Certified Coding Specialist (CCS) Practice Exam
The Certified Coding Specialist (CCS) credential, offered by the American Health Information Management Association (AHIMA), validates your proficiency in accurately classifying medical data for healthcare billing, reimbursement, and research.
Who should consider This Certification:
- Individuals seeking a career in medical coding within hospitals, physician offices, or other healthcare settings.
- Experienced medical billers or coders looking to validate their skills and advance their careers.
- Healthcare professionals seeking to transition into a coding role.
Key Roles and Responsibilities
- Analyze medical records to assign accurate numeric and alphanumeric codes for diagnoses and procedures.
- Utilize coding systems like ICD-10-CM, ICD-10-PCS, and CPT® to ensure accurate and efficient coding practices.
- Stay updated on coding regulations and guidelines to maintain compliance with industry standards.
- Communicate effectively with healthcare providers and other stakeholders regarding coding practices.
- Participate in quality assurance processes to ensure the accuracy and completeness of coded data.
Exam Details:
● Format: 60 multiple-choice questions
● Time Limit: 4 hours
● Cost: USD 230 (plus tax where applicable)
● Languages: English, Spanish
● Passing Score: 300 and above
Course Structure
Module 1 – Describe the Coding Knowledge and Skills (39-41%)
- Skills to assign diagnosis and procedure codes on the basis of provider’s documentation in the health record
- Ability to identify principal/first-listed diagnosis and procedure on the basis of respective guidelines
- Skills to apply coding conventions/guidelines and regulatory guidance
- Learning to attach CPT/HCPCS modifiers to outpatient procedures
- Identify suitable sequencing of diagnoses and procedure codes based on the case scenario
- Implementing present on admission (POA) guidelines
- Illustrate knowledge of coding edits (including, NCCI, Medical Necessity)
- Showcasing knowledge of reimbursement methodologies (including DRG, APC)
- Learning about abstract applicable data from the health record
- Determining major co-morbid conditions (MCC) and co-morbid conditions (CC)
Module 2 – Understanding the Coding Documentation (18-22%)
- Ability to identify and resolve conflicting documentation in the health record (e.g., admission type, laterality)
- Making sure all documentation required for assigning a specified code is available within the body of the health record
- Skills to verify and validate documentation within the health record
Module 3 – Understanding Provider Queries (9-11%)
- Determining the elements of an ethical compliant query
- Identify and evaluate if a provider query is compliant (like non-leading, contains appropriate clinical indicators)
- Evaluate current documentation to identify query opportunities
Module 4 – Understanding Regulatory Compliance (18-22%)
- Making sure the health records are complete and accurate
- Learn payer-specific guidelines
- Determine patient safety indicators (PSIs) and hospital-acquired conditions (HACs) based on the provider’s documentation
- Make sure to comply with HIPAA guidelines
- Ensure compliance with the ethical coding standards established by AHIMA
- Ensure compliance with the Uniform Hospital Discharge Data Set (UHDDS)
Module 5 – Understanding Information Technologies (9-11%)
- Learning about the various types of Electronic Health Records (EHR) and their application
- Illustrating a basic understanding of encoding and grouper software
- Showcasing and understanding of computer-assisted coding (CAC) software and its impact on coding
- Ensuring compliance with HITECH guidelines