NCCQ UK THEORY PAST PAPER PRACTICE WITH ACTUAL EXAM QUESTIONS&
ANSWERS PLUS WELL DETAILED/NEWEST UPDATE 2025/2026
Question 1
According to National Clinical Coding Standards, what precise wording—other than "status
asthmaticus"—must be documented in the medical record to assign code J46.X?
A) Brittle asthma
B) Acute severe asthma
C) Refractory asthma
D) Chronic obstructive asthma with exacerbation
E) Asthmatic bronchitis
Correct Answer: B) Acute severe asthma
Rationale: The UK National Clinical Coding Standards specifically mandate that for the
assignment of ICD-10 code J46.X (Status asthmaticus), the clinician must have documented
either the term "status asthmaticus" or "acute severe asthma." Other descriptions of
asthma severity, such as "brittle" or "exacerbation of," do not meet the criteria for J46.X
and would instead lead to codes within the J45 category. This standard ensures that only
the most critical presentations of asthma are captured under the status asthmaticus rubric.
Question 2
When coding a fracture fixation where the description mentions multiple devices, such as a "pin
and plate," what is the primary coding standard to follow?
A) Code every device mentioned in the operation note.
B) Code only the device that was inserted first.
C) Code only the main part of the device holding the fracture together.
D) Use a combination code that covers all types of metalwork.
E) Only code the most expensive device used.
Correct Answer: C) Only the main part of the device that is holding the fracture together
must be coded.
Rationale: National standards for orthopaedic coding in OPCS-4 state that when multiple
fixation components are used (e.g., screws, pins, and plates), the coder must identify the
primary mechanism of stabilization. Coding every individual screw or pin would lead to
over-coding and do not accurately reflect the procedure's intent. If the documentation does
not make it clear which device is the "main" component, the coder must seek clarification
from the responsible consultant to ensure the most clinically accurate code is selected.
Question 3
Which of the following forms of chest pain are specifically categorised to the ICD-10 category
R07 (Pain in throat and chest)?
A) Pleuritic pain and Angina
B) Central chest pain and Musculoskeletal chest pain
C) Heartburn and Dysphagia
, 2
D) Ischaemic chest pain and Pre-cordial pain
E) Retrosternal pain and Intercostal pain
Correct Answer: B) Central chest pain and Musculoskeletal chest pain
Rationale: Category R07 is used for symptoms and signs involving the digestive system and
abdomen, specifically chest pain that has not been further specified as a definitive cardiac
or respiratory diagnosis. The UK standards explicitly list "Central chest pain" and
"Musculoskeletal chest pain" as the two clinical entities that belong here when a more
specific underlying cause (like MI or pleurisy) is not documented. This avoids using more
specific "heart disease" codes for symptoms that may be non-cardiac in nature.
Question 4
In ICD-10, how is "per rectal (PR) haemorrhage" coded if the source of the bleeding is not
specified as being from the actual rectum or anus?
A) K62.5 Haemorrhage of anus and rectum
B) K92.2 Gastrointestinal haemorrhage, unspecified
C) K29.0 Acute haemorrhagic gastritis
D) R19.5 Other fecal abnormalities
E) K55.2 Angiodysplasia of colon with haemorrhage
Correct Answer: B) Gastrointestinal haemorrhage, unspecified
Rationale: There is a vital distinction in UK coding between "Rectal Haemorrhage" and
"Per Rectal (PR) Haemorrhage." Code K62.5 is a site-specific code and must only be used
if the haemorrhage is confirmed to originate from the rectal or anal tissue. If the
documentation states "PR bleeding," this simply describes the exit point of the blood. Since
the blood could be coming from higher up in the GI tract (stomach, small intestine, or
colon), the more general code K92.2 must be assigned unless a more specific underlying
cause is diagnosed.
Question 5
A patient undergoes a colonoscopy with ileal intubation that includes a biopsy of the terminal
ileum. How should this be coded in OPCS-4?
A) H22.9 Unspecified diagnostic fiberoptic endoscopic examination of colon
B) H22.1 Diagnostic fibreoptic endoscopic examination of colon and biopsy of lesion of colon
followed by Z27.6 Ileum
C) G45.1 Fibreoptic endoscopic examination of upper gastrointestinal tract
D) H25.1 Therapeutic fibreoptic endoscopic examination of colon and biopsy of lesion of colon
E) H22.1 followed by Z28.5 Sigmoid colon
Correct Answer: B) H22.1 Diagnostic fibreoptic endoscopic examination of colon and biopsy
of lesion of colon followed by the site code (Z27.6) Ileum
Rationale: When an endoscopist passes the scope through the ileocaecal valve into the
, 3
terminal ileum (ileal intubation) and performs a biopsy, the procedure is still classified
under the colonoscopy category (H22). However, to accurately reflect the extent of the
procedure and the site of the biopsy, the coder must assign the biopsy code H22.1 and add
the site code Z27.6 (Ileum) as a secondary code. This follows the standard of using site
codes (Z codes) to specify the exact anatomy involved in an endoscopic procedure.
Question 6
Under what circumstances should a coder assign a code from ICD-10 category O63 (Long
labour)?
A) Whenever the labour lasts more than 12 hours.
B) Only if the patient has a Caesarean section.
C) When it is documented that the labour/stage of labour is prolonged, and the cause is unknown.
D) For every primigravida patient.
E) Only when requested by the midwifery lead.
Correct Answer: C) When it is documented that the labour/stage of labour is prolonged, and
the cause is unknown.
Rationale: The assignment of O63 is strictly dependent on clinician documentation of
"prolonged" or "long" labour. Coders must not calculate the length of labour themselves
based on timestamps. Furthermore, if a specific reason for the delay is documented (such as
cephalopelvic disproportion or malpresentation), the coder must assign the code for that
specific condition instead of O63. This ensures that the classification reflects the pathology
causing the delay rather than just the symptom of time.
Question 7
When is it mandatory to code the insertion of a Nasogastric (NG) feeding tube in OPCS-4?
A) Every time it is performed on a ward.
B) Only when performed under general anaesthetic.
C) When the patient is admitted solely for the purpose of the insertion.
D) When it is performed during a major abdominal surgery.
E) It is never coded as it is a nursing procedure.
Correct Answer: C) When a patient is admitted solely for the purpose of insertion.
Rationale: In UK clinical coding, many minor procedures (like NG tube insertion or
catheterization) are considered "bundled" into the general care of the patient and are not
coded if they are subsidiary to a larger episode of care. However, if the entire reason for the
hospital admission (the "primary reason for encounter") is to have the NG tube placed,
then it must be coded to ensure the activity of the admission is captured for resource and
statistical purposes.
Question 8
What is the standard procedure when a gastroscope is introduced but cannot be passed further
, 4
than the patient's mouth?
A) Code as a complete OGD.
B) Code as a discontinued procedure using a 'discontinued' modifier.
C) Use the code for "Examination of mouth."
D) The procedure must not be coded.
E) Code only the sedation given.
Correct Answer: D) The procedure must not be coded.
Rationale: The OPCS-4 classification is based on procedures actually performed. If an
endoscope does not reach the intended anatomical site (e.g., it does not enter the
esophagus/stomach), it does not meet the criteria for an endoscopic procedure code.
Documentation of an attempt that fails at the oral level is considered a failed attempt that
does not warrant a procedure code, as no diagnostic or therapeutic intervention of the GI
tract occurred.
Question 9
The ICD-10 classification consists of 22 chapters. Which of the following correctly identifies the
three different "chapter types"?
A) Acute, Chronic, and Surgical
B) Special group, Body system, and Other chapters
C) Primary, Secondary, and External
D) Mandatory, Optional, and Supplemental
E) Diagnostic, Procedural, and Administrative
Correct Answer: B) Special group, Body system, and Other chapters
Rationale: The axis of the ICD-10 classification is structured into three types: 1. Special
group chapters (e.g., Infectious diseases, Neoplasms, Pregnancy) which take priority
because they relate to conditions that affect the whole body or specific life stages; 2. Body
system chapters (e.g., Diseases of the Circulatory System); and 3. Other chapters (e.g.,
External causes, Factors influencing health status). This hierarchy helps coders determine
the correct code when a condition could potentially be classified in two places.
Question 10
When there is doubt about which chapter a condition should be coded to, which chapter type
takes precedence in the ICD-10 axis?
A) Body system chapters
B) Other chapters
C) Special group chapters
D) The chapter with the most specific code
E) The chapter the consultant suggests
ANSWERS PLUS WELL DETAILED/NEWEST UPDATE 2025/2026
Question 1
According to National Clinical Coding Standards, what precise wording—other than "status
asthmaticus"—must be documented in the medical record to assign code J46.X?
A) Brittle asthma
B) Acute severe asthma
C) Refractory asthma
D) Chronic obstructive asthma with exacerbation
E) Asthmatic bronchitis
Correct Answer: B) Acute severe asthma
Rationale: The UK National Clinical Coding Standards specifically mandate that for the
assignment of ICD-10 code J46.X (Status asthmaticus), the clinician must have documented
either the term "status asthmaticus" or "acute severe asthma." Other descriptions of
asthma severity, such as "brittle" or "exacerbation of," do not meet the criteria for J46.X
and would instead lead to codes within the J45 category. This standard ensures that only
the most critical presentations of asthma are captured under the status asthmaticus rubric.
Question 2
When coding a fracture fixation where the description mentions multiple devices, such as a "pin
and plate," what is the primary coding standard to follow?
A) Code every device mentioned in the operation note.
B) Code only the device that was inserted first.
C) Code only the main part of the device holding the fracture together.
D) Use a combination code that covers all types of metalwork.
E) Only code the most expensive device used.
Correct Answer: C) Only the main part of the device that is holding the fracture together
must be coded.
Rationale: National standards for orthopaedic coding in OPCS-4 state that when multiple
fixation components are used (e.g., screws, pins, and plates), the coder must identify the
primary mechanism of stabilization. Coding every individual screw or pin would lead to
over-coding and do not accurately reflect the procedure's intent. If the documentation does
not make it clear which device is the "main" component, the coder must seek clarification
from the responsible consultant to ensure the most clinically accurate code is selected.
Question 3
Which of the following forms of chest pain are specifically categorised to the ICD-10 category
R07 (Pain in throat and chest)?
A) Pleuritic pain and Angina
B) Central chest pain and Musculoskeletal chest pain
C) Heartburn and Dysphagia
, 2
D) Ischaemic chest pain and Pre-cordial pain
E) Retrosternal pain and Intercostal pain
Correct Answer: B) Central chest pain and Musculoskeletal chest pain
Rationale: Category R07 is used for symptoms and signs involving the digestive system and
abdomen, specifically chest pain that has not been further specified as a definitive cardiac
or respiratory diagnosis. The UK standards explicitly list "Central chest pain" and
"Musculoskeletal chest pain" as the two clinical entities that belong here when a more
specific underlying cause (like MI or pleurisy) is not documented. This avoids using more
specific "heart disease" codes for symptoms that may be non-cardiac in nature.
Question 4
In ICD-10, how is "per rectal (PR) haemorrhage" coded if the source of the bleeding is not
specified as being from the actual rectum or anus?
A) K62.5 Haemorrhage of anus and rectum
B) K92.2 Gastrointestinal haemorrhage, unspecified
C) K29.0 Acute haemorrhagic gastritis
D) R19.5 Other fecal abnormalities
E) K55.2 Angiodysplasia of colon with haemorrhage
Correct Answer: B) Gastrointestinal haemorrhage, unspecified
Rationale: There is a vital distinction in UK coding between "Rectal Haemorrhage" and
"Per Rectal (PR) Haemorrhage." Code K62.5 is a site-specific code and must only be used
if the haemorrhage is confirmed to originate from the rectal or anal tissue. If the
documentation states "PR bleeding," this simply describes the exit point of the blood. Since
the blood could be coming from higher up in the GI tract (stomach, small intestine, or
colon), the more general code K92.2 must be assigned unless a more specific underlying
cause is diagnosed.
Question 5
A patient undergoes a colonoscopy with ileal intubation that includes a biopsy of the terminal
ileum. How should this be coded in OPCS-4?
A) H22.9 Unspecified diagnostic fiberoptic endoscopic examination of colon
B) H22.1 Diagnostic fibreoptic endoscopic examination of colon and biopsy of lesion of colon
followed by Z27.6 Ileum
C) G45.1 Fibreoptic endoscopic examination of upper gastrointestinal tract
D) H25.1 Therapeutic fibreoptic endoscopic examination of colon and biopsy of lesion of colon
E) H22.1 followed by Z28.5 Sigmoid colon
Correct Answer: B) H22.1 Diagnostic fibreoptic endoscopic examination of colon and biopsy
of lesion of colon followed by the site code (Z27.6) Ileum
Rationale: When an endoscopist passes the scope through the ileocaecal valve into the
, 3
terminal ileum (ileal intubation) and performs a biopsy, the procedure is still classified
under the colonoscopy category (H22). However, to accurately reflect the extent of the
procedure and the site of the biopsy, the coder must assign the biopsy code H22.1 and add
the site code Z27.6 (Ileum) as a secondary code. This follows the standard of using site
codes (Z codes) to specify the exact anatomy involved in an endoscopic procedure.
Question 6
Under what circumstances should a coder assign a code from ICD-10 category O63 (Long
labour)?
A) Whenever the labour lasts more than 12 hours.
B) Only if the patient has a Caesarean section.
C) When it is documented that the labour/stage of labour is prolonged, and the cause is unknown.
D) For every primigravida patient.
E) Only when requested by the midwifery lead.
Correct Answer: C) When it is documented that the labour/stage of labour is prolonged, and
the cause is unknown.
Rationale: The assignment of O63 is strictly dependent on clinician documentation of
"prolonged" or "long" labour. Coders must not calculate the length of labour themselves
based on timestamps. Furthermore, if a specific reason for the delay is documented (such as
cephalopelvic disproportion or malpresentation), the coder must assign the code for that
specific condition instead of O63. This ensures that the classification reflects the pathology
causing the delay rather than just the symptom of time.
Question 7
When is it mandatory to code the insertion of a Nasogastric (NG) feeding tube in OPCS-4?
A) Every time it is performed on a ward.
B) Only when performed under general anaesthetic.
C) When the patient is admitted solely for the purpose of the insertion.
D) When it is performed during a major abdominal surgery.
E) It is never coded as it is a nursing procedure.
Correct Answer: C) When a patient is admitted solely for the purpose of insertion.
Rationale: In UK clinical coding, many minor procedures (like NG tube insertion or
catheterization) are considered "bundled" into the general care of the patient and are not
coded if they are subsidiary to a larger episode of care. However, if the entire reason for the
hospital admission (the "primary reason for encounter") is to have the NG tube placed,
then it must be coded to ensure the activity of the admission is captured for resource and
statistical purposes.
Question 8
What is the standard procedure when a gastroscope is introduced but cannot be passed further
, 4
than the patient's mouth?
A) Code as a complete OGD.
B) Code as a discontinued procedure using a 'discontinued' modifier.
C) Use the code for "Examination of mouth."
D) The procedure must not be coded.
E) Code only the sedation given.
Correct Answer: D) The procedure must not be coded.
Rationale: The OPCS-4 classification is based on procedures actually performed. If an
endoscope does not reach the intended anatomical site (e.g., it does not enter the
esophagus/stomach), it does not meet the criteria for an endoscopic procedure code.
Documentation of an attempt that fails at the oral level is considered a failed attempt that
does not warrant a procedure code, as no diagnostic or therapeutic intervention of the GI
tract occurred.
Question 9
The ICD-10 classification consists of 22 chapters. Which of the following correctly identifies the
three different "chapter types"?
A) Acute, Chronic, and Surgical
B) Special group, Body system, and Other chapters
C) Primary, Secondary, and External
D) Mandatory, Optional, and Supplemental
E) Diagnostic, Procedural, and Administrative
Correct Answer: B) Special group, Body system, and Other chapters
Rationale: The axis of the ICD-10 classification is structured into three types: 1. Special
group chapters (e.g., Infectious diseases, Neoplasms, Pregnancy) which take priority
because they relate to conditions that affect the whole body or specific life stages; 2. Body
system chapters (e.g., Diseases of the Circulatory System); and 3. Other chapters (e.g.,
External causes, Factors influencing health status). This hierarchy helps coders determine
the correct code when a condition could potentially be classified in two places.
Question 10
When there is doubt about which chapter a condition should be coded to, which chapter type
takes precedence in the ICD-10 axis?
A) Body system chapters
B) Other chapters
C) Special group chapters
D) The chapter with the most specific code
E) The chapter the consultant suggests
