CCA PRACTICE TEST|| 200 QUESTIONS||
CORRECT SOLUTIONS
The assignment of a diagnosis code is based on ________. - ANSWER The provider's statement that the
patient has a particular condition
The assignment of a diagnosis code is based on the provider's diagnostic statement that the condition
exists (CMS 2018).
Identify the diagnosis code(s) for carcinoma in situ of vocal cord. - ANSWER D02.0
Index Carcinoma, in situ, see also Neoplasm, by site, in situ (Schraffenberger 2018, 137, 145).
Identify the diagnosis code(s) for melanoma of skin of right shoulder. - ANSWER C43.61
Index Melanoma (malignant), shoulder. Melanoma is considered a malignant neoplasm and is referenced
as such in the index of ICD-10-CM. The term "benign neoplasm" is considered a growth that does not
invade adjacent structures or spread to distant sites but may displace or exert pressure on adjacent
structures (Schraffenberger 2018, 137, 145).
Which of the following organizations is responsible for updating the procedure classification of ICD-10-
PCS? - ANSWER Centers for Medicare and Medicaid Services (CMS)
CMS is responsible for updating the procedure classification (ICD-10-PCS) (Giannangelo 2016, 124).
"Code, if applicable, on causal condition first," note indicates that this code may be assigned as a first
listed or principal diagnosis when: - ANSWER the causal condition is unknown or not applicable
"Causal condition first" general coding guideline states, "this code may be assigned as principal diagnosis
when the causal condition is unknown or not specified." (CMS, CG7, 2019).
Which character in an ICD-10-CM diagnosis code provides information regarding encounter of care? -
ANSWER Seventh
The seventh character provides information about encounter of care, such as initial encounter,
subsequent encounter, or sequelae (Giannangelo 2016, 123).
, What does the fourth character of an ICD-10-CM diagnosis code capture? - ANSWER Etiology
The fourth character captures etiology. The fifth captures anatomic site. The sixth captures severity
(Giannangelo 2016, 123).
ICD-10-CM codes must be a minimum length of how many characters? - ANSWER Three
Codes must be at least three characters, with a decimal point used after the third character (Giannangelo
2016, 123).
Notes appearing under a 3-character code apply to which of the following? - ANSWER To all codes within
that category
When a note appears under a three-character code in ICD-10-CM, it applies to all codes within that
category (Giannangelo 2016, 123).
Which volume of ICD-10-CM contains the Tabular and Alphabetic Index of procedures? - ANSWER None
of the above
ICD-10-CM includes diagnoses only. In the development of the ICD-10 code sets, it was determined that
creating a separate volume for procedures would be insufficient. Because of this, an entirely new
procedure code system, ICD-10-PCS, was developed (Giannangelo 2016, 123).
An exception to the Excludes 1 definition is the circumstance when the two conditions ________. -
ANSWER Are unrelated to each other
Coding Guideline I.A.12.a explicitly states this exception (CMS 2018a).
Identify the correct diagnosis code(s) for adenoma of left adrenal cortex with Conn's syndrome. -
ANSWER D35.02, E26.01
Index Adenoma, adrenal (cortex). Index Syndrome, Conn's. According to the Index in ICD-10-CM, except
where otherwise indicated, the morphological varieties of adenoma should be coded by site as for
"Neoplasm, benign" (Schraffenberger 2018, 146-147).
Which of the following is a standard terminology used to code medical procedures and services? -
ANSWER CPT
CPT is a comprehensive descriptive listing of terms and codes for reporting diagnostic and therapeutic
procedures and medical services (Giannangelo 2016, 119).
, Identify the appropriate ICD-10-CM diagnosis code for right cerebral contusion with 15-minute loss of
consciousness, initial encounter for care. - ANSWER S06.311A
Index Contusion, cerebral. Add a sixth character of "1" for loss of consciousness of 30 minutes or less.
Cerebral contusions are often caused by a blow to the head. A cerebral contusion is a more severe injury
involving a bruise of the brain with bleeding into the brain tissue, but without disruption of the brain's
continuity. The loss of consciousness that occurs often lasts longer than that of a concussion. Codes for
cerebral laceration and contusion range from S06.0-S06.9 with sixth characters indicating whether a loss
of consciousness or concussion occurred (Schraffenberger 2018, 581-582).
If a patient has an excision of a malignant lesion of the skin, the CPT code is determined by the body area
from which the excision occurs and which of the following? - ANSWER Diameter of the lesion as well as
the most narrow margins required to adequately excise the lesion described in the operative report
The code selection is determined by measuring the greatest clinical diameter of the apparent lesion plus
that margin required for complete excision (lesion diameter plus the most narrow margins required
equals the excised diameter) (AMA 2018, 99).
According to CPT, a repair of a laceration that includes retention sutures would be considered what type
of closure? - ANSWER Complex
Complex closure includes the repair of wounds requiring more than layered closure, namely, scar
revision, debridement, extensive undermining, stents, or retention sutures (AMA 2018, 90).
A patient is admitted with spotting. She had been treated two weeks previously for a miscarriage with
sepsis. The sepsis had resolved, and she is afebrile at this time. She is treated with an aspiration dilation
and curettage and products of conception are found. Which of the following should be the principal
diagnosis? - ANSWER Miscarriage
Guideline I.C.15.q.2 Retained Products of Conception following an abortion: Subsequent admissions for
retained products of conception following a spontaneous or legally induced abortion are assigned the
appropriate code from category O03, spontaneous abortion, or codes O07.4, Failed attempted
termination of pregnancy without complication and Z33.2, Encounter for elective termination of
pregnancy. This advice is appropriate even when the patient was discharged previously with a discharge
diagnosis of complete abortion (Schraffenberger 2018, 481-482).
An 80-year-old female is admitted with fever, lethargy, hypotension, tachycardia, oliguria, and elevated
WBC. The patient has more than 100,000 organisms of Escherichia coli per cc of urine. The attending
physician documents "urosepsis." How should the coder proceed to code this case? - ANSWER Query the
physician to determine if the patient has sepsis due to the symptomatology.
, The term "urosepsis" is a nonspecific term and is not codable in ICD-10-CM. It is not to be considered
synonymous with sepsis. It has no default code in the Alphabetic Index. Should a provider use this term,
he or she must be queried for clarification (Schraffenberger 2018, 114).
A 65-year-old patient, with a history of lung cancer, is admitted to a healthcare facility with ataxia and
syncope and a fractured arm as a result of falling. The patient undergoes a closed reduction of the
fracture in the emergency department and undergoes a complete workup for metastatic carcinoma of
the brain. The patient is found to have metastatic carcinoma of the lung to the brain and undergoes
radiation therapy to the brain. Which of the following would be the principal diagnosis in this case? -
ANSWER Metastatic carcinoma of the brain
Guideline I.C.2.a If treatment is directed at the malignancy, designate the malignancy as the principal
diagnosis. The only exception to this guideline is if a patient admission or encounter is solely for the
administration of chemotherapy, immunotherapy, or radiation therapy, assign the appropriate Z51.-code
as the first-listed or principal diagnosis and the diagnosis or problem for which the service is being
performed as a secondary diagnosis (Schraffenberger 2018, 139).
A patient is seen in the emergency department for chest pain. After evaluation of the patient it is
suspected that the patient may have gastroesophageal reflux disease (GERD). The final diagnosis was
"chest pain versus GERD." The correct ICD-10-CM code is: - ANSWER R07.9 Chest pain, unspecified
Signs, symptoms, abnormal test results, or other reasons for the outpatient visit are used when a
physician qualifies a diagnostic statement as "rule out" or other similar terms indicating uncertainty. In
the outpatient setting the condition qualified in that statement should not be coded as if it existed.
Rather, the condition should be coded to the highest degree of certainty, such as the sign or symptom
the patient exhibits. In this case, assign the code R07.9 Chest pain, unspecified (Schraffenberger 2018,
103; Coding Guidelines Section IV.H.).
A skin lesion is removed from a patient's cheek in the dermatologist's office. The dermatologist
documents "skin lesion" in the health record. Before billing, the pathology report returns with a
diagnosis of basal cell carcinoma. Which of the following actions should the coding professional do for
claim submission? - ANSWER Code basal cell carcinoma
For outpatient encounters for diagnostic tests that have been interpreted by a physician, and the final
report is available at the time of coding, code any confirmed or definitive diagnosis(es) documented in
the interpretation. Do not code related signs and symptoms as additional diagnosis. Note: This differs
from the coding practice in the hospital inpatient setting regarding abnormal findings on test results
(Schraffenberger 2018, 103).
