How difficult is the Certified Coding Specialist (CCS) Exam?

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The Certified Coding Specialist (CCS) exam is a certification exam offered by the American Health Information Management Association (AHIMA) for individuals who want to demonstrate their expertise in medical coding. The difficulty level of the CCS exam depends on the individual’s level of knowledge, experience, and preparation.

The CCS exam consists of two parts: a multiple-choice section and a medical scenario section. The multiple-choice section contains 97 questions that test the candidate’s knowledge of medical coding principles and guidelines. The medical scenario section consists of 8 case studies that test the candidate’s ability to apply medical coding principles to real-world scenarios.

The CCS exam is considered to be a challenging exam, as it requires a thorough understanding of medical terminology, anatomy and physiology, and medical coding guidelines. Candidates must be familiar with various code sets, such as ICD-10-CM, ICD-10-PCS, and CPT, and be able to apply them correctly to medical scenarios.

To prepare for the CCS exam, candidates must have a strong foundation in medical coding principles and guidelines and undergo extensive study and practice. AHIMA provides various resources, such as study guides, online courses, and practice exams, to help candidates prepare for the exam.

In summary, the CCS exam is a challenging exam that requires a strong knowledge of medical coding principles and guidelines, as well as extensive preparation and practice.

Certified Coding Specialist (CCS) Exam Glossary

Here are some important terms and concepts that are covered in the Certified Coding Specialist (CCS) exam:

  1. ICD-10-CM: International Classification of Diseases, 10th Revision, Clinical Modification. A coding system used to classify and code diagnoses in healthcare.
  2. ICD-10-PCS: International Classification of Diseases, 10th Revision, Procedure Coding System. A coding system used to classify and code medical procedures in healthcare.
  3. CPT: Current Procedural Terminology. A coding system used to describe medical procedures and services provided by healthcare professionals.
  4. DRG: Diagnosis-Related Group. A system used to classify inpatient hospital cases into groups based on similar clinical characteristics and expected resource use.
  5. E/M Codes: Evaluation and Management Codes. Codes used to describe and bill for healthcare services related to the evaluation and management of a patient’s healthcare needs.
  6. NCCI: National Correct Coding Initiative. A program designed to promote correct coding methodologies and eliminate improper coding practices.
  7. Modifier: A code used to indicate that a service or procedure has been altered in some way from the standard description.
  8. CMS: Centers for Medicare and Medicaid Services. A federal agency that administers the Medicare and Medicaid programs and oversees many aspects of healthcare in the United States.
  9. HIPAA: Health Insurance Portability and Accountability Act. A federal law that sets standards for the protection of individually identifiable health information.
  10. Revenue Code: A code used to identify and bill for specific types of services or supplies provided to a patient in a healthcare facility.

These are just a few of the many important terms and concepts covered in the CCS exam. Understanding these terms and concepts is essential for anyone looking to become a certified medical coder and pass the CCS exam.

Certified Coding Specialist (CCS) Exam Tips and Tricks

Preparing for the Certified Coding Specialist (CCS) exam can be a challenging task, but with the right strategies and approach, you can increase your chances of success. Here are some tips and tricks to help you prepare for the CCS exam:

  1. Create a study plan: Make a study plan that outlines what topics you need to cover and how much time you will devote to each one. This can help you stay on track and avoid cramming.
  2. Use multiple resources: Use a variety of resources to prepare for the exam, such as study guides, online courses, practice exams, and flashcards. This can help you get a well-rounded understanding of the material.
  3. Practice coding scenarios: The CCS exam includes a medical scenario section that tests your ability to apply coding principles to real-world scenarios. Practice coding scenarios and case studies to get comfortable with this type of question.
  4. Focus on your weaknesses: Identify your weak areas and focus on improving them. This can help you make the most of your study time and improve your overall performance on the exam.
  5. Take breaks: Take regular breaks while studying to avoid burnout and stay fresh. Make sure to take care of your physical and mental health, as this can have a significant impact on your performance on the exam.
  6. Review the exam format: Familiarize yourself with the CCS exam format, including the number of questions, time limit, and types of questions. This can help you feel more comfortable and confident on exam day.

By following these tips and tricks, you can prepare effectively for the CCS exam and increase your chances of success. Remember to stay focused, dedicated, and motivated throughout the process.

Preparation method for the Certified Coding Specialist (CCS) exam

When it comes to the exam difficulty part, the first and the most important area that requires the most focus is the eligibility criteria. Learning about this will not only help you understand the requirements but also let you know if there is any skill or area you are missing. Let’s understand the Certified Coding Specialist (CCS) exam eligibility section.

Preparation method for the Certified Coding Specialist (CCS) exam

1. Exam Eligibility Requirements

When it comes to CCS, one of the following options is recommended for taking the exam:

  • Complete courses in anatomy and physiology, pathophysiology, pharmacology, medical terminology, reimbursement methodology, intermediate/advanced ICD diagnostic coding, procedural coding, and medical services (CPT/HCPCS), as well as one (1) year of direct coding experience.


  • A minimum of two (2) years of direct coding experience in a related field.


  • Have the CCA® certificate and at least one (1) year of direct coding experience.


  • Have one (1) year of coding experience directly applying codes and a coding certificate from another certifying organization.


  • Have a CCS-P®, RHIT®, or RHIA® certification.

2. Gain an understanding of exam domains

CCS competencies are divided into four categories. On the certification exam, each domain accounts for a certain percentage of the total questions.

Domain 1 – Coding Knowledge and Skills

The tasks covered in this include:

  • Applying diagnosis and procedure codes depending on the provider’s documentation in the health record
  • Deciding principal/primary diagnosis and procedure
  • Applying coding conventions/guidelines and regulatory guidance
  • Applying CPT®/HCPCS modifiers to outpatient procedures
  • Sequence diagnoses and procedures
  • Applying present on admission (POA) guidelines
  • Addressing coding edits
  • Assigning reimbursement classifications
  • Abstracting pertinent data from health record
  • Recognizing major complication/co-morbidity (MCC) and complication and co-morbidity (CC)
Domain 2 – Coding Documentation

The tasks covered in this include:

  • Reviewing health records to assign diagnosis and procedure codes for an encounter
  • Reviewing and addressing health record discrepancies
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Domain 3 – Provider Queries

The tasks covered in this include:

  • Deciding if a provider query is compliant
  • Analyzing current documentation to identify query opportunities
Domain 4 – Regulatory Compliance

The tasks covered in this include:

  • Ensuring the integrity of health records
  • Applying payer-specific guidelines
  • Recognizing patient safety indicators (PSIs) and hospital-acquired conditions (HACs) based on documentation
  • Ensuring compliance with HIPAA guidelines
  • Ensuring adherence to AHIMA’s Standards of Ethical Coding
  • Applying the Uniform Hospital Discharge Data Set (UHDDS)

3. Enhance Patient and Outpatient Coding skills

Many inpatient coders are confident in their ability to code inpatient accounts and answer queries about inpatient topics. However, because these coders usually code inpatient accounts, many of them are unfamiliar with coding for outpatient sessions.

Some healthcare providers have offered to cross-train inpatient and outpatient coders to assist counter this and give their coders the expertise they need to sit for the CCS exam. Ardent Health Services, for example, is a Nashville-based healthcare company that owns and operates 12 acute care facilities. This demonstrates their dedication to their coders by providing on-the-job cross-training for outpatient coders who believe they lack coding skills.

Coders can participate in the program by completing outpatient coding education modules, passing a test, and then being promoted to Inpatient Coder II, which changes their work description and raises their income. This would provide the coders with plenty of opportunities to get the hands-on experience they need to pass the CCS exam.

In addition, inpatient coders must not only improve their outpatient coding skills but must also become more familiar with outpatient-related ideas, such as:

  • Outpatient Prospective Payment System (OPPS)
  • Current Procedural Terminology (CPT)
  • Healthcare Common Procedure Coding System (HCPCS)
  • Evaluation and Management (E/M)
  • Correct Coding Initiative (CCI) 
  • Medicare Code Editor (MCE)
  • Outpatient Code Editor (OCE)

Further, for inpatient coding, these coders have to focus on concepts such as: 

  • Inpatient Prospective Payment System (IPPS)
  • Diagnosis Related Groups (DRGs)
  • Major complications or comorbidities (MCC), complication or comorbidity (CC)
  • Clinical documentation improvement (CDI)
  • Present on Admission (POA)

4. Get familiar with the Coding Guidelines

The Official Coding Guidelines issued by the Centers for Medicare and Medicaid Services (CMS) and the National Center for Health Statistics (NCHS) have many coders feeling overwhelmed. While many coders refer to them as needed when coding their daily visits, others have difficulty comprehending the content as a whole.

Some find it tough to recollect and apply content rapidly on the CCS examination, and many run out of time or barely have enough time to complete the exam. One major source of anxiety for coders planning to take the CCS will be when the guidelines reflect ICD-10 rather than ICD-9. Coders are required to become familiar with these rules as part of their day-to-day coding activities, which should serve as further motivation to learn ICD-10 in detail. Before taking the exam, coders should read the guidelines at least once, preferably twice.

5. Focusing on the non-coding part of the exam

The indirect domains in the CCS examination are Data Quality and Management (three percent of the test), Information and Communication Technologies (two percent), Privacy/Confidentiality/Legal/Ethical Issues (three percent), and Compliance (three percent). Reimbursement techniques, documentation standards, and laws, abstracted data pieces for database integrity and claims processing, and utilizing technology to ensure data collection, analysis, storage, reporting, and application in HIM work processes are among the topics covered.

Further, additional topics include privacy and security concerns, data integrity protection, access and dissemination of personal health information, accuracy and completeness of the patient record, organization-wide compliance monitoring, and ethical coding standards. These parts account for 11% of the final examination score.

6. Gaining knowledge of clinical scenarios

If the CCS exam includes ICD-10, which won’t happen until after the new code set is introduced in the US, the clinical scenario section of the exam will most likely present the greatest obstacle for coders. Inpatient and outpatient visits are among the eight medical record scenarios that coders must code. There are, however, a number of steps coders can take to overcome their fear of this section of the exam.

Attending an ICD-10 training to have a better understanding of the ICD-10-CM and ICD-10-PCS concepts can help a lot. Additionally, coders can buy resources from AHIMA and other publishers to practice ICD-10 coding problems.

7. Use code books

Using the codebooks will help in improved CCS exam preparation. Future test-takers will also benefit from scanning the Index to Diseases and the Tabular List, as well as other sections of the ICD-9 and ICD-10 codebooks, such as the V Codes, E Codes, Appendices, Table of Drugs and Chemicals, Hypertension Table, Official Coding Guidelines, Procedures section, and other sections. And, to get better offers on codebooks, become a member of AHIMA. 

8. Work on your time management skills

For a number of reasons, time management is a valid concern. Completing the test in four hours demonstrates that test takers have acquired the subject at a high cognitive level and can recall, apply, and analyze the information. Participants will be asked to identify facts, basic concepts, theories, procedures, and principles in some test questions. Other questions will challenge test takers to apply principles and concepts to circumstances, recognize data correlations, and solve specific problems involving the integration of diverse concepts. 

Therefore, to enhance their chances of answering questions accurately and swiftly, test-takers must have extensively studied the ideas stated in the CCS Examination Content Outline. Before taking the exam, students should practice taking a timed examination.

9. Take formal Coding Education

Individuals who have attended formal coding training at a local community college, university, or through online distance learning have a good chance of passing the CCS exam. They may, however, opt to begin with the CCA exam to gain the mastery level of knowledge and skill required to pass the CCS exam.

Only a few students, however, are able to take and pass the CCS exam right away. That is to say, students who obtained above-average grades in ICD-9 and CPT coding classes, as well as other classes such as reimbursement, statistics, legal, and management, are more likely to be able to combine their classroom learning with an effective study strategy and pass the exam on the first attempt.

10. Complete your preparation using the Practice Tests

Taking practice exams is the most effective method to assess your level of preparation. The Practice Exams will help you discover weak areas in your preparation and reduce your risk of making mistakes in the future. To ensure thorough review, begin taking full-length practice examinations after studying a topic.

Final Words

To pass the Certified Coding Specialist exam, you’ll need to create and stick to a study plan that covers all of the essential topics, includes practice exams, and allows you to improve your skills. Furthermore, you must concentrate on all of the essential areas, such as inpatient and outpatient coding, the ICD-10-CM, ICD-10-PCS, and CPT® coding systems, medical terminology, disease processes, and pharmacology principles, in order to improve your preparation. Use the methods and areas given above to gain a better understanding of the exam topics, then start studying and passing the exam right away.

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