Certified Coding Specialist (CCS)

Applicants outside the U.S. should visit the  international exam tab.
CCSs are skilled in classifying medical data from patient records, generally in a hospital setting. These coding practitioners:

  • Review patients’ records and assign numeric codes for each diagnosis and procedure
  • Possess expertise in the ICD-10-CM and CPT coding systems
  • Are knowledgeable about medical terminology, disease processes, and pharmacology.

Different facilities and institutions make use of a CCSs’ skills:

  • Hospitals and medical providers take the coded data created by CCSs to insurance companies—or to the government in the case of Medicare and Medicaid recipients—for reimbursement of expenses
  • Researchers and public health officials also use this data to monitor patterns and explore new interventions

Coding accuracy is highly important to healthcare organizations, and has an impact on revenues and describing health outcomes. In fact, certification has become an implicit industry standard. Accordingly, the CCS credential demonstrates a practitioner’s tested data quality and integrity skills, and mastery of coding proficiency. Professionals experienced in coding inpatient and outpatient records should consider obtaining this certification.

Exam Specifications

  • Multiple Choice Section- The multiple choice section will consist of 97 single response multiple-choice items (79 “scored” and 18 “pre-test” items). Pre-test items are unscored items that are included in the examination to assess the item’s performance prior to using it for operational use in a future examination. The pre-test items are scrambled randomly throughout the examination and do not count toward the candidate’s score.
  • Medical Scenarios – The medical scenarios will consist of 8 scenarios (6 scored/ 2 pre-test); each scenario will have up to three separate questions. They will require candidates to pick from a range of codes/ list to answer each question.
  • The total testing time for the exams is 4 hours.

Tasks:

1. Interpret health record documentation using knowledge of anatomy, physiology, clinical indicators and disease processes, pharmacology and medical terminology to identify codeable diagnoses and/or procedures

2. Determine when additional clinical documentation is needed to assign the diagnosis and/or procedure code(s)

3. Consult with physicians and other healthcare providers to obtain further clinical documentation to assist with code assignment

4. Compose a compliant physician query

5. Consult reference materials to facilitate code assignment

6. Identify patient encounter type

7. Identify and post charges for healthcare services based on documentation

Tasks:

Diagnosis:

1. Select the diagnoses that require coding according to current coding and reporting requirements for acute care

(inpatient) services

2. Select the diagnoses that require coding according to current coding and reporting requirements for outpatient services

3. Interpret conventions, formats, instructional notations, tables, and definitions of the classification system to select diagnoses, conditions, problems, or other reasons for the encounter that require coding

4. Sequence diagnoses and other reasons for encounter according to notations and conventions of the classification system and standard data set definitions (such as Uniform Hospital Discharge Data Set [UHDDS])

5. Apply the official ICD-10-CM coding guidelines

Procedure:

1. Select the procedures that require coding according to current coding and reporting requirements for acute care

(inpatient) services

2. Select the procedures that require coding according to current coding and reporting requirements for outpatient services

3. Interpret conventions, formats, instructional notations, and definitions of the classification system and/or nomenclature to select procedures/services that require coding

4. Sequence procedures according to notations and conventions of the classification system/nomenclature and standard data set definitions (such as UHDDS)

5. Apply the official ICD-10-PCS procedure coding guidelines

6. Apply the official CPT/HCPCS Level II coding guidelines

Tasks:

1. Select the principal diagnosis, principal procedure, complications, comorbid conditions, other diagnoses and procedures that require coding according to UHDDS definitions and Coding Clinic

2. Assign the present on admission (POA) indicators

3. Evaluate the impact of code selection on Diagnosis Related Group (DRG) assignment

4. Verify DRG assignment based on Inpatient Prospective Payment System (IPPS) definitions

5. Assign and/or validate the discharge disposition

Tasks:

1. Select the reason for encounter, pertinent secondary conditions, primary procedure, and other procedures that require coding according to UHDDS definitions, CPT Assistant, Coding Clinic, and HCPCS

2. Apply Outpatient Prospective Payment System (OPPS) reporting requirements:

a. Modifiers

b. CPT/ HCPCS Level II

c. Medical necessity

d. Evaluation and Management code assignment (facility reporting)

3. Apply clinical laboratory service requirements

Tasks:

1. Assess the quality of coded data

2. Communicate with healthcare providers regarding reimbursement methodologies, documentation rules, and regulations related to coding

3. Analyze health record documentation for quality and completeness of coding

4. Review the accuracy of abstracted data elements for database integrity and claims processing

5. Review and resolve coding edits such as Correct Coding Initiative (CCI), Medicare Code Editor (MCE) and Outpatient Code Editor (OCE)

Tasks:

1. Use computer to ensure data collection, storage, analysis, and reporting of information.

2. Use common software applications (for example, word processing, spreadsheets, and e-mail) in the execution of work processes

3. Use specialized software in the completion of HIM processes

Tasks:

1. Apply policies and procedures for access and disclosure of personal health information

2. Apply AHIMA Code of Ethics/Standards of Ethical Coding

3. Recognize and report privacy and/or security concerns

4. Protect data integrity and validity using software or hardware technology

Tasks:

  1. Evaluate the accuracy and completeness of the patient record as defined by organizational policy and external regulations and standards
  2. Monitor compliance with organization-wide health record documentation and coding guidelines
  3. Recognize and report compliance concerns