NCCQ UK Theory Past Paper Practice | Exam Questions
and Correct Answers| Updated
The requirement for national collection of the use of fifth characters appears in which four ICD-
10 4th Edition chapters? Either chapter numbers (Arabic or Roman numeral) or full titles are
acceptable. [3 Marks]correct answer: Chapter IX (9) Diseases of the circulatory system
Chapter X (10) Diseases of the respiratory system
Chapter XIII (13) Diseases of the musculoskeletal system and connective tissue
Chapter XIX (19) Injury, poisoning and certain other consequences of external causes
The circumstances surrounding reactions to drug/medication are classified in two ways within
ICD-10 Tabular List, Volume 1. Name both ways. [2 Marks]correct answer: Poisoning
(improper use)
Adverse effect (proper use)
What must a coder do if a surgical eponym is used in the medical record to describe a procedure?
[3 Marks]correct answer: The coder must analyse the procedural information and ensure that
code assignment fully reflects the procedure performed.
Where the coder is unsure what procedure the eponym describes, they must seek advice from the
responsible consultant to ensure that the correct codes are assigned.
When should site codes from Chapter Z be assigned? [1 Mark]correct answer: They must always
be assigned when this adds further information about the site on which the procedure was
performed
What two conditions must be coded if a diagnosis of 'severe sepsis' alone is made by the clinician?
No actual codes are required. [2 Marks]correct answer: (A41.9) Sepsis (unspecified) (R65.1)
Systemic Inflammatory Response Syndrome (SIRS) of infectious origin with organ failure
What is the standard regarding the use of the OPCS-4.7 code X35.1 Intravenous induction of
labour? [1 Mark]correct answer: It must never be used.
On what occasion is it a mandatory requirement to assign an OPCS-4.7 general anaesthetic code?
[1 Mark]correct answer: When radiotherapy is delivered under general anaesthetic, a code from
category Y80 General anaesthetic must be assigned in addition to the radiotherapy delivery.
When should codes from ICD-10 category Z54.- Convalescence be assigned and how should
they be sequenced? No actual codes are required. [2 Marks]correct answer: Never in primary.
They must only be assigned in a secondary position when a patient has received convalescence
in a dedicated convalescent unit.
How should an injury caused by a geriatric fall be coded? Describe the possible sequencing of
these codes. No actual codes are required. [4 Marks]correct answer: Code classifying the injury
,sustained (from Chapter XIX). External cause code to describe the fall (from categories W00-
W19).
(R29.6) Tendency to fall, (not elsewhere classified).
In this sequence, unless the patient remains in hospital for investigation of the falls and this
becomes the primary focus of care, then this code (R29.6) must be sequenced before the codes
for the injury
What must be coded when an excision and biopsy (excision biopsy) is performed on the same
site during the same theatre visit, and why? No actual codes are required. [2 Marks]correct
answer: Only assign a code(s) for the excision as a biopsy is an integral part of an excision.
When must codes from ICD-10 category Z38.- Liveborn infants according to place of birth be
assigned in the primary coding field? [1 Mark]correct answer: If the baby is a completely well
baby and has no morbid conditions that have been treated or investigated.
During which procedure should OPCS-4.7 code X50.5 Evaluation of a cardiodefibrillator not be
assigned when carried out? No actual codes are required. [1 Mark]correct answer: When testing
is performed during the insertion of the cardioverter defibrillator (K59 Cardioverter defibrillator
introduced through the vein or K72 Other cardioverter defibrillator).
What precise wording, other than 'status asthmaticus', must be present in the medical records to
be able to assign J46.X Status asthmaticus? [1 Mark]correct answer: Acute severe asthma
How should a fracture fixation procedure be coded when the description names more than one
type of fixation device, e.g. pin and plate? No actual codes are required. [2 Marks]correct answer:
Only the main part of the device that is holding the fracture together must be coded. When it is
not clear which part of the fixation device is the main part holding the fracture together, advice
must be sought from the responsible consultant.
In accordance with national clinical coding standards, name the two specific forms of chest pain
categorized to ICD-10 category R07 Pain in throat and chest. [2 Marks]correct answer: Central
chest pain
Musculoskeletal chest pain
In ICD-10 coding terms, describe the difference between a 'rectal haemorrhage' and 'per rectal
haemorrhage', and the coding standards related to these terms. No actual codes are required. [3
Marks]correct answer: The code (K62.5) for 'haemorrhage of anus and rectum' must only be
assigned for an actual haemorrhage of the anus and/or rectum. It must not be assigned for
haemorrhage that has occurred from elsewhere in the gastrointestinal tract that is merely exiting
via the rectum, i.e. per rectal haemorrhage.
The code (K92.2) for 'gastrointestinal haemorrhage, unspecified' must be assigned for a
haemorrhage that occurred via the rectum (per rectal haemorrhage) but is not specified as being
from the actual rectum or anus. This code must not be assigned when it is a symptom of a
specific disease which has been diagnosed.
,How must a colonoscopy with ileal intubation that includes a biopsy of the terminal ileum be
coded? No actual codes are required. [2 Marks]correct answer: (H22.1) Diagnostic fibre optic
endoscopic examination of colon and biopsy of lesion of colon followed by the site code (Z27.6)
Ileum
What clinical coding standards relating to the use of ICD-10 category O63 Long labour must the
coder be aware of? [2 Marks]correct answer: It must be documented in the medical record that
the labour or stage of labour is prolonged/long for this category to be used.
If the reason for the prolonged/long labour is stated, then this must be coded instead
When must the insertion of a nasogastric (NG) feeding tube be coded? [1 Mark]correct answer:
When a patient is admitted solely for the purpose of insertion.
What is the OPCS-4 standard when a gastroscope is not able to be inserted further than the
patient's mouth during an endoscopy? No actual codes are required. [1 Mark]correct answer: The
procedure must not be coded.
The ICD-10 classification contains 22 chapters and is divided into three different chapter types.
Name the three types of chapter. [3 Marks]correct answer: Special group chapters
Body system chapters
Other chapters
When there is doubt as to where a condition should be coded which of the three chapter types
found in the axis of the ICD-10 classification takes priority? [1 Mark]correct answer: Where
there is any doubt as to where a condition should be coded, the 'special group' chapters must take
priority.
In order for an ICD-10 classification code to be valid what is the minimum character length that
it must be? Describe the structure of a code and how it must be extended as documented in
DRule.2: Category and code structure. [5 Marks]correct answer: Four.
Three character category codes must subdivided into four character subcategories.
Where a three character category code is not subdivided into four character subdivisions the 'X'
filler must be assigned in the fourth character field so the codes are of a standard length for data
processing and validation.
Where a three character code requires assignment of both the 'X' filler and a fifth character
subdivision, the 'X' filler must continue to be recorded in the fourth field before the fifth
character, for example M45.X3 Ankylosing spondylitis, cervicothoracic region.
Where is the 'point dash (.-)' punctuation found in the ICD-10 classification and describe its
purpose? [3 Marks]correct answer: A point-dash is found in both the Tabular List and the
Alphabetical Index to indicate there are fourth character subdivisions.
, Unique identifiers (reference number) are applied to four areas of the National Clinical Coding
Standards ICD-10 4th Edition (2015) reference book; flow charts are one of these, name the
other three. [3 Marks]correct answer: Rules
Conventions
Standards
Name the three types of standard documented in the National Clinical Coding Standards ICD-10
4th Edition (2015) reference book. Briefly describe their locations within it and how they should
be applied. [9 Marks]correct answer: General coding standards are located at the beginning of
the reference book and are applicable throughout the classification.
Chapter standards are located at the beginning of an ICD-10 chapter of the reference book and
are applicable throughout that chapter. Note that not all chapters will have chapter standards.
Coding standards are located throughout each ICD-10 chapter of the reference book and are
applicable to a specific diagnosis, disorder, disease or condition, or describe the correct usage of
a code, category or range of codes. Coding standards are, generally, listed in code, category or
range order.
What must clinical coders take into account when coding a 'radical operation'? [3 Marks]correct
answer: When coding radical operations:
Code assignment must fully reflect the procedure(s) performed during the radical operation.
Instructional Notes must be applied in order to fully reflect all procedures performed.
Any uncertainty as to what procedures were performed during the radical operation must be
clarified with the responsible consultant in order to ensure correct code assignment.
What sequencing rules must be applied when a resection and reconstruction of an organ or site
has been performed during the same theatre visit? [2 Marks]correct answer: Where resection and
reconstruction have been performed the codes that classify the resection must be assigned before
the codes that classify the reconstruction.
What is being described when codes from OPCS-4.7 category V55 Levels of spine are assigned?
[1 Mark]correct answer: The number of levels being operated on.
A level of spine can mean one of three things; what can they mean and give one example of an
operation specific to each meaning? [6 Marks]correct answer: A 'level of spine' means either a
vertebra, a disc, or a motion segment.
Operations carried out on vertebrae include:
Vertebral excision
Decompression of fractured vertebrae
Reduction and fixation of fractured vertebrae
Biopsy of vertebrae
and Correct Answers| Updated
The requirement for national collection of the use of fifth characters appears in which four ICD-
10 4th Edition chapters? Either chapter numbers (Arabic or Roman numeral) or full titles are
acceptable. [3 Marks]correct answer: Chapter IX (9) Diseases of the circulatory system
Chapter X (10) Diseases of the respiratory system
Chapter XIII (13) Diseases of the musculoskeletal system and connective tissue
Chapter XIX (19) Injury, poisoning and certain other consequences of external causes
The circumstances surrounding reactions to drug/medication are classified in two ways within
ICD-10 Tabular List, Volume 1. Name both ways. [2 Marks]correct answer: Poisoning
(improper use)
Adverse effect (proper use)
What must a coder do if a surgical eponym is used in the medical record to describe a procedure?
[3 Marks]correct answer: The coder must analyse the procedural information and ensure that
code assignment fully reflects the procedure performed.
Where the coder is unsure what procedure the eponym describes, they must seek advice from the
responsible consultant to ensure that the correct codes are assigned.
When should site codes from Chapter Z be assigned? [1 Mark]correct answer: They must always
be assigned when this adds further information about the site on which the procedure was
performed
What two conditions must be coded if a diagnosis of 'severe sepsis' alone is made by the clinician?
No actual codes are required. [2 Marks]correct answer: (A41.9) Sepsis (unspecified) (R65.1)
Systemic Inflammatory Response Syndrome (SIRS) of infectious origin with organ failure
What is the standard regarding the use of the OPCS-4.7 code X35.1 Intravenous induction of
labour? [1 Mark]correct answer: It must never be used.
On what occasion is it a mandatory requirement to assign an OPCS-4.7 general anaesthetic code?
[1 Mark]correct answer: When radiotherapy is delivered under general anaesthetic, a code from
category Y80 General anaesthetic must be assigned in addition to the radiotherapy delivery.
When should codes from ICD-10 category Z54.- Convalescence be assigned and how should
they be sequenced? No actual codes are required. [2 Marks]correct answer: Never in primary.
They must only be assigned in a secondary position when a patient has received convalescence
in a dedicated convalescent unit.
How should an injury caused by a geriatric fall be coded? Describe the possible sequencing of
these codes. No actual codes are required. [4 Marks]correct answer: Code classifying the injury
,sustained (from Chapter XIX). External cause code to describe the fall (from categories W00-
W19).
(R29.6) Tendency to fall, (not elsewhere classified).
In this sequence, unless the patient remains in hospital for investigation of the falls and this
becomes the primary focus of care, then this code (R29.6) must be sequenced before the codes
for the injury
What must be coded when an excision and biopsy (excision biopsy) is performed on the same
site during the same theatre visit, and why? No actual codes are required. [2 Marks]correct
answer: Only assign a code(s) for the excision as a biopsy is an integral part of an excision.
When must codes from ICD-10 category Z38.- Liveborn infants according to place of birth be
assigned in the primary coding field? [1 Mark]correct answer: If the baby is a completely well
baby and has no morbid conditions that have been treated or investigated.
During which procedure should OPCS-4.7 code X50.5 Evaluation of a cardiodefibrillator not be
assigned when carried out? No actual codes are required. [1 Mark]correct answer: When testing
is performed during the insertion of the cardioverter defibrillator (K59 Cardioverter defibrillator
introduced through the vein or K72 Other cardioverter defibrillator).
What precise wording, other than 'status asthmaticus', must be present in the medical records to
be able to assign J46.X Status asthmaticus? [1 Mark]correct answer: Acute severe asthma
How should a fracture fixation procedure be coded when the description names more than one
type of fixation device, e.g. pin and plate? No actual codes are required. [2 Marks]correct answer:
Only the main part of the device that is holding the fracture together must be coded. When it is
not clear which part of the fixation device is the main part holding the fracture together, advice
must be sought from the responsible consultant.
In accordance with national clinical coding standards, name the two specific forms of chest pain
categorized to ICD-10 category R07 Pain in throat and chest. [2 Marks]correct answer: Central
chest pain
Musculoskeletal chest pain
In ICD-10 coding terms, describe the difference between a 'rectal haemorrhage' and 'per rectal
haemorrhage', and the coding standards related to these terms. No actual codes are required. [3
Marks]correct answer: The code (K62.5) for 'haemorrhage of anus and rectum' must only be
assigned for an actual haemorrhage of the anus and/or rectum. It must not be assigned for
haemorrhage that has occurred from elsewhere in the gastrointestinal tract that is merely exiting
via the rectum, i.e. per rectal haemorrhage.
The code (K92.2) for 'gastrointestinal haemorrhage, unspecified' must be assigned for a
haemorrhage that occurred via the rectum (per rectal haemorrhage) but is not specified as being
from the actual rectum or anus. This code must not be assigned when it is a symptom of a
specific disease which has been diagnosed.
,How must a colonoscopy with ileal intubation that includes a biopsy of the terminal ileum be
coded? No actual codes are required. [2 Marks]correct answer: (H22.1) Diagnostic fibre optic
endoscopic examination of colon and biopsy of lesion of colon followed by the site code (Z27.6)
Ileum
What clinical coding standards relating to the use of ICD-10 category O63 Long labour must the
coder be aware of? [2 Marks]correct answer: It must be documented in the medical record that
the labour or stage of labour is prolonged/long for this category to be used.
If the reason for the prolonged/long labour is stated, then this must be coded instead
When must the insertion of a nasogastric (NG) feeding tube be coded? [1 Mark]correct answer:
When a patient is admitted solely for the purpose of insertion.
What is the OPCS-4 standard when a gastroscope is not able to be inserted further than the
patient's mouth during an endoscopy? No actual codes are required. [1 Mark]correct answer: The
procedure must not be coded.
The ICD-10 classification contains 22 chapters and is divided into three different chapter types.
Name the three types of chapter. [3 Marks]correct answer: Special group chapters
Body system chapters
Other chapters
When there is doubt as to where a condition should be coded which of the three chapter types
found in the axis of the ICD-10 classification takes priority? [1 Mark]correct answer: Where
there is any doubt as to where a condition should be coded, the 'special group' chapters must take
priority.
In order for an ICD-10 classification code to be valid what is the minimum character length that
it must be? Describe the structure of a code and how it must be extended as documented in
DRule.2: Category and code structure. [5 Marks]correct answer: Four.
Three character category codes must subdivided into four character subcategories.
Where a three character category code is not subdivided into four character subdivisions the 'X'
filler must be assigned in the fourth character field so the codes are of a standard length for data
processing and validation.
Where a three character code requires assignment of both the 'X' filler and a fifth character
subdivision, the 'X' filler must continue to be recorded in the fourth field before the fifth
character, for example M45.X3 Ankylosing spondylitis, cervicothoracic region.
Where is the 'point dash (.-)' punctuation found in the ICD-10 classification and describe its
purpose? [3 Marks]correct answer: A point-dash is found in both the Tabular List and the
Alphabetical Index to indicate there are fourth character subdivisions.
, Unique identifiers (reference number) are applied to four areas of the National Clinical Coding
Standards ICD-10 4th Edition (2015) reference book; flow charts are one of these, name the
other three. [3 Marks]correct answer: Rules
Conventions
Standards
Name the three types of standard documented in the National Clinical Coding Standards ICD-10
4th Edition (2015) reference book. Briefly describe their locations within it and how they should
be applied. [9 Marks]correct answer: General coding standards are located at the beginning of
the reference book and are applicable throughout the classification.
Chapter standards are located at the beginning of an ICD-10 chapter of the reference book and
are applicable throughout that chapter. Note that not all chapters will have chapter standards.
Coding standards are located throughout each ICD-10 chapter of the reference book and are
applicable to a specific diagnosis, disorder, disease or condition, or describe the correct usage of
a code, category or range of codes. Coding standards are, generally, listed in code, category or
range order.
What must clinical coders take into account when coding a 'radical operation'? [3 Marks]correct
answer: When coding radical operations:
Code assignment must fully reflect the procedure(s) performed during the radical operation.
Instructional Notes must be applied in order to fully reflect all procedures performed.
Any uncertainty as to what procedures were performed during the radical operation must be
clarified with the responsible consultant in order to ensure correct code assignment.
What sequencing rules must be applied when a resection and reconstruction of an organ or site
has been performed during the same theatre visit? [2 Marks]correct answer: Where resection and
reconstruction have been performed the codes that classify the resection must be assigned before
the codes that classify the reconstruction.
What is being described when codes from OPCS-4.7 category V55 Levels of spine are assigned?
[1 Mark]correct answer: The number of levels being operated on.
A level of spine can mean one of three things; what can they mean and give one example of an
operation specific to each meaning? [6 Marks]correct answer: A 'level of spine' means either a
vertebra, a disc, or a motion segment.
Operations carried out on vertebrae include:
Vertebral excision
Decompression of fractured vertebrae
Reduction and fixation of fractured vertebrae
Biopsy of vertebrae
