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Certified Coding Specialist (CCS) Exam
Prep Questions - AHIMA 6th Edition
Carcinoma in situ
Tumor cells that are undergoing malignant changes but are still confined to the point of origin without invasion of the surrounding normal tissue
Examples of carcinoma in situ
Intraepithelial infiltrating
The patient was admitted from the emergency department because of chest pain. Following blood work, it was determined that the patient had elevated CPKs and MB enzymes. The EKG shows nonspecific ST changes.
What type of diagnosis might this indicate?
a. Unstable angina
b. Myocardial infarction
c. Congestive heart failure
d. Mitral valve stenosis
b
The CPK elevation with MB enzymes elevated and the EKG ST changes denote a possible Ml (Leon-Chisen 2013, 386-387).
A patient is admitted and diagnosed with fever and urinary burning. The discharge diagnosis· is Escherichia coli, urinary tract infection.
Which of the following represents the correct diagnoses and appropriate sequence of those conditions?
a. Fever, urinary burning, urosepsis
b. Fever, urinary burning, sepsis
c. Escherichia coli, urinary tract infection
d. Urinary tract infection, Escherichia coli
d
Symptoms are not coded when a definitive diagnosis is present on discharge. The patient discharge diagnosis of urinary tract infection. The organism (E. coli) is coded with a seco diagnosis code (B96.20) which is to be added as an additional code to identify the bacterial agent (HHS 2014, Section II.A., 98).
A patient was admitted with heart failure within one week of a heart transplant. Due to the timing, the coder thought that it may represent a postoperative transplant rejection following heart transplant.
What action(s) should the coding staff take?
a. Query the physician.
b. Assign the codes for the postoperative transplant rejection.
c. Assign only the code for the transplant rejection.
d. Assign only the code for heart failure.
a
Inpatient:
A 75-year-old male patient was admitted from a nursing home with dehydration and dysphagia due to a previous stroke. During hospitalization the patient was rehydrated and transferred back to the nursing home.
ICD- 10 - CM: E86.0, I69.
(Schraffenberger 2013, 131, 209-210).
Stroke= cerebral infarction
Inpatient:
A patient is admitted to an acute care facility for detoxification from alcohol and barbiturate intoxication with chronic alcoholism and barbiturate abuse. The patient also has cirrhosis of the liver due to alcoholism.
ICD- 10 - CM: F10.229, F13.129, K70.30,
(Schraffenberger 2013, 140-143.)
ICD- 10 - PCS HZ2ZZZZ
(Leon-Chisen 2014, 186).
Inpatient:
A 30-year-old patient was seen in the emergency department for recurrent epileptic seizures. The patient also had tic douloureux.
ICD- 10 - CM: G40.909, G50.
(Schraffenberger 2013,158-159).
Inpatient:
A patient was admitted to an acute care facility with a temperature of 102 and atrial fibrillation. The chest x-ray reveals pneumonia with subsequent documentation by the physician of pneumonia in the progress notes and discharge summary. The patient was treated with oral antiarrhythmia medications and IV antibiotics.
ICD- 10 - CM: J18.9, 148.91-
In accordance with the UHDDS, both conditions are not equally treated. The pneumonia was treated with IV antibiotics. This diagnosis had greater utilization of resources of medications and staff time compared with the atrial fibrillation, which was treated with oral medication. Because of this, the pneumonia is sequenced first (HHS 2014, Section II, C).
Inpatient:
A patient with chronic cholecystitis and gallbladder stones underwent a laparoscopic cholecystectomy in an acute care facility. However, due to extensive gallbladder adhesions the procedure was converted to an open cholecystectomy.
ICD- 10 - CM: K80.10, K82.8 (Schraffenberger 2013, 249-250, 454); HHS 2011, Section I, 18. d, 14), ICD- 10 - PCS: OFT40ZZ, OFJ44ZZ (Leon-Chisen 2014, 250).
ICD- 10 - CM: M51.26,
ICD- 10 - PCS: OSB20ZZ, OQBOOZZ
(Schraffenberger 2013,279, 282-284).
Inpatient:
A 34-year-old woman delivered a live born, term baby boy (39 weeks) with macrosomia. She had a hemorrhage following an episiotomy with a low forceps delivery but prior to expulsion of the placenta.
ICD- 10 - CM: 067.9, 033.7, Z37.0, Z3A.39, ICD- 10 - PCS: 10D07Z3, OW8NXZZ-
The patient had a hemorrhage that occurred after delivery but before the expulsion of the placenta. This hemorrhage, by definition, occurred in the third stage of labor (Schraffenberger 2013, 270, 278-283, 313).
Inpatient:
A single, newborn, term live-born baby boy, born in hospital via vaginal delivery.
ICD- 10 - CM: Z38.
(Schraffenberger 2013, 340).
Inpatient:
Twin newborns, both born prematurely at 32 weeks via cesarean section, 1,002 g was the birth weight of the first twin, whose mate was stillborn. The baby was admitted to the nursery from the delivery room. The baby also was treated for jaundice due to ABO incompatibility.
ICD- 10 - CM: Z38.31, P07.14, P07.35, P55.
(Schraffenberger 2013, 337).
Inpatient:
A patient is admitted to the acute care facility with chest pain. The patient was awakened from sleep; this was ;:he patient's first experience with chest pain. The patient was given two nitroglycerin tablets in the emergency department. The chest pain was not relieved, resulting in the diagnosis of new onset unstable angina. Serial CPK was normal. Following a left cardiac catheterization with angiogram of multiple coronary arteries with low osmolar contrast, the patient is found to have arteriosclerotic coronary artery disease.
ICD- 10 - CM: 125.110,
ICD- 10 - PCS: 4A023N7, B2111ZZ
(Schraffenberger 2013, 202-204).
Inpatient:
This is the first admission for a patient with adenocarcinoma of the right lower lung who was also found with metastasis to the brain. The patient underwent a right lower lung lobectomy via laparotomy.
ICD- 10 - CM: C34.31, C79.31,
required an open reduction of the left fibula fracture.
ICD- 10 - CM: S82.402A, S82.002A, T14.8, Y92.480, V03.10XA,
ICD- 10 - PCS: OQSKOZZ
(Schraffenberger 2013, 380-381, 443, 428).
Inpatient:
Syncope; bradycardia ruled out; due to taking Valium as prescribed by a physician. Patient also took an antihistamine as directed on the package without consulting a healthcare provider.
ICD- 10 - CM: T42.4X1A, T45.0X1A, R55-The patient took over-the-counter medications with a prescription medication without consulting the prescribing physician. This is a poisoning.
Per the Official ICD- 10 - CM Guidelines for Coding and Reporting, I.C.19.e.5.b.: Nonprescribed drug taken with correctly prescribed and properly administered drug: If a nonprescribed drug or medicinal agent was taken in combination jVith a correctly prescribed and properly administered drug, any drug toxicity or other reaction resulting from the interaction of the two drugs would be classified as a poisoning (HHS 2014, Section I, 19, e, Sa; Schraffenberger 2013, 406-407).
Inpatient:
Sepsis due to the presence of an indwelling urinary catheter with a positive blood culture reflected in the progress notes of Staphylococcus aureus sepsis.
ICD- 10 - CM: T83.51XA, A41.
(Leon-Chisen 2013, 150, 154, 535).
Inpatient:
Respiratory distress syndrome, 26-day-old baby, temporary tracheostomy completed.
ICD- 10 - CM: P22.0,
ICD- 10 - PCS: OB110F
(Schraffenberger 2013, 339; Coding Clinic 1986 Nov.-Dec., 6; 1" Quarter 1989, 10)
Ambulatory/Outpatient
Noncardiac chest pain, esophageal acid reflux test.
ICD- 10 - CM: R07.89; CPT: 91034
(Schraffenberger 2013, 362-363; CPT Assistant May 2005,3)
Ambulatory/Outpatient
Annual screening mammogram.
Metastatic ovarian cancer to the pleura. Thoracoscopic pleurodesis.
ICD- 10 - CM: C78.2, C56.9;
CPT: 32650
(Schraffenberger 2013, 100-101; CPT Assistant F 1994, 1, 6; CPT Changes: An Insider's View 2002).
Ambulatory/Outpatient
Symptomatic bradycardia due to sick sinus syndrome with replacement of dual chamber pacemaker generator with removal of old generator.
ICD- 10 - CM: 149.5; CPT: 33228 (Schraffenberger 2013, 206, 362-363; CPT Changes: An In-sider's View 2003; CPT Assistant Summer 1994, 10, 19; CPT Assistant Nov. 1999, 16; CPT CHANGES 200,
Ambulatory/Outpatient
Esophagogastroduodenoscopy with sclerotherapy of esophageal varices.
ICD- 10 - CM: 185.00;
CPT: 43243
Leon-Chisen 2013, 246; Smith 2015, 115; CPT assistant Spring 1994, 4).
Ambulatory/Outpatient
Transurethral resection of the prostate for benign prostatic hypertrophy with electrocautery.
ICD- 10 - CM: N40.0;
CPT: 52601 (
Schraffenberger 2013, 294-295; Smith 2015, 134; CPT Assistant Nov. 1997, 20; CPT Assistant April2001, 4; CPT Assistant June 2003, 6).
Ambulatory/Outpatient
Cryosurgical destruction of simple papilloma of the penis.
ICD- 10 - CM: D29.0;
CPT: 54056
(Schraffenberger 2013, 103; Smith 2015, 134).
Ambulatory/Outpatient
Dysfunctional uterine bleeding for which hysteroscopy with endometrial ablation was undertaken.
CD- 10 - CM: N93.8;
CPT: 58563
(Schraffenberger 2013, 296; CPT Assistant Nov. 1999,2 : March 2000, 10; March 2002, 11; CPT Changes: An Insider's View 2000, 2002).
c
The patient has abdominal adhesions with obstruction, and lysis of adhesions was performed. The abdominal pain is not coded as it is a symptom (HHS 2014, Section I.B.4, 13; Leon-Chisen 2013,140)
A patient has a principal diagnosis of pneumonia (118.9) (MS-DRG 195).
Which of the following may legitimately change the coding of the pneumonia in accordance with the UHDDS and relevant clinical documentation?
a. Sputum culture reflects growth of normal flora.
b. Patient has a positive gram stain.
c. Patient is found to have dysphagia with aspiration.
d. Patient has nonproductive sputum.
c
Patient is found to have dysphagia with aspiration is the correct answer because it changes the coding to aspiration pneumonia and would result in MS-DRG 179 RESPIRATORY INFECTIONS & INFLAMMATIONS W/0 CC/MCC, which has a weight of 0.9718 (Medicare Grouper Version Used: 31). This is in comparison to MS-DRG 0195, SIMPLE PNEUMONIA & PLEURISY W/0 CC/MCC MDC: 04 which has a DRG weight of 0.6978 (Medicare Grouper Version Used: 31).
A patient is diagnosed with infertility due to endometriosis and undergoes an outpatient laparoscopic laser destruction of pelvic endometriosis.
In order to code this encounter accurately, what steps must the coder take?
a. Review the operative report to determine what procedure codes to use and also to determine the site or sites of endometriosis so codes with the highest specificity may be assigned, and use infertility as a principal diagnosis.
b. Review the operative report to determine where the laser was used in the pelvis so the site or sites of endometriosis can be specified, and assign a principal diagnosis of infertility.
c. Review the operative report to determine where the laser was used in the pelvis so the site or sites of endometriosis can be specified as principal, and assign a secondary diagnosis of infertility.
d. Review the operative report to determine what procedure codes to use and also to determine the site or sites of endometriosis so codes with the highest specificity may be assigned, and use the diagnosis of infertility as a secondary condition.
d
There may be endometrial implants throughout the pelvic cavity which may attach to various anatomic structures such as the fallopian tube, ovary, and omentum. These locations should be identified so that the appropriate diagnostic codes can be assigned and the appropriate procedure codes can be assigned based on the destruction of the endometrial implants. Therefore, the correct answer is to review the operative report to determine what procedure codes to use and determine the site or sites of endometriosis so that codes with the highest specificity may be assigned. Also, use the diagnosis of infertility as a secondary condition (Schraffenberger 2013, 296; Leon-Chisen 2013, 33, 271).
In order to establish the adequacy of documentation in the medical record the following must be reflected:
a. Decisions of patient's caregivers
The requirements for documentation and record completion (documents such as history and physicals, discharge summaries, and consultations) as well as penalties for non-adherence must be specified in:
a. Hospital rules and regulations
b. Conditions of nonparticipation
c. Medical staff bylaws
d. Nursing staff policies
c
The medical staff bylaws are required by accreditation and regulatory organizations to refer to the timeline required for completion (LaTour and Eichenwald Maki 2013, 240; Sayles 2014, 353).
A patient was admitted to the emergency department for abdominal pain with diarrhea and was diagnosed with infectious gastroenteritis. The patient also had angina and chronic obstructive pulmonary disease.
List the diagnoses that would be coded in the order of sequence.
a. Abdominal pain, infectious gastroenteritis, chronic obstructive pulmonary disease, angina
b. Infectious gastroenteritis, chronic obstructive pulmonary disease, angina
c. Gastroenteritis, abdominal pain, angina
d. Diarrhea, chronic obstructive pulmonary disease, angina
b
The abdominal pain and diarrhea are not coded as they are symptoms integral to the diagnosis of infectious gastroenteritis. Review Coding Guideline II.A, 98 for additional information on coding of symptoms, signs, and ill-defined conditions.
A patient was admitted to the endoscopy unit for a screening colonoscopy. During the colonoscopy, polyps of the colon were found and a polypectomy was performed.
What diagnostic codes should be used and how should they be sequenced?
Z12.11 Encounter for screening for malignant neoplasm of colon
D12.6 Benign neoplasm of colon, unspecified
a. Z12.
b. Dl2.6 Encounter for screening for malignant neoplasm of colon Benign neoplasm of colon, unspecified
c. Zl2.ll,Dl2.
d. D12.6, Z12.
c
