CERTIFIED CODING SPECIALIST (CCS)
EXAM PREPARATION CORRECT 100%
Diagnostic-related groups (DRGs) and ambulatory patient classifications (APCs) are
similar in that they are both:
a. Determined by HCPCS codes
b. Focused on hospital outpatients
c. Focused on hospital inpatients
d. Prospective payment systems - ANSWER d. Prospective payment systems
** Both are types of prospective payment systems (Casto and Forrestal 2015, 6).
A patient is treated for esophageal varices with hemorrhage due to cirrhosis. The
diagnostic codes that would be assigned are:
I85.01 Esophageal varices with bleeding
I85.11 Secondary esophageal varices with bleeding
K74.60 Unspecified cirrhosis of liver - ANSWER d. K74.60, I85.11
K74.60: Unspecified cirrhosis of liver
I85.11:Secondary esophageal varices with bleeding
**The patient has cirrhosis of the liver with resulting bleeding esophageal varices.
Cirrhosis of liver is sequenced first followed by the code for the bleeding esophageal
varices (HHS 2017, Section I.A.13, 11).
Assign the code(s) for bronchoscopy with bilateral transbronchial biopsy for each lobe of
each lung.
31628 Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed;
with transbronchial lung biopsy(s), single lobe
31629 Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed;
with transbronchial needle aspiration biopsy(s), trachea, main stem and/or lobar
bronchus(i)
31632 Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed;
with transbronchial lung biopsy(s), each additional lobe
−50 Bilateral procedure - ANSWER
Assign the code(s) for endoscopic sinusotomy with bilateral anterior ethmoidectomy.
31231 Nasal endoscopy, diagnostic, unilateral or bilateral (separate procedure)
31254 Nasal/sinus endoscopy, surgical; with ethmoidectomy, partial (anterior)
−50 Bilateral procedurea.
a. 31254
,b. 31254-50
c. 31254, 31254
d. 31231 - ANSWER b. 31254-50
31254 Nasal/sinus endoscopy, surgical; with ethmoidectomy, partial (anterior)
−50 Bilateral procedurea.
** A code for the anterior ethmoidectomy is assigned and to denote the bilateral
procedure, a modifier of -50 is added (CPT Assistant Winter 1993, 23; Jan. 1997, 4;
Sept. 1997, 10; Oct. 1997, 5; Dec. 2001, 6; May 2003, 5). The sinusotomy is not coded
separately, as it is a diagnostic procedure.
The most common language used for both data definition language and data
manipulation language is:
a. Unified modeling language
b. JAVA
c. Perl
d. Structured query language - ANSWER d. Structured query language
** Structured query language (SQL) is used commonly for data language and data
definitions (Sharp 2016, 184).
An ethmoidectomy removes infected tissue and bone in the ethmoid sinuses that blocks
natural drainage. The surgeon views your ethmoid sinuses with an endoscope, a thin
flexible tube with a very small camera and light at the end of it. - ANSWER
Documentation from the nursing or other allied health professionals' notes can be used
to establish which of the following diagnoses:
a. Body mass index (BMI)
b. Malnutrition
c. Aspiration pneumonia
d. Fatigue - ANSWER a. Body mass index (BMI)
** The physician must establish the diagnosis—obesity or morbid obesity—and the
additional information can be pulled from ancillary documentation to establish the
correct code assignment for body mass index (BMI) (Leon-Chisen 2017, 168).
A 55-year-old patient has hypertensive heart disease with congestive heart failure. What
code would be assigned?
a. I15.8, Other secondary hypertension
b. I11.0, Hypertensive heart disease with heart failure and I50.9, Heart failure,
unspecified
c. I50.9, Heart failure, unspecified and I15.0, Renovascular hypertension
d. N18.6, End stage renal disease - ANSWER b. I11.0, Hypertensive heart disease with
heart failure and I50.9, Heart failure, unspecified
,** There is a cause and effect relationship established between the hypertension and
the congestive heart failure. A separate code for the congestive heart failure is assigned
based on the "code also" note (HHS 2017, Section I.C.9.a., 40).
A surgeon would like to undertake a research study on his patients with stage II
malignant melanoma of the back, who have undergone wide excision of the melanoma.
What work processes and associated software could be used to provide this
information?
a. Obtain a summary of the cases from the cancer registry, import them into a
spreadsheet, and provide to the surgeon.
b. Obtain a summary of the cases from the chart completion software, import them into
a spreadsheet, and provide to the surgeon.
c. Obtain a summary of the cases from the master patient index, import them into a
spreadsheet, and provide to the surgeon.
d. Obtain a summary of the cases from the transcription tracking software, import them
into a spreadsheet, and provide to the surgeon. - ANSWER a. Obtain a summary of the
cases from the cancer registry, import them into a spreadsheet, and provide to the
surgeon.
**The cancer registry can be used to undertake studies in addition to reporting cases to
a central registry (Sharp and Madlock-Brown 2016, 173).
A facility located near a national park has a significant number of snake bites, and
patients receive treatment with antivenom in urgent-care settings. Sometimes a patient
is admitted to the hospital after several days. Can the urgent-care setting provide the
hospital with a list of names of patients treated with snake antivenom?
a. Only the names of patients who are admitted to the hospital can be requested if the
physician needs it for continuity of care, but an entire list of patients cannot be provided.
b. A list of names could be provided.
c. No information can be obtained under any circumstances.
d. A list of patients may be available after consultation with the national park ranger. -
ANSWER a. Only the names of patients who are admitted to the hospital can be
requested if the physician needs it for continuity of care, but an entire list of patients
cannot be provided.
**Only records that are required for care or authorized by the patient can be released by
the urgent-care facility to the acute-care facility (Brodnik 2012, 225; Rinehart-Thompson
2016b, 243-247).
What diagnoses and procedures should be reported for recurrent left inguinal hernia
with laparoscopic repair?
, K40.30 Unilateral inguinal hernia, with obstruction, without gangrene, not specified as
recurrent
K40.31 Unilateral inguinal hernia, with obstruction, without gangrene, recurrent
K40.91 Unilateral inguinal hernia, without mention of obstruction or gangrene, recurrent
49520 Repair recurrent inguinal hernia, any age; reducible
49521 Repair recurrent inguinal hernia, any age; incarcerated or strangulated
49651 Laparoscopy, surgical; repair recurrent inguinal hernia
a. K40.91, 49520
b. K40.31, 49521
c. K40.91, 49651
d. K40.30, 49520 - ANSWER c. K40.91:Unilateral inguinal hernia, without mention of
obstruction or gangrene, recurrent
49651:Laparoscopy, surgical; repair recurrent inguinal hernia
**The patient has a recurrent hernia without obstruction and this is captured in diagnosis
code K40.91 (Leon-Chisen 2017, 253; CPT Assistant Nov. 1999, 24; March 2000, 9).
.In order to accurately code a cardiac catheterization, what needs to be determined
based on a review of the documentation?
a. The approach and the side of the heart (chambers) into which the catheter was
inserted
b. The approach, the side of the heart (chambers) into which the catheter was inserted,
as well as any additional procedures performed
c. The duration of the procedure
d. If there is documentation of the procedure in the medical record that stents are
considered - ANSWER b. The approach, the side of the heart (chambers) into which the
catheter was inserted, as well as any additional procedures performed
A condition is present on admission when:
a. It is the principal diagnosis
b. It is accordance with medical staff bylaws
c. A condition that occurs prior to an inpatient admission
d. It is present within 3 days after admission - ANSWER c. A condition that occurs prior
to an inpatient admission
**It is important to understand the time frame for assigning a status code specifying that
a condition is present on admission (Leon-Chisen 2017, 571-574).
A patient was admitted after a fall down the steps. The patient was unconscious for
approximately 45 minutes and was admitted to the emergency department (ED) within 3
hours of the fall. A CT scan was performed within an hour of admission to the ED. A
cerebral contusion was diagnosed by the ED physician based on the findings in the CT
scan. What conditions should be reported on the Uniform Billing form 04 (UB-04)?
EXAM PREPARATION CORRECT 100%
Diagnostic-related groups (DRGs) and ambulatory patient classifications (APCs) are
similar in that they are both:
a. Determined by HCPCS codes
b. Focused on hospital outpatients
c. Focused on hospital inpatients
d. Prospective payment systems - ANSWER d. Prospective payment systems
** Both are types of prospective payment systems (Casto and Forrestal 2015, 6).
A patient is treated for esophageal varices with hemorrhage due to cirrhosis. The
diagnostic codes that would be assigned are:
I85.01 Esophageal varices with bleeding
I85.11 Secondary esophageal varices with bleeding
K74.60 Unspecified cirrhosis of liver - ANSWER d. K74.60, I85.11
K74.60: Unspecified cirrhosis of liver
I85.11:Secondary esophageal varices with bleeding
**The patient has cirrhosis of the liver with resulting bleeding esophageal varices.
Cirrhosis of liver is sequenced first followed by the code for the bleeding esophageal
varices (HHS 2017, Section I.A.13, 11).
Assign the code(s) for bronchoscopy with bilateral transbronchial biopsy for each lobe of
each lung.
31628 Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed;
with transbronchial lung biopsy(s), single lobe
31629 Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed;
with transbronchial needle aspiration biopsy(s), trachea, main stem and/or lobar
bronchus(i)
31632 Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed;
with transbronchial lung biopsy(s), each additional lobe
−50 Bilateral procedure - ANSWER
Assign the code(s) for endoscopic sinusotomy with bilateral anterior ethmoidectomy.
31231 Nasal endoscopy, diagnostic, unilateral or bilateral (separate procedure)
31254 Nasal/sinus endoscopy, surgical; with ethmoidectomy, partial (anterior)
−50 Bilateral procedurea.
a. 31254
,b. 31254-50
c. 31254, 31254
d. 31231 - ANSWER b. 31254-50
31254 Nasal/sinus endoscopy, surgical; with ethmoidectomy, partial (anterior)
−50 Bilateral procedurea.
** A code for the anterior ethmoidectomy is assigned and to denote the bilateral
procedure, a modifier of -50 is added (CPT Assistant Winter 1993, 23; Jan. 1997, 4;
Sept. 1997, 10; Oct. 1997, 5; Dec. 2001, 6; May 2003, 5). The sinusotomy is not coded
separately, as it is a diagnostic procedure.
The most common language used for both data definition language and data
manipulation language is:
a. Unified modeling language
b. JAVA
c. Perl
d. Structured query language - ANSWER d. Structured query language
** Structured query language (SQL) is used commonly for data language and data
definitions (Sharp 2016, 184).
An ethmoidectomy removes infected tissue and bone in the ethmoid sinuses that blocks
natural drainage. The surgeon views your ethmoid sinuses with an endoscope, a thin
flexible tube with a very small camera and light at the end of it. - ANSWER
Documentation from the nursing or other allied health professionals' notes can be used
to establish which of the following diagnoses:
a. Body mass index (BMI)
b. Malnutrition
c. Aspiration pneumonia
d. Fatigue - ANSWER a. Body mass index (BMI)
** The physician must establish the diagnosis—obesity or morbid obesity—and the
additional information can be pulled from ancillary documentation to establish the
correct code assignment for body mass index (BMI) (Leon-Chisen 2017, 168).
A 55-year-old patient has hypertensive heart disease with congestive heart failure. What
code would be assigned?
a. I15.8, Other secondary hypertension
b. I11.0, Hypertensive heart disease with heart failure and I50.9, Heart failure,
unspecified
c. I50.9, Heart failure, unspecified and I15.0, Renovascular hypertension
d. N18.6, End stage renal disease - ANSWER b. I11.0, Hypertensive heart disease with
heart failure and I50.9, Heart failure, unspecified
,** There is a cause and effect relationship established between the hypertension and
the congestive heart failure. A separate code for the congestive heart failure is assigned
based on the "code also" note (HHS 2017, Section I.C.9.a., 40).
A surgeon would like to undertake a research study on his patients with stage II
malignant melanoma of the back, who have undergone wide excision of the melanoma.
What work processes and associated software could be used to provide this
information?
a. Obtain a summary of the cases from the cancer registry, import them into a
spreadsheet, and provide to the surgeon.
b. Obtain a summary of the cases from the chart completion software, import them into
a spreadsheet, and provide to the surgeon.
c. Obtain a summary of the cases from the master patient index, import them into a
spreadsheet, and provide to the surgeon.
d. Obtain a summary of the cases from the transcription tracking software, import them
into a spreadsheet, and provide to the surgeon. - ANSWER a. Obtain a summary of the
cases from the cancer registry, import them into a spreadsheet, and provide to the
surgeon.
**The cancer registry can be used to undertake studies in addition to reporting cases to
a central registry (Sharp and Madlock-Brown 2016, 173).
A facility located near a national park has a significant number of snake bites, and
patients receive treatment with antivenom in urgent-care settings. Sometimes a patient
is admitted to the hospital after several days. Can the urgent-care setting provide the
hospital with a list of names of patients treated with snake antivenom?
a. Only the names of patients who are admitted to the hospital can be requested if the
physician needs it for continuity of care, but an entire list of patients cannot be provided.
b. A list of names could be provided.
c. No information can be obtained under any circumstances.
d. A list of patients may be available after consultation with the national park ranger. -
ANSWER a. Only the names of patients who are admitted to the hospital can be
requested if the physician needs it for continuity of care, but an entire list of patients
cannot be provided.
**Only records that are required for care or authorized by the patient can be released by
the urgent-care facility to the acute-care facility (Brodnik 2012, 225; Rinehart-Thompson
2016b, 243-247).
What diagnoses and procedures should be reported for recurrent left inguinal hernia
with laparoscopic repair?
, K40.30 Unilateral inguinal hernia, with obstruction, without gangrene, not specified as
recurrent
K40.31 Unilateral inguinal hernia, with obstruction, without gangrene, recurrent
K40.91 Unilateral inguinal hernia, without mention of obstruction or gangrene, recurrent
49520 Repair recurrent inguinal hernia, any age; reducible
49521 Repair recurrent inguinal hernia, any age; incarcerated or strangulated
49651 Laparoscopy, surgical; repair recurrent inguinal hernia
a. K40.91, 49520
b. K40.31, 49521
c. K40.91, 49651
d. K40.30, 49520 - ANSWER c. K40.91:Unilateral inguinal hernia, without mention of
obstruction or gangrene, recurrent
49651:Laparoscopy, surgical; repair recurrent inguinal hernia
**The patient has a recurrent hernia without obstruction and this is captured in diagnosis
code K40.91 (Leon-Chisen 2017, 253; CPT Assistant Nov. 1999, 24; March 2000, 9).
.In order to accurately code a cardiac catheterization, what needs to be determined
based on a review of the documentation?
a. The approach and the side of the heart (chambers) into which the catheter was
inserted
b. The approach, the side of the heart (chambers) into which the catheter was inserted,
as well as any additional procedures performed
c. The duration of the procedure
d. If there is documentation of the procedure in the medical record that stents are
considered - ANSWER b. The approach, the side of the heart (chambers) into which the
catheter was inserted, as well as any additional procedures performed
A condition is present on admission when:
a. It is the principal diagnosis
b. It is accordance with medical staff bylaws
c. A condition that occurs prior to an inpatient admission
d. It is present within 3 days after admission - ANSWER c. A condition that occurs prior
to an inpatient admission
**It is important to understand the time frame for assigning a status code specifying that
a condition is present on admission (Leon-Chisen 2017, 571-574).
A patient was admitted after a fall down the steps. The patient was unconscious for
approximately 45 minutes and was admitted to the emergency department (ED) within 3
hours of the fall. A CT scan was performed within an hour of admission to the ED. A
cerebral contusion was diagnosed by the ED physician based on the findings in the CT
scan. What conditions should be reported on the Uniform Billing form 04 (UB-04)?
