100+ Free CHONC Practice Questions

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Which ICD-10-CM code reports thrombocytopenia due to chemotherapy?

D69.6

D69.59

D61.810

D70.1

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2026 Statistics

Key Facts: CHONC Exam

150

Total Items

AAPC

5h 40m

Exam Time

AAPC

$299

AAPC Member Fee

AAPC

Required Since 7/2023

Zero-waste single-use vial reporting

The AAPC CHONC consists of 150 MCQ items over 5h40m with 70% passing. Fee $299 AAPC member. Master chemo administration code hierarchy (initial 96413 first hr; addt'l hr 96415; sequential 96417), JW/JZ wastage modifiers (JZ required since 7/2023 when zero waste), and ICD-10-CM neoplasm sequencing rules.

Sample CHONC Practice Questions

Try these sample questions to test your CHONC exam readiness. Each question includes a detailed explanation. Start the interactive quiz above for the full 100+ question experience with AI tutoring.

1Which of the following best describes the function of erythrocytes?

A.Phagocytosis of bacteria and debris

B.Transport of oxygen via hemoglobin

C.Production of antibodies

D.Initiation of clot formation

Explanation: Erythrocytes (red blood cells) carry oxygen from the lungs to tissues using hemoglobin. CHONC coders must understand basic hematologic anatomy to interpret pathology reports.

2Acute myeloid leukemia (AML) primarily affects which cell line?

A.Lymphoid progenitor cells

B.Myeloid progenitor cells

C.Plasma cells only

D.Erythroid cells exclusively

Explanation: AML arises from the myeloid progenitor cells in the bone marrow, leading to overproduction of immature myeloblasts. Documented as C92.0x in ICD-10-CM.

3The term 'lymphadenopathy' refers to:

A.Inflammation of lymphatic vessels

B.Disease or enlargement of lymph nodes

C.Cancer originating in lymphocytes

D.A surgical removal of a lymph node

Explanation: Lymphadenopathy refers to abnormality (most often enlargement) of lymph nodes. ICD-10-CM coding is R59.x when not specified as malignant.

4Which type of Hodgkin lymphoma is characterized by Reed-Sternberg cells?

A.Nodular lymphocyte-predominant

B.Classical Hodgkin lymphoma

C.Burkitt lymphoma

D.Mantle cell lymphoma

Explanation: Classical Hodgkin lymphoma (C81.1-C81.4) is defined pathologically by the presence of Reed-Sternberg cells. Nodular lymphocyte-predominant HL has L&H 'popcorn' cells instead.

5What pathologic feature distinguishes carcinoma in situ from invasive carcinoma?

A.Presence of metastatic disease

B.Tumor cells confined within the basement membrane

C.Lymph node involvement

D.Distant organ spread

Explanation: Carcinoma in situ (CIS) is a non-invasive lesion in which malignant cells remain confined to the epithelium and have not breached the basement membrane. CIS is coded under D00-D09 in ICD-10-CM.

6Multiple myeloma is a malignant proliferation of which cell type?

A.Megakaryocytes

B.Plasma cells

C.Mast cells

D.Eosinophils

Explanation: Multiple myeloma (C90.00-C90.02) is a clonal proliferation of plasma cells producing monoclonal immunoglobulin (M-protein), often causing CRAB criteria (hyperCalcemia, Renal failure, Anemia, Bone lesions).

7Tumor staging using the TNM system describes:

A.Tumor size, Node involvement, Metastasis

B.Treatment, Necrosis, Mortality

C.Tissue, Number, Mass

D.Type, Number, Modifier

Explanation: TNM is the AJCC system describing the primary Tumor (T), regional lymph Node involvement (N), and distant Metastasis (M). It guides treatment selection and is critical context for ICD-10-CM cancer coding.

8Which of the following is a myeloproliferative neoplasm characterized by JAK2 V617F mutation in most cases?

A.Chronic lymphocytic leukemia

B.Polycythemia vera

C.Hairy cell leukemia

D.Multiple myeloma

Explanation: Polycythemia vera (D45) is a BCR-ABL-negative myeloproliferative neoplasm with JAK2 V617F mutation in over 95% of cases. CHONC coders must distinguish MPNs for accurate ICD-10-CM assignment.

9A pathology report describes a 'small round blue cell tumor with starry-sky pattern.' This is most consistent with:

A.Burkitt lymphoma

B.Hodgkin lymphoma

C.Chronic myeloid leukemia

D.Polycythemia vera

Explanation: Burkitt lymphoma (C83.7-) is a highly aggressive B-cell non-Hodgkin lymphoma with the classic 'starry-sky' histology from tingible body macrophages. Important distinction for assigning the correct ICD-10-CM lymphoma code.

10Anemia caused by destruction of red blood cells is termed:

A.Hemolytic anemia

B.Aplastic anemia

C.Iron-deficiency anemia

D.Pernicious anemia

Explanation: Hemolytic anemia (D55-D59) results from RBC destruction. CHONC coders frequently encounter this as a complication of chemotherapy or as autoimmune disease.

About the CHONC Exam

AAPC specialty credential for hematology/oncology coders. Validates expertise in chemotherapy administration CPT (96360-96549, with strict initial vs sequential vs concurrent rules), HCPCS J-codes for cancer drugs, ICD-10-CM neoplasm coding (sequencing of Z51.x with malignancy), modifiers JW/JZ for drug wastage (post-July 2023), and the 340B program plus ESA/biosimilar compliance.

Questions

150 scored questions

Time Limit

5 hours 40 minutes

Passing Score

70%

Exam Fee

$299 AAPC member (AAPC)

CHONC Exam Content Outline

10%

Hematology/Oncology Anatomy and Pathology

Lymphatic system, bone marrow, common cancer types and staging basics

25%

CPT Chemotherapy Administration and Hydration

96360-96549 hierarchy, initial vs sequential vs concurrent rules

15%

CPT Hem/Onc E/M and Procedures

BMA/biopsy 38220-38222, lumbar puncture 62270, intrathecal chemo 96450

15%

HCPCS J-Codes for Cancer Drugs

Pembrolizumab J9271, rituximab J9312, trastuzumab J9355, paclitaxel J9267

15%

ICD-10-CM Cancer Diagnosis Coding

C00-C75 malignant, C77-C80 metastatic, Z51 encounter for chemo/RT/IT

20%

Modifiers, Bundling and Compliance

JW/JZ wastage (JZ required since 7/2023), 340B JG modifier history, ESA monitoring

How to Pass the CHONC Exam

What You Need to Know

Passing score: 70%
Exam length: 150 questions
Time limit: 5 hours 40 minutes
Exam fee: $299 AAPC member

Keys to Passing

Complete 500+ practice questions
Score 80%+ consistently before scheduling
Focus on highest-weighted sections
Use our AI tutor for tough concepts

CHONC Study Tips from Top Performers

1Master chemo admin hierarchy: ONE initial code per IV access (office); additional hours of SAME drug; sequential for DIFFERENT drug; concurrent (96368) for simultaneous infusions

2Know JW (waste) / JZ (zero waste) — required reporting for Medicare single-use vial drugs since July 2023

3Memorize Z51 sequencing: Z51.0 RT, Z51.11 chemo, Z51.12 immunotherapy = PRINCIPAL when admission is FOR therapy. Complication of therapy = complication is principal

4Know common J-codes: J9312 rituximab, J9271 pembrolizumab, J9299 nivolumab, J9355 trastuzumab, J9267 paclitaxel, J9000/J9002 doxorubicin

Frequently Asked Questions

What is the chemo administration code hierarchy?

Per encounter, only ONE 'initial' code per IV access (in physician office). Initial codes: 96413 (chemo IV infusion 1st hr), 96409 (chemo IV push initial), 96365 (non-chemo IV infusion 1st hr), 96374 (non-chemo IV push initial). Each addt'l hour of same drug: 96415 (chemo) or 96366 (non-chemo). Each addt'l SEQUENTIAL different drug: 96417 (chemo) or 96367 (non-chemo). Concurrent (multiple drugs running at same time): 96368.

When do I use JW vs JZ?

JW = drug or biological wasted/discarded from a single-use vial (Medicare requires reporting wasted units along with administered units). JZ (added July 2023) = ZERO drug wasted from single-use vial (must be reported when no waste). One must be reported on every claim line for single-use vial drugs from Medicare. Multi-use vials don't require JW/JZ.

How do I sequence Z51 codes with cancer diagnoses?

When admission/encounter is FOR chemo (Z51.11), radiation (Z51.0), or immunotherapy (Z51.12), the Z51 code is PRINCIPAL/FIRST-LISTED, then the malignancy. When admission is for management of a complication (anemia, neutropenia, dehydration from chemo side effect), the COMPLICATION is principal. Personal history (Z85.x) is used when patient is no longer being actively treated.