Free AHIMA CCS-P Practice Test: 52 Questions With Answers

Answer: C. N30.01 is a combination code for acute cystitis with hematuria, so one code captures both. A splits a combination into two codes and uses the "without hematuria" code. D adds dysuria, a symptom routinely associated with cystitis, which isn't coded separately when the definitive diagnosis is documented. B uses urinary tract infection, site not specified, when the site (bladder) is documented.

Source: FY2026 ICD-10-CM Official Guidelines, Sections I.B.5 and I.B.9.

Topic: Combination codes · ID CCSP-DX-01

Answer: B. When a patient with diabetes is treated with both oral hypoglycemic drugs and insulin, the guidelines direct assigning both Z79.4 (insulin) and Z79.84 (oral hypoglycemic drugs). D drops the oral drug code. C changes the type: insulin use alone never makes diabetes type 1. A uses Z79.85, which is for injectable non-insulin antidiabetic drugs, not metformin.

Source: FY2026 ICD-10-CM Official Guidelines, Section I.C.4.a.3.

Topic: Long-term drug therapy codes · ID CCSP-DX-02

Answer: D. ICD-10-CM presumes a causal relationship between hypertension and chronic kidney disease, so I12.9 (hypertensive CKD with stage 1–4 or unspecified CKD) is assigned with a code for the stage. B and A code the conditions as unrelated, which would need documentation saying they're unrelated. C uses stage 3 unspecified when stage 3a is documented.

Source: FY2026 ICD-10-CM Official Guidelines, Section I.C.9.a.2.

Topic: Hypertension with chronic kidney disease · ID CCSP-DX-03

Answer: A. When a primary malignancy has been excised or eradicated, no further treatment is directed to it and there's no evidence of existing disease, a personal history code from Z85 is used. C codes the cancer as current. D is personal history of in situ neoplasm of the breast, not invasive cancer. B is family history.

Source: FY2026 ICD-10-CM Official Guidelines, Section I.C.2.d.

Topic: History of malignancy · ID CCSP-DX-04

Answer: C. When the provider documents that the pregnancy is incidental, Z33.1 is used instead of a Chapter 15 code, and the injury that brought the patient in is listed first. D uses a Chapter 15 code, which the documentation rules out. A omits the pregnant state. B lists the incidental pregnancy ahead of the reason for the visit.

Source: FY2026 ICD-10-CM Official Guidelines, Sections I.C.15.a.1, I.C.21.c.3 and IV.G.

Topic: Pregnancy incidental to the visit · ID CCSP-DX-05

Answer: A. Alzheimer's disease is the underlying condition and is sequenced first; F02.80 reports the dementia as a manifestation of a disease classified elsewhere. D puts a manifestation code first, which the convention doesn't allow. C uses unspecified dementia when the cause is known. B omits the dementia that the "use additional code" instruction calls for.

Source: FY2026 ICD-10-CM Official Guidelines, Section I.A.13 and the note at category G30.

Topic: Etiology and manifestation · ID CCSP-DX-06

Answer: B. BMI may be taken from documentation by clinicians other than the patient's provider, as long as the provider documents the associated diagnosis (here, obesity). C misstates the rule. A reports BMI without the diagnosis it supports. D uses an obesity-class code the physician didn't document.

Source: FY2026 ICD-10-CM Official Guidelines, Sections I.B.14 and I.C.4.b.

Topic: BMI documentation · ID CCSP-DX-07

Answer: C. When the affected side is documented but dominance isn't, the default for the right side is dominant, so the sequela code for right dominant side applies. B assumes nondominant. A is an acute cerebral infarction code, not a late effect. D is the left side.

Source: FY2026 ICD-10-CM Official Guidelines, Sections I.C.6.a and I.C.9.d.1.

Topic: Late effects and dominant side · ID CCSP-DX-08

Answer: B. SDOH codes may be assigned from documentation by clinicians who aren't the patient's provider, such as nurses, because this information is often recorded by them. C and A add a requirement the guideline doesn't have. D is wrong because the hypertension follow-up is the reason for the visit and is listed first.

Source: FY2026 ICD-10-CM Official Guidelines, Sections I.B.14 and I.C.21.c.17.

Topic: Social determinants of health · ID CCSP-DX-09

Answer: D. For an adverse effect of a drug that was correctly prescribed and properly taken, code the nature of the effect first, then the T36–T50 code with the adverse-effect character (5). C reverses the sequence. A codes a poisoning, which requires an error or misuse. B uses allergic urticaria, which isn't what was documented.

Source: FY2026 ICD-10-CM Official Guidelines, Section I.C.19.e.5.a.

Topic: Adverse effect of a drug · ID CCSP-DX-10

Answer: B. Since January 1, 2023, the initial hospital inpatient care codes also cover observation care, and the old observation codes 99218–99220 were deleted, so C uses codes that no longer exist. A is for admission and discharge on the same date, which didn't happen here. D is for office and outpatient visits, not observation stays.

Source: CMS MLN006764, Evaluation and Management Services Guide (May 2026), pp. 4 and 11–13; AMA 2023 E/M descriptors and guidelines, pp. 22–26.

Topic: E/M: observation care · ID CCSP-PR-01

Answer: A. Emergency department visit levels are chosen by medical decision making only; time isn't used, and the codes don't distinguish new from established patients. Low MDM maps to 99283. C uses time, which doesn't apply. B is an office code. D requires moderate MDM.

Source: AMA 2023 E/M descriptors and guidelines, pp. 4, 19 and 31; CMS MLN006764, Evaluation and Management Services Guide (May 2026), p. 24.

Topic: E/M: emergency department · ID CCSP-PR-02

Answer: D. Modifier 24 reports an unrelated E/M service by the same physician during a postoperative period. A is for a significant, separately identifiable E/M on the same day as a procedure. C is for an unrelated procedure, not a visit. B marks the decision for surgery.

Source: CMS MLN907166, Global Surgery Booklet (Dec. 2025), pp. 9–13.

Topic: Modifier 24 · ID CCSP-PR-03

Answer: B. Modifier 78 reports an unplanned return to the operating room by the same physician for a procedure related to the first one during its postoperative period. A is for an unrelated procedure. C is a repeat of the same procedure. D is for a staged or planned related procedure, and this return wasn't planned.

Source: CMS MLN907166, Global Surgery Booklet (Dec. 2025), pp. 13–14.

Topic: Modifier 78 · ID CCSP-PR-04

Answer: D. The radiologist provided only the interpretation and report, the professional component, reported with modifier 26. C is the technical component, which belongs to the hospital that owns the equipment and staff. B, with no modifier, is the global service: both components. A is a distinct-procedure modifier that doesn't describe component splitting.

Source: Noridian, Modifier 26.

Topic: Professional component · ID CCSP-PR-05

Answer: D. Lengths of repairs of the same classification (both simple) in the same anatomic group (scalp, neck, axillae, external genitalia, trunk and extremities share one simple-repair code family) are added: 2.0 + 3.0 = 5.0 cm, which falls in 12002 (2.6 to 7.5 cm). A and C report the wounds separately. B is for 7.6 to 12.5 cm.

Source: AAPC Part B Coding Alert on laceration repair.

Topic: Adding repair lengths · ID CCSP-PR-06

Answer: A. Excised diameter is the lesion's greatest clinical diameter plus the narrowest margin on each side: 1.4 + 0.3 + 0.3 = 2.0 cm, which falls in 11402 (1.1 to 2.0 cm, trunk, arms or legs). B uses the lesion size without margins. D is for 2.1 to 3.0 cm. C adds a simple repair, which is included in the excision code.

Source: AAPC Dermatology Coding Alert on lesion excision; NCCI Policy Manual 2026, Ch. 3, §E.6, p. III-7 (simple repair included).

Topic: Excised diameter · ID CCSP-PR-07

Answer: C. 17000 reports the first premalignant lesion and add-on 17003 reports each lesion from the 2nd through the 14th, so nine lesions = 17000 + 17003 ×8. D is for 15 or more lesions. A repeats a first-lesion code. B is for destruction of benign lesions such as warts, not actinic keratoses.

Source: AAPC Part B Coding Alert on 17000–17004; NCCI Policy Manual 2026, Ch. 3, §L.14.

Topic: Destroying premalignant lesions · ID CCSP-PR-08

Answer: D. A biopsy and a removal can both be reported when they're performed on different lesions, with an NCCI-associated modifier on the biopsy to show the separate site. If the same lesion had been biopsied and then removed, only the removal would be reported (A's logic). B drops the polypectomy. C adds the diagnostic colonoscopy, which is included in any therapeutic colonoscopy.

Source: NCCI Policy Manual 2026, Ch. 6, §H.25, p. VI-15; NCCI Policy Manual 2026, Ch. 1, §A, p. I-5.

Topic: NCCI: endoscopy on separate lesions · ID CCSP-PR-09

Answer: B. An MAI of 2 makes the MUE a date-of-service edit based on policy: all units of the code for that date are summed and compared with the MUE value, and CMS treats units above it as contrary to policy. Modifiers such as 59 let the same code appear on separate lines only for MAI 1 (claim-line) edits. D describes an MAI 1 claim-line edit. A applies the modifier rule to the wrong indicator. C is wrong because MUEs are applied when claims are processed.

Source: NCCI Policy Manual 2026, Ch. 1, §V, pp. I-28 to I-29.

Topic: Medically unlikely edits · ID CCSP-PR-10

Answer: C. XS means a separate structure: a different organ or structure. A means a separate encounter. D means an unusual non-overlapping service. B means a different practitioner.

Source: NCCI Policy Manual 2026, Ch. 1, §E, pp. I-17 to I-20.

Topic: Modifiers XE, XS, XP, XU · ID CCSP-PR-11

Answer: B. For Medicare, influenza vaccine administration is reported with HCPCS G0008, plus the CPT code for the vaccine product given. A is the general CPT immunization administration code, which Medicare doesn't use for the flu shot. D is a therapeutic injection code, not vaccine administration. C omits the product.

Source: CMS Vaccine Pricing (seasonal influenza, G0008).

Topic: Medicare flu vaccine administration · ID CCSP-PR-12

Answer: D. Coding Clinic is the official advice for ICD-10-CM and ICD-10-PCS; its content is approved by the four Cooperating Parties (AHA, AHIMA, CMS and NCHS). C is the AMA's newsletter for CPT, not ICD-10-CM. A and B are not authoritative sources.

Source: Coding Clinic Advisor, About the AHA Central Office; FY2026 ICD-10-CM Official Guidelines, introduction.

Topic: Which source governs · ID CCSP-RS-01

Answer: A. A MAC writes an LCD when no NCD addresses a service, or to explain an NCD in more detail, and the LCD applies within that MAC's jurisdiction. D confuses LCDs with NCDs. C ignores LCDs. B is false; LCDs cover services billed by physicians and other providers in the jurisdiction.

Source: CMS, Information about LCDs; CMS, Local Coverage Determination process.

Topic: Local coverage determinations · ID CCSP-RS-02

Answer: D. CAC and encoders are tools, not substitutes for the coder's judgment; NLP can misread negation, family history and context, so the coder validates every suggestion against the record. B trusts the tool over the documentation. A is a query with no clinical indicators that the patient has the condition. C still reports a diagnosis the patient doesn't have.

Source: AHIMA Standards of Ethical Coding (2016), Standard 9, guideline 9.2; Standard 4, guideline 4.4.

Topic: Computer-assisted coding · ID CCSP-RS-03

Answer: C. Yes/no queries can't be used to introduce a diagnosis that no provider has documented; ancillary documentation such as a dietitian's note doesn't count. A multiple-choice query is the compliant format there. B, D and A describe compliant practices.

Source: ACDIS/AHIMA Guidelines for Achieving a Compliant Query Practice—2026 Update, pp. 8 and 11–14.

Topic: Compliant queries · ID CCSP-CO-01

Answer: C. When a scribe, including AI technology, creates an entry, the physician or other practitioner must sign it to authenticate the documentation; handwritten and protected electronic signatures are accepted. D: Medicare generally doesn't accept stamped signatures; the exception is an author with a physical disability who provides proof of being unable to sign. A and B don't authenticate the entry by its author.

Source: CMS MLN905364, Complying with Medicare Signature Requirements (July 2025), pp. 2 and 4.

Topic: Signature requirements · ID CCSP-CO-02

Answer: A. "Incident-to" billing requires that the billing practitioner personally performed an initial service for the course of treatment and remains actively involved, under direct supervision. A new problem hasn't been initiated by Dr. Lee, so the PA bills under their own NPI (paid at 85% of the physician fee schedule amount). B ignores the initial-service requirement. C uses a modifier that doesn't address the issue. D is false.

Source: CMS, Incident To Services & Supplies.

Topic: Incident-to billing · ID CCSP-CO-03

Answer: C. GA reports that a required ABN was issued and is on file. B means the service is expected to be denied as not reasonable and necessary and no ABN was issued. D is for services that are statutorily excluded or not a Medicare benefit, where no notice is required. A reports a voluntary notice for a service Medicare never covers.

Source: CGS Medicare, Advance Beneficiary Notices.

Topic: ABNs and claim modifiers · ID CCSP-CO-04

Answer: B. POS 10 is telehealth provided in the patient's home. A is telehealth provided somewhere other than the patient's home. D is the office. C is the patient's home for an in-person service.

Source: CMS Place of Service Code Set.

Topic: Place of service · ID CCSP-CO-05

Answer: A. A covered entity must act within 30 days of receiving the request and may take one extension of up to 30 more days by giving the individual a written explanation and a completion date before the first deadline passes. D, B and C state timeframes the rule doesn't use.

Source: 45 CFR 164.524, paragraph (b)(2).

Topic: HIPAA right of access · ID CCSP-CO-06

Answer: B. OIG's compliance guidance treats auditing and monitoring, training, and corrective action as core elements, and identified overpayments must be reported and returned. C asks for documentation added now for the purpose of supporting codes already billed, an improper documentation practice that misrepresents the record. D and A leave known errors uncorrected.

Source: HHS-OIG General Compliance Program Guidance (Nov. 2023), §II.C p. 19; §III Elements 3, 6 and 7; AHIMA Standards of Ethical Coding (2016), Standards 3 and 5.

Topic: Responding to an audit · ID CCSP-CO-07

Answer: D. Codes must be supported by the documentation for the encounter; adding unaddressed diagnoses to raise risk scores misrepresents the record, and coders shouldn't take part in or conceal that practice. A and C report unsupported codes. B sends queries with no clinical indicators, which the standards say not to do.

Source: AHIMA Standards of Ethical Coding (2016), Standards 3, 4 (guideline 4.4), 5 and 11; FY2026 ICD-10-CM Official Guidelines, Section IV.J.

Topic: Ethical coding and risk adjustment · ID CCSP-CO-08

Answer: C. Add the RVUs (1.50 + 1.20 + 0.10 = 2.80), adjust each by its GPCI (all 1.000 here), and multiply by the conversion factor: 2.80 × $33.4009 = $93.52. B uses the qualifying-APM conversion factor ($33.5675). A applies the 95% non-participating rate, which the question didn't ask for. D multiplies only the work RVU.

Source: CMS Physician Fee Schedule documentation, payment formula; Minnesota Medical Association, CY2026 PFS final rule, CY2026 conversion factors.

Topic: RBRVS payment math · ID CCSP-RC-01

Answer: A. After the deductible, Part B usually pays 80% of the allowed amount and the patient owes 20% coinsurance: $120 × 0.80 = $96 and $120 × 0.20 = $24. C ignores coinsurance. B uses a 30% split. D reverses the shares.

Source: Medicare.gov, Medicare costs, Part B.

Topic: Coinsurance · ID CCSP-RC-02

Answer: D. CO (contractual obligation) assigns responsibility for the adjustment to the provider, and CMS says Medicare beneficiaries may be billed only for adjustments with group code PR. A is PR (patient responsibility). C is OA (other adjustment). B is PI (payer-initiated reduction).

Source: CMS, Health Care Payment and Remittance Advice, group codes; X12 Claim Adjustment Group Codes.

Topic: Remittance group codes · ID CCSP-RC-03

Answer: B. A claim returned as unprocessable was never adjudicated, so it has no appeal rights; the fix is a corrected new claim within the timely-filing limit. D wastes time and delays payment. A and C don't resolve the error.

Source: First Coast, Claims returned as unprocessable, citing Claims Processing Manual Ch. 1, §80.3.

Topic: Unprocessable claims · ID CCSP-RC-04

Answer: B. Item 24E holds the diagnosis pointer: a reference letter (A through L) that matches a diagnosis in item 21. C puts the code itself in the wrong field. A goes in the modifier field of 24D. D goes in 24B.

Source: CMS MLN CMS-1500 training, billing details, item 24E.

Topic: Linking diagnosis to service · ID CCSP-RC-05

Answer: A. 2026 completes the three-year phase-in that began in 2024, so 100% of risk scores use the 2024 CMS-HCC model. B and D were blend shares in earlier years of the phase-in. C is wrong for 2026.

Source: CMS fact sheet, 2026 Medicare Advantage and Part D Rate Announcement.

Topic: HCC risk adjustment model · ID CCSP-RC-06

Answer: C. Acute MI codes apply for four weeks or less from onset; an old or healed MI that isn't currently presenting symptoms is reported with I25.2. B reports an acute MI that would overstate the patient's current condition, which matters for risk adjustment. D is a subsequent MI within four weeks of a prior one. A is wrong because I25.2 exists to report this status.

Source: FY2026 ICD-10-CM Official Guidelines, Section I.C.9.e.1.

Topic: Old vs. acute MI · ID CCSP-RC-07

Answer: B. MDM needs two of three elements. Problems: a chronic illness that is worsening (an exacerbation or progression) is moderate. Risk: changing the insulin dose is prescription drug management, which is moderate. Data: reviewing one test result and ordering one test is limited. Two elements at moderate = moderate MDM = 99214. C (low) understates the problem and risk. D needs high MDM in two elements. A (straightforward) doesn't fit.

Source: AMA 2023 E/M descriptors and guidelines, pp. 7–10; CGS E/M fact sheet; CMS MLN006764, Evaluation and Management Services Guide (May 2026).

Topic: Medical decision making · ID CCSP-SC-EM-01

Answer: D. An office visit level may be chosen by MDM or by total time on the date of the encounter, whichever the documentation supports. 42 minutes meets the 40-minute threshold for 99215. B is the MDM-based level, but time supports a higher one. A and C add prolonged services, which apply only well beyond the 99215 time threshold. (CMS's E/M guide lists 99215 as 40–54 minutes for Medicare prolonged-service counting; 42 minutes qualifies under either reading.)

Source: CMS MLN006764, Evaluation and Management Services Guide (May 2026), pp. 15 and 20.

Topic: Selecting the level by time · ID CCSP-SC-EM-02

Answer: C, D and E. E11.65 is type 2 diabetes with hyperglycemia, Z79.4 reports current insulin use, and I10 is essential hypertension. F conflicts with the documented hyperglycemia. B is hypertensive chronic kidney disease, and no CKD is documented. A is for oral hypoglycemic drugs, and the patient takes only insulin for diabetes; lisinopril isn't an antidiabetic drug.

Source: FY2026 ICD-10-CM Official Guidelines, Section I.C.4.a.3 and Tabular List.

Topic: Diagnosis codes · ID CCSP-SC-EM-03

Answer: A. The first-listed diagnosis is the condition chiefly responsible for the visit; the worsening diabetes drove the work and the medication change. D was stable and needed no change. B is a status code that supports the diabetes code. C (hyperglycemia, unspecified) is a sign included in E11.65.

Source: FY2026 ICD-10-CM Official Guidelines, Section IV.G.

Topic: First-listed diagnosis · ID CCSP-SC-EM-04

Answer: D. 49505 reports an open repair of an initial, reducible inguinal hernia in a patient age 5 or older. B adds 49568, a mesh-implantation code that was deleted in 2023; mesh isn't separately reported with inguinal hernia repair. C is the laparoscopic repair. A is for an incarcerated or strangulated hernia.

Source: NCCI Policy Manual 2026, Ch. 6, §E.7, p. VI-8; ACS Bulletin, 2023 CPT changes for general surgery.

Topic: Hernia repair code · ID CCSP-SC-SU-01

Answer: C. K40.90 is a unilateral inguinal hernia without obstruction or gangrene, not specified as recurrent. D is the recurrent version. B is bilateral. A is unilateral with obstruction.

Source: FY2026 ICD-10-CM Official Guidelines, Tabular List, category K40.

Topic: Hernia diagnosis code · ID CCSP-SC-SU-02

Answer: C. The repair has a 90-day global period, and routine postoperative visits are part of the payment for the surgery. 99024 is the CPT code for a postoperative follow-up visit included in the global service; CMS requires it only from certain practices in its global-surgery data collection, and many others report it for tracking. A is for an unrelated E/M. B puts a procedure modifier on a visit. D is for a separately identifiable E/M on the same day as a procedure.

Source: CMS MLN907166, Global Surgery Booklet (Dec. 2025), pp. 5 and 13.

Topic: Postoperative visit · ID CCSP-SC-SU-03

Answer: B, D and E. For major surgery, preoperative visits the day before or the day of surgery are included unless the visit is where the decision for surgery was made (modifier 57); routine postoperative care is included; and a related unplanned return to the operating room is reported with modifier 78. C is wrong because an unrelated E/M is separately reportable with modifier 24. A is wrong because routine postoperative visits aren't billed separately.

Source: CMS MLN907166, Global Surgery Booklet (Dec. 2025), pp. 5–6, 9 and 14.

Topic: Global surgical package · ID CCSP-SC-SU-04

Answer: A. 99392 is the periodic preventive visit for an established patient aged 1 through 4 years. D is the new-patient version. C is for an established infant younger than 1 year. B is a problem-oriented office visit, and no problem was addressed.

Source: California Medical Association, preventive medicine codes.

Topic: Preventive visit code · ID CCSP-SC-ME-01

Answer: A and D. Z00.129 is a routine child health exam without abnormal findings, and Z23 reports the encounter for immunization; Z23 may be used with the routine exam code. B is for an exam with abnormal findings. C is for an adult exam.

Source: FY2026 ICD-10-CM Official Guidelines, Sections I.C.21.c.2 and I.C.21.c.12.

Topic: Diagnosis codes · ID CCSP-SC-ME-02

Answer: A. For patients through age 18 whose physician or other qualified professional counsels on the vaccines, 90460 reports the first component of each vaccine and 90461 each additional component. MMR has three components (one 90460 + two 90461) and varicella has one (one 90460): 90460 ×2 and 90461 ×2. B counts every component as a first component. D is for administration without that counseling. C treats the two vaccines as one.

Source: AAFP Family Practice Management, immunization coding (Mar. 2019).

Topic: Immunization administration · ID CCSP-SC-ME-03

Answer: A. 90707 is the MMR vaccine (live, subcutaneous) and 90716 is the varicella vaccine (live, subcutaneous); each product given is reported. D is the combined MMRV vaccine, which wasn't given. B and C each leave out a product.

Source: CDC IIS vaccine CPT code table.

Topic: Vaccine product codes · ID CCSP-SC-ME-04