CCS FINAL STUDY GUIDE 2026 CORRECT
SOLUTIONS GRADED A+
◍ 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).
◍ 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).
◍ 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
d. Procedure not performed for other reason. Answer: Correct
Answer: B
SOLUTIONS GRADED A+
◍ 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).
◍ 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).
◍ 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
d. Procedure not performed for other reason. Answer: Correct
Answer: B
