CCS EXAM PREP 2025/2026 QUESTIONS
AND ANSWERS 100% PASS
This patient was admitted for chemotherapy due to a primary hepatocellular carcinoma of the
transplanted liver. What codes are assigned?
a. Z51.11, C22.0
b. Z51.11, C22.0, C80.2
c. Z51.11, T86.49, C80.2, C22.0
d. T86.49, C80.2, C22.0 - ANS Correct Answer: C
Code T86.49 should be assigned for complication of liver transplant along with code C80.2 for
malignancy associated with organ transplant. A malignant neoplasm of a transplanted organ
should be coded as a transplant complication (CMS 2018a, Section I.C.2.r., 34).
A 7-year-old patient was admitted to the emergency department for treatment of shortness of
breath. The patient is given epinephrine and nebulizer treatments. The shortness of breath and
wheezing are unabated following treatment. What diagnosis should be suspected?
a. Acute bronchitis
b. Acute bronchitis with chronic obstructive pulmonary disease
c. Asthma with status asthmaticus
d. Chronic obstructive asthma - ANS Correct Answer: C
"Status asthmaticus is an acute asthmatic attack in which the degree of bronchial obstruction is
not relieved by the usual treatment, such as by epinephrine or aminophylline" (Schraffenberger
and Palkie 2018, 346-347).
1 @COPYRIGHT 2025/2026.
,. A patient is admitted with a high temperature, lethargy, hypotension, tachycardia, oliguria,
and elevated WBC. The patient also has more than 100,000 organisms of Escherichia coli per cc
of urine. The attending physician documents "urosepsis." What is the next step for the coder?
a. Code sepsis as the principal with a secondary diagnosis of urinary tract infection due to E.
coli.
b. Code urinary tract infection with sepsis as a secondary diagnosis.
c. Query the physician to determine if the patient is being treated for sepsis, highlighting the
clinical signs and symptoms.
d. Ask the physician whether the patient had septic shock so that this may be used as the
principal diagnosis. - ANS Correct Answer: C
The term urosepsis is a nonspecific term. It has no default code in the Alphabetic Index. Should
providers use this term, they must be queried for clarification (CMS 2018a, Section I.C.1.d., 22).
During a coronary artery bypass surgery, the patient underwent saphenous bypass grafts; from
the aorta to the left anterior descending branch of the left main coronary artery, and the left
posterior descending of the left main coronary artery. The patient also underwent a
repositioning of the mammary artery to the right coronary artery. Choose the best description
for this procedure.
a. Three aortocoronary grafts
b. Two aortocoronary grafts and one mammary-coronary graft
c. Two aortocoronary grafts and two saphenous bypass grafts
d. Three aortocoronary grafts and one mammary-coronary graft - ANS Correct Answer: B
It is rare for only one coronary artery to be bypassed, and it is also fairly common to perform
both an internal mammary-coronary artery bypass and an aortocoronary bypass at the same
operative episode (Schraffenberger and Palkie 2018, 324-326).
According to CPT, an endoscopy that is undertaken to the level of the midtransverse colon
would be coded as a:
a. Proctosigmoidoscopy
b. Sigmoidoscopy
c. Colonoscopy
d. Proctoscopy - ANS orrect Answer: C
2 @COPYRIGHT 2025/2026.
,A colonoscopy is an examination of the entire colon, from the rectum to the cecum that may
include the terminal ileum. In general, a colonoscopy examines the colon to a level of 60 cm or
higher (Smith 2018, 135-136).
Infusion of Herceptin, a monoclonal antibody used for treatment of breast cancer in patients
carrying a certain mutation of the HER2 gene, is classified as:
a. Chemotherapy
b. Radiotherapy
c. Molecular Targets
d. Immunotherapy - ANS Correct Answer: C
Targeted cancer therapies are drugs or other substances that block the growth and spread of
cancer by interfering with specific molecules involved in tumor growth and progression.
Herceptin is a type of targeted cancer therapy also referred to as a monoclonal antibody
(National Cancer Institute 2018).
A patient has findings suggestive of chronic obstructive pulmonary disease (COPD) on chest x-
ray. The attending physician mentions the x-ray finding in one progress note but no medication,
treatment, or further evaluation is provided. The coder should:
a. Query the attending physician regarding the x-ray finding
b. Code the condition because the documentation reflects it
c. Question the radiologist regarding whether to code this condition
d. Use a code from abnormal findings to reflect the condition - ANS Correct Answer: A
Query the attending physician regarding the clinical significance of the findings and request that
appropriate documentation be provided. This is an example of a circumstance where the
chronic condition must be verified. All secondary conditions must meet the UHDDS definitions;
it is not clear if COPD does (CMS 2018a, Section III, 105-106).
If a patient undergoes an inpatient procedure and the final summary diagnosis is different from
the diagnosis on the pathology report, the coder should:
a. Code only from the discharge diagnoses
b. Code the diagnosis reflected on the pathology report
c. Code the most severe symptom
d. Query the attending physician as to the final diagnosis - ANS Correct Answer: D
3 @COPYRIGHT 2025/2026.
, Coding strictly from the pathology report is not appropriate as the coder is assigning a diagnosis
without the attending physician's corroboration. It is therefore appropriate to query the
physician (CMS 2018a, Section III, 105-106).
A 56-year-old woman is admitted to an acute-care facility from a skilled nursing facility. The
patient has multiple sclerosis and hypertension. During the course of hospitalization, a
decubitus ulcer is found and debrided at the bedside by a physician. There is no typed operative
report and no pathology report. The coder should:
a. Use an excisional debridement code as these charts are rarely reviewed to verify the
excisional debridement
b. Code with a nonexcisional debridement procedure code
c. Query the healthcare provider who performed the procedure to determine if the
debridement was excisional
d. Eliminate the procedure code all together - ANS Correct Answer: C
Excisional debridement can be performed in the operating room, the emergency department,
or at the bedside. Coders are encouraged to work with the physician and other healthcare
providers to ensure that the documentation in the health record is very specific regarding the
type of debridement performed. If there is any question as to whether the debridement is
excisional or nonexcisional, the provider should be queried for clarification (Schraffenberger
and Palkie 2018, 402).
A 23-year-old female is admitted for shock following treatment of a miscarriage. The pathology
report from the previous admission reveals that the patient had no decidua or products of
conception in the tissue removed. This encounter would be coded as:
a. O03.81, Spontaneous abortion complicated by shock
b. O08.9, Complication following abortion and ectopic and molar pregnancies
c. R57.9, Shock NOS
d. T81.10XA, Postoperative shock - ANS Correct Answer: B
When a patient is readmitted because a complication has developed following discharge for a
treated miscarriage, a code from category O08 is assigned as the principal diagnosis. Code
O08.9 is used because the miscarriage (spontaneous abortion) was dealt with in a prior episode
of care (Leon-Chisen 2018, 347-348).
Most hospitals require a medical record is completed within:
4 @COPYRIGHT 2025/2026.
AND ANSWERS 100% PASS
This patient was admitted for chemotherapy due to a primary hepatocellular carcinoma of the
transplanted liver. What codes are assigned?
a. Z51.11, C22.0
b. Z51.11, C22.0, C80.2
c. Z51.11, T86.49, C80.2, C22.0
d. T86.49, C80.2, C22.0 - ANS Correct Answer: C
Code T86.49 should be assigned for complication of liver transplant along with code C80.2 for
malignancy associated with organ transplant. A malignant neoplasm of a transplanted organ
should be coded as a transplant complication (CMS 2018a, Section I.C.2.r., 34).
A 7-year-old patient was admitted to the emergency department for treatment of shortness of
breath. The patient is given epinephrine and nebulizer treatments. The shortness of breath and
wheezing are unabated following treatment. What diagnosis should be suspected?
a. Acute bronchitis
b. Acute bronchitis with chronic obstructive pulmonary disease
c. Asthma with status asthmaticus
d. Chronic obstructive asthma - ANS Correct Answer: C
"Status asthmaticus is an acute asthmatic attack in which the degree of bronchial obstruction is
not relieved by the usual treatment, such as by epinephrine or aminophylline" (Schraffenberger
and Palkie 2018, 346-347).
1 @COPYRIGHT 2025/2026.
,. A patient is admitted with a high temperature, lethargy, hypotension, tachycardia, oliguria,
and elevated WBC. The patient also has more than 100,000 organisms of Escherichia coli per cc
of urine. The attending physician documents "urosepsis." What is the next step for the coder?
a. Code sepsis as the principal with a secondary diagnosis of urinary tract infection due to E.
coli.
b. Code urinary tract infection with sepsis as a secondary diagnosis.
c. Query the physician to determine if the patient is being treated for sepsis, highlighting the
clinical signs and symptoms.
d. Ask the physician whether the patient had septic shock so that this may be used as the
principal diagnosis. - ANS Correct Answer: C
The term urosepsis is a nonspecific term. It has no default code in the Alphabetic Index. Should
providers use this term, they must be queried for clarification (CMS 2018a, Section I.C.1.d., 22).
During a coronary artery bypass surgery, the patient underwent saphenous bypass grafts; from
the aorta to the left anterior descending branch of the left main coronary artery, and the left
posterior descending of the left main coronary artery. The patient also underwent a
repositioning of the mammary artery to the right coronary artery. Choose the best description
for this procedure.
a. Three aortocoronary grafts
b. Two aortocoronary grafts and one mammary-coronary graft
c. Two aortocoronary grafts and two saphenous bypass grafts
d. Three aortocoronary grafts and one mammary-coronary graft - ANS Correct Answer: B
It is rare for only one coronary artery to be bypassed, and it is also fairly common to perform
both an internal mammary-coronary artery bypass and an aortocoronary bypass at the same
operative episode (Schraffenberger and Palkie 2018, 324-326).
According to CPT, an endoscopy that is undertaken to the level of the midtransverse colon
would be coded as a:
a. Proctosigmoidoscopy
b. Sigmoidoscopy
c. Colonoscopy
d. Proctoscopy - ANS orrect Answer: C
2 @COPYRIGHT 2025/2026.
,A colonoscopy is an examination of the entire colon, from the rectum to the cecum that may
include the terminal ileum. In general, a colonoscopy examines the colon to a level of 60 cm or
higher (Smith 2018, 135-136).
Infusion of Herceptin, a monoclonal antibody used for treatment of breast cancer in patients
carrying a certain mutation of the HER2 gene, is classified as:
a. Chemotherapy
b. Radiotherapy
c. Molecular Targets
d. Immunotherapy - ANS Correct Answer: C
Targeted cancer therapies are drugs or other substances that block the growth and spread of
cancer by interfering with specific molecules involved in tumor growth and progression.
Herceptin is a type of targeted cancer therapy also referred to as a monoclonal antibody
(National Cancer Institute 2018).
A patient has findings suggestive of chronic obstructive pulmonary disease (COPD) on chest x-
ray. The attending physician mentions the x-ray finding in one progress note but no medication,
treatment, or further evaluation is provided. The coder should:
a. Query the attending physician regarding the x-ray finding
b. Code the condition because the documentation reflects it
c. Question the radiologist regarding whether to code this condition
d. Use a code from abnormal findings to reflect the condition - ANS Correct Answer: A
Query the attending physician regarding the clinical significance of the findings and request that
appropriate documentation be provided. This is an example of a circumstance where the
chronic condition must be verified. All secondary conditions must meet the UHDDS definitions;
it is not clear if COPD does (CMS 2018a, Section III, 105-106).
If a patient undergoes an inpatient procedure and the final summary diagnosis is different from
the diagnosis on the pathology report, the coder should:
a. Code only from the discharge diagnoses
b. Code the diagnosis reflected on the pathology report
c. Code the most severe symptom
d. Query the attending physician as to the final diagnosis - ANS Correct Answer: D
3 @COPYRIGHT 2025/2026.
, Coding strictly from the pathology report is not appropriate as the coder is assigning a diagnosis
without the attending physician's corroboration. It is therefore appropriate to query the
physician (CMS 2018a, Section III, 105-106).
A 56-year-old woman is admitted to an acute-care facility from a skilled nursing facility. The
patient has multiple sclerosis and hypertension. During the course of hospitalization, a
decubitus ulcer is found and debrided at the bedside by a physician. There is no typed operative
report and no pathology report. The coder should:
a. Use an excisional debridement code as these charts are rarely reviewed to verify the
excisional debridement
b. Code with a nonexcisional debridement procedure code
c. Query the healthcare provider who performed the procedure to determine if the
debridement was excisional
d. Eliminate the procedure code all together - ANS Correct Answer: C
Excisional debridement can be performed in the operating room, the emergency department,
or at the bedside. Coders are encouraged to work with the physician and other healthcare
providers to ensure that the documentation in the health record is very specific regarding the
type of debridement performed. If there is any question as to whether the debridement is
excisional or nonexcisional, the provider should be queried for clarification (Schraffenberger
and Palkie 2018, 402).
A 23-year-old female is admitted for shock following treatment of a miscarriage. The pathology
report from the previous admission reveals that the patient had no decidua or products of
conception in the tissue removed. This encounter would be coded as:
a. O03.81, Spontaneous abortion complicated by shock
b. O08.9, Complication following abortion and ectopic and molar pregnancies
c. R57.9, Shock NOS
d. T81.10XA, Postoperative shock - ANS Correct Answer: B
When a patient is readmitted because a complication has developed following discharge for a
treated miscarriage, a code from category O08 is assigned as the principal diagnosis. Code
O08.9 is used because the miscarriage (spontaneous abortion) was dealt with in a prior episode
of care (Leon-Chisen 2018, 347-348).
Most hospitals require a medical record is completed within:
4 @COPYRIGHT 2025/2026.
