Certified Coding Specialist (CCS) Exam
Preparation questions and answers
2026\2027 A+ Grade
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
- correct 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
- correct 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
- correct 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
- correct 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
- correct 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.
- correct 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
- correct 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
- correct 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.
- correct 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.
Preparation questions and answers
2026\2027 A+ Grade
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
- correct 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
- correct 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
- correct 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
- correct 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
- correct 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.
- correct 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
- correct 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
- correct 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.
- correct 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.
