Free AAPC CRC Practice Test: 50 Questions With Answers

Answer: B. R05.3

In the outpatient setting, a diagnosis documented as "probable," "suspected" or "rule out" isn't coded as if it were confirmed. Code what is established: a chronic cough, R05.3. Risk adjustment doesn't change this rule. An unconfirmed COPD diagnosis can't be captured, however likely it looks.

• A and C code COPD the physician hasn't confirmed.
• D (R05.9) is cough, unspecified. The note documents a chronic cough, and R05.3 says so.

Source: ICD-10-CM Official Guidelines, FY2027, Section IV.H, p. 114 (uncertain diagnoses, outpatient); Tabular List, category R05.

Answer: D. E11.51, Z79.84

ICD-10-CM's "with" convention presumes a link between diabetes and the conditions listed under "with" in the Alphabetic Index, including peripheral angiopathy, unless the provider says they're unrelated. E11.51 is type 2 diabetes with diabetic peripheral angiopathy without gangrene. Z79.84 reports long-term use of oral hypoglycemic drugs.

• A ignores the presumed link.
• B (E11.52) is with gangrene, which isn't documented.
• C adds I73.9 even though the combination code already describes the peripheral angiopathy. When a combination code fully identifies the conditions, don't add a separate code for them.

Source: ICD-10-CM Official Guidelines, FY2027, Sections I.A.15, p. 11 ("with"); I.B.9, p. 14 (combination codes); and I.C.4.a.3, p. 40 (long-term drug codes); Alphabetic Index, Diabetes, type 2, with, peripheral angiopathy.

Answer: B. I13.0, I50.22, N18.4

The classification presumes a causal relationship between hypertension and heart involvement and between hypertension and kidney involvement. When all three conditions are present, one I13 combination code replaces separate hypertension, heart and kidney codes. I13.0 covers heart failure with stage 1–4 CKD, and its notes tell you to add the type of heart failure (I50.22) and the CKD stage (N18.4).

• A codes the hypertension as if it were unrelated.
• C uses I11 and I12 together, which I13 replaces.
• D drops the heart failure type that I13.0 instructs you to add.

Source: ICD-10-CM Official Guidelines, FY2027, Section I.C.9.a, pp. 50–51; Tabular List, I13.0 "use additional code" notes.

Answer: D. Z85.3

When a primary malignancy has been excised or eradicated, no further treatment is directed to that site, and there is no evidence of existing disease, report a Z85 personal history code. Z85.3 is personal history of malignant neoplasm of breast.

Coding a former cancer as active is one of the most common risk adjustment errors, because the active cancer code can carry a payment weight that the history code doesn't.

• A and C code a cancer that the record says is gone.
• B (Z80.3) is family history of breast cancer.

Source: ICD-10-CM Official Guidelines, FY2027, Sections I.C.2.d, pp. 34–35, and I.C.2.m, p. 38.

Answer: D. L89.153

Pressure ulcer stage is one of the few details that can be taken from another clinician's documentation, such as a nurse's. The diagnosis of a pressure ulcer must come from the patient's provider, and here it does. L89.153 is pressure ulcer of sacral region, stage 3.

• A (L89.159) is unspecified stage, but the stage is documented.
• B (L89.93) is pressure ulcer of an unspecified site, but the site is documented.
• C (L89.150) is unstageable, which means the stage can't be clinically determined. That isn't the case here.

Source: ICD-10-CM Official Guidelines, FY2027, Section I.B.14, pp. 15–16 (documentation by clinicians other than the provider), and Section I.C.12.a, p. 58.

Answer: C. I10

BMI can be taken from a dietitian's documentation, but the associated diagnosis, such as obesity, must be documented by the patient's provider. BMI codes are reported only as secondary codes. A BMI code supports a provider's weight diagnosis; it can't stand in for one.

This is a documentation-improvement opportunity: if the patient's weight affects care, the provider can address and document it.

• A and D code an obesity diagnosis the physician never made.
• B reports BMI with no provider-documented diagnosis behind it.

Source: ICD-10-CM Official Guidelines, FY2027, Section I.B.14, pp. 15–16.

Answer: C. Z86.73

A past cerebral infarction with no residual deficits is reported with Z86.73, personal history of cerebral infarction without residual deficits. Category I69 has an Excludes1 note pointing to Z86.73 for exactly this situation. (Long-term antiplatelet use can be reported separately.)

• A (I63.9) is an acute infarction. Reporting acute stroke codes at office follow-up visits is a classic audit finding.
• B and D (I69.-) are sequelae codes, which require a documented residual deficit.

Source: ICD-10-CM Official Guidelines, FY2027, Section I.C.9.d, p. 53; Tabular List, category I69, Excludes1 note.

Answer: B. I69.353

For a left-handed patient, the right side is the non-dominant side. I69.353 is hemiplegia and hemiparesis following cerebral infarction affecting the right non-dominant side.

When handedness isn't documented, the guidelines supply defaults: an ambidextrous patient is treated as dominant on the affected side; otherwise, the left side defaults to non-dominant and the right side to dominant. Here handedness is documented, so no default applies.

• A (I69.351) is right dominant, which would fit a right-handed patient.
• C (I69.354) is the wrong side.
• D (G81.91) omits the stroke that caused the hemiparesis.

Source: ICD-10-CM Official Guidelines, FY2027, Sections I.C.6.a, p. 45, and I.C.9.d, p. 53; Tabular List, I69.351–I69.359.

Answer: D. Z21

When "HIV positive" is documented with no symptoms or HIV-related illness, the guideline directs Z21, asymptomatic HIV infection status. That remains true when the patient is managed on antiretroviral medication. Z79.899 may be added for the long-term drug therapy.

• A (B20) requires AIDS, HIV disease, or a documented HIV-related illness, now or previously.
• B (Z11.4) is screening for HIV.
• C (R75) is inconclusive laboratory evidence of HIV.

Source: ICD-10-CM Official Guidelines, FY2027, Section I.C.1.a.2(a), (e) and (j), pp. 20–22.

Answer: B. F33.1

Major depressive disorder is classified by episode (single, F32, or recurrent, F33) and by severity. Recurrent and moderate are both documented, so F33.1 applies.

• A (F32.1) is a single episode.
• C (F33.9) is recurrent, unspecified severity, but the severity is documented.
• D (F32.A) is depression, unspecified.

Source: Tabular List, categories F32 and F33 (CMS ICD-10 code files).

Answer: D. G40.909

In the Alphabetic Index, "Disorder, seizure" leads to G40.909, epilepsy, unspecified, not intractable, without status epilepticus. The Tabular List lists "seizure disorder NOS" as an inclusion term under that code.

• A (R56.9) is a seizure or convulsion NOS. It's for a seizure event, not a seizure disorder, and category G40 excludes it.
• B (G40.901) is with status epilepticus.
• C (G40.919) is intractable. The G40 note treats "poorly controlled" as intractable, but this disorder is documented as controlled.

Source: Alphabetic Index, Disorder, seizure; Tabular List, category G40 notes and G40.909 inclusion terms (CMS ICD-10 code files).

Answer: A. I12.0, N18.6, Z99.2

Hypertension and CKD are presumed related. I12.0 is hypertensive CKD with stage 5 CKD or ESRD. Its note says to add the stage code (N18.6), and N18.6 instructs you to add dialysis status (Z99.2).

• B codes the hypertension as unrelated.
• C (I12.9) is for stage 1–4 or unspecified CKD.
• D leaves out the hypertension altogether.

Source: ICD-10-CM Official Guidelines, FY2027, Section I.C.9.a, pp. 50–51; Tabular List, I12.0 and N18.6 "use additional code" notes.

Answer: B. Z89.512

Category Z89 reports amputation status. Z89.512 is acquired absence of left leg below knee.

• A (Z89.511) is the right leg.
• C (Z89.612) is above the knee.
• D (Z89.522) is acquired absence of the left knee.

Source: Tabular List, category Z89 (includes amputation status) and Z89.51- (CMS ICD-10 code files).

Answer: C. Z93.3

Z93.3, colostomy status, reports an artificial opening that exists but needs no attention at this visit.

• A (K94.00) is a colostomy complication, and none is documented.
• B (Z43.3) is an encounter for attention to the colostomy, but none was given.
• D (Z98.890) is a nonspecific postprocedural state when a specific status code exists.

Source: Tabular List, category Z93 Excludes1 notes (attention to artificial openings, Z43.-; complications of external stoma, K94.-) (CMS ICD-10 code files).

Answer: B. J44.1

J44.1 is COPD with (acute) exacerbation.

• A (J44.9) is COPD, unspecified, which misses the exacerbation.
• C (J44.0) is COPD with acute lower respiratory infection, which isn't documented.
• D adds the unspecified code to the specific one for the same condition.

Source: Tabular List, category J44 (CMS ICD-10 code files).

Answer: D. HHS-HCC, concurrent

The HHS-HCC model risk-adjusts the ACA individual and small-group markets. It is concurrent: diagnoses from the current benefit year set that same year's risk scores. Medicare Advantage's CMS-HCC model is prospective: base-year diagnoses predict the following year's costs.

• A is the Medicare Advantage model.
• B (RxHCC) adjusts Medicare Part D payments.
• C (CDPS) is a Medicaid model.

Source: Kautter et al., The HHS-HCC Risk Adjustment Model for Individual and Small Group Markets under the Affordable Care Act, Medicare & Medicaid Research Review, 2014, p. E4, "Model Type" (concurrent versus prospective; HHS-HCC for the ACA markets); CMS, HHS Notice of Benefit and Payment Parameters for 2026 final rule fact sheet, January 13, 2025, risk adjustment section.

Answer: A. CDPS

The Chronic Illness and Disability Payment System (CDPS) is a diagnosis-based risk adjustment model, maintained at UC San Diego, that is widely used to adjust capitated payments for Medicaid health plans. CDPS+Rx combines it with a pharmacy-based model.

• B is the ACA marketplace model.
• C is the Medicare Part D model.
• D is Medicare's model for enrollees with ESRD.

Source: UC San Diego, Chronic Illness and Disability Payment System, program description.

Answer: D. Demographic factors plus HCCs

A CMS-HCC risk score adds up demographic variables (such as age, sex and Medicaid status) and HCC variables, each with its own coefficient. Diagnoses enter the score only through HCCs. Visit counts and past spending aren't model variables. A visit matters only as the face-to-face encounter where a diagnosis is documented.

• A counts visits, which the model doesn't use.
• B leaves out the HCCs. CMS uses demographic-only models for new enrollees without a full year of diagnosis data, which is why this question asks about a continuing enrollee.
• C uses spending, which the model predicts rather than takes as an input.

Source: MedPAC, comment letter on the CY2027 Advance Notice, February 25, 2026, CMS-HCC model description (demographic and HCC variables, each with a coefficient).

Answer: C. The 2024 model (V28)

CMS's CY2027 Rate Announcement says CMS will continue to use the 2024 CMS-HCC model for non-PACE organizations. The model was fully phased in for 2026. CMS had proposed a recalibrated 2027 model but didn't finalize it.

• A and B are older models no longer used alone for MA payment.
• D is the CY2027 blend for PACE organizations.

Source: CMS, Announcement of CY2027 MA Capitation Rates and Part C and Part D Payment Policies, April 6, 2026, pp. 2–3, "CMS-HCC Risk Adjustment Models."

Answer: C. The ESRD CMS-HCC (dialysis) model

CMS uses separate ESRD CMS-HCC models for enrollees in dialysis, transplant and functioning-graft status. For CY2027, it continues to use the 2023 ESRD models for non-PACE organizations.

• A is for Part D drug costs.
• B is the ACA marketplace model.
• D is a Medicaid model.

Source: CMS, CY2027 Rate Announcement, p. 5, "End-Stage Renal Disease (ESRD) CMS-HCC Risk Adjustment Models."

Answer: B. RxHCC

The RxHCC model risk-adjusts Medicare Part D payments. For CY2027, CMS updated it to reflect Inflation Reduction Act changes to the Part D benefit.

• A adjusts Part C (medical) payments.
• C is the ACA model, which includes drug-based factors but doesn't pay Part D plans.
• D is a Medicaid model.

Source: CMS, CY2027 Rate Announcement, pp. 5–6, "RxHCC Risk Adjustment Models."

Answer: A. Audio-only services identified with modifier 93 or FQ

CMS finalized excluding diagnoses from audio-only services, identified by modifier 93 or FQ, from CY2027 risk score calculations. The policy targets those audio-only modifiers. It doesn't remove video telehealth, hospital outpatient or nurse practitioner encounters.

• B, C and D aren't excluded by this policy.

Source: CMS, CY2027 Rate Announcement, p. 5, "Sources of Diagnoses for Risk Scores Calculated with CMS-HCC Risk Adjustment Models."

Answer: A.

RADV checks whether the diagnoses a Medicare Advantage organization submitted for payment are supported by the enrollee's medical record. CMS's checklist asks whether the record is for the right enrollee and date of service, comes from a valid provider type, carries an acceptable signature and credentials, and documents the diagnosis.

• B, C and D describe other review programs.

Source: CMS, RADV Medical Record Checklist and Guidance.

Answer: C. A diagnostic radiology report

CMS's provider-source reference for Medicare Part C medical record reviews states that diagnostic radiology isn't a valid provider source, and the record must document a face-to-face visit. Radiology findings matter only when a treating provider documents the diagnosis at a qualifying encounter.

• A, B and D come from acceptable sources when they are complete and properly authenticated.

Source: CMS, CY24 Part C Improper Payment Measure Provider Source Reference Document (diagnostic radiology not a valid source; face-to-face requirement); CMS, RADV Medical Record Checklist (valid provider type).

Answer: C.

CMS accepts a CMS-Generated Attestation for physician and hospital outpatient records that lack an acceptable signature or credentials. It must be signed by the physician or practitioner who provided the services. A form the plan writes itself doesn't count, and neither does one signed by anyone else. The attestation fixes the missing signature; it can't add a diagnosis the note doesn't support.

• A and D don't authenticate the note. CMS's attestation instructions specifically reject stamped signatures.
• B is a plan-generated attestation, which CMS doesn't accept.

Source: CMS, PY2024 MA Contract-Specific RADV Audit Methods and Instructions, August 28, 2026, Section 6.4, pp. 10–11; CMS, RADV Medical Record Checklist and Guidance, signature and attestation items; CMS, CMS-Generated Attestation Instructions (stamped signatures).

Answer: B. It is excluded.

CMS finalized excluding diagnoses from unlinked chart review records from CY2027 risk score calculations. The exception is for beneficiaries who switch from one MA organization to another. The exclusion doesn't apply to PACE organizations.

• A, C and D have no basis in the policy.

Source: CMS, CY2027 Rate Announcement, pp. 3 and 5, "Sources of Diagnoses."

Answer: D.

By statute, an MA organization that has received an overpayment must report and return it no later than 60 days after the date it was identified. CMS's regulation at 42 CFR 422.326 implements this and covers the six most recent completed payment years. (CMS notes that a court vacated the regulation's definition of "identified," but the statutory 60-day duty remains.) An overpayment kept past the deadline is an obligation under the False Claims Act.

• A waits for CMS when the duty belongs to the organization.
• B and C have no basis in the rule.

Source: 42 CFR 422.326, paragraphs (d)–(f); CMS, Status of December 2022 Proposed Rule.

Answer: A. I63.9

Acute stroke codes (I63) belong to the acute phase of care. At an office follow-up, a residual deficit is coded as a sequela from category I69. For a right-handed patient, the left side is non-dominant, so I69.354 is supported.

• B is the correct sequela code.
• C (long-term antiplatelet use) and D (hypertension) are supported by the note.

Source: ICD-10-CM Official Guidelines, FY2027, Section I.C.9.d, p. 53; Tabular List, I69.35-.

Answer: C. The False Claims Act

The False Claims Act (31 U.S.C. 3729) imposes liability for knowingly submitting false claims, or knowingly keeping an overpayment, to the government. CMS's MA overpayment regulation states that a retained overpayment is an obligation under that law.

• A governs emergency screening and stabilization.
• B governs the privacy of health information.
• D restricts certain physician self-referrals.

Source: 42 CFR 422.326(e) (retained overpayment as an obligation under 31 U.S.C. 3729).

Answer: C.

Code assignment is based on the provider's diagnostic statement. A prospective review can point the provider toward a condition worth evaluating. It can't establish the diagnosis. If the provider evaluates the patient and documents the condition at the encounter, it can be coded from that note.

• A and D report a diagnosis no provider made at this encounter.
• B puts words in the provider's note.

Source: ICD-10-CM Official Guidelines, FY2027, Section I.A.19, p. 12 (code assignment based on the provider's statement); CMS, RADV Medical Record Checklist (face-to-face visit and diagnosis on the record).

Answer: B.

Industry query guidance says a query must include the clinical indicators that justify it, cited to where they appear in the record. Its options must be clinically relevant, and the provider must be able to give a different explanation, which an "other, please specify" choice allows.

• A steers the provider to one diagnosis and mentions payment. Queries must never include reimbursement impact.
• C uses a yes/no format to introduce a new diagnosis, which the guidance doesn't allow, and gives no clinical indicators.
• D turns a lab value into a diagnosis, which is the provider's job.

Source: ACDIS/AHIMA, Guidelines for Achieving a Compliant Query Practice—2026 Update, August 2026, p. 8 (clinical indicators; no reimbursement information), p. 11 (multiple-choice options and alternative explanations) and p. 13 (yes/no queries).

Answer: B.

Code assignment rests on the provider's diagnostic statement, not on a test result the coder interprets. Ejection fraction isn't among the details a coder may take from documentation other than the provider's. As documented, the code is I50.9. A compliant query about type (such as systolic or diastolic) and acuity can make the record complete.

• A and D turn the coder's reading of an echo into a diagnosis.
• C misses a clear chance to improve the record's specificity.

Source: ICD-10-CM Official Guidelines, FY2027, Sections I.A.19, p. 12, and I.B.14, pp. 15–16 (the list of exceptions doesn't include ejection fraction).

Answer: D.

The cancer was excised, no treatment is directed to the site, and there's no evidence of disease, so the history code Z85.46 applies. The carried-forward problem list conflicts with the note. Flagging it so the provider can correct it is the documentation-improvement step. CMS's RADV guidance specifically tells reviewers to pay attention to EHR problem lists.

• A and C code an active cancer that the note contradicts.
• B drops a history that is relevant and reportable.

Source: ICD-10-CM Official Guidelines, FY2027, Section I.C.2.d, pp. 34–35; CMS, RADV Medical Record Checklist (problem-list guidance).

Answer: B.

Outpatient guidelines say to code documented conditions that coexist at the encounter and require or affect patient care, treatment or management. Option B shows the provider evaluating and managing the condition, with the type and acuity specified. Many risk adjustment teams teach this with the mnemonic MEAT (monitor, evaluate, assess, treat). It's an industry convention, not a CMS rule, but it reflects the same idea.

• A repeats a label without showing care.
• C isn't provider documentation of a diagnosis.
• D adds a code but not documentation.

Source: ICD-10-CM Official Guidelines, FY2027, Section IV.J, p. 114.

Answer: A.

"Major depression" without further detail indexes to F32.9, major depressive disorder, single episode, unspecified. That code is accurate for the documentation, but episode and severity are clinically meaningful details the provider can add. A compliant query is the improvement step.

• B (F32.A) is depression, unspecified, but major depression is documented.
• C (F33.9) assumes a recurrence the note doesn't state.
• D codes correctly but ignores the gap in specificity.

Source: Alphabetic Index, Depression, major; Tabular List, F32–F33 (CMS ICD-10 code files); ICD-10-CM Official Guidelines, FY2027, Section I.B.18, p. 17 (unspecified codes).

Answer: B. E11.9, I12.9, N18.32

The "with" presumption links diabetes and CKD unless the documentation clearly states the conditions are unrelated. Here it does, so E11.22 isn't used. The hypertension–CKD link stands (I12.9), with the stage added (N18.32).

• A and C override the provider's explicit statement.
• D codes the hypertension as unrelated, when the provider linked it.

Source: ICD-10-CM Official Guidelines, FY2027, Sections I.A.15, p. 11, and I.C.9.a, pp. 50–51.

Answer: D. Only HCC 37 counts.

HCC models apply hierarchies (often called "trumping"). When a member has more than one HCC in the same disease hierarchy, only the higher-ranked one counts. In V28's diabetes hierarchy, HCC 37 sits above HCC 38. Both codes are still reported; the hierarchy is applied to the risk score, not to coding.

• A ignores the hierarchy.
• B invents a conflict. The two codes aren't contradictory.
• C reverses it.

Source: AAFP, What Family Physicians Need to Know About the Wave of 2024 HCC Changes, FPM, Nov/Dec 2023 (V28 diabetes hierarchy).

Answer: B.

Coding follows the documentation and the official guidelines, not the payment weight. Codes are reported to the highest specificity documented. Constraining changes the coefficients CMS assigns; it doesn't change how to code.

• A and C let payment drive code selection.
• D reports "without complications" alongside "with complications" for the same diabetes.

Source: AAFP, 2024 HCC Changes (constrained diabetes HCCs); ICD-10-CM Official Guidelines, FY2027, Section I.B.2, p. 12 (level of detail).

Answer: C. 2027

The CMS-HCC model is prospective: base-year diagnoses predict costs in the following payment year. CMS's 2026 schedule shows the pattern: the midyear and final 2026 risk scores use diagnoses with 2025 dates of service. That's why chronic conditions need to be documented every year. A diagnosis from 2026 doesn't carry into 2028 unless the condition is documented again.

• A reverses the direction.
• B describes a concurrent model, such as HHS-HCC.
• D assumes diagnoses carry forward indefinitely, and they don't.

Source: Kautter et al., The HHS-HCC Risk Adjustment Model for Individual and Small Group Markets under the Affordable Care Act, Medicare & Medicaid Research Review, 2014, p. E4, "Model Type" (prospective versus concurrent); CMS, CY2026 Risk Adjustment Implementation memo, September 29, 2025, Section IV (risk score runs and dates of service); CMS, CY2027 Rate Announcement, pp. 5–6.

Answer: D.

Data mining and predictive modeling can find care gaps and conditions that may need attention. They don't create diagnoses. If the provider evaluates the member and documents heart failure at a qualifying encounter, it can be coded for that year.

• A and C report a diagnosis no 2026 provider made.
• B throws away a legitimate care-management tool.

Source: CMS, RADV Medical Record Checklist (record from the correct year with a face-to-face visit); ICD-10-CM Official Guidelines, FY2027, Section I.A.19, p. 12.

Answer: A.

By law, CMS must apply at least a minimum adjustment for differences in diagnostic coding between MA and Original Medicare. For CY2027, CMS applied the statutory minimum of 5.90 percent. The adjustment reduces MA risk scores.

• B, C and D describe other parts of MA payment or quality policy.

Source: CMS, CY2027 Rate Announcement, p. 5, "MA Coding Pattern Difference Adjustment."

Answer: C. NCQA

HEDIS (Healthcare Effectiveness Data and Information Set) is a measure set from the National Committee for Quality Assurance. CMS's Star Ratings use some HEDIS measures, along with CAHPS survey and other measures.

• A and D don't develop HEDIS.
• B runs the Star Ratings program and uses some HEDIS measures in it.

Source: NCQA, Health Plan Ratings vs. Medicare Part C and D Star Ratings Methodology FAQ, February 2026.

Answer: A.

CMS publishes Medicare Advantage and Part D Star Ratings each year to measure the quality of the health and drug services enrollees receive. Each measure is scored from one to five stars, and the ratings help people compare plans. A risk score does a different job. It combines demographic factors and HCCs to estimate how a member's expected costs compare with average.

They do touch. Several Star measures come from HEDIS, and some HEDIS measures apply only to members with a particular condition. So accurate diagnosis documentation matters to both.

• B mixes up the two programs. Neither one grades an individual doctor.
• C is wrong because Star Ratings also draw on member surveys, plan operations and other data.
• D invents a link that doesn't exist.

Source: CMS, 2027 Medicare Advantage and Part D Star Ratings fact sheet, October 8, 2026; NCQA, HPR vs. CMS Stars FAQ, February 2026 (HEDIS measures shared with Stars); MedPAC, CY2027 Advance Notice comment letter (CMS-HCC risk score inputs).

Answer: C. 15–29

CKD is staged by eGFR: stage 3 is 30–59, stage 4 is 15–29, and stage 5 is under 15. For coding, though, the stage comes from the provider's documentation, not from the coder reading a lab value.

• A is stage 2.
• B is stage 3.
• D is stage 5.

Source: National Kidney Foundation, What is Estimated Glomerular Filtration Rate (eGFR)?, stages table; ICD-10-CM Official Guidelines, FY2027, Section I.A.19, p. 12.

Answer: D. Disease of the kidney

Nephr- means kidney, and -pathy means disease.

• A is neuritis (neur- means nerve; -itis means inflammation).
• B is retinopathy.
• C is arteriosclerosis.

Source: MedlinePlus, Appendix A: Word Parts and What They Mean.

Answer: A. E11.42, E11.22, I12.9, N18.32, Z79.84

• Polyneuropathy is documented, so the code is E11.42, not the unspecified neuropathy code E11.40.
• CKD is presumed linked to both the diabetes (E11.22) and the hypertension (I12.9), because the provider doesn't state otherwise. The stage code is N18.32 (stage 3b).
• Metformin is an oral hypoglycemic, so Z79.84 applies.

Why the others are wrong:

• B uses unspecified neuropathy and codes the hypertension as unrelated.
• C misses the diabetes–CKD link.
• D uses unspecified stage 3 and the insulin code.

Source: ICD-10-CM Official Guidelines, FY2027, Sections I.A.15, p. 11; I.C.4.a, pp. 39–40; and I.C.9.a, pp. 50–51; Tabular List, E11.4-, E11.22 and N18.3-.

Answer: C. G30.1, F02.80, L89.612

• Alzheimer's dementia follows the etiology/manifestation convention. The underlying disease (G30.1, late onset) comes first, then the dementia in other diseases classified elsewhere (F02.80; unspecified severity, without behavioral, psychotic, mood or anxiety disturbance).
• The pressure ulcer stage can come from the wound nurse because the physician documents the ulcer itself. L89.612 is right heel, stage 2.

Why the others are wrong:

• A (F03.90) is unspecified dementia, but the cause is documented.
• B puts the manifestation code first, which the convention never allows.
• D is unspecified stage, but the stage is documented.

Source: ICD-10-CM Official Guidelines, FY2027, Sections I.A.13, p. 11 (etiology/manifestation convention); I.B.14, pp. 15–16; and I.C.12.a, p. 58; Tabular List, F02 "code first" note.

Answer: A. C34.11, C79.51

The lung cancer is under active treatment, so it's coded as a current malignancy, C34.11 (right upper lobe). Spread to the spine is a secondary malignancy of bone, C79.51.

• B codes the lung cancer as history while treatment is ongoing.
• C (C79.52) is bone marrow.
• D (C34.91) is an unspecified part of the right lung, but the lobe is documented.

Source: ICD-10-CM Official Guidelines, FY2027, Section I.C.2.m, p. 38; Table of Neoplasms and Tabular List, C34.1- and C79.5-.

Answer: A. I48.21, Z79.01, I25.10, I25.2

• I48.21 is permanent atrial fibrillation, and Z79.01 reports long-term anticoagulant use.
• I25.10 is atherosclerotic heart disease of the native coronary artery without angina.
• I25.2 is old myocardial infarction. The acute MI codes apply only for four weeks from onset.

Why the others are wrong:

• B (I48.20) is chronic atrial fibrillation, unspecified, but permanent is documented.
• C (I21.9) treats a three-year-old MI as acute.
• D uses unspecified atrial fibrillation and drops the anticoagulant.

Source: ICD-10-CM Official Guidelines, FY2027, Sections I.C.9.b, p. 52, and I.C.9.e, p. 54; Tabular List, I48.2-, I25.1-, I25.2 and Z79.01.

Answer: A. J44.9, Z99.81, E66.01, Z68.41, Z87.891

• J44.9 is stable COPD, and Z99.81 is dependence on supplemental oxygen.
• Morbid obesity indexes to E66.01, and the provider documented it, so the BMI code Z68.41 (40.0–44.9, adult) is added.
• Z87.891 is personal history of nicotine dependence, for a former smoker.

Why the others are wrong:

• B uses unspecified obesity and codes current nicotine dependence.
• C codes an exacerbation that isn't documented.
• D leaves out the oxygen dependence.

Source: ICD-10-CM Official Guidelines, FY2027, Section I.B.14, pp. 15–16; Alphabetic Index, Obesity, morbid; Tabular List, E66 "use additional code" note, J44, Z68.41, Z87.891 and Z99.81.