CERTIFIED CODING SPECIALIST TEST ALL SET
ANSWERS AND QUESTIONS SET A+
✔✔OCE :Outpatient Code Editor - ✔✔Outpatient Code Editor
The Medicare Outpatient Code Editor (OCE) is a software program that is used to
detect and report errors in coding while processing outpatient hospital claims. The OCE
also assigns an APC number for each service that is covered under OPPS and returns
information to be used as input to a pricer program.
✔✔A patient was discharged from the same-day-surgery unit with the following
diagnoses: posterior subcapsular mature incipient senile cataract right eye, diabetes
mellitus, hypertension, and was treated for mild acute renal failure. Which codes are
correct?
E11.36 Type 2 diabetes mellitus without complications
E11.29 Type 2 diabetes mellitus with other diabetic kidney complication
H25.9 Unspecified age-related cataract
H25.21 Age-related cataract, morgagnian type, right eye
H25.041 Posterior subcapsular polar age-related cataract, right eye
I10 Essential hypertension
I12.9 Hypertensive chronic kidney disease with stage 1 through stage 4, or unspecified
chronic kidney disease
N17.9 Acute kidney failure, unspecified
a. H25.21, E11.29, I12.9, N17.9
b. H25.041, E11.36, I10, N17.9
c. H25.9, E11.29, I12.9, N17.9
d. H25.041, E11.9, I12.9 - ✔✔b. H25.041:
E11.36:Type 2 diabetes mellitus without complications
I10:Essential hypertension
N17.9:Acute kidney failure, unspecified
, **The patient has posterior subcapsular mature incipient senile cataract right eye,
diabetes mellitus, hypertension, acute renal failure. The hypertension is not related to
the renal failure as it is acute and not chronic. Because of this, a combination code for
hypertension and chronic renal failure is not coded (HHS 2017, Sections A.15. and
I.B.9., 15., and AHA Coding Clinic 2016 2nd Quarter, 36-37).
✔✔A patient was admitted with heart failure within one week of a heart transplant. Due
to the timing, the coder thought that it may represent a postoperative transplant
rejection following heart transplant. What action(s) should the coding staff take?
a. Query the physician.
b. Assign the codes for the postoperative transplant rejection.
c. Assign only the code for the transplant rejection.
d. Assign only the code for heart failure. - ✔✔a. Query the physician.
**When the documentation is not clear regarding a potential complication, it is
appropriate to query the physician (HHS 2017, Section II.B., 101; Leon-Chisen 2017,
42-44).
✔✔The UHDDS definition of principal diagnosis does not apply to the coding of
outpatient encounters because:
a. There is not enough documentation
b. Usually there are multiple reasons for the encounter
c. No after study element is involved as continued evaluation cannot occur
d. A pre-admission work up is not available - ✔✔c. No after study element is involved as
continued evaluation cannot occur
**The principal diagnosis requires that the condition after study, which occasioned the
patient's admission to the hospital, be assigned as the principal diagnosis. In the
outpatient setting, no after study element is involved as continued evaluation cannot
occur (Leon-Chisen 2017, 30; HHS 2017, Section IV, 104).
✔✔UHDDS :Uniforn Hospital Discharge Data Set - ✔✔Uniform Hospital Discharge Data
Set (UHDDS) Used for reporting inpatient data in acute care, short-term care, and long-
term care hospitals. Minimum set of items based on standard definitions to provide
consistent data for multiple users. Required for reporting Medicare and Medicaid
patients.
✔✔Assign the code(s) for bilateral epidural lumbar injection of steroids:
62282 Injection/infusion of neurolytic substance (eg, alcohol, phenol, iced saline
solutions, with or without other therapeutic substance; epidural, lumbar, sacral [caudal])
62311 Injection(s), of diagnostic or therapeutic substance(s) (including
anesthetic,antispasmodic, opioid, steroid, other solution), not including neurolytic
ANSWERS AND QUESTIONS SET A+
✔✔OCE :Outpatient Code Editor - ✔✔Outpatient Code Editor
The Medicare Outpatient Code Editor (OCE) is a software program that is used to
detect and report errors in coding while processing outpatient hospital claims. The OCE
also assigns an APC number for each service that is covered under OPPS and returns
information to be used as input to a pricer program.
✔✔A patient was discharged from the same-day-surgery unit with the following
diagnoses: posterior subcapsular mature incipient senile cataract right eye, diabetes
mellitus, hypertension, and was treated for mild acute renal failure. Which codes are
correct?
E11.36 Type 2 diabetes mellitus without complications
E11.29 Type 2 diabetes mellitus with other diabetic kidney complication
H25.9 Unspecified age-related cataract
H25.21 Age-related cataract, morgagnian type, right eye
H25.041 Posterior subcapsular polar age-related cataract, right eye
I10 Essential hypertension
I12.9 Hypertensive chronic kidney disease with stage 1 through stage 4, or unspecified
chronic kidney disease
N17.9 Acute kidney failure, unspecified
a. H25.21, E11.29, I12.9, N17.9
b. H25.041, E11.36, I10, N17.9
c. H25.9, E11.29, I12.9, N17.9
d. H25.041, E11.9, I12.9 - ✔✔b. H25.041:
E11.36:Type 2 diabetes mellitus without complications
I10:Essential hypertension
N17.9:Acute kidney failure, unspecified
, **The patient has posterior subcapsular mature incipient senile cataract right eye,
diabetes mellitus, hypertension, acute renal failure. The hypertension is not related to
the renal failure as it is acute and not chronic. Because of this, a combination code for
hypertension and chronic renal failure is not coded (HHS 2017, Sections A.15. and
I.B.9., 15., and AHA Coding Clinic 2016 2nd Quarter, 36-37).
✔✔A patient was admitted with heart failure within one week of a heart transplant. Due
to the timing, the coder thought that it may represent a postoperative transplant
rejection following heart transplant. What action(s) should the coding staff take?
a. Query the physician.
b. Assign the codes for the postoperative transplant rejection.
c. Assign only the code for the transplant rejection.
d. Assign only the code for heart failure. - ✔✔a. Query the physician.
**When the documentation is not clear regarding a potential complication, it is
appropriate to query the physician (HHS 2017, Section II.B., 101; Leon-Chisen 2017,
42-44).
✔✔The UHDDS definition of principal diagnosis does not apply to the coding of
outpatient encounters because:
a. There is not enough documentation
b. Usually there are multiple reasons for the encounter
c. No after study element is involved as continued evaluation cannot occur
d. A pre-admission work up is not available - ✔✔c. No after study element is involved as
continued evaluation cannot occur
**The principal diagnosis requires that the condition after study, which occasioned the
patient's admission to the hospital, be assigned as the principal diagnosis. In the
outpatient setting, no after study element is involved as continued evaluation cannot
occur (Leon-Chisen 2017, 30; HHS 2017, Section IV, 104).
✔✔UHDDS :Uniforn Hospital Discharge Data Set - ✔✔Uniform Hospital Discharge Data
Set (UHDDS) Used for reporting inpatient data in acute care, short-term care, and long-
term care hospitals. Minimum set of items based on standard definitions to provide
consistent data for multiple users. Required for reporting Medicare and Medicaid
patients.
✔✔Assign the code(s) for bilateral epidural lumbar injection of steroids:
62282 Injection/infusion of neurolytic substance (eg, alcohol, phenol, iced saline
solutions, with or without other therapeutic substance; epidural, lumbar, sacral [caudal])
62311 Injection(s), of diagnostic or therapeutic substance(s) (including
anesthetic,antispasmodic, opioid, steroid, other solution), not including neurolytic
