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The CHONC exam has 100 questions and runs 4 hours.
These 10 free CHONC questions are organized by exam domain, so you can see how each part of the Certified Hematology and Oncology Coder blueprint is tested. Reveal the answer and explanation under each question.
A breast core biopsy is being classified as in situ or invasive carcinoma. Which microscopic finding establishes invasion rather than describing changes confined to a duct?
Correct answer: C - Malignant epithelial cells extending through the duct wall into adjacent breast stroma
A 9-year-old receiving leukemia chemotherapy arrives at the clinic with an oral temperature of 38.6°C. The CBC shows a white blood cell count of 1,200/µL, segmented neutrophils of 18%, and bands of 4%. Which interpretation and response are appropriate?
Correct answer: D - ANC 264/µL; alert the oncology clinician for immediate assessment
During an established Medicare patient's oncology office visit, a nurse practitioner independently evaluates a new, uncomplicated rash and initiates treatment. The rash is not covered by the physician's existing care plan. The physician is in the office suite but does not see the patient or participate in managing the rash. The NP is enrolled in Medicare and acts within state scope-of-practice rules. How should the E/M service be submitted?
Correct answer: A - Use the NP's NPI for the independently performed office E/M service
A radiation oncologist who is treating a patient requests the oncology clinic's notes and copies of the patient's pathology and operative reports to plan treatment. The requester and treatment relationship have been verified. The records contain no psychotherapy notes, and no additional legal restriction applies. The patient has not signed a separate release. Which disclosure is permitted under HIPAA?
Correct answer: A - Securely send the requested records to the treating radiation oncologist without separate authorization
An oncology office administers 200 mg of pembrolizumab from two single-dose vials, each labeled 100 mg. All 200 mg of labeled content is given; the only drug discarded is 6 mg documented as manufacturer overfill. The drug is separately payable under Medicare Part B, and J9271 represents 1 mg. What should the drug portion of the claim show?
Correct answer: A - 200 units with JZ; do not report the discarded overfill
An oncologist documents anemia caused by an active sigmoid colon carcinoma, explicitly excluding blood loss and treatment-related anemia. Today's outpatient encounter is solely for a red blood cell transfusion; no antineoplastic treatment is given. Which diagnosis sequence follows the ICD-10-CM guideline for this situation?
Correct answer: D - C18.7 (sigmoid colon malignancy), then D63.0 (anemia in neoplastic disease)
A radiation department's claim lists Z51.0 followed by Z85.3 for a woman's scheduled adjuvant external-beam radiation treatment. Her invasive upper-outer-quadrant right breast tumor was removed by lumpectomy six weeks earlier, and radiation to that breast is still ongoing. No complication is treated at today's visit. Which correction is required?
Correct answer: D - Replace Z85.3 with C50.411 and retain Z51.0 as the first-listed diagnosis
For an established office patient with immune thrombocytopenia, the hematologist documents an exacerbation with new bruising, adjusts the prednisone prescription, and reviews a CBC. There is no major bleeding, consideration of hospitalization, or drug therapy requiring intensive toxicity monitoring. No other data are reviewed or analyzed. The visit is selected by medical decision making rather than time. Which coding conclusion is supported?
Correct answer: B - 99214: the problem addressed and prescription management support moderate MDM
A Medicare patient attends a physician's office for scheduled chemotherapy. Through one IV site, the nurse first infuses ondansetron for 25 minutes, then infuses cyclophosphamide for 50 minutes. Saline serves only as the drug carrier and line flush. No other administration services are performed. Select the administration codes for this encounter.
Correct answer: B - 96413 and 96367
The original treatment plan lists Herceptin. A physician-approved substitution is documented, and both the medication administration record and the pharmacy dispensing record identify Kanjinti (trastuzumab-anns) as the IV product actually given. Which HCPCS Level II code belongs on the drug claim line?
Correct answer: C - Q5117
The CHONC exam also covers these domains. Drill them in the full free practice test:
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