visit. Modifier -57 is for decision for surgery. CCA Exam Tip:
Preventive visits and problem-oriented visits can be billed on the same day by
appending modifier -25 to the problem-oriented E/M code.
Q8: A patient receives an intravenous infusion of Rituximab, 500 mg, for rheumatoid
arthritis in the outpatient setting. How is this coded?
A. J9310
B. 96413
C. J9310, 96413
D. 96365
Correct Answer: C
Rationale: Both the drug product and the administration service must be coded. J9310
is the HCPCS code for Rituximab, 100 mg (reported as 5 units for 500 mg). 96413 is the
CPT code for intravenous infusion for therapy/diagnosis, first hour. CCA Exam Tip:
Always remember to code both the drug (HCPCS J-code) and the administration (CPT
code) for infused medications, ensuring drug units are calculated correctly.
, Q9: A patient is seen for a follow-up visit after a total knee replacement performed 6
weeks ago. The physician documents "healing well, no complications." What
ICD-10-CM code is assigned?
A. Z96.651
B. M17.11
C. Z48.815
D. No code is assigned
Correct Answer: A
Rationale: Z96.651 (Presence of right artificial knee joint) is the correct code for a
routine follow-up after joint replacement where no complication is present. The history of
osteoarthritis (M17.11) is not coded for a routine follow-up. Z48.815 is for aftercare
following joint replacement. CCA Exam Tip: Distinguish between aftercare Z codes
(used by the surgeon performing the procedure) and status Z codes (used for long-term
presence of a device).
Q10: An inpatient undergoes a total colectomy with formation of an ileostomy. In
ICD-10-PCS, what is the root operation for creating the ileostomy?
A. Bypass
B. Supplement
C. Replacement
D. Drainage
Correct Answer: A
Rationale: Creating an ileostomy involves altering the route of passage of the intestinal
contents. In ICD-10-PCS, altering the route of passage of body contents without taking
out a body part is defined as a Bypass. Drainage is taking or letting out fluids/gases.
CCA Exam Tip: Understand that creating an ostomy (colostomy, ileostomy) is coded as
a Bypass because it reroutes the physiological pathway.
Q11: A patient is admitted for chemotherapy for acute myeloid leukemia (AML). The
admission is solely for the administration of chemotherapy. What is the correct principal
diagnosis?
A. Z51.11
B. C92.0
C. Z51.11, C92.0
D. T45.1X5A
Correct Answer: A
Rationale: When a patient is admitted solely for the administration of chemotherapy, the
appropriate principal diagnosis is Z51.11 (Encounter for antineoplastic chemotherapy).
The malignancy code (C92.0) is assigned as a secondary diagnosis. CCA Exam Tip: If
the admission is solely for chemo/radiation, the Z code is principal. If admitted for a
