CCS Practice Questions (2026) — Free Sample Questions with Answers

Answer: D

Pneumonia first, followed by sepsis: Wrong. When sepsis and a localized infection are both present on admission, the systemic infection is sequenced first.

Severe sepsis code first, followed by pneumonia: Wrong. Severe sepsis requires associated acute organ dysfunction, which is not present. The severe sepsis code can also never be principal.

SIRS code for infectious origin first, followed by the pneumonia as the localized infection: Wrong. Sepsis is coded to the underlying systemic infection code. A SIRS code is not used for sepsis due to infection.

The underlying systemic infection (sepsis) code first, followed by pneumonia: Correct. If the reason for admission is sepsis and a localized infection such as pneumonia, the guidelines direct that the systemic infection be sequenced first and the localized infection be coded secondarily.

Sepsis plus a localized infection at admission: sepsis (systemic infection) first, then the localized infection. Add the severe sepsis code only when organ dysfunction is documented, and never as principal.

Answer: C

Code fever and cough only: Wrong. Coding symptoms in place of an uncertain diagnosis is the outpatient rule. Inpatient rules are different.

Code pneumonia, unspecified, because the organism was not confirmed: Wrong. In the inpatient setting, the uncertain diagnosis is coded as if it existed, including the specificity the provider documented (bacterial).

Code bacterial pneumonia as if it were established: Correct. For short-term acute care inpatient admissions, a diagnosis documented as 'probable', 'suspected' or 'likely' at discharge is coded as if it existed or was established.

Code an observation encounter for suspected condition ruled out: Wrong. The condition was not ruled out. It was treated as probable bacterial pneumonia.

Inpatient: code uncertain diagnoses ('probable', 'suspected', 'likely') documented at discharge as if confirmed. Outpatient: code the symptoms instead.

Answer: B

Code the laterality documented most often in the record: Wrong. Laterality is not decided by majority. Conflicting documentation must be clarified with the provider.

Query the attending provider (or surgeon) for clarification: Correct. The guidelines state that when there is conflicting medical record documentation, from the same clinician or different clinicians, the patient's attending provider should be queried for clarification.

Assign unspecified laterality, because the record conflicts: Wrong. Choosing 'unspecified' to avoid a conflict produces an inaccurate code. The conflict should be resolved through a query.

Code bilateral, because both sides are documented: Wrong. Coding bilateral would report a procedure that was not performed on both sides.

Laterality may be taken from other clinicians' notes, but when documentation conflicts, query the attending provider. Never resolve a conflict by guessing or by using 'unspecified'.

Answer: C

'The patient's anemia appears to be acute blood loss anemia. Please document this so the case reflects the correct severity.': Wrong. This is leading: it introduces a single diagnosis and mentions the impact on severity, both of which compliant query practice prohibits.

'Please document acute blood loss anemia, which would add a CC to this case.': Wrong. It directs a specific answer and states a financial/DRG impact, which is not allowed in a compliant query.

'Hgb 13.1 pre-op, 8.2 post-op; 2 units PRBCs transfused. Please clarify the type of anemia: acute blood loss anemia; anemia of chronic disease; other (please specify); unable to determine.': Correct. It gives the clinical indicators, offers clinically reasonable options including 'other' and 'unable to determine', and does not lead toward an answer or mention reimbursement.

'Do you agree that the patient had acute blood loss anemia? Yes / No': Wrong. Yes/no queries should not be used to establish a new diagnosis that is not already documented in the record.

Compliant queries present the clinical indicators, offer reasonable options (including 'other' and 'unable to determine'), avoid leading wording, and never mention financial or quality impact.

Answer: D

Follow the instruction, because the coding supervisor is responsible for setting department coding policy and answers for it: Wrong. Following an instruction to code undocumented diagnoses violates the Standards of Ethical Coding, whoever gave it.

Add the code only when it changes the MS-DRG: Wrong. Choosing codes based on payment impact, without documentation, is unethical and may be fraudulent.

Code malnutrition only for Medicare patients: Wrong. Coding standards apply to every payer, and the documentation problem remains.

Decline to code undocumented diagnoses, query when indicators exist, and escalate to compliance: Correct. AHIMA's standards require codes to be supported by provider documentation, allow compliant queries when clinical indicators exist, and call for reporting practices that are not compliant.

Ethical coding: report only what provider documentation supports, query when indicators exist, and refuse and report instructions to code otherwise.

Answer: A

Assigning the case to an MS-DRG based on the codes, demographics and discharge status entered: Correct. A grouper applies the payment classification logic (e.g., MS-DRG or APC) to the coded data to assign the payment group.

Converting physician dictation into text: Wrong. That is speech recognition or transcription software, not a grouper.

Guiding the coder through the Alphabetic Index and Tabular List to select the most specific codes: Wrong. That describes an encoder, a code-selection tool that is separate from the grouper.

Scanning paper records into the electronic health record: Wrong. That is document imaging, not grouping.

Encoder = helps select codes; grouper = assigns the payment group (MS-DRG/APC) from the codes and abstracted data.