CCS Inpatient Diagnosis Coding Practice Questions
Inpatient Diagnosis Coding makes up 6 of every 50 questions on a Tigertest CCS practice test. Here are 10 of the 24 questions on it, each with the answer and the reason.
Updated by the Tigertest team. Weighted to the AHIMA CCS Exam Content Outline. Original questions on coding guidelines and concepts; not affiliated with AHIMA.
1. A patient with lung cancer is admitted solely to receive chemotherapy. The principal diagnosis is:
- A.Long-term drug therapy use
- B.Encounter for chemotherapy
- C.The lung cancer itself
- D.Adverse effect of the drug
Answer: B. When the only reason for admission is antineoplastic chemotherapy, the Z51.11 encounter code is sequenced first and the malignancy follows. If a complication arises, the Z code still stays first.
2. A cancer patient is admitted to treat dehydration due to the malignancy, and only the dehydration is treated. Sequence first:
- A.The chemotherapy encounter
- B.The adverse effect code
- C.The malignancy
- D.The dehydration
Answer: D. For an admission to manage dehydration due to the malignancy, with treatment directed only at the dehydration, the dehydration is sequenced first, followed by the malignancy.
3. A patient is admitted to treat anemia caused by the malignancy itself. Sequence first:
- A.The malignancy
- B.The anemia of chronic disease
- C.The anemia
- D.An encounter for transfusion
Answer: A. When admission is for management of anemia associated with the malignancy, the malignancy code is sequenced first, followed by D63.0, anemia in neoplastic disease. Anemia from chemotherapy follows a different rule.
4. A patient is admitted with fever, and the provider documents 'due to UTI or pneumonia,' neither confirmed. Code:
- A.The pneumonia, then fever
- B.The fever and no others
- C.Fever, then both conditions
- D.The UTI, then the fever
Answer: C. A symptom followed by contrasting or comparative diagnoses is sequenced first, and the contrasting conditions are coded as additional diagnoses, as if established in the inpatient setting.
5. A patient in observation for chest pain is admitted as an inpatient after an acute MI is found. The principal diagnosis is:
- A.Observation encounter
- B.Either one, by choice
- C.The acute MI
- D.The chest pain
Answer: C. When a patient is admitted after observation for a medical condition, the principal diagnosis is the condition that led to the inpatient admission, here the MI. The chest pain is integral to it.
6. After outpatient surgery, a patient is admitted because of a complication of that surgery. The principal diagnosis is:
- A.The complication
- B.The surgical encounter
- C.Any chronic condition
- D.The reason for surgery
Answer: A. When an outpatient surgery patient is admitted for a complication of the surgery, the complication is the principal diagnosis. With no complication, the reason for the admission is used.
7. A condition is documented as both acute and chronic, and the Index lists both at the same indentation level. Code:
- A.One combination code only
- B.The acute one only
- C.Both, with the chronic first
- D.Both, with the acute first
Answer: D. When separate subentries exist for acute and chronic at the same indentation level, both are coded and the acute (subacute) code is sequenced first. A combination code is used only when one exists.
8. For a sequela (late effect), which is usually sequenced first?
- A.The external cause code
- B.The residual condition
- C.The sequela code itself
- D.The original injury code
Answer: B. Coding a sequela generally takes two codes: the nature of the residual condition first, then the sequela code. The exception is when the Index or Tabular directs otherwise or a combination code exists.
9. A patient admitted for a planned surgery has it canceled because of a new problem that is then treated. The principal diagnosis is:
- A.A Z53 code by itself
- B.The reason for admission
- C.The new problem treated
- D.The canceled procedure
Answer: B. When the treatment plan is not carried out, the principal diagnosis is still the condition that, after study, occasioned the admission. A Z53 code shows the procedure was not carried out.
10. A patient admitted for cellulitis develops sepsis on day 3. The principal diagnosis is:
- A.Severe sepsis
- B.Either, by circumstances
- C.The sepsis
- D.The cellulitis
Answer: D. If sepsis develops after admission, the localized infection that occasioned the admission is the principal diagnosis and sepsis is an additional diagnosis with POA indicator N.
Practice all 24 inpatient diagnosis coding questions, and the rest of the 200-question bank, in the free CCS training sets. Questions you miss come back until you have mastered them.
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