MEDICAL CODING EXAM 4 | MEDICAL CODER
| LATEST 2025-2026 QUESTION AND CORRECT
ANSWER WITH EXPLANATION WEST COAST
UNIVERSITY
1. A patient is admitted for pneumonia due to COVID-19 with acute
hypoxic respiratory failure. The provider lists respiratory failure as
the principal reason for admission. What is the correct sequencing?
A. J96.01, U07.1, J12.82
B. U07.1, J12.82, J96.01
C. J12.82, J96.01, U07.1
D. J96.01 only
Correct Answer: B
Rationale: COVID-19 is always sequenced first regardless of provider
wording when it is the confirmed underlying etiology.
2. A patient presents with chest pain. After full workup, myocardial
infarction is ruled out, and GERD is diagnosed. What is coded?
A. I21.-
B. R07.9
C. K21.9
D. Both B and C
Correct Answer: C
Rationale: Once a definitive diagnosis is established, symptoms are not
coded.
3. A patient undergoes laparoscopic appendectomy converted to open
due to adhesions. The surgeon documents “laparoscopy started.”
How is this coded?
A. Laparoscopic appendectomy
B. Open appendectomy only
C. Both codes
D. Unlisted procedure
,Correct Answer: B
Rationale: Conversion requires reporting only the completed open
procedure.
4. A patient has sepsis due to postoperative wound infection with
acute kidney injury. What is sequenced first?
A. N17.9
B. T81.4XXA
C. A41.-
D. R65.20
Correct Answer: B
Rationale: Postoperative complication is sequenced before sepsis.
5. A patient has type 2 diabetes with hypoglycemia due to insulin use
and coma. Which is correct sequencing?
A. E11.649, T38.3X1A
B. T38.3X1A, E11.649
C. E16.2, E11.9
D. E11.65 only
Correct Answer: B
Rationale: Adverse effect (insulin) is sequenced first.
6. A patient has acute MI and develops ventricular fibrillation arrest.
Which is coded?
A. I49.01 only
B. I21.- only
C. I21.- and I49.01
D. I46.9 only
Correct Answer: C
Rationale: Both MI and arrest are coded.
, 7. A patient has anemia due to CKD stage 3. What is correct
sequencing?
A. D63.1, N18.3
B. N18.3, D63.1
C. D64.9 only
D. N17.9 only
Correct Answer: B
Rationale: CKD is sequenced before anemia.
8. A patient is admitted for dehydration and acute kidney injury.
Which is principal?
A. N17.9
B. E86.0
C. Both equal
D. Symptoms only
Correct Answer: B
Rationale: Dehydration is underlying cause.
9. A patient undergoes diagnostic colonoscopy followed by
polypectomy. What is coded?
A. Diagnostic only
B. Polypectomy only
C. Both always
D. Neither
Correct Answer: B
Rationale: Therapeutic procedure overrides diagnostic.
10. A patient has acute respiratory failure due to opioid overdose.
What is sequenced first?
A. J96.00
B. T40.2X1A
| LATEST 2025-2026 QUESTION AND CORRECT
ANSWER WITH EXPLANATION WEST COAST
UNIVERSITY
1. A patient is admitted for pneumonia due to COVID-19 with acute
hypoxic respiratory failure. The provider lists respiratory failure as
the principal reason for admission. What is the correct sequencing?
A. J96.01, U07.1, J12.82
B. U07.1, J12.82, J96.01
C. J12.82, J96.01, U07.1
D. J96.01 only
Correct Answer: B
Rationale: COVID-19 is always sequenced first regardless of provider
wording when it is the confirmed underlying etiology.
2. A patient presents with chest pain. After full workup, myocardial
infarction is ruled out, and GERD is diagnosed. What is coded?
A. I21.-
B. R07.9
C. K21.9
D. Both B and C
Correct Answer: C
Rationale: Once a definitive diagnosis is established, symptoms are not
coded.
3. A patient undergoes laparoscopic appendectomy converted to open
due to adhesions. The surgeon documents “laparoscopy started.”
How is this coded?
A. Laparoscopic appendectomy
B. Open appendectomy only
C. Both codes
D. Unlisted procedure
,Correct Answer: B
Rationale: Conversion requires reporting only the completed open
procedure.
4. A patient has sepsis due to postoperative wound infection with
acute kidney injury. What is sequenced first?
A. N17.9
B. T81.4XXA
C. A41.-
D. R65.20
Correct Answer: B
Rationale: Postoperative complication is sequenced before sepsis.
5. A patient has type 2 diabetes with hypoglycemia due to insulin use
and coma. Which is correct sequencing?
A. E11.649, T38.3X1A
B. T38.3X1A, E11.649
C. E16.2, E11.9
D. E11.65 only
Correct Answer: B
Rationale: Adverse effect (insulin) is sequenced first.
6. A patient has acute MI and develops ventricular fibrillation arrest.
Which is coded?
A. I49.01 only
B. I21.- only
C. I21.- and I49.01
D. I46.9 only
Correct Answer: C
Rationale: Both MI and arrest are coded.
, 7. A patient has anemia due to CKD stage 3. What is correct
sequencing?
A. D63.1, N18.3
B. N18.3, D63.1
C. D64.9 only
D. N17.9 only
Correct Answer: B
Rationale: CKD is sequenced before anemia.
8. A patient is admitted for dehydration and acute kidney injury.
Which is principal?
A. N17.9
B. E86.0
C. Both equal
D. Symptoms only
Correct Answer: B
Rationale: Dehydration is underlying cause.
9. A patient undergoes diagnostic colonoscopy followed by
polypectomy. What is coded?
A. Diagnostic only
B. Polypectomy only
C. Both always
D. Neither
Correct Answer: B
Rationale: Therapeutic procedure overrides diagnostic.
10. A patient has acute respiratory failure due to opioid overdose.
What is sequenced first?
A. J96.00
B. T40.2X1A
