CCS Exam Prep -Questions With Complete Solutions
7 yo pt admitted to ED for tx of shortness of breath and given epinephrine and
nebulizer tx. Shortness of breath and wheezing are unabated following tx, so
what dx should be suspected? Correct Answer - Asthma with status
asthmaticus
Pt admitted with high temp, lethargy, hypotension, tachycardia, oliguria,
elevated WBC, and has more than 100K organisms of E. coli per cc of urine.
Attending phys documents "urosepsis", so what is the next step for the coder?
Correct Answer - Since PD is a nonspecific term and has no code in Alpha
Index, query phys to determine if pt is being treated for sepsis, highlighting
the clinical signs, symptoms
During CABG, pt underwent saphenous bypass grafts; from aorta to left ant
desc branch of left main coronary artery, and the left post desc of left main
coronary artery. Pt also underwent repositioning of the mammary artery to
the right coronary artery. What is the best description for this px? Correct
Answer - 2 aortocoronary grafts and 1 mammary-coronary graft
According to CPT, an endoscopy that is undertaken to the level of
midtransverse colon would be coded as a: Correct Answer - Colonoscopy
since this is an examination of entire colon from rectum to cecum that may
include terminal ileum
Infusion of Herceptin, a monoclonal antibody used for tx of breast cancer in
pts carrying a certain mutation of the HER2 gene, is classified as: Correct
Answer - Molecular Targets which block the growth, spread of cancer by
interfering with specific molecules involved in tumor growth, progression
Pt has findings suggestive of COPD on chest x-ray and Attending phys
mentions x-ray finding in one progress note but no meds, tx, or further eval.
The coder should: Correct Answer - Query phys regarding clinical
significance of findings and request appropriate documentation be provided
as this is example of a circumstance where chronic condition must be verified;
,all secondary conditions must meet the UHDDS definitions although it is not
clear if COPD does
Pt undergoes inpatient px and final summary dx is difference from dx on path
report, the coder should: Correct Answer - Query Attending phys as
final dx as coding strictly from path report is not appropriate since coder
would be assigning dx without Attending phys' corroboration
56 yo woman admitted to acute-care facility from SNF and has multiple
sclerosis and hypertension. During course of hospitalization, decubitus ulcer
is found and debrided at bedside by phys. There is no typed op report and no
path report. The coder should: Correct Answer - Query healthcare
provider who performed px to determine if debridement was excisional as
coders are encouraged to work with physicians, healthcare providers to
ensure documentation is very specific and clarified
23 yo female admitted for shock following tx of miscarriage and path report
from prev admit reveals pt had no decidua or POC in tissue removed.
Encounter would be coded as: Correct Answer - O08.9 = complication
following abortion and ectopic and molar pregnancies since miscarriage was
dealt with in a prior episode of care
Most hospitals require a medical record is completed within: Correct
Answer - 30 days due to Medicare CofP and TJC
To correct an entry in the MR, the provider should: Correct Answer -
Draw single line through the error, add a note explaining the error, initial,
date, and add correct info in chronological order
After pt is discharged from hospital, the MR must be reviewed for:
Correct Answer - Certain basic reports such as history and physical,
discharge summary, etc.
Pt is discharged with diagnosis of acute pulmonary edema due to CHF so what
cn(s) should be coded? Correct Answer - CHF
Pt is admitted for chest pain, was stabilized and discharged. In subsequent
adm, pt was admitted an outpt for left heart catheterization, coronary
arteriography using 2 catheters, left ventricular angiography, and found to
,have arteriosclerotic heart disease. Pt has no hx of cardiac surgery. What is
the proper sequencing of ICD-10-CM and CPT codes for outpt catheterization?
Correct Answer - I25.10 (Atherosclerotic heart disease of native coronary
artery without angina pectoris)
93458 (Catheter placement in coronary artery(s) for coronary angiography,
incl intraprocedural injection(s) for coronary angiography, imaging
supervision and interpretation with left heart catheterization including
intraprocedural injection(s) for left ventriculography, when performed
65yo pt adm w/pain and loosening of left total hip prosthesis along with the
loosening of the acetabular component which has become painful. Pt ad for
open removal/replacement of acetabular component of left hip prosthesis, so
what is the correct coding for admission? Correct Answer - T84.031A
(mechanical loosening of int lt hip prosth jt, initial enc
0SPB0JZ (removal synthetic sub fro lt hip jt, open approach
0SRE0JZ (replacement lt hip jt, acetabular surface w/synthetic sub, open
approach)
Maternity pt adm in labor at 43 wks and has normal delivery with vacuum
extraction to facilitate baby's delivery. What is the PD? Correct Answer -
O48.1 (prolonged pg)
With regard to implementation of ICD-10-CM, all of these are correct:
Correct Answer - ICD-10-CM was developed by NCHS; it was implemented
on 10/1/15; was already being used by death certificate coding in US; the
process of adopting ICD-10-CM is specified in HIPAA
What does NCHS stand for? Correct Answer - National Center for Health
Statistics
75yo female was adm for AMI and underwent a diagnostic cardiac cath.
Following the cath, pt dev a thrombophlebitis documented as due to the
catheter in the common femoral artery. The thrombophlebitis would be coded
as: Correct Answer - T81.718A, complication of other artery following a
procedure, NEC, initial enc
, Pt adm to ED w/chest pain, and dx w/abort MI w/acute myocardial ischemia
with no prior cardiac surgery, and normal cardiac enzymes. What is coding for
this case? Correct Answer - I24.0 (acute coronary thrombosis not
resulting in MI) Pts w/acute ischemic heart disease or acute myocardial
ischemia do not always indicate an infarction and it is often possible to
prevent infarction by means of surgery or use of thrombolytic agents if tx
promptly
Pt has nausea, vomiting, abdominal pain due to acute cholecystitis. Phys doc
the following on DS: Acute cholecystitis, nausea, vomiting, and abdominal
pain. What is correct coding? Correct Answer - Acute cholecystitis
Pt adm bc of CHF, and also found to have elevated liver function tests. Phys
worked up ELF test but able to determine dx, so the following dx is assigned:
Correct Answer - CHF and abnormal liver function tests
Pt adm with hypotension due to dobutamine taken and prescribed correctly.
How is this coded? Correct Answer - I95.2, Hypotension due to drugs
T44.5X5A, adverse effects of dobutamine
Pt adm 2 wks after laminectomy for spinal stenosis w/headache (headache
due to tear in dura accidentally occurred during prior laminectomy surgery).
Pt taken to OR for repair of dura. How is this case coded? Correct Answer
- G97.41, Accidental puncture or laceration of dura during procedure
Pt adm w/SOB, CHF, and subsequently dev resp fail. Pt undergoes intubation
w/ventilator mgmt. Correct seq of dx would be: Correct Answer - CHF
and resp failure
Pt adm w/pneumococcal pneumonia and pneumococcal sepsis, so the coder
should: Correct Answer - Assign code for sepsis, pneumonia, and severe
sepsis. Pt w/pneumococcal sepsis and pneumococcal pneumonia also has
severe sepsis and Guidelines provide info related to coding, seq of sepsis,
severe sepsis, and localized infection, such as pneumonia
Pt adm w/ESRD following kidney transplant, who also had angina and COPD,
so dx would be seq as: Correct Answer - ESRD; status post kidney
transplant; COPD; angina
7 yo pt admitted to ED for tx of shortness of breath and given epinephrine and
nebulizer tx. Shortness of breath and wheezing are unabated following tx, so
what dx should be suspected? Correct Answer - Asthma with status
asthmaticus
Pt admitted with high temp, lethargy, hypotension, tachycardia, oliguria,
elevated WBC, and has more than 100K organisms of E. coli per cc of urine.
Attending phys documents "urosepsis", so what is the next step for the coder?
Correct Answer - Since PD is a nonspecific term and has no code in Alpha
Index, query phys to determine if pt is being treated for sepsis, highlighting
the clinical signs, symptoms
During CABG, pt underwent saphenous bypass grafts; from aorta to left ant
desc branch of left main coronary artery, and the left post desc of left main
coronary artery. Pt also underwent repositioning of the mammary artery to
the right coronary artery. What is the best description for this px? Correct
Answer - 2 aortocoronary grafts and 1 mammary-coronary graft
According to CPT, an endoscopy that is undertaken to the level of
midtransverse colon would be coded as a: Correct Answer - Colonoscopy
since this is an examination of entire colon from rectum to cecum that may
include terminal ileum
Infusion of Herceptin, a monoclonal antibody used for tx of breast cancer in
pts carrying a certain mutation of the HER2 gene, is classified as: Correct
Answer - Molecular Targets which block the growth, spread of cancer by
interfering with specific molecules involved in tumor growth, progression
Pt has findings suggestive of COPD on chest x-ray and Attending phys
mentions x-ray finding in one progress note but no meds, tx, or further eval.
The coder should: Correct Answer - Query phys regarding clinical
significance of findings and request appropriate documentation be provided
as this is example of a circumstance where chronic condition must be verified;
,all secondary conditions must meet the UHDDS definitions although it is not
clear if COPD does
Pt undergoes inpatient px and final summary dx is difference from dx on path
report, the coder should: Correct Answer - Query Attending phys as
final dx as coding strictly from path report is not appropriate since coder
would be assigning dx without Attending phys' corroboration
56 yo woman admitted to acute-care facility from SNF and has multiple
sclerosis and hypertension. During course of hospitalization, decubitus ulcer
is found and debrided at bedside by phys. There is no typed op report and no
path report. The coder should: Correct Answer - Query healthcare
provider who performed px to determine if debridement was excisional as
coders are encouraged to work with physicians, healthcare providers to
ensure documentation is very specific and clarified
23 yo female admitted for shock following tx of miscarriage and path report
from prev admit reveals pt had no decidua or POC in tissue removed.
Encounter would be coded as: Correct Answer - O08.9 = complication
following abortion and ectopic and molar pregnancies since miscarriage was
dealt with in a prior episode of care
Most hospitals require a medical record is completed within: Correct
Answer - 30 days due to Medicare CofP and TJC
To correct an entry in the MR, the provider should: Correct Answer -
Draw single line through the error, add a note explaining the error, initial,
date, and add correct info in chronological order
After pt is discharged from hospital, the MR must be reviewed for:
Correct Answer - Certain basic reports such as history and physical,
discharge summary, etc.
Pt is discharged with diagnosis of acute pulmonary edema due to CHF so what
cn(s) should be coded? Correct Answer - CHF
Pt is admitted for chest pain, was stabilized and discharged. In subsequent
adm, pt was admitted an outpt for left heart catheterization, coronary
arteriography using 2 catheters, left ventricular angiography, and found to
,have arteriosclerotic heart disease. Pt has no hx of cardiac surgery. What is
the proper sequencing of ICD-10-CM and CPT codes for outpt catheterization?
Correct Answer - I25.10 (Atherosclerotic heart disease of native coronary
artery without angina pectoris)
93458 (Catheter placement in coronary artery(s) for coronary angiography,
incl intraprocedural injection(s) for coronary angiography, imaging
supervision and interpretation with left heart catheterization including
intraprocedural injection(s) for left ventriculography, when performed
65yo pt adm w/pain and loosening of left total hip prosthesis along with the
loosening of the acetabular component which has become painful. Pt ad for
open removal/replacement of acetabular component of left hip prosthesis, so
what is the correct coding for admission? Correct Answer - T84.031A
(mechanical loosening of int lt hip prosth jt, initial enc
0SPB0JZ (removal synthetic sub fro lt hip jt, open approach
0SRE0JZ (replacement lt hip jt, acetabular surface w/synthetic sub, open
approach)
Maternity pt adm in labor at 43 wks and has normal delivery with vacuum
extraction to facilitate baby's delivery. What is the PD? Correct Answer -
O48.1 (prolonged pg)
With regard to implementation of ICD-10-CM, all of these are correct:
Correct Answer - ICD-10-CM was developed by NCHS; it was implemented
on 10/1/15; was already being used by death certificate coding in US; the
process of adopting ICD-10-CM is specified in HIPAA
What does NCHS stand for? Correct Answer - National Center for Health
Statistics
75yo female was adm for AMI and underwent a diagnostic cardiac cath.
Following the cath, pt dev a thrombophlebitis documented as due to the
catheter in the common femoral artery. The thrombophlebitis would be coded
as: Correct Answer - T81.718A, complication of other artery following a
procedure, NEC, initial enc
, Pt adm to ED w/chest pain, and dx w/abort MI w/acute myocardial ischemia
with no prior cardiac surgery, and normal cardiac enzymes. What is coding for
this case? Correct Answer - I24.0 (acute coronary thrombosis not
resulting in MI) Pts w/acute ischemic heart disease or acute myocardial
ischemia do not always indicate an infarction and it is often possible to
prevent infarction by means of surgery or use of thrombolytic agents if tx
promptly
Pt has nausea, vomiting, abdominal pain due to acute cholecystitis. Phys doc
the following on DS: Acute cholecystitis, nausea, vomiting, and abdominal
pain. What is correct coding? Correct Answer - Acute cholecystitis
Pt adm bc of CHF, and also found to have elevated liver function tests. Phys
worked up ELF test but able to determine dx, so the following dx is assigned:
Correct Answer - CHF and abnormal liver function tests
Pt adm with hypotension due to dobutamine taken and prescribed correctly.
How is this coded? Correct Answer - I95.2, Hypotension due to drugs
T44.5X5A, adverse effects of dobutamine
Pt adm 2 wks after laminectomy for spinal stenosis w/headache (headache
due to tear in dura accidentally occurred during prior laminectomy surgery).
Pt taken to OR for repair of dura. How is this case coded? Correct Answer
- G97.41, Accidental puncture or laceration of dura during procedure
Pt adm w/SOB, CHF, and subsequently dev resp fail. Pt undergoes intubation
w/ventilator mgmt. Correct seq of dx would be: Correct Answer - CHF
and resp failure
Pt adm w/pneumococcal pneumonia and pneumococcal sepsis, so the coder
should: Correct Answer - Assign code for sepsis, pneumonia, and severe
sepsis. Pt w/pneumococcal sepsis and pneumococcal pneumonia also has
severe sepsis and Guidelines provide info related to coding, seq of sepsis,
severe sepsis, and localized infection, such as pneumonia
Pt adm w/ESRD following kidney transplant, who also had angina and COPD,
so dx would be seq as: Correct Answer - ESRD; status post kidney
transplant; COPD; angina
