CCA Mock Exam| 53 QUESTIONS| WITH COMPLETE
SOLUTIONS
Course
CCA
1. Question:
A patient was admitted for treatment of uncontrolled type 2 diabetes mellitus with diabetic
nephropathy. Which code(s) should be assigned?
Answer:
E11.21 - Type 2 diabetes mellitus with diabetic nephropathy.
Rationale:
The combination code E11.21 captures both the type 2 diabetes and the presence of
nephropathy, which is a specific manifestation associated with the diabetes. Coding
guidelines state that a combination code should be used when possible.
2. Question:
A coder notices an overuse of unspecified codes in the documentation. Which approach
should be used to improve specificity?
Answer:
Encourage providers to document more specific details about diagnoses and procedures.
Rationale:
Coders should educate and work with providers to improve documentation quality.
Specificity in documentation allows for more accurate coding, supporting better clinical
outcomes and reimbursement accuracy.
3. Question:
When coding a hospital inpatient chart, the principal diagnosis is defined as:
Answer:
The condition, after study, that occasioned the admission to the hospital.
Rationale:
The principal diagnosis is determined based on the condition that was chiefly responsible for
the hospital admission, identified after thorough study.
,4. Question:
What is the correct CPT code for a laparoscopic cholecystectomy?
Answer:
47562 - Laparoscopy, surgical; cholecystectomy.
Rationale:
CPT code 47562 is the correct code for a laparoscopic removal of the gallbladder
(cholecystectomy). Coding guidelines indicate selecting the code that accurately reflects the
surgical technique used.
5. Question:
Which of the following is not a component of the outpatient prospective payment system
(OPPS)?
A) Ambulatory Payment Classification (APC)
B) DRG
C) Status Indicators
D) Packaging of services
Answer:
B) DRG
Rationale:
Diagnosis-Related Groups (DRGs) are part of the inpatient prospective payment system, not
OPPS. The OPPS uses APCs, status indicators, and packaging for outpatient payment.
6. Question:
When using the ICD-10-CM code book, which chapter should be referenced for congenital
malformations?
Answer:
Chapter 17 - Congenital malformations, deformations, and chromosomal abnormalities.
Rationale:
Chapter 17 (codes Q00-Q99) covers congenital anomalies and deformations, and should be
referenced for conditions that a patient is born with.
7. Question:
, For a patient receiving physical therapy due to a rotator cuff tear, which modifier should be
added if the service is distinct from others provided on the same day?
Answer:
Modifier 59 - Distinct procedural service.
Rationale:
Modifier 59 is used to indicate that a procedure is distinct or independent from other services
provided on the same day. It allows for proper reimbursement and prevents bundling errors.
8. Question:
When coding for a closed fracture of the right femur with delayed healing, which seventh
character should be assigned?
Answer:
D - Subsequent encounter for fracture with delayed healing.
Rationale:
For fractures, ICD-10-CM guidelines specify using a seventh character to indicate the
encounter type. “D” denotes a subsequent encounter for delayed healing.
9. Question:
Which coding system is primarily used for outpatient procedures in the United States?
Answer:
CPT (Current Procedural Terminology).
Rationale:
The CPT code set, maintained by the American Medical Association, is primarily used for
coding outpatient procedures and physician services.
10. Question:
In the context of coding, what is upcoding?
Answer:
Upcoding is the practice of assigning codes that do not accurately reflect the level of service
provided, typically to receive a higher reimbursement.
Rationale:
Upcoding is unethical and illegal because it results in false claims. Accurate coding should
reflect the services actually provided, supporting correct reimbursement and compliance.
SOLUTIONS
Course
CCA
1. Question:
A patient was admitted for treatment of uncontrolled type 2 diabetes mellitus with diabetic
nephropathy. Which code(s) should be assigned?
Answer:
E11.21 - Type 2 diabetes mellitus with diabetic nephropathy.
Rationale:
The combination code E11.21 captures both the type 2 diabetes and the presence of
nephropathy, which is a specific manifestation associated with the diabetes. Coding
guidelines state that a combination code should be used when possible.
2. Question:
A coder notices an overuse of unspecified codes in the documentation. Which approach
should be used to improve specificity?
Answer:
Encourage providers to document more specific details about diagnoses and procedures.
Rationale:
Coders should educate and work with providers to improve documentation quality.
Specificity in documentation allows for more accurate coding, supporting better clinical
outcomes and reimbursement accuracy.
3. Question:
When coding a hospital inpatient chart, the principal diagnosis is defined as:
Answer:
The condition, after study, that occasioned the admission to the hospital.
Rationale:
The principal diagnosis is determined based on the condition that was chiefly responsible for
the hospital admission, identified after thorough study.
,4. Question:
What is the correct CPT code for a laparoscopic cholecystectomy?
Answer:
47562 - Laparoscopy, surgical; cholecystectomy.
Rationale:
CPT code 47562 is the correct code for a laparoscopic removal of the gallbladder
(cholecystectomy). Coding guidelines indicate selecting the code that accurately reflects the
surgical technique used.
5. Question:
Which of the following is not a component of the outpatient prospective payment system
(OPPS)?
A) Ambulatory Payment Classification (APC)
B) DRG
C) Status Indicators
D) Packaging of services
Answer:
B) DRG
Rationale:
Diagnosis-Related Groups (DRGs) are part of the inpatient prospective payment system, not
OPPS. The OPPS uses APCs, status indicators, and packaging for outpatient payment.
6. Question:
When using the ICD-10-CM code book, which chapter should be referenced for congenital
malformations?
Answer:
Chapter 17 - Congenital malformations, deformations, and chromosomal abnormalities.
Rationale:
Chapter 17 (codes Q00-Q99) covers congenital anomalies and deformations, and should be
referenced for conditions that a patient is born with.
7. Question:
, For a patient receiving physical therapy due to a rotator cuff tear, which modifier should be
added if the service is distinct from others provided on the same day?
Answer:
Modifier 59 - Distinct procedural service.
Rationale:
Modifier 59 is used to indicate that a procedure is distinct or independent from other services
provided on the same day. It allows for proper reimbursement and prevents bundling errors.
8. Question:
When coding for a closed fracture of the right femur with delayed healing, which seventh
character should be assigned?
Answer:
D - Subsequent encounter for fracture with delayed healing.
Rationale:
For fractures, ICD-10-CM guidelines specify using a seventh character to indicate the
encounter type. “D” denotes a subsequent encounter for delayed healing.
9. Question:
Which coding system is primarily used for outpatient procedures in the United States?
Answer:
CPT (Current Procedural Terminology).
Rationale:
The CPT code set, maintained by the American Medical Association, is primarily used for
coding outpatient procedures and physician services.
10. Question:
In the context of coding, what is upcoding?
Answer:
Upcoding is the practice of assigning codes that do not accurately reflect the level of service
provided, typically to receive a higher reimbursement.
Rationale:
Upcoding is unethical and illegal because it results in false claims. Accurate coding should
reflect the services actually provided, supporting correct reimbursement and compliance.
