A patient last saw Dr. Lee, a family physician, two and a half years ago. Today he sees Dr. Patel, also a family physician in the same group practice, for the first time. How is the visit classified?

New patient, because more than two years have passed

Consultation, because Dr. Patel has not seen him

New patient, because the physician is different

Two CPT codes billed for the same patient and date form an NCCI procedure-to-procedure pair with a modifier indicator of 0. The coder appends modifier 59 to the column 2 code. What is the result?

The column 2 code is denied; the edit cannot be bypassed

Both codes are denied because modifier 59 is invalid

The column 1 code is denied and the column 2 code is paid

Both codes are paid because modifier 59 bypasses the edit

A CDI program's report shows a 99% provider agreement rate on its multiple-choice queries, most of which list a single CC or MCC diagnosis and 'other.' What does this suggest?

The queries may be leading and need a compliance review

Providers should be required to agree with every query

The program is performing ideally and needs no review

Open-ended queries should be eliminated

A physician performs a procedure that has no Category I CPT code but is described by an existing Category III code. How should it be reported?

Report the unlisted procedure code

Report the closest Category I code

Through which edit program are NCCI PTP edits applied to hospital outpatient (OPPS) claims?

The Integrated Outpatient Code Editor (I/OCE)

The Medicare Code Editor (MCE) for inpatient claims

A reviewer finds that progress notes for five consecutive days contain identical examination findings and vital signs copied forward, including a 'surgical incision healing well' entry dated before the surgery. What type of problem is this?

A documentation integrity issue found in qualitative review

A completeness deficiency found in quantitative review

An MPI overlay caused by registering the wrong patient for those days

A consulting nephrologist documents acute kidney injury in a consultation note. The attending's notes neither confirm nor contradict the diagnosis. How should the coder proceed?

Code acute kidney injury from the consultant's documentation

Code only the attending's diagnoses

Query the attending before coding the AKI

Code acute kidney injury only if the attending cosigns the consult

CCA – Certified Coding Associate

Free CCA Practice Questions

10 sample questions for the CCA – Certified Coding Associate, with the correct answer and an explanation for each. No account needed. Try each one before you open the answer.

Sections covered on the exam: Clinical Classification Systems, Compliance, Reimbursement Methodologies, Health Records and Data Content, Information Technologies, Encoders & Groupers, Confidentiality and Privacy.

Question 1 · Clinical Classification Systems
A patient is admitted with dyspnea and edema. The discharge summary states: acute on chronic diastolic heart failure due to hypertensive heart disease; chronic kidney disease stage 3a. Which code assignment and sequence is correct?
- A.I50.33, I10, N18.31
- B.I11.0, I50.33, N18.31
- C.I50.33, I13.0, N18.31
- D.I13.0, I50.33, N18.31
Show answer and explanation
Answer: D. I13.0, I50.33, N18.31
When hypertension, heart disease, and chronic kidney disease are all present, ICD-10-CM presumes the causal relationship and assigns combination category I13. I13.0 (with heart failure and stage 1–4 CKD) is sequenced first, followed by additional codes for the type of heart failure (I50.33) and the CKD stage (N18.31). I11.0 omits the kidney component, and I10 is never used with heart failure attributed to hypertension.
Question 2 · Clinical Classification Systems
A patient last saw Dr. Lee, a family physician, two and a half years ago. Today he sees Dr. Patel, also a family physician in the same group practice, for the first time. How is the visit classified?
- A.New patient, because more than two years have passed
- B.Established patient
- C.Consultation, because Dr. Patel has not seen him
- D.New patient, because the physician is different
Show answer and explanation
Answer: B. Established patient
A new patient has not received professional services from the physician or another physician of the exact same specialty and subspecialty in the same group practice within the past three years. The patient was seen by a family physician in the same group within three years, so he is established.
Question 3 · Reimbursement Methodologies
Two CPT codes billed for the same patient and date form an NCCI procedure-to-procedure pair with a modifier indicator of 0. The coder appends modifier 59 to the column 2 code. What is the result?
- A.The column 2 code is denied; the edit cannot be bypassed
- B.Both codes are denied because modifier 59 is invalid
- C.The column 1 code is denied and the column 2 code is paid
- D.Both codes are paid because modifier 59 bypasses the edit
Show answer and explanation
Answer: A. The column 2 code is denied; the edit cannot be bypassed
A modifier indicator of 0 means no modifier is allowed to bypass the edit under any circumstances, so the column 2 code is not paid. A modifier indicator of 1 would allow a supported modifier such as 59 or XS to bypass the edit.
Question 4 · Health Records and Data Content
A physician practice organizes each patient's record by a numbered problem list, with progress notes written in Subjective, Objective, Assessment, and Plan (SOAP) format for each problem. Which record format is this?
- A.Reverse chronological record
- B.Integrated record
- C.Problem-oriented record
- D.Source-oriented record
Show answer and explanation
Answer: C. Problem-oriented record
The problem-oriented medical record (POMR) is organized around a numbered problem list, an initial plan for each problem, and progress notes in SOAP format linked to each problem. Source-oriented records group documents by discipline, integrated records file all documents in date order, and reverse chronological describes filing order rather than the organizing structure.
Question 5 · Compliance
A CDI program's report shows a 99% provider agreement rate on its multiple-choice queries, most of which list a single CC or MCC diagnosis and 'other.' What does this suggest?
- A.Providers should be required to agree with every query
- B.The program is performing ideally and needs no review
- C.Open-ended queries should be eliminated
- D.The queries may be leading and need a compliance review
Show answer and explanation
Answer: D. The queries may be leading and need a compliance review
An unusually high agreement rate, especially when options list only the diagnosis that increases payment, can indicate leading queries. Compliant multiple-choice queries include all clinically reasonable options and 'clinically undetermined.' Query practices should be audited regularly.
Question 6 · Clinical Classification Systems
An inpatient has type 2 diabetes with diabetic chronic kidney disease, stage 4, documented by the attending. Which code assignment is correct?
- A.E11.22 only
- B.E11.22, N18.4
- C.E11.9, N18.4
- D.N18.4, E11.22
Show answer and explanation
Answer: B. E11.22, N18.4
Diabetes with CKD is a combination code (E11.22), and the Tabular instruction 'use additional code to identify stage of chronic kidney disease' requires N18.4 after it. E11.9 would ignore the documented complication, the stage code is sequenced after the combination code, and E11.22 alone omits the required stage.
Question 7 · Clinical Classification Systems
A physician performs a procedure that has no Category I CPT code but is described by an existing Category III code. How should it be reported?
- A.Report the unlisted procedure code
- B.Report the closest Category I code
- C.Report a Category II code
- D.Report the Category III code
Show answer and explanation
Answer: D. Report the Category III code
CPT instructs that when a Category III code exists for a service, it must be reported instead of an unlisted Category I code. Reporting a similar Category I code misrepresents the service, and Category II codes are performance-measure codes.
Question 8 · Reimbursement Methodologies
Through which edit program are NCCI PTP edits applied to hospital outpatient (OPPS) claims?
- A.The MS-DRG grouper
- B.The Integrated Outpatient Code Editor (I/OCE)
- C.The hospital chargemaster
- D.The Medicare Code Editor (MCE) for inpatient claims
Show answer and explanation
Answer: B. The Integrated Outpatient Code Editor (I/OCE)
NCCI edits for hospital outpatient claims are incorporated in the Integrated Outpatient Code Editor. The Medicare Code Editor checks inpatient claims for coding errors such as age and sex conflicts, the grouper assigns DRGs, and the chargemaster supplies codes and charges.
Question 9 · Health Records and Data Content
A reviewer finds that progress notes for five consecutive days contain identical examination findings and vital signs copied forward, including a 'surgical incision healing well' entry dated before the surgery. What type of problem is this?
- A.A completeness deficiency found in quantitative review
- B.An MPI overlay caused by registering the wrong patient for those days
- C.A release of information error
- D.A documentation integrity issue found in qualitative review
Show answer and explanation
Answer: D. A documentation integrity issue found in qualitative review
Copy-and-paste (cloned) documentation that is inaccurate or internally inconsistent is a documentation integrity problem identified by qualitative review. Quantitative review checks for the presence of documents and signatures, not the accuracy of content.
Question 10 · Compliance
A consulting nephrologist documents acute kidney injury in a consultation note. The attending's notes neither confirm nor contradict the diagnosis. How should the coder proceed?
- A.Code only the attending's diagnoses
- B.Query the attending before coding the AKI
- C.Code acute kidney injury from the consultant's documentation
- D.Code acute kidney injury only if the attending cosigns the consult
Show answer and explanation
Answer: C. Code acute kidney injury from the consultant's documentation
Code assignment may be based on documentation from any physician or qualified provider involved in the patient's care, as long as it does not conflict with the attending physician's documentation. A query is required only when the documentation conflicts.

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