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CCS Exam prep - exam 1 2024 – Questions and Answers
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CCS Exam prep - exam 1 2024 –Questions and Answers
. A patient is admitted with a high temperature, lethargy, hypotension,
tachycardia, oliguria, and elevated WBC. The patient also has more than
100,000 organisms of Escherichia coli per cc of urine. The attending
physician documents "urosepsis." What is the next step for the coder?
a. Code sepsis as the principal with a secondary diagnosis of urinary tract
infection due to E. coli.
b. Code urinary tract infection with sepsis as a secondary diagnosis.
c. Query the physician to determine if the patient is being treated for sepsis,
highlighting the clinical signs and symptoms.
d. Ask the physician whether the patient had septic shock so that this may
be used as the principal diagnosis. - -Correct Answer: C
The term urosepsis is a nonspecific term. It has no default code in the
Alphabetic Index. Should providers use this term, they must be queried for
clarification (CMS 2018a, Section I.C.1.d., 22).
-2. A patient is prescribed Diazepam and reports taking more than the
prescribed amount. The patient is admitted to the hospital for complete work
up. The final diagnosis is documented as Diazepam use and abuse. How
should this be coded?
a. F13.180
b. F13.188
c. F13.10
d. F13.11 - -Correct Answer: C
Diazepam is a sedative. When use and abuse are documented, assign only
the code for abuse (CMS 2018a, Section I.C.5.b.2., 37).
-5-year-old patient admitted with Insulin dependent diabetes. The type of
diabetes is not specified in the medical record. How should this be coded?
a. E11.9, Z79.4
b. E11.8
c. E11.8, Z79.4
d. Z79.4, E11.8 - -Correct Answer: A
If the type of diabetes mellitus is not documented in the medical record the
default is E11.-, Type 2 diabetes mellitus. Code Z79.4, Long term (current)
use of insulin, should also be assigned for patients who take insulin (CMS
2018a, Section I.C.4.a.2, 34).
-67-year-old patient presents with carcinoma of multiple overlapping sites of
the bladder. Diagnostic cystoscopy and transurethral fulguration of bladder
lesions (1.9 cm, 6.0 cm) are undertaken. The appropriate CPT code(s) would
be:
,52000 Cystourethroscopy (separate procedure)
52224 Cystourethroscopy, with fulguration (including cryosurgery or laser
surgery) or treatment of minor (less than 0.5 cm) lesion(s) with or without
biopsy
52234 Cystourethroscopy, with fulguration (including cryosurgery or laser
surgery) and/or resection of small bladder tumor(s) (0.5 cm to 2.0 cm)
52235 Cystourethroscopy, with fulguration (including cryosurgery or laser
surgery) and/or resection of medium bladder tumor(s) (2.0 cm to 5.0 cm)
52240 Cystourethroscopy, with fulguration (including cryosurgery or laser
surgery) and/or resection of large bladder tumor(s)
a. 52234, 52240
b. 52235
c. 52240
d. 52000, 52234 - -Correct Answer: C
Codes 52234-52240 should only be reported once, regardless of the number
of tumors removed. Only one of the three codes may be reported per
session. Select the code based on the largest tumor. Code 52240 is used
when one or more of the tumors are larger than 5.0 cm (CPT Assistant Aug.
2009, 6).
-A 23-year-old female is admitted for shock following treatment of a
miscarriage. The pathology report from the previous admission reveals that
the patient had no decidua or products of conception in the tissue removed.
This encounter would be coded as:
a. O03.81, Spontaneous abortion complicated by shock
b. O08.9, Complication following abortion and ectopic and molar pregnancies
c. R57.9, Shock NOS
d. T81.10XA, Postoperative shock - -Correct Answer: B
When a patient is readmitted because a complication has developed
following discharge for a treated miscarriage, a code from category O08 is
assigned as the principal diagnosis. Code O08.9 is used because the
miscarriage (spontaneous abortion) was dealt with in a prior episode of care
(Leon-Chisen 2018, 347-348).
-A 30-year-old woman with a 6-year history of anorexia nervosa was seen in
her physician's office because of significant weight loss over the past three
months going from 82 pounds down to 53 pounds. She was admitted to the
hospital to increase body weight and to be given nutrition counseling
because of her severe malnutrition. How should this be coded?
a. F50.00, Anorexia nervosa, unspecified
b. F50.00, Anorexia nervosa, unspecified E43, Unspecified severe protein-
calorie malnutrition
c. F50.01, Anorexia nervosa, restricting type
d. E43, Unspecified severe protein-calorie malnutrition - -Correct Answer: B
,Code E43 should be assigned as an additional diagnosis for the severe
malnutrition. For some anorexic patients, the weight loss is so severe that it
leads to malnutrition. Code E43 further describes the severity of the patient's
condition (Leon-Chisen 2018, 548).
-A 45-year-old man with known AIDS is admitted to the hospital for
treatment of Pneumocystis carinii pneumonia. What is the principal diagnosis
code?
a. B20
b. J18.9
c. B59
d. Any of the above - -Correct Answer: A
AIDS stands for acquired immunodeficiency syndrome, frequently referred to
as human immunodeficiency virus (HIV). Whenever an HIV-positive patient is
admitted with an HIV-related condition, the principal diagnosis is B20,
followed by additional ICD-10-CM codes for all reported HIV-related
conditions (CMS 2018a, Section I.C.1.a.2., 19).
-A 56-year-old woman is admitted to an acute-care facility from a skilled
nursing facility. The patient has multiple sclerosis and hypertension. During
the course of hospitalization, a decubitus ulcer is found and debrided at the
bedside by a physician. There is no typed operative report and no pathology
report. The coder should:
a. Use an excisional debridement code as these charts are rarely reviewed to
verify the excisional debridement
b. Code with a nonexcisional debridement procedure code
c. Query the healthcare provider who performed the procedure to determine
if the debridement was excisional
d. Eliminate the procedure code all together - -Correct Answer: C
Excisional debridement can be performed in the operating room, the
emergency department, or at the bedside. Coders are encouraged to work
with the physician and other healthcare providers to ensure that the
documentation in the health record is very specific regarding the type of
debridement performed. If there is any question as to whether the
debridement is excisional or nonexcisional, the provider should be queried
for clarification (Schraffenberger and Palkie 2018, 402).
-A 65-year-old male patient is being assessed for possible colon cancer and
treated in the special procedure unit of the hospital. He undergoes a
colonoscopy into the ascending colon with biopsy of a suspicious area in the
transverse colon using the cold biopsy forceps. In addition, a colonic
ultrasound of the area is performed, with transmural biopsy of an area of the
mesentery adjacent to the transverse colon. Assign the appropriate CPT
codes.
a. 45384, 45342
b. 45380, 45391
, c. 45384, 45392
d. 45380, 45392 - -Correct Answer: D
Use index entry Colonoscopy, flexible, biopsy to assign CPT 45380 and entry
Colonoscopy, flexible, ultrasound for 45392. The CPT coding guidelines and
descriptions of colonoscopy codes and the Colonoscopy Decision Tree should
be referenced for correct coding of these procedures (AMA CPT Professional
Edition 2018, 314-317).
-A 65-year-old man is admitted due to an acute myocardial infarction. The
patient also has coronary artery disease. How should this be coded?
a. CAD, AMI
b. AMI
c. AMI, CAD
d. Query the physician for the principal diagnosis - -Correct Answer: C
If a patient with coronary artery disease is admitted due to an acute
myocardial infarction (AMI), the AMI should be sequenced before the
coronary artery disease (CMS 2018a, Section I.C.9.b, 44).
-A 65-year-old patient is admitted with pain and loosening of a left total hip
prosthesis. The acetabular component has loosened and become painful. The
patient was admitted for open removal and replacement of the acetabular
component of the left hip prosthesis. What is the appropriate code(s) for the
admission?
T84.031A Mechanical loosening of internal left hip prosthetic joint, initial
encounter
T84.031D Mechanical loosening of internal left hip prosthetic joint,
subsequent encounter
T84.030A Mechanical loosening of internal right hip prosthetic joint, initial
encounter
T84.50XA Infection and inflammatory reaction due to unspecified internal
joint prosthesis, initial encounter
Z96.642 Presence of left artificial hip joint
0SP90JZ Removal of synthetic substitute from right hip joint, open approach
0SPB0JZ Removal of synthetic substitute from left hip joint, open approach
0SUA0BZ Supplement right hip joint, acetabula - -Correct Answer: A
Common reasons for revision joint replacement surgery include mechanical
loosening of the prosthesis, dislocation of the prosthetic joint, fracture of the
bone around the implant. In addition to the complication code, an additional
code can be assigned to identify the previous joint replacement. Revision of
the acetabular component involves removal and exchange of the entire
acetabular component, including both the metal shell and the polyethylene,
ceramic, or metal modular bearing surface (Leon-Chisen 2018, 302-303).
-A 7-year-old patient was admitted to the emergency department for
treatment of shortness of breath. The patient is given epinephrine and
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