CCS QUESTIONS AND VERIFIED
ANSWERS
1. A 12-year-old boy was seen in an ambulatory surgical centre for pain in his right arm. The x-ray
showed fracture of ulna. Patient underwent closed reduction of fracture right proximal ulna and an
elbow-to-finger cast was applied. What diagnostic and procedure codes should be assigned?
S52.101A
Unspecified fracture of upper end of right radius, initial encounter for closed fracture
S52.101B
Unspecified fracture of upper end of right radius, initial encounter for open fracture
S52.001A
Unspecified fracture of upper end of right ulna, initial encounter for closed fracture
S52.001B
Unspecified fracture of upper end of right ulna, initial encounter for open fracture
0PSH0ZZ
Reposition right radius, open approach
0PSK0ZZ
Reposition right ulna, open approach
24670
Closed treatment of ulnar fracture, proximal end (eg, olecranon or coronoid process(es) ); without
manipulation
24675
Closed treatment of ulnar fracture, proxi ✅✅ANSW-d The patient has a fracture of the right
proximal ulna and closed reduction is necessary. In the ICD-10-CM Code Book, under Fracture, ulna,
proximal, the coder is referred to Fracture, ulna, upper end. The term "manipulation" is used to
indicate reduction in CPT. According to CPT guidelines, cast application or strapping (including
removal) is only reported as a replacement procedure or when the cast application or strapping is an
initial service performed without a restorative treatment or procedure (AMA CPT Professional
Edition 2020, 182). (Note: Since this is an ambulatory surgery center case, CPT codes are assigned
rather than ICD-10-PCS codes.)
2. A 75-year-old male patient was admitted from a nursing home with dehydration and dysphagia
due to a previous stroke. During hospitalization, the patient was rehydrated and transferred back to
the nursing home. What codes should be assigned?
a. E86.0, I69.390, R13.19
,b. E86.1, I69.391, R13.10
c. E86.9, I69.390, R13.19
d. E86.0, I69.391, R13.10 ✅✅ANSW-d Assign dehydration as the first listed diagnosis as it is the
key circumstance of the admission and was treated. Code the previous stroke and dysphagia as
additional diagnoses (CMS 2020a, Section II, 107; Section III, 110; Schraffenberger and Palkie 2020,
196).
3. Sepsis due to the presence of an indwelling urinary catheter with a positive blood culture
reflected in the progress notes as Staphylococcus aureus sepsis. What codes should be assigned?
a. T83.511A, A41.01
b. T83.511A, A41.9
c. T83.510A, R78.81
d. T81.4XXA, A41.01 ✅✅ANSW-a For a diagnosis of sepsis secondary to the presence of an
indwelling urinary catheter, assign an additional appropriate code for the underlying systemic
infection. Category T83 classifies complications of genitourinary devices (Leon-Chisen 2020, 144-148,
543; CMS 2020a, Section I.C.1. d.1.a, 24).
4. A laparoscopic tubal ligation is completed. What is the correct CPT code assignment?
49320
Laparoscopy, abdomen, peritoneum, and omentum, diagnostic, with or without collection of
specimen(s) by brushing or washing (separate procedure)
58662
Laparoscopy, surgical; with fulguration or excision of lesions of the ovary, pelvic viscera, or
peritoneal surface by any method
58670
Laparoscopy, surgical; with fulguration of oviducts (with or without transection)
58671
Laparoscopy, surgical; with occlusion of oviducts by device (eg, band, clip, or Falope ring)
a. 49320, 58662
b. 58670
c. 58671
d. 49320 ✅✅ANSW-b The code that best reports the tubal ligation is 58670 Laparoscopy,
surgical; with fulguration of oviducts because there are no clips or excision of lesion completed
during the procedure (CPT Assistant Nov. 1999, 29; March 2000, 10).
, 5. A patient is admitted to an acute-care facility with chest pain. The patient was awakened from
sleep by the pain. This was the patient's first experience with chest pain. The patient was given two
nitroglycerin tablets in the emergency department. The chest pain was not relieved, resulting in the
diagnosis of new onset unstable angina. Serial creatine phosphokinase was normal. Following a left
cardiac catheterization with fluoroscopic angiogram of multiple coronary arteries with low osmolar
contrast, the patient is found to have arteriosclerotic coronary artery disease. What ICD-10-CM and
PCS codes should be assigned?
a. I25.10, 4A023N7, B2111ZZ
b. I25.110, 4A023N7, B211Y10
c. I25.110, 4A023N7, B2111ZZ
d. I25.110, 4A023N6, B2111ZZ ✅✅ANSW-c ICD-10-CM has combination codes for atherosclerotic
heart disease with angina pectoris. The subcategories for these codes include I25.11, Atherosclerotic
heart disease of native coronary artery with angina pectoris. When using one of these combination
codes, it is not necessary to use an additional code for angina pectoris. A causal relationship can be
assumed in a patient with both atherosclerosis and angina pectoris, unless the documentation
indicates the angina is due to something other than the atherosclerosis (CMS 2020a, Section I.C.9.b.,
49). Use 4A023N7 for Measurement of cardiac sampling and pressure, left heart, percutaneous
approach. The left heart catheterization is reported with code B2111ZZ. The ICD-10-PCS root
operation is Measurement along with the function value of Sampling and Pressure. The angiogram
code reflects the use of fluoroscopy performed with low osmolar contrast (Schraffenberger and
Palkie 2020, 308-310).
6. Normal twin delivery at 30 weeks. Both babies were delivered vaginally and were liveborn. What
conditions should have codes assigned?
O30.003
Twin pregnancy, unspecified number of placenta and unspecified number of amniotic sacs, third
trimester
O30.009
Twin pregnancy, unspecified number of placenta and unspecified number of amniotic sacs,
unspecified trimester
O60.14X0
Preterm labor third trimester with preterm delivery third trimester, not applicable or unspecified
O60.14X1
Preterm labor third trimester with preterm delivery third trimester, fetus 1
O60.14X2
Preterm labor third trimester with preterm delivery third trimester, fetus 2
O80
Encounter for full-term uncomplicated delivery
ANSWERS
1. A 12-year-old boy was seen in an ambulatory surgical centre for pain in his right arm. The x-ray
showed fracture of ulna. Patient underwent closed reduction of fracture right proximal ulna and an
elbow-to-finger cast was applied. What diagnostic and procedure codes should be assigned?
S52.101A
Unspecified fracture of upper end of right radius, initial encounter for closed fracture
S52.101B
Unspecified fracture of upper end of right radius, initial encounter for open fracture
S52.001A
Unspecified fracture of upper end of right ulna, initial encounter for closed fracture
S52.001B
Unspecified fracture of upper end of right ulna, initial encounter for open fracture
0PSH0ZZ
Reposition right radius, open approach
0PSK0ZZ
Reposition right ulna, open approach
24670
Closed treatment of ulnar fracture, proximal end (eg, olecranon or coronoid process(es) ); without
manipulation
24675
Closed treatment of ulnar fracture, proxi ✅✅ANSW-d The patient has a fracture of the right
proximal ulna and closed reduction is necessary. In the ICD-10-CM Code Book, under Fracture, ulna,
proximal, the coder is referred to Fracture, ulna, upper end. The term "manipulation" is used to
indicate reduction in CPT. According to CPT guidelines, cast application or strapping (including
removal) is only reported as a replacement procedure or when the cast application or strapping is an
initial service performed without a restorative treatment or procedure (AMA CPT Professional
Edition 2020, 182). (Note: Since this is an ambulatory surgery center case, CPT codes are assigned
rather than ICD-10-PCS codes.)
2. A 75-year-old male patient was admitted from a nursing home with dehydration and dysphagia
due to a previous stroke. During hospitalization, the patient was rehydrated and transferred back to
the nursing home. What codes should be assigned?
a. E86.0, I69.390, R13.19
,b. E86.1, I69.391, R13.10
c. E86.9, I69.390, R13.19
d. E86.0, I69.391, R13.10 ✅✅ANSW-d Assign dehydration as the first listed diagnosis as it is the
key circumstance of the admission and was treated. Code the previous stroke and dysphagia as
additional diagnoses (CMS 2020a, Section II, 107; Section III, 110; Schraffenberger and Palkie 2020,
196).
3. Sepsis due to the presence of an indwelling urinary catheter with a positive blood culture
reflected in the progress notes as Staphylococcus aureus sepsis. What codes should be assigned?
a. T83.511A, A41.01
b. T83.511A, A41.9
c. T83.510A, R78.81
d. T81.4XXA, A41.01 ✅✅ANSW-a For a diagnosis of sepsis secondary to the presence of an
indwelling urinary catheter, assign an additional appropriate code for the underlying systemic
infection. Category T83 classifies complications of genitourinary devices (Leon-Chisen 2020, 144-148,
543; CMS 2020a, Section I.C.1. d.1.a, 24).
4. A laparoscopic tubal ligation is completed. What is the correct CPT code assignment?
49320
Laparoscopy, abdomen, peritoneum, and omentum, diagnostic, with or without collection of
specimen(s) by brushing or washing (separate procedure)
58662
Laparoscopy, surgical; with fulguration or excision of lesions of the ovary, pelvic viscera, or
peritoneal surface by any method
58670
Laparoscopy, surgical; with fulguration of oviducts (with or without transection)
58671
Laparoscopy, surgical; with occlusion of oviducts by device (eg, band, clip, or Falope ring)
a. 49320, 58662
b. 58670
c. 58671
d. 49320 ✅✅ANSW-b The code that best reports the tubal ligation is 58670 Laparoscopy,
surgical; with fulguration of oviducts because there are no clips or excision of lesion completed
during the procedure (CPT Assistant Nov. 1999, 29; March 2000, 10).
, 5. A patient is admitted to an acute-care facility with chest pain. The patient was awakened from
sleep by the pain. This was the patient's first experience with chest pain. The patient was given two
nitroglycerin tablets in the emergency department. The chest pain was not relieved, resulting in the
diagnosis of new onset unstable angina. Serial creatine phosphokinase was normal. Following a left
cardiac catheterization with fluoroscopic angiogram of multiple coronary arteries with low osmolar
contrast, the patient is found to have arteriosclerotic coronary artery disease. What ICD-10-CM and
PCS codes should be assigned?
a. I25.10, 4A023N7, B2111ZZ
b. I25.110, 4A023N7, B211Y10
c. I25.110, 4A023N7, B2111ZZ
d. I25.110, 4A023N6, B2111ZZ ✅✅ANSW-c ICD-10-CM has combination codes for atherosclerotic
heart disease with angina pectoris. The subcategories for these codes include I25.11, Atherosclerotic
heart disease of native coronary artery with angina pectoris. When using one of these combination
codes, it is not necessary to use an additional code for angina pectoris. A causal relationship can be
assumed in a patient with both atherosclerosis and angina pectoris, unless the documentation
indicates the angina is due to something other than the atherosclerosis (CMS 2020a, Section I.C.9.b.,
49). Use 4A023N7 for Measurement of cardiac sampling and pressure, left heart, percutaneous
approach. The left heart catheterization is reported with code B2111ZZ. The ICD-10-PCS root
operation is Measurement along with the function value of Sampling and Pressure. The angiogram
code reflects the use of fluoroscopy performed with low osmolar contrast (Schraffenberger and
Palkie 2020, 308-310).
6. Normal twin delivery at 30 weeks. Both babies were delivered vaginally and were liveborn. What
conditions should have codes assigned?
O30.003
Twin pregnancy, unspecified number of placenta and unspecified number of amniotic sacs, third
trimester
O30.009
Twin pregnancy, unspecified number of placenta and unspecified number of amniotic sacs,
unspecified trimester
O60.14X0
Preterm labor third trimester with preterm delivery third trimester, not applicable or unspecified
O60.14X1
Preterm labor third trimester with preterm delivery third trimester, fetus 1
O60.14X2
Preterm labor third trimester with preterm delivery third trimester, fetus 2
O80
Encounter for full-term uncomplicated delivery
