CCS PRACTICE EXAM 2025/ 2026
QUESTIONS WITH VERIFIED
ANSWERS
A payer's policy does not cover tetanus injections when provided as a preventive service but will
cover them when provided as a postinjury service. If the injection is provided in the emergency
department, what part of the claim will need to be modified to indicate the injection was a
postinjury service rather than a preventive service?
a. Diagnosis code
b. Procedure code
c. Revenue code
d. Disposition code - correct answer -Correct answer: C
The revenue code will need to be changed according to the payer guidelines from one that
indicates preventive service to one that indicates the emergency department (Casto 2018, 258).
Which of the following represents a potential hospital-acquired condition?
a. Stage 4 pressure ulcer of the coccyx
b. Foreign body of the skin
c. Urinary tract infection
d. Diabetes - correct answer -Correct answer: A
Stage 3 and 4 pressure ulcers fall on the CMS hospital-acquired conditions list (CMS 2020c)
,A 75-year-old patient is admitted for a complex, ventral hernia repair. While in the hospital, the
patient slips and falls, suffering a left hip fracture. Will the hip fracture be identified as part of
the facility's patient safety indicators (PSI)? Why or why not?
a. No, the hip fracture is the principal diagnosis and will not be part of the PSI
b. Yes, the hip fracture is the principal diagnosis and would still be part of the PSI
c. No, the hip fracture is a secondary diagnosis and therefore, will not be part of the PSI
d. Yes, the hip fracture is a secondary diagnosis and will be part of the PSI - correct answer -
Correct answer: D
Patient safety indicators are designed to capture adverse effects following surgery, procedures,
or childbirth. Therefore, it is a secondary diagnosis of hip fracture that will necessitate capture
of the PSI (CMS 2020d).
A patient is admitted for treatment of hemophilia with a blood transfusion. The patient had an
ABO incompatibility reaction to the transfusion and was taken to the ICU for monitoring and IV
saline. The admission is complicated by the development of a pneumonia and the patient's
ongoing medical conditions of hypothyroidism and hyperlipidemia, both of which required
medication during hospitalization. Breathing treatments continued for the pneumonia and no
further transfusions were given. Which condition in the above scenario reflects a hospital-
acquired condition?
a. Hemophilia
b. Pneumonia
c. ABO incompatibility
d. Hypothyroidism - correct answer -Correct answer: C
The ABO incompatibility was a transfusion reaction which is on the CMS hospital-acquired
conditions list (CMS 2020c).
,An urgent care facility located near a national park treats a significant number of patients with
snake bites. Patients receive treatment with antivenom. On occasion, a patient must later be
admitted to the hospital. Can the urgent care facility provide the hospital with a list of names of
patients treated with snake antivenom?
a. Only the names of patients who are admitted to the hospital for continuation of care could be
provided.
b. A full list of names could be provided.
c. No information can be obtained under any circumstances.
d. A list of patients may be available after consultation with the medical director. - correct
answer -Correct answer: A
Only records that are required for care or authorized by the patient can be released by the
urgent-care facility to the acute-care facility (Rinehart-Thompson 2017a, 216-217; Rinehart-
Thompson 2020a, 272-277).
The patient was admitted for breast carcinoma in the right breast at two o'clock. This was
removed via lumpectomy. An axillary lymph node dissection, performed along with the
lumpectomy, identified 1 of 7 lymph nodes positive for carcinoma. One of the patient's
neighbors, who works at the hospital, called the coding department to get the patient's
diagnosis because she is a cancer survivor herself. The coder should:
a. Discuss the case with the coworker
b. Report the incident to hospital security
c. Give the caller false information
d. Explain that discussing the case would violate the patient's right to privacy - correct answer -
Correct answer: D
Disclosing information without the patient's written consent violates the patient's right to
privacy (Rinehart-Thompson 2017a, 221-230; Hamilton 2020, 669-670).
, The billing department has requested that copies of patients' final coding summaries with
associated code meanings for Medicare be printed remotely in the admission department.
Currently, they only request the summaries when there is an unspecified procedure. On
previous visits to the admission department, the coding supervisor has found the coding
summaries were left on a table near the patient entrance. Of the actions presented here, what
would be the best action for the coding supervisor to take?
a. Comply with the request.
b. Refuse to undertake this without further explanation.
c. Ignore the request.
d. Explain to the billing department supervisor that leaving the coding summary in public view
violates the patient's right to privacy. - correct answer -Correct answer: D
Health information should not be left in public view (Rinehart-Thompson 2017b, 257).
Code sets that are mandated under HIPAA include all of the following except:
a. National Drug Codes
b. ICD-10-CM and ICD-10-PCS
c. CPT
d. Hierarchical Condition Category - correct answer -Correct answer: D
Hierarchical condition categories are used for risk adjustment but are not part of the HIPAA
designated code sets. Hierarchical condition category (HCC) coding is a risk-adjusted
reimbursement model based on the reporting of ICD-10-CM diagnosis codes (Casto 2018, 31-34,
238).
The electronic transactions and code sets standards are found under which part of HIPAA?
a. Administrative Simplification
QUESTIONS WITH VERIFIED
ANSWERS
A payer's policy does not cover tetanus injections when provided as a preventive service but will
cover them when provided as a postinjury service. If the injection is provided in the emergency
department, what part of the claim will need to be modified to indicate the injection was a
postinjury service rather than a preventive service?
a. Diagnosis code
b. Procedure code
c. Revenue code
d. Disposition code - correct answer -Correct answer: C
The revenue code will need to be changed according to the payer guidelines from one that
indicates preventive service to one that indicates the emergency department (Casto 2018, 258).
Which of the following represents a potential hospital-acquired condition?
a. Stage 4 pressure ulcer of the coccyx
b. Foreign body of the skin
c. Urinary tract infection
d. Diabetes - correct answer -Correct answer: A
Stage 3 and 4 pressure ulcers fall on the CMS hospital-acquired conditions list (CMS 2020c)
,A 75-year-old patient is admitted for a complex, ventral hernia repair. While in the hospital, the
patient slips and falls, suffering a left hip fracture. Will the hip fracture be identified as part of
the facility's patient safety indicators (PSI)? Why or why not?
a. No, the hip fracture is the principal diagnosis and will not be part of the PSI
b. Yes, the hip fracture is the principal diagnosis and would still be part of the PSI
c. No, the hip fracture is a secondary diagnosis and therefore, will not be part of the PSI
d. Yes, the hip fracture is a secondary diagnosis and will be part of the PSI - correct answer -
Correct answer: D
Patient safety indicators are designed to capture adverse effects following surgery, procedures,
or childbirth. Therefore, it is a secondary diagnosis of hip fracture that will necessitate capture
of the PSI (CMS 2020d).
A patient is admitted for treatment of hemophilia with a blood transfusion. The patient had an
ABO incompatibility reaction to the transfusion and was taken to the ICU for monitoring and IV
saline. The admission is complicated by the development of a pneumonia and the patient's
ongoing medical conditions of hypothyroidism and hyperlipidemia, both of which required
medication during hospitalization. Breathing treatments continued for the pneumonia and no
further transfusions were given. Which condition in the above scenario reflects a hospital-
acquired condition?
a. Hemophilia
b. Pneumonia
c. ABO incompatibility
d. Hypothyroidism - correct answer -Correct answer: C
The ABO incompatibility was a transfusion reaction which is on the CMS hospital-acquired
conditions list (CMS 2020c).
,An urgent care facility located near a national park treats a significant number of patients with
snake bites. Patients receive treatment with antivenom. On occasion, a patient must later be
admitted to the hospital. Can the urgent care facility provide the hospital with a list of names of
patients treated with snake antivenom?
a. Only the names of patients who are admitted to the hospital for continuation of care could be
provided.
b. A full list of names could be provided.
c. No information can be obtained under any circumstances.
d. A list of patients may be available after consultation with the medical director. - correct
answer -Correct answer: A
Only records that are required for care or authorized by the patient can be released by the
urgent-care facility to the acute-care facility (Rinehart-Thompson 2017a, 216-217; Rinehart-
Thompson 2020a, 272-277).
The patient was admitted for breast carcinoma in the right breast at two o'clock. This was
removed via lumpectomy. An axillary lymph node dissection, performed along with the
lumpectomy, identified 1 of 7 lymph nodes positive for carcinoma. One of the patient's
neighbors, who works at the hospital, called the coding department to get the patient's
diagnosis because she is a cancer survivor herself. The coder should:
a. Discuss the case with the coworker
b. Report the incident to hospital security
c. Give the caller false information
d. Explain that discussing the case would violate the patient's right to privacy - correct answer -
Correct answer: D
Disclosing information without the patient's written consent violates the patient's right to
privacy (Rinehart-Thompson 2017a, 221-230; Hamilton 2020, 669-670).
, The billing department has requested that copies of patients' final coding summaries with
associated code meanings for Medicare be printed remotely in the admission department.
Currently, they only request the summaries when there is an unspecified procedure. On
previous visits to the admission department, the coding supervisor has found the coding
summaries were left on a table near the patient entrance. Of the actions presented here, what
would be the best action for the coding supervisor to take?
a. Comply with the request.
b. Refuse to undertake this without further explanation.
c. Ignore the request.
d. Explain to the billing department supervisor that leaving the coding summary in public view
violates the patient's right to privacy. - correct answer -Correct answer: D
Health information should not be left in public view (Rinehart-Thompson 2017b, 257).
Code sets that are mandated under HIPAA include all of the following except:
a. National Drug Codes
b. ICD-10-CM and ICD-10-PCS
c. CPT
d. Hierarchical Condition Category - correct answer -Correct answer: D
Hierarchical condition categories are used for risk adjustment but are not part of the HIPAA
designated code sets. Hierarchical condition category (HCC) coding is a risk-adjusted
reimbursement model based on the reporting of ICD-10-CM diagnosis codes (Casto 2018, 31-34,
238).
The electronic transactions and code sets standards are found under which part of HIPAA?
a. Administrative Simplification
