CCS EXAM 2 LATEST VERSIONS 2024 (VERSION A AND B) COMPLETE 400 QUESTIONS AND CORRECT
DETAILED ANSWERS
Assign code(s) for the following diagnosis: Congestive heart failure due to hypertension.
I10Essential (primary) hypertension
I11.0Hypertensive heart disease with heart failure
I50.9Heart failure, unspecified
I50.23Acute on chronic systolic (congestive) heart failure
a. I10, I50.9
b. I11.0
c. I50.23, I10
d. I11.0, I50.9 - (answer) Correct Answer: D
Heart failure is assigned a combination code when a causal relationship is stated (due to hypertension)
or implied (hypertensive). Use an additional code to identify the type of heart failure in those patients
with heart failure (CMS 2020a, Section I.C.9.a.1, 46-47).
A patient is seen for evaluation of a right orbital roof fracture. How should this be coded?
S02.121AFracture of orbital roof, right side, initial encounter for closed fracture
S02.31XAFracture of orbital floor, right side, initial encounter for closed fracture
S02.92XAUnspecified fracture of facial bones, initial encounter for closed fracture
S02.91XAUnspecified fracture of skull, initial encounter for closed fracture
a. S02.121A
b. S02.31XA
c. S02.92XA
d. S02.91XA - (answer) Correct Answer: A
Alphabetic Index for fracture, traumatic; orbit, orbital; roof guides the coder to S02.12. Evaluation of a
fracture is an example of active treatment which is reported with 7th character "A" (Schraffenberger and
Palkie 2020, 580-584).
,CCS EXAM 2 LATEST VERSIONS 2024 (VERSION A AND B) COMPLETE 400 QUESTIONS AND CORRECT
DETAILED ANSWERS
Patient presents in the ER with thrombosis of a loop PTFE hemodialysis fistula without mechanical
complications. The physician performed a percutaneous thrombectomy of the left brachial vein. Assign a
facility code for this outpatient procedure.
05CA3ZZExtirpation of matter from left brachial vein, percutaneous approach
36904Percutaneous transluminal mechanical thrombectomy and/or infusion for thrombolysis, dialysis
circuit, any method, including all imaging and radiological supervision and interpretation, diagnostic
angiography, fluoroscopic guidance, catheter placement(s), and intraprocedural pharmacological
thrombolytic injection(s)
36832Revision, open, arteriovenous fistula; without thrombectomy, autogenous or nonautogenous
dialysis graft (separate procedure)
37184Primary percutaneous transluminal mechanical thrombectomy, noncoronary, arterial or arterial
bypass graft, including fluoroscopic guidance and intrapro - (answer) Correct Answer: B
This episode of care occurs in the ER which is an outpatient setting, therefore, a CPT code should be
used. CPT code 36904 correctly identifies the thrombectomy procedure because it specifies the site of
the thrombectomy as "dialysis circuit." 36904 includes imaging guidance, diagnostic angiography,
catheter placement, and intraprocedural pharmacological thrombolytic injections" (Kirchoff 2009, 203).
Patient admitted for laparoscopic repair of right diaphragmatic hernia. Assign the ICD-10-PCS procedure
code for this surgery.
0BQT4ZZRepair diaphragm, percutaneous endoscopic approach
0BQT3ZZRepair diaphragm, percutaneous approach
0WQF4ZZRepair abdominal wall, percutaneous endoscopic approach
0BQT0ZZRepair diaphragm, open approach
a. 0BQT4ZZ
b. 0BQT3ZZ
c. 0WQF4ZZ
d. 0BQT0ZZ - (answer) Correct Answer: A
ICD-10-PCS code 0BQT4ZZ is the correct code based on the values for the body part and approach. The
correct body part is diaphragm and laparoscopy is reported as a percutaneous endoscopic method of
approach (Leon-Chisen 2020, 250-251).
,CCS EXAM 2 LATEST VERSIONS 2024 (VERSION A AND B) COMPLETE 400 QUESTIONS AND CORRECT
DETAILED ANSWERS
A 23-year-old female is admitted for vaginal bleeding following a miscarriage two weeks prior to this
admission. She is afebrile at this time and is treated with an aspiration dilation and curettage. Products
of conception are found. Which of the following should be the principal diagnosis?
a. O03.1, Delayed or excessive hemorrhage following incomplete spontaneous abortion
b. O08.1, Delayed or excessive hemorrhage following ectopic and molar pregnancy
c. O03.6, Delayed or excessive hemorrhage following complete or unspecified spontaneous abortion
d. O07.1, Delayed or excessive hemorrhage following failed attempted termination of pregnancy -
(answer) Correct Answer: A
A miscarriage is a spontaneous abortion. If the readmission is for the purpose of dealing with retained
products of conception, the spontaneous abortion is incomplete; use a code from the O03 category
(CMS 2020a, Section I.C.15.q., 68).
A patient presents to the emergency department with a fractured arm secondary to a fall precipitated by
syncope and ataxia. The patient undergoes a closed reduction of the fracture in the emergency
department and is then admitted for work up for metastatic carcinoma secondary to ataxia and syncope
in a patient with recent history of lung cancer. The patient's work-up confirms recurrent lung carcinoma
metastatic to the brain.The principal diagnosis should be:
a. Fractured arm
b. Syncope
c. Metastatic carcinoma of the brain
d. Carcinoma of the lung - (answer) Correct Answer: C
According to the UHDDS definition, the principal diagnosis is "that condition established after study to
be chiefly responsible for occasioning the admission of the patient to the hospital for care." In this case,
metastatic carcinoma of the brain is responsible for the patient's ataxia and syncope, which led to the fall
(CMS 2020a, Section II, 107).
A female patient with hematochezia presents to the hospital outpatient surgery department for a
colonoscopy but the procedure was not performed due to elevated blood pressure. What is the
firstlisted diagnosis for this encounter?
a. Elevated blood pressure
b. Hematochezia
c. Procedure not performed due to contraindication
, CCS EXAM 2 LATEST VERSIONS 2024 (VERSION A AND B) COMPLETE 400 QUESTIONS AND CORRECT
DETAILED ANSWERS
d. Procedure not performed for other reason - (answer) Correct Answer: B
When a patient presents for outpatient surgery, code the reason for the surgery as the firstlisted
diagnosis (reason for the encounter) even if the surgery is not performed due to a contraindication (CMS
2020a, Section IV.A.1., 113).
A 55-year-old patient with AIDS admitted after being struck by car while walking in a parking lot. She has
a comminuted, right femoral shaft fracture and a contusion of both hands and right elbow abrasion. The
principal diagnosis should be the:
a. AIDS
b. Fractured femur
c. Abrasion elbow
d. Contusion hand - (answer) Correct Answer: B
If a patient with HIV disease is admitted for an unrelated condition (such as a traumatic injury), the code
for the unrelated condition (for example, the nature of injury code) should be the principal diagnosis.
The most severe injury should be sequenced first. Other diagnoses would be B20 followed by additional
diagnosis codes for all reported HIV-related conditions (CMS 2020a, Section I.C.1.a.2.b., 21).
A patient takes Coumadin as prescribed and correctly administered. However, the patient develops
hematuria secondary to the Coumadin use. The correct coding assignment for this case would be:
a. Poisoning due to Coumadin
b. Unspecified adverse reaction to Coumadin
c. Hematuria, poisoning due to Coumadin
d. Hematuria, adverse reaction to Coumadin - (answer) Correct Answer: D
An adverse reaction can occur when a drug was correctly prescribed and administered. In the case of an
adverse reaction, the manifestation is coded first (Hematuria) followed by a T code for the medication
(Coumadin) (CMS 2020a, Section I.C.19.e.5(a), 81).
A patient with human immunodeficiency virus (HIV) with methicillin susceptible pneumonia due to
Staphylococcus aureus was discharged from the acute-care setting. The physician documented that the
pneumonia was HIV related. How should this be coded?B20Human immunodeficiency virus [HIV]
disease
J15.20Pneumonia due to staphylococcus, unspecified
DETAILED ANSWERS
Assign code(s) for the following diagnosis: Congestive heart failure due to hypertension.
I10Essential (primary) hypertension
I11.0Hypertensive heart disease with heart failure
I50.9Heart failure, unspecified
I50.23Acute on chronic systolic (congestive) heart failure
a. I10, I50.9
b. I11.0
c. I50.23, I10
d. I11.0, I50.9 - (answer) Correct Answer: D
Heart failure is assigned a combination code when a causal relationship is stated (due to hypertension)
or implied (hypertensive). Use an additional code to identify the type of heart failure in those patients
with heart failure (CMS 2020a, Section I.C.9.a.1, 46-47).
A patient is seen for evaluation of a right orbital roof fracture. How should this be coded?
S02.121AFracture of orbital roof, right side, initial encounter for closed fracture
S02.31XAFracture of orbital floor, right side, initial encounter for closed fracture
S02.92XAUnspecified fracture of facial bones, initial encounter for closed fracture
S02.91XAUnspecified fracture of skull, initial encounter for closed fracture
a. S02.121A
b. S02.31XA
c. S02.92XA
d. S02.91XA - (answer) Correct Answer: A
Alphabetic Index for fracture, traumatic; orbit, orbital; roof guides the coder to S02.12. Evaluation of a
fracture is an example of active treatment which is reported with 7th character "A" (Schraffenberger and
Palkie 2020, 580-584).
,CCS EXAM 2 LATEST VERSIONS 2024 (VERSION A AND B) COMPLETE 400 QUESTIONS AND CORRECT
DETAILED ANSWERS
Patient presents in the ER with thrombosis of a loop PTFE hemodialysis fistula without mechanical
complications. The physician performed a percutaneous thrombectomy of the left brachial vein. Assign a
facility code for this outpatient procedure.
05CA3ZZExtirpation of matter from left brachial vein, percutaneous approach
36904Percutaneous transluminal mechanical thrombectomy and/or infusion for thrombolysis, dialysis
circuit, any method, including all imaging and radiological supervision and interpretation, diagnostic
angiography, fluoroscopic guidance, catheter placement(s), and intraprocedural pharmacological
thrombolytic injection(s)
36832Revision, open, arteriovenous fistula; without thrombectomy, autogenous or nonautogenous
dialysis graft (separate procedure)
37184Primary percutaneous transluminal mechanical thrombectomy, noncoronary, arterial or arterial
bypass graft, including fluoroscopic guidance and intrapro - (answer) Correct Answer: B
This episode of care occurs in the ER which is an outpatient setting, therefore, a CPT code should be
used. CPT code 36904 correctly identifies the thrombectomy procedure because it specifies the site of
the thrombectomy as "dialysis circuit." 36904 includes imaging guidance, diagnostic angiography,
catheter placement, and intraprocedural pharmacological thrombolytic injections" (Kirchoff 2009, 203).
Patient admitted for laparoscopic repair of right diaphragmatic hernia. Assign the ICD-10-PCS procedure
code for this surgery.
0BQT4ZZRepair diaphragm, percutaneous endoscopic approach
0BQT3ZZRepair diaphragm, percutaneous approach
0WQF4ZZRepair abdominal wall, percutaneous endoscopic approach
0BQT0ZZRepair diaphragm, open approach
a. 0BQT4ZZ
b. 0BQT3ZZ
c. 0WQF4ZZ
d. 0BQT0ZZ - (answer) Correct Answer: A
ICD-10-PCS code 0BQT4ZZ is the correct code based on the values for the body part and approach. The
correct body part is diaphragm and laparoscopy is reported as a percutaneous endoscopic method of
approach (Leon-Chisen 2020, 250-251).
,CCS EXAM 2 LATEST VERSIONS 2024 (VERSION A AND B) COMPLETE 400 QUESTIONS AND CORRECT
DETAILED ANSWERS
A 23-year-old female is admitted for vaginal bleeding following a miscarriage two weeks prior to this
admission. She is afebrile at this time and is treated with an aspiration dilation and curettage. Products
of conception are found. Which of the following should be the principal diagnosis?
a. O03.1, Delayed or excessive hemorrhage following incomplete spontaneous abortion
b. O08.1, Delayed or excessive hemorrhage following ectopic and molar pregnancy
c. O03.6, Delayed or excessive hemorrhage following complete or unspecified spontaneous abortion
d. O07.1, Delayed or excessive hemorrhage following failed attempted termination of pregnancy -
(answer) Correct Answer: A
A miscarriage is a spontaneous abortion. If the readmission is for the purpose of dealing with retained
products of conception, the spontaneous abortion is incomplete; use a code from the O03 category
(CMS 2020a, Section I.C.15.q., 68).
A patient presents to the emergency department with a fractured arm secondary to a fall precipitated by
syncope and ataxia. The patient undergoes a closed reduction of the fracture in the emergency
department and is then admitted for work up for metastatic carcinoma secondary to ataxia and syncope
in a patient with recent history of lung cancer. The patient's work-up confirms recurrent lung carcinoma
metastatic to the brain.The principal diagnosis should be:
a. Fractured arm
b. Syncope
c. Metastatic carcinoma of the brain
d. Carcinoma of the lung - (answer) Correct Answer: C
According to the UHDDS definition, the principal diagnosis is "that condition established after study to
be chiefly responsible for occasioning the admission of the patient to the hospital for care." In this case,
metastatic carcinoma of the brain is responsible for the patient's ataxia and syncope, which led to the fall
(CMS 2020a, Section II, 107).
A female patient with hematochezia presents to the hospital outpatient surgery department for a
colonoscopy but the procedure was not performed due to elevated blood pressure. What is the
firstlisted diagnosis for this encounter?
a. Elevated blood pressure
b. Hematochezia
c. Procedure not performed due to contraindication
, CCS EXAM 2 LATEST VERSIONS 2024 (VERSION A AND B) COMPLETE 400 QUESTIONS AND CORRECT
DETAILED ANSWERS
d. Procedure not performed for other reason - (answer) Correct Answer: B
When a patient presents for outpatient surgery, code the reason for the surgery as the firstlisted
diagnosis (reason for the encounter) even if the surgery is not performed due to a contraindication (CMS
2020a, Section IV.A.1., 113).
A 55-year-old patient with AIDS admitted after being struck by car while walking in a parking lot. She has
a comminuted, right femoral shaft fracture and a contusion of both hands and right elbow abrasion. The
principal diagnosis should be the:
a. AIDS
b. Fractured femur
c. Abrasion elbow
d. Contusion hand - (answer) Correct Answer: B
If a patient with HIV disease is admitted for an unrelated condition (such as a traumatic injury), the code
for the unrelated condition (for example, the nature of injury code) should be the principal diagnosis.
The most severe injury should be sequenced first. Other diagnoses would be B20 followed by additional
diagnosis codes for all reported HIV-related conditions (CMS 2020a, Section I.C.1.a.2.b., 21).
A patient takes Coumadin as prescribed and correctly administered. However, the patient develops
hematuria secondary to the Coumadin use. The correct coding assignment for this case would be:
a. Poisoning due to Coumadin
b. Unspecified adverse reaction to Coumadin
c. Hematuria, poisoning due to Coumadin
d. Hematuria, adverse reaction to Coumadin - (answer) Correct Answer: D
An adverse reaction can occur when a drug was correctly prescribed and administered. In the case of an
adverse reaction, the manifestation is coded first (Hematuria) followed by a T code for the medication
(Coumadin) (CMS 2020a, Section I.C.19.e.5(a), 81).
A patient with human immunodeficiency virus (HIV) with methicillin susceptible pneumonia due to
Staphylococcus aureus was discharged from the acute-care setting. The physician documented that the
pneumonia was HIV related. How should this be coded?B20Human immunodeficiency virus [HIV]
disease
J15.20Pneumonia due to staphylococcus, unspecified
