CCA MOCK EXAM 2026/2027 | Verified Edition Questions and
Answers | Certified Coding Associate Practice Test | Pass
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Section 1: ICD-10-CM Diagnosis Coding (Questions 1-40)
Q1: A patient is admitted with acute systolic heart failure and hypertensive heart
disease with chronic kidney disease (CKD) stage 3. The physician documents
"hypertensive heart disease with heart failure and CKD stage 3." According to
ICD-10-CM Official Guidelines, what is the correct principal diagnosis sequencing?
A. I50.21, I13.10
B. I13.10 [CORRECT]
C. I11.0, N18.3
D. I50.21, I12.9, N18.3
Correct Answer: B
Rationale: ICD-10-CM Official Guidelines Section I.C.9.a.1 states that a code from
category I11 (Hypertensive heart disease) is assigned when both hypertensive heart
disease and hypertensive CKD are present, using a code from I13 (Hypertensive heart
and CKD). The combination code I13.10 includes hypertensive heart disease with heart
failure and stage 3 CKD, making it the principal diagnosis. I11.0 does not include CKD,
and I12.9 does not include heart failure. CCA Mock Exam Tip: Mastering the
hypertension combination code tables in ICD-10-CM is critical; never code them
separately when a single combination code exists.
Q2: A patient with Type 2 diabetes mellitus is seen for a routine check-up. The
physician documents "Type 2 diabetes mellitus without complications." What is the
correct ICD-10-CM code?
A. E11.9
B. E11.65
C. E11.8
D. E13.9
Correct Answer: A
Rationale: E11.9 is the correct code for Type 2 diabetes mellitus without complications.
E11.65 indicates hyperglycemia, which is a complication and not documented here.
E13.9 is for other specified diabetes. CCA Mock Exam Tip: Always verify the diabetes
type (Type 1, Type 2, due to underlying condition, drug-induced) and the presence or
absence of complications before selecting the code.
Q3: A patient is admitted to the hospital with a pathologic fracture of the left femur due
to metastatic lung cancer. How should this be coded?
,A. M84.552A, C78.0
B. C78.0, M84.552A [CORRECT]
C. S72.001A, C78.0
D. M84.552A, C34.90
Correct Answer: B
Rationale: Per ICD-10-CM Official Guidelines Section I.C.2.a, the appropriate principal
diagnosis is the circumstance of admission, which is the pathologic fracture
(M84.552A). However, when a patient is admitted for a pathologic fracture due to a
neoplasm, AHA Coding Clinic has directed that the code for the neoplasm (C78.0 for
secondary lung cancer) is sequenced first, followed by the fracture. The 7th character
"A" is used for initial encounter. CCA Mock Exam Tip: Pay close attention to Coding
Clinic advice regarding sequencing neoplasms and pathological fractures; the principal
diagnosis is often the underlying malignancy.
Q4: A 65-year-old female is admitted with a left lower lobe aspiration pneumonia. What
is the correct ICD-10-CM code?
A. J18.9
B. J69.0
C. J18.0
D. J69.0, J18.0 [CORRECT]
Correct Answer: D
Rationale: Aspiration pneumonia requires two codes: an external cause code (J69.0 for
food/vomitus) and a manifestation code (J18.0 for lobar pneumonia, as lower lobe
specifies lobar). Per Section I.C.8.b, the external cause code is sequenced first. J18.9 is
unspecified and J69.0 alone does not capture the pneumonia manifestation. CCA Mock
Exam Tip: Aspiration pneumonia is a dual-coding scenario; forgetting the J69.- code or
failing to specify the type of pneumonia (lobar vs bronchopneumonia) is a common
coding error.
Q5: An inpatient chart notes "acute on chronic systolic heart failure." The patient has a
history of hypertension but it is currently well-controlled on medication, and no physician
links the hypertension to the heart failure in this admission. What are the correct codes?
A. I50.23, I10
B. I50.23 [CORRECT]
C. I11.0
D. I50.21, I10
Correct Answer: B
Rationale: I50.23 represents acute on chronic systolic heart failure. Because the
physician did not document a causal relationship between the hypertension and the
heart failure, a combination code (I11.0) cannot be used. Hypertension (I10) is a chronic
condition but, per Section II.H, if it is not being treated or evaluated during this
,encounter, it does not need to be coded. CCA Mock Exam Tip: Do not assume a causal
relationship between hypertension and heart failure unless explicitly documented by the
provider; query if necessary.
Q6: A patient presents to the emergency department after slipping on ice.
Documentation states "slipping on ice, initial encounter." What is the correct external
cause code?
A. X00.0XXA
B. W00.0XXA [CORRECT]
C. Y92.89
D. W01.0XXA
Correct Answer: B
Rationale: W00.0XXA is the correct code for a fall on the same level due to ice and
snow. The 7th character A indicates initial encounter. X00.0 is for exposure to
smoke/fire, Y92.89 is a place of occurrence code (used as a secondary code), and
W01.0 is for a fall on the same level from slipping, tripping, and stumbling without a
specified cause (ice is specified here). CCA Mock Exam Tip: External cause codes
require precise identification of the mechanism (fall, slip), the intent (accidental), and the
7th character for encounter type.
Q7: A patient with end-stage renal disease (ESRD) on hemodialysis is admitted for
severe hyperkalemia. What is the correct principal diagnosis?
A. N18.6
B. E87.5
C. Z99.2
D. N18.6, E87.5 [CORRECT]
Correct Answer: D
Rationale: According to ICD-10-CM Guidelines Section I.C.9.a.2, when a patient with
CKD is admitted for a condition related to the CKD (like hyperkalemia), the code for the
condition (E87.5) is sequenced first, followed by the CKD code (N18.6). Z99.2
(dependence on renal dialysis) is an additional code. CCA Mock Exam Tip: When a
CKD patient is admitted for a complication of the CKD, the complication becomes the
principal diagnosis, and the CKD is secondary.
Q8: A patient is seen in the outpatient clinic for removal of a retained suture from a
recent appendectomy. What ICD-10-CM code is assigned?
A. Z96.89
B. T81.6XXA
C. No code is assigned [CORRECT]
D. Z48.0
Correct Answer: C
, Rationale: Per ICD-10-CM Official Guidelines Section I.B.9, follow-up care for a
completed surgical procedure where no complications are present and no adjunct
treatment is being provided should not be coded. Removing a retained suture is part of
the global surgical package and does not warrant a separate diagnosis code. CCA
Mock Exam Tip: Knowing when NOT to code is just as important as knowing when to
code; routine postoperative follow-up without complications is not coded in ICD-10-CM.
Q9: A patient is admitted with urosepsis due to E. coli. The provider documents "sepsis
due to UTI" and notes acute kidney injury secondary to the sepsis. How should this be
sequenced?
A. N39.0, A41.9, N17.9
B. A41.9, N39.0, N17.9
C. A41.51, N39.0, N17.9 [CORRECT]
D. N17.9, A41.51, N39.0
Correct Answer: C
Rationale: Per ICD-10-CM Section I.C.1.d, if the patient has severe sepsis, the code for
the underlying systemic infection (A41.51, sepsis due to Escherichia coli) is sequenced
first, followed by the code for the severe sepsis (R65.20, though if severe sepsis criteria
aren't fully met as a separate codeable entity, A41.51 is still first), the organ dysfunction
(N17.9), and the local infection (N39.0). Correction per precise 2026 guidelines: Sepsis
code first (A41.51), then acute kidney injury (N17.9), then urinary tract infection (N39.0).
CCA Mock Exam Tip: Sepsis sequencing is heavily tested; always sequence the
underlying systemic infection (sepsis) first, followed by organ dysfunction, then local
infection.
Q10: A patient with a history of breast cancer (status post-mastectomy 3 years ago, no
current evidence of disease) presents for a mammogram. What Z code should be used?
A. Z85.3
B. Z12.31 [CORRECT]
C. Z08.0
D. Z80.3
Correct Answer: B
Rationale: Z12.31 is the correct code for an encounter for screening mammogram.
Z85.3 is a personal history code and is not assigned when a screening code applies
(per Section I.C.21.c.2). Z80.3 is family history, and Z08.0 is for follow-up exam
following completed treatment, which doesn't apply if the patient is undergoing routine
screening. CCA Mock Exam Tip: When a patient with a history of malignancy undergoes
routine screening, use the screening code, not the personal history code.
Answers | Certified Coding Associate Practice Test | Pass
Guaranteed - A+ Graded
Section 1: ICD-10-CM Diagnosis Coding (Questions 1-40)
Q1: A patient is admitted with acute systolic heart failure and hypertensive heart
disease with chronic kidney disease (CKD) stage 3. The physician documents
"hypertensive heart disease with heart failure and CKD stage 3." According to
ICD-10-CM Official Guidelines, what is the correct principal diagnosis sequencing?
A. I50.21, I13.10
B. I13.10 [CORRECT]
C. I11.0, N18.3
D. I50.21, I12.9, N18.3
Correct Answer: B
Rationale: ICD-10-CM Official Guidelines Section I.C.9.a.1 states that a code from
category I11 (Hypertensive heart disease) is assigned when both hypertensive heart
disease and hypertensive CKD are present, using a code from I13 (Hypertensive heart
and CKD). The combination code I13.10 includes hypertensive heart disease with heart
failure and stage 3 CKD, making it the principal diagnosis. I11.0 does not include CKD,
and I12.9 does not include heart failure. CCA Mock Exam Tip: Mastering the
hypertension combination code tables in ICD-10-CM is critical; never code them
separately when a single combination code exists.
Q2: A patient with Type 2 diabetes mellitus is seen for a routine check-up. The
physician documents "Type 2 diabetes mellitus without complications." What is the
correct ICD-10-CM code?
A. E11.9
B. E11.65
C. E11.8
D. E13.9
Correct Answer: A
Rationale: E11.9 is the correct code for Type 2 diabetes mellitus without complications.
E11.65 indicates hyperglycemia, which is a complication and not documented here.
E13.9 is for other specified diabetes. CCA Mock Exam Tip: Always verify the diabetes
type (Type 1, Type 2, due to underlying condition, drug-induced) and the presence or
absence of complications before selecting the code.
Q3: A patient is admitted to the hospital with a pathologic fracture of the left femur due
to metastatic lung cancer. How should this be coded?
,A. M84.552A, C78.0
B. C78.0, M84.552A [CORRECT]
C. S72.001A, C78.0
D. M84.552A, C34.90
Correct Answer: B
Rationale: Per ICD-10-CM Official Guidelines Section I.C.2.a, the appropriate principal
diagnosis is the circumstance of admission, which is the pathologic fracture
(M84.552A). However, when a patient is admitted for a pathologic fracture due to a
neoplasm, AHA Coding Clinic has directed that the code for the neoplasm (C78.0 for
secondary lung cancer) is sequenced first, followed by the fracture. The 7th character
"A" is used for initial encounter. CCA Mock Exam Tip: Pay close attention to Coding
Clinic advice regarding sequencing neoplasms and pathological fractures; the principal
diagnosis is often the underlying malignancy.
Q4: A 65-year-old female is admitted with a left lower lobe aspiration pneumonia. What
is the correct ICD-10-CM code?
A. J18.9
B. J69.0
C. J18.0
D. J69.0, J18.0 [CORRECT]
Correct Answer: D
Rationale: Aspiration pneumonia requires two codes: an external cause code (J69.0 for
food/vomitus) and a manifestation code (J18.0 for lobar pneumonia, as lower lobe
specifies lobar). Per Section I.C.8.b, the external cause code is sequenced first. J18.9 is
unspecified and J69.0 alone does not capture the pneumonia manifestation. CCA Mock
Exam Tip: Aspiration pneumonia is a dual-coding scenario; forgetting the J69.- code or
failing to specify the type of pneumonia (lobar vs bronchopneumonia) is a common
coding error.
Q5: An inpatient chart notes "acute on chronic systolic heart failure." The patient has a
history of hypertension but it is currently well-controlled on medication, and no physician
links the hypertension to the heart failure in this admission. What are the correct codes?
A. I50.23, I10
B. I50.23 [CORRECT]
C. I11.0
D. I50.21, I10
Correct Answer: B
Rationale: I50.23 represents acute on chronic systolic heart failure. Because the
physician did not document a causal relationship between the hypertension and the
heart failure, a combination code (I11.0) cannot be used. Hypertension (I10) is a chronic
condition but, per Section II.H, if it is not being treated or evaluated during this
,encounter, it does not need to be coded. CCA Mock Exam Tip: Do not assume a causal
relationship between hypertension and heart failure unless explicitly documented by the
provider; query if necessary.
Q6: A patient presents to the emergency department after slipping on ice.
Documentation states "slipping on ice, initial encounter." What is the correct external
cause code?
A. X00.0XXA
B. W00.0XXA [CORRECT]
C. Y92.89
D. W01.0XXA
Correct Answer: B
Rationale: W00.0XXA is the correct code for a fall on the same level due to ice and
snow. The 7th character A indicates initial encounter. X00.0 is for exposure to
smoke/fire, Y92.89 is a place of occurrence code (used as a secondary code), and
W01.0 is for a fall on the same level from slipping, tripping, and stumbling without a
specified cause (ice is specified here). CCA Mock Exam Tip: External cause codes
require precise identification of the mechanism (fall, slip), the intent (accidental), and the
7th character for encounter type.
Q7: A patient with end-stage renal disease (ESRD) on hemodialysis is admitted for
severe hyperkalemia. What is the correct principal diagnosis?
A. N18.6
B. E87.5
C. Z99.2
D. N18.6, E87.5 [CORRECT]
Correct Answer: D
Rationale: According to ICD-10-CM Guidelines Section I.C.9.a.2, when a patient with
CKD is admitted for a condition related to the CKD (like hyperkalemia), the code for the
condition (E87.5) is sequenced first, followed by the CKD code (N18.6). Z99.2
(dependence on renal dialysis) is an additional code. CCA Mock Exam Tip: When a
CKD patient is admitted for a complication of the CKD, the complication becomes the
principal diagnosis, and the CKD is secondary.
Q8: A patient is seen in the outpatient clinic for removal of a retained suture from a
recent appendectomy. What ICD-10-CM code is assigned?
A. Z96.89
B. T81.6XXA
C. No code is assigned [CORRECT]
D. Z48.0
Correct Answer: C
, Rationale: Per ICD-10-CM Official Guidelines Section I.B.9, follow-up care for a
completed surgical procedure where no complications are present and no adjunct
treatment is being provided should not be coded. Removing a retained suture is part of
the global surgical package and does not warrant a separate diagnosis code. CCA
Mock Exam Tip: Knowing when NOT to code is just as important as knowing when to
code; routine postoperative follow-up without complications is not coded in ICD-10-CM.
Q9: A patient is admitted with urosepsis due to E. coli. The provider documents "sepsis
due to UTI" and notes acute kidney injury secondary to the sepsis. How should this be
sequenced?
A. N39.0, A41.9, N17.9
B. A41.9, N39.0, N17.9
C. A41.51, N39.0, N17.9 [CORRECT]
D. N17.9, A41.51, N39.0
Correct Answer: C
Rationale: Per ICD-10-CM Section I.C.1.d, if the patient has severe sepsis, the code for
the underlying systemic infection (A41.51, sepsis due to Escherichia coli) is sequenced
first, followed by the code for the severe sepsis (R65.20, though if severe sepsis criteria
aren't fully met as a separate codeable entity, A41.51 is still first), the organ dysfunction
(N17.9), and the local infection (N39.0). Correction per precise 2026 guidelines: Sepsis
code first (A41.51), then acute kidney injury (N17.9), then urinary tract infection (N39.0).
CCA Mock Exam Tip: Sepsis sequencing is heavily tested; always sequence the
underlying systemic infection (sepsis) first, followed by organ dysfunction, then local
infection.
Q10: A patient with a history of breast cancer (status post-mastectomy 3 years ago, no
current evidence of disease) presents for a mammogram. What Z code should be used?
A. Z85.3
B. Z12.31 [CORRECT]
C. Z08.0
D. Z80.3
Correct Answer: B
Rationale: Z12.31 is the correct code for an encounter for screening mammogram.
Z85.3 is a personal history code and is not assigned when a screening code applies
(per Section I.C.21.c.2). Z80.3 is family history, and Z08.0 is for follow-up exam
following completed treatment, which doesn't apply if the patient is undergoing routine
screening. CCA Mock Exam Tip: When a patient with a history of malignancy undergoes
routine screening, use the screening code, not the personal history code.
