Certified Coding Associate Exam Certified Coding Associate Classification 4 — Questions and Answers
Question 1: Which of the following best describes the 'Excision' root operation in ICD-10-PCS?
- Cutting out or off, without replacement, a portion of a body part (Correct answer)
- Taking out or off all of a body part
- Removing a device from a body part
- Altering the route of passage of the contents of a tubular body part
Correct answer: Cutting out or off, without replacement, a portion of a body part
Excision is defined in ICD-10-PCS as cutting out or off, without replacement, a portion (not all) of a body part.
Question 2: Under ICD-10-CM guidelines, signs and symptoms that are integral to a confirmed disease are:
- Coded separately to provide additional specificity
- Not coded separately, as they are included in the confirmed diagnosis code (Correct answer)
- Coded with a 'manifestation' code
- Reported using a 'Z' code for the symptom
Correct answer: Not coded separately, as they are included in the confirmed diagnosis code
Signs and symptoms that are routinely associated with a disease process are not coded separately when a definitive diagnosis has been established.
Question 3: In CPT, what is the purpose of an 'add-on' code (indicated by a '+' symbol)?
- It can be reported alone without a primary procedure code
- It must be reported in addition to a primary procedure and cannot be used alone (Correct answer)
- It indicates a service performed by a second surgeon
- It replaces the primary code when a more complex service is performed
Correct answer: It must be reported in addition to a primary procedure and cannot be used alone
CPT add-on codes, marked with a '+', are always reported in conjunction with a primary procedure code and are never used independently.
Question 4: Which ICD-10-CM chapter contains codes for factors influencing health status and contact with health services?
- Chapter 19 — Injury and Poisoning
- Chapter 20 — External Causes of Morbidity
- Chapter 21 — Factors Influencing Health Status (Z codes) (Correct answer)
- Chapter 18 — Symptoms, Signs, and Abnormal Findings
Correct answer: Chapter 21 — Factors Influencing Health Status (Z codes)
Chapter 21 of ICD-10-CM contains Z codes, which represent encounters for reasons other than illness or injury, such as screenings, vaccinations, and history.
Question 5: A patient receives a prescription for a drug that causes an adverse effect when taken correctly as prescribed. How is this coded in ICD-10-CM?
- Code the adverse effect first, then a code from T36–T50 with 5th character '5' (Correct answer)
- Code only the drug code with a poisoning character
- Code underdosing, then the drug code
- Code with an external cause code only
Correct answer: Code the adverse effect first, then a code from T36–T50 with 5th character '5'
For adverse effects, ICD-10-CM instructs coding the nature of the adverse effect first, followed by the drug code (T36–T50) with the appropriate 5th/6th character for adverse effect.
Question 6: In the outpatient setting, which of the following should be coded as the first-listed diagnosis?
- The condition that caused the greatest resource use
- The condition chiefly responsible for the outpatient service as documented by the provider (Correct answer)
- The condition requiring the most complex treatment
- The chronic condition that is always managed at each visit
Correct answer: The condition chiefly responsible for the outpatient service as documented by the provider
For outpatient services, the first-listed diagnosis is the condition, after study, chiefly responsible for the service provided on that encounter.
Question 7: Which of the following correctly describes DRG (Diagnosis Related Group) reimbursement?
- Hospitals are paid per individual service rendered
- Payment is based on a fixed rate determined by the patient's diagnosis group (Correct answer)
- Physicians are reimbursed based on resource-based relative value units
- Payment is determined by actual costs incurred during the stay
Correct answer: Payment is based on a fixed rate determined by the patient's diagnosis group
DRG reimbursement pays hospitals a fixed, predetermined rate based on the assigned DRG, regardless of actual costs incurred during the stay.
