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ACA CCS practice questions

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Question 1Coding Fundamentals and Professional Standards

In ICD-10-CM, what does the seventh character 'A' indicate in an injury code?

  1. Initial encounter Correct answer.
  2. Complication
  3. Subsequent encounter
  4. Sequel

Explanation

The seventh character A is used for the initial encounter, meaning the patient is receiving active treatment for the injury. Subsequent encounters use D, and sequelae use S.

Question 2Coding Fundamentals and Professional Standards

Which of the following best describes the purpose of the ICD-10-CM Official Guidelines for Coding and Reporting?

  1. To provide a uniform set of rules for consistent coding Correct answer.
  2. To replace the need for physician documentation
  3. To establish reimbursement rates for procedures
  4. To list all possible code combinations

Explanation

The guidelines are designed to ensure consistent and accurate coding by providing rules that complement the code set. They do not set reimbursement or replace documentation.

Question 3Coding Fundamentals and Professional Standards

When coding a patient with diabetic retinopathy, what is the correct coding sequence according to ICD-10-CM guidelines?

  1. Code only the diabetes
  2. Code the retinopathy first, then the diabetes
  3. Code only the retinopathy
  4. Code the diabetes first, then the retinopathy Correct answer.

Explanation

ICD-10-CM guidelines state that for diabetic complications, the diabetes code should be sequenced first, followed by the manifestation code. This reflects the causal relationship.

Question 4Coding Fundamentals and Professional Standards

A patient is admitted for a myocardial infarction and also has a documented history of tobacco use. How should the tobacco use be coded?

  1. As a secondary diagnosis Correct answer.
  2. Not coded because it is a history
  3. As a primary diagnosis only if it caused the MI
  4. As a principal diagnosis

Explanation

History of tobacco use is a status code that should be coded as a secondary diagnosis when it is relevant to the patient's care, even if it is not the reason for admission. It is not a principal diagnosis.

Question 5Coding Fundamentals and Professional Standards

Which coding classification system is used in the United States for reporting inpatient procedures?

  1. ICD-10-CM
  2. ICD-10-PCS Correct answer.
  3. CPT
  4. HCPCS Level II

Explanation

ICD-10-PCS is the official procedure coding system for inpatient hospital reporting in the U.S. CPT is used for outpatient procedures and physician services.

Question 6Coding Fundamentals and Professional Standards

In CPT, what does a modifier -25 indicate?

  1. Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure Correct answer.
  2. Reduced services
  3. Bilateral procedure
  4. Multiple procedures

Explanation

Modifier -25 is appended to an E/M code when a significant, separately identifiable E/M service is provided on the same day as a procedure. It distinguishes the E/M service from the procedure's usual pre- and post-work.

Question 7Coding Fundamentals and Professional Standards

A coder assigns a code that is not supported by the physician's documentation. This is an example of:

  1. Downcoding
  2. False claim
  3. Unbundling
  4. Upcoding Correct answer.

Explanation

Upcoding is assigning a code that is not supported by documentation, often to obtain higher reimbursement. It is a fraudulent practice.

Question 8Coding Fundamentals and Professional Standards

Which of the following is a key component of the HIPAA Privacy Rule as it applies to coding professionals?

  1. Sharing patient information freely with colleagues
  2. Posting patient codes on public forums
  3. Protecting the confidentiality of protected health information Correct answer.
  4. Disclosing PHI without patient consent for marketing

Explanation

The HIPAA Privacy Rule requires safeguarding protected health information (PHI) and limiting its use and disclosure. Coding professionals must ensure confidentiality.

Question 9Coding Fundamentals and Professional Standards

What is the first step in the coding process for an outpatient encounter?

  1. Assign codes based on the chief complaint
  2. Query the physician for clarification
  3. Verify insurance eligibility
  4. Review the entire medical record Correct answer.

Explanation

The coding process begins with a thorough review of the medical record to identify all documented diagnoses and procedures. This ensures accurate code assignment.

Question 10Coding Fundamentals and Professional Standards

Which of the following is an example of a query to the physician?

  1. Please clarify if the pneumonia is viral or bacterial. Correct answer.
  2. Please schedule a follow-up appointment.
  3. Please update the patient's address.
  4. Please resubmit the claim with the correct modifier.

Explanation

A physician query is used when documentation is ambiguous or incomplete and clarification is needed for code assignment. Asking about the type of pneumonia is a clinical clarification.

Question 11Coding Fundamentals and Professional Standards

In ICD-10-CM, what does the term 'excludes1' note indicate?

  1. The condition is a manifestation that requires an additional code
  2. The condition is not coded here because it is always coded elsewhere Correct answer.
  3. The condition is a temporary code
  4. The condition may be coded here and elsewhere if present

Explanation

An excludes1 note means the condition excluded is not part of the condition represented by the code and should be coded separately. It indicates mutually exclusive diagnoses.

Question 12Coding Fundamentals and Professional Standards

A patient is seen for a fracture of the left femur. The coder assigns a code for fracture of the right femur. This is an error in:

  1. Laterality Correct answer.
  2. Sequela
  3. Etiology
  4. Severity

Explanation

Laterality specifies the side of the body (left, right, bilateral). Assigning the wrong side is a laterality error.

Question 13Coding Fundamentals and Professional Standards

What is the purpose of the CPT Assistant?

  1. To list all ICD-10-CM codes
  2. To provide coding guidance and clarification from the AMA Correct answer.
  3. To publish Medicare reimbursement rates
  4. To offer legal advice for malpractice

Explanation

CPT Assistant is an official AMA publication that provides guidance, examples, and clarifications for CPT coding. It helps coders apply codes consistently.

Question 14Coding Fundamentals and Professional Standards

Which of the following is a characteristic of a 'clean claim'?

  1. It is submitted without patient consent
  2. It is submitted after the appeal deadline
  3. It includes only the primary diagnosis
  4. It contains all required information and is free of errors Correct answer.

Explanation

A clean claim is complete, accurate, and free of errors, allowing it to be processed without delay. It includes all necessary data elements.

Question 15Coding Fundamentals and Professional Standards

In medical coding, what does the term 'NEC' stand for?

  1. Non-Essential Condition
  2. Not Elsewhere Classified Correct answer.
  3. No Exact Code
  4. Not Elsewhere Coded

Explanation

NEC stands for Not Elsewhere Classified, used in ICD-10-CM when a condition is not specifically classified elsewhere. It indicates a residual category.

Question 16Coding Fundamentals and Professional Standards

A coder is reviewing a record where the physician documents 'probable pneumonia.' According to ICD-10-CM guidelines for outpatient coding, how should this be coded?

  1. Query the physician for confirmation
  2. Code the pneumonia as a rule-out
  3. Do not code the pneumonia; code symptoms only Correct answer.
  4. Code the pneumonia as confirmed

Explanation

In outpatient settings, uncertain diagnoses such as 'probable' or 'rule-out' should not be coded. Instead, code the symptoms or reason for the visit.

Question 17Coding Fundamentals and Professional Standards

What is the correct sequence when coding a patient with sepsis due to a urinary tract infection?

  1. Code UTI first, then sepsis
  2. Code only the sepsis
  3. Code sepsis first, then UTI Correct answer.
  4. Code only the UTI

Explanation

ICD-10-CM guidelines require coding the systemic infection (sepsis) first, followed by the localized infection (UTI). This reflects the severity and reason for admission.

Question 18Coding Fundamentals and Professional Standards

Which of the following is a violation of the AHIMA Code of Ethics?

  1. Discussing a patient's diagnosis in a public elevator Correct answer.
  2. Reporting a colleague who falsifies records
  3. Using official coding guidelines
  4. Attending a coding workshop

Explanation

The AHIMA Code of Ethics requires protecting patient confidentiality. Discussing PHI in a public place is a breach of privacy.

Question 19Coding Fundamentals and Professional Standards

In CPT, what does a modifier -59 indicate?

  1. Discontinued procedure
  2. Distinct procedural service Correct answer.
  3. Bilateral procedure
  4. Reduced services

Explanation

Modifier -59 is used to indicate that a procedure or service was distinct and independent from other procedures performed on the same day. It helps prevent bundling.

Question 20Coding Fundamentals and Professional Standards

A patient has a history of a previous myocardial infarction. How is this coded in ICD-10-CM?

  1. As an acute myocardial infarction
  2. As a personal history of MI code Correct answer.
  3. As a family history of MI code
  4. As a history of myocardial infarction code

Explanation

A personal history of myocardial infarction is coded with a specific history code (Z86.7-). It indicates the patient had an MI in the past and is no longer receiving active treatment for it.

Question 21Medical Terminology, Anatomy, and Pathophysiology

Which term describes a word root combined with a combining vowel, used to link a root to a suffix or another root?

  1. Plural marker
  2. Prefix
  3. Suffix
  4. Combining form Correct answer.

Explanation

A combining form is a root plus a connecting vowel (usually 'o') that eases pronunciation when joining word parts. Prefixes and suffixes attach to roots but are not roots with a vowel.

Question 22Medical Terminology, Anatomy, and Pathophysiology

The suffix '-itis' in terms such as gastritis indicates which condition?

  1. Abnormal softening
  2. Inflammation Correct answer.
  3. Surgical removal
  4. Excessive flow

Explanation

The suffix '-itis' denotes inflammation of the structure named by the root. For example, gastritis is inflammation of the stomach lining.

Question 23Medical Terminology, Anatomy, and Pathophysiology

In the term 'pericardium', what does the prefix 'peri-' mean?

  1. Around Correct answer.
  2. Within
  3. Through
  4. Below

Explanation

'Peri-' means around or surrounding, so the pericardium is the sac surrounding the heart. Other prefixes such as 'endo-' mean within and 'hypo-' means below.

Question 24Medical Terminology, Anatomy, and Pathophysiology

Which directional term means toward the head or upper part of the body?

  1. Caudad
  2. Cephalad Correct answer.
  3. Ventral
  4. Distal

Explanation

Cephalad (or superior) refers to movement toward the head. Caudad refers to movement toward the tail or lower body.

Question 25Medical Terminology, Anatomy, and Pathophysiology

Which body plane divides the body into equal right and left halves?

  1. Frontal plane
  2. Transverse plane
  3. Oblique plane
  4. Midsagittal plane Correct answer.

Explanation

The midsagittal (median) plane passes through the midline and creates equal right and left halves. A transverse plane divides the body into upper and lower portions.

Question 26Medical Terminology, Anatomy, and Pathophysiology

Which blood cell type is primarily responsible for transporting oxygen from the lungs to tissues?

  1. Erythrocyte Correct answer.
  2. Lymphocyte
  3. Thrombocyte
  4. Leukocyte

Explanation

Erythrocytes contain hemoglobin, which binds oxygen in the lungs and releases it in tissues. Leukocytes and thrombocytes serve immune and clotting functions.

Question 27Medical Terminology, Anatomy, and Pathophysiology

A patient report notes 'hepatomegaly.' Which structure is enlarged?

  1. Spleen
  2. Liver Correct answer.
  3. Heart
  4. Kidney

Explanation

The root 'hepat/o' refers to the liver, and '-megaly' means enlargement. Hepatomegaly therefore means an enlarged liver.

Question 28Medical Terminology, Anatomy, and Pathophysiology

Which term describes the surgical creation of an opening into the colon?

  1. Colectomy
  2. Colostomy Correct answer.
  3. Coloplasty
  4. Colotomy

Explanation

The suffix '-stomy' means surgical creation of an opening, so colostomy is an opening into the colon. '-ectomy' means removal and '-otomy' means incision.

Question 29Medical Terminology, Anatomy, and Pathophysiology

Which abbreviation commonly documented in a patient chart stands for 'by mouth'?

  1. PR
  2. NPO
  3. PO Correct answer.
  4. IM

Explanation

PO comes from the Latin 'per os,' meaning by mouth, and describes an oral route of administration. PR means per rectum and IM means intramuscular.

Question 30Medical Terminology, Anatomy, and Pathophysiology

Which anatomical structure connects the pharynx to the stomach?

  1. Duodenum
  2. Trachea
  3. Larynx
  4. Esophagus Correct answer.

Explanation

The esophagus is a muscular tube that carries swallowed food from the pharynx to the stomach. The trachea and larynx belong to the airway.

Question 31Medical Terminology, Anatomy, and Pathophysiology

Which condition is characterized by a deficiency of red blood cells or hemoglobin, often presenting with fatigue and pallor?

  1. Anemia Correct answer.
  2. Leukemia
  3. Thrombocytopenia
  4. Polycythemia

Explanation

Anemia is a reduction in red cell mass or hemoglobin, limiting oxygen delivery and causing fatigue and pallor. Polycythemia is the opposite, an excess of red cells.

Question 32Medical Terminology, Anatomy, and Pathophysiology

A patient has a fracture in which the bone protrudes through the skin. Which classification applies?

  1. Greenstick fracture
  2. Comminuted fracture
  3. Closed fracture
  4. Open fracture Correct answer.

Explanation

An open (compound) fracture involves a break in the skin overlying the fracture, exposing bone to the environment. A closed fracture leaves the skin intact.

Question 33Medical Terminology, Anatomy, and Pathophysiology

Which term refers to difficult or labored breathing?

  1. Apnea
  2. Bradypnea
  3. Dyspnea Correct answer.
  4. Orthopnea

Explanation

'Dys-' means difficult or painful and '-pnea' means breathing, so dyspnea is difficult breathing. Apnea is absence of breathing.

Question 34Medical Terminology, Anatomy, and Pathophysiology

Which electrolyte imbalance is most directly associated with muscle weakness, cardiac arrhythmias, and flattened T waves on an ECG?

  1. Hypokalemia Correct answer.
  2. Hypercalcemia
  3. Hyperchloremia
  4. Hyponatremia

Explanation

Potassium is central to resting membrane potential and cardiac repolarization; low potassium produces weakness and flattened T waves. Sodium and chloride imbalances present differently.

Question 35Medical Terminology, Anatomy, and Pathophysiology

Which structure is the functional unit of the kidney responsible for filtration?

  1. Alveolus
  2. Hepatocyte
  3. Neuron
  4. Nephron Correct answer.

Explanation

The nephron is the kidney's functional unit, comprising the glomerulus and tubules that filter and process urine. Alveoli are the gas-exchange units of the lung.

Question 36Medical Terminology, Anatomy, and Pathophysiology

A patient's chart documents 'hyperglycemia.' Which finding does this describe?

  1. Elevated blood pressure
  2. Elevated blood glucose Correct answer.
  3. Low oxygen saturation
  4. Low blood glucose

Explanation

'Hyper-' means excessive, 'glyc/o' refers to glucose, and '-emia' means blood condition. Hyperglycemia therefore means abnormally high blood glucose.

Question 37Medical Terminology, Anatomy, and Pathophysiology

Which term best describes the spread of a malignant tumor to a distant site such as the lung or bone?

  1. Metastasis Correct answer.
  2. Hypertrophy
  3. Atrophy
  4. Dysplasia

Explanation

Metastasis is the dissemination of malignant cells from a primary tumor to distant organs. Dysplasia refers to disordered cell growth confined to a tissue.

Question 38Medical Terminology, Anatomy, and Pathophysiology

In the term 'electroencephalogram,' what does the root 'encephal/o' refer to?

  1. Nerve
  2. Spinal cord
  3. Brain Correct answer.
  4. Heart

Explanation

'Encephal/o' means brain, so an electroencephalogram records the brain's electrical activity. 'Cardi/o' refers to the heart and 'neur/o' to nerve.

Question 39Medical Terminology, Anatomy, and Pathophysiology

Which mechanism best explains edema formation in a patient with advanced liver disease and low albumin?

  1. Lymphatic obstruction
  2. Increased blood hydrostatic pressure
  3. Increased capillary permeability
  4. Decreased plasma oncotic pressure Correct answer.

Explanation

Albumin is the main contributor to plasma oncotic pressure; low albumin reduces the pull of fluid back into capillaries, allowing fluid into tissues. Hydrostatic pressure and permeability changes reflect different mechanisms.

Question 40Medical Terminology, Anatomy, and Pathophysiology

Which statement correctly distinguishes the somatic from the autonomic nervous system?

  1. Somatic is part of the peripheral nervous system; autonomic is part of the central nervous system
  2. Somatic controls voluntary skeletal muscle; autonomic controls involuntary smooth muscle and glands Correct answer.
  3. Somatic uses only sensory fibers; autonomic uses only motor fibers
  4. Somatic controls involuntary glands; autonomic controls voluntary skeletal muscle

Explanation

The somatic nervous system mediates voluntary control of skeletal muscle, while the autonomic nervous system regulates involuntary effectors such as smooth muscle, cardiac muscle, and glands. Both are subdivisions of the peripheral nervous system.

Question 41ICD-10-CM Diagnosis Coding

A patient is seen for a first-time visit for type 2 diabetes mellitus with no complications. Which ICD-10-CM code is reported?

  1. E11.9 Correct answer.
  2. E10.9
  3. E11.65
  4. E11.319

Explanation

Category E11 covers type 2 diabetes mellitus, and the fourth character 9 denotes uncomplicated status when no complication is documented. E11.9 requires no additional characters because it is a complete code.

Question 42ICD-10-CM Diagnosis Coding

Which section of ICD-10-CM contains the official guidelines for selecting and sequencing diagnosis codes?

  1. The Table of Drugs and Chemicals
  2. The Tabular List
  3. The Alphabetic Index
  4. The Official Guidelines for Coding and Reporting Correct answer.

Explanation

The Official Guidelines for Coding and Reporting govern how codes are selected and sequenced and take precedence over other coding conventions. The Index and Tabular List are the code lookup resources, not the guideline source.

Question 43ICD-10-CM Diagnosis Coding

A patient with acute bronchitis also has documented chronic obstructive pulmonary disease. How are these conditions coded?

  1. Code the COPD as principal and the bronchitis as additional
  2. Code only the COPD
  3. Code only the acute bronchitis
  4. Code the acute bronchitis as principal and the COPD as additional Correct answer.

Explanation

When a respiratory condition such as acute bronchitis is present with chronic COPD, the acute condition is sequenced first and the chronic condition is reported as an additional diagnosis. Both conditions are coded because both are documented and managed.

Question 44ICD-10-CM Diagnosis Coding

A patient is diagnosed with dehydration due to acute gastroenteritis. Which is the principal diagnosis?

  1. Both are coded as principal
  2. Neither is principal; a symptom code is used
  3. Dehydration Correct answer.
  4. Acute gastroenteritis

Explanation

When dehydration is due to an underlying condition, coding guidelines direct that the dehydration be sequenced as principal with the causative condition coded as additional. The systemic effect takes precedence over the cause in this pairing.

Question 45ICD-10-CM Diagnosis Coding

Which character position in an ICD-10-CM code indicates laterality?

  1. The seventh character
  2. The fifth character
  3. The fourth character
  4. The sixth character Correct answer.

Explanation

Laterality is captured in the sixth character of applicable injury and musculoskeletal codes. The seventh character is reserved for encounter type or episode of care.

Question 46ICD-10-CM Diagnosis Coding

A patient is seen for a routine annual gynecologic examination with no complaints and no abnormalities found. Which code is reported?

  1. Z12.4
  2. Z01.419 Correct answer.
  3. Z01.411
  4. Z00.00

Explanation

Z01.419 is used for an encounter for a gynecologic examination with no abnormal findings. Z00.00 is a general adult medical examination without abnormal findings.

Question 47ICD-10-CM Diagnosis Coding

A patient presents with a cough and fever but no definitive diagnosis is established at the visit. What is coded?

  1. Z00.00 for general examination
  2. A code for acute upper respiratory infection
  3. The symptom codes for cough and fever Correct answer.
  4. No code is reported

Explanation

When a definitive diagnosis has not been established, signs and symptoms that prompted the encounter are coded rather than an unconfirmed condition. Coding a suspected condition as confirmed is not permitted.

Question 48ICD-10-CM Diagnosis Coding

A patient is admitted with a suspected myocardial infarction that is ruled out after testing. How is the encounter coded?

  1. No diagnosis code is assigned
  2. Chest pain or the presenting symptom code Correct answer.
  3. Z03.89 observation for other suspected condition
  4. Acute myocardial infarction code

Explanation

When a suspected condition is ruled out, the condition itself is not coded; instead the signs or symptoms that prompted the encounter are reported. Z03.89 is not used for a ruled-out condition in the inpatient setting.

Question 49ICD-10-CM Diagnosis Coding

A patient with chronic kidney disease also has documented anemia attributed to the kidney disease. Which code captures the anemia?

  1. D50.9
  2. D64.9
  3. D63.1 Correct answer.
  4. N18.9

Explanation

D63.1 is anemia in chronic kidney disease, reflecting the documented causal relationship. The anemia code should be sequenced before the CKD code when both are reported.

Question 50ICD-10-CM Diagnosis Coding

Which of the following best describes a combination code in ICD-10-CM?

  1. A single code that reports two diagnoses or a diagnosis with a complication Correct answer.
  2. A code from the external cause section
  3. A code assigned only for inpatient encounters
  4. A code that requires a seventh character

Explanation

A combination code captures two diagnoses, a diagnosis with an associated manifestation, or a diagnosis with a complication in a single code. Additional codes are only added when the combination code does not fully describe the conditions.