Clinical Classification Systems
30-34%of exam
Reimbursement Methodologies
21-25%of exam
Health Records
13-17%of exam
Compliance
12-16%of exam
Supported CodingProvider QueriesEthical CodingAudits
Information Technologies
6-10%of exam
Confidentiality and Privacy
6-10%of exam
Minimum NecessaryAuthorized ReleaseSecure TransferRetention
Quick Facts
- Exam
- CCA
- Owner
- AHIMA
- Questions
- 105 total
- Scored
- 90 scored
- Pretest
- 15 unscored
- Time
- 2 hours
- Pass
- 300 scaled
- Delivery
- Pearson VUE center
- Fee
- $199/$299
- Codebooks
- 2026 CM/PCS/CPT
Domain Order
Classify, reimburse, record, comply, tech, privacy
Classify biggestReimburse secondTech/privacy smallest
CM vs PCS
ICD-10-CM
- Diagnoses
- All settings
- Clinical conditions
ICD-10-PCS
- Inpatient procedures
- Seven characters
- Root operations
Condition vs inpatient procedure
Code System Picker
- Diagnosis needed→ICD-10-CM(All settings)
- Inpatient procedure→ICD-10-PCS(Facility)
- Physician service→CPT(Professional)
- Modifier needed→CPT appendix(Verify notes)
- Code pair edit→NCCI(PTP)
- Unit edit→MUE(Limit)
Exam Control
- Total
- 105 items
- Scored
- 90 items
- Pretest
- 15 random
- Time
- Two hours
- Pass
- 300 scaled
- Site
- Pearson VUE
- Eligibility
- High school diploma
- Retake
- 30-day wait
PCS Seven
Section-System-Root-Part-Approach-Device-Qualifier
Root: objectiveApproach: accessDevice: remains
Principal vs First-Listed
Principal
- Inpatient
- After study
- Admission reason
First-listed
- Outpatient
- Encounter reason
- No rule-out
Admission vs encounter
Setting Picker
- Inpatient admission→Principal dx(After study)
- Outpatient encounter→First-listed dx(Visit reason)
- Rule-out inpatient→Code documented(Discharge)
- Rule-out outpatient→Symptoms(No diagnosis)
- Procedure inpatient→PCS(Facility)
- Procedure outpatient→CPT(Service)
Blueprint Weights
- Classification
- 30-34%
- Reimbursement
- 21-25%
- Records
- 13-17%
- Compliance
- 12-16%
- Technology
- 6-10%
- Privacy
- 6-10%
Setting First
Inpatient principal; outpatient first-listed
Inpatient: after studyOutpatient: visit reasonRule-out differs
Excludes1 vs Excludes2
Excludes1
- Not here
- Never together
- Mutually exclusive
Excludes2
- Not included
- May coexist
- Code both
Never vs maybe
Codebooks
- ICD-10-CM
- Diagnosis coding
- ICD-10-PCS
- Inpatient procedures
- CPT
- Physician procedures
- 2026 rule
- After May 1
- Wrong books
- No test
- Index
- Start search
- Guidelines
- Control assignment
- Tables
- Validate PCS
CM Rules
- Principal dx
- After-study reason
- First-listed
- Encounter reason
- Secondary dx
- Affects care
- Combination
- One code covers
- Excludes1
- Not coded together
- Excludes2
- May code both
- Use additional
- Add detail code
- Code first
- Sequence cause first
- Sequela
- Residual first
- Laterality
- Match side
PCS Build
- Characters
- Seven required
- Section
- Procedure type
- Body system
- General system
- Root op
- Objective
- Body part
- Specific site
- Approach
- Access route
- Device
- Remains after
- Qualifier
- Extra meaning
- No decimals
- PCS format
- Table
- Final authority
CPT Modifiers
- 25
- Separate E/M
- 59
- Distinct service
- 51
- Multiple procedures
- LT/RT
- Body side
- TC
- Technical component
- 26
- Professional component
- 52
- Reduced service
- 53
- Discontinued procedure
DRG vs APC
DRG
- Inpatient
- Principal dx
- MCC/CC impact
APC
- Outpatient
- CPT driven
- OPPS impact
Inpatient vs outpatient
Reimbursement Picker
- Inpatient payment→MS-DRG(IPPS)
- Outpatient payment→APC(OPPS)
- Risk adjustment→HCC(Chronic burden)
- Coverage question→LCD/NCD(Necessity)
- Bundling question→NCCI(Edits)
- Denied claim→Review support(Appeal)
Payment Groups
- MS-DRG
- Inpatient payment
- APC
- Outpatient payment
- HCC
- Risk adjustment
- MCC
- Major complication
- CC
- Complication
- OPPS
- Outpatient system
- IPPS
- Inpatient system
- Charge ticket
- Fee capture
NCCI vs MUE
NCCI
- Pair edits
- Bundling
- Modifier check
MUE
- Unit edits
- Quantity limit
- Same beneficiary
Pair vs quantity
Edits + Necessity
- NCCI
- Code-pair edits
- PTP
- Procedure pair
- MUE
- Unit limit
- LCD
- Local coverage
- NCD
- National coverage
- ABN
- Medicare notice
- Denial
- Claim rejected
- Appeal
- Payer response
Quantitative vs Qualitative
Quantitative
- Completeness
- Missing forms
- Signatures
Qualitative
- Validity
- Consistency
- Record meaning
Complete vs credible
Record Content
- H&P
- Initial picture
- Progress notes
- Ongoing status
- Op report
- Procedure detail
- Pathology
- Tissue result
- Lab
- Clinical evidence
- Discharge summary
- Final summary
- Orders
- Provider direction
- Consents
- Authorization support
Data Quality
- Quantitative
- Completeness check
- Qualitative
- Content validity
- Abstraction
- Data capture
- MPI
- Patient identity
- Duplicate
- Identity risk
- Deficiency
- Missing element
- Report
- Data output
- Standard
- Consistent meaning
Query Neutral
Issue, indicators, options, unable
No leadingRecord supportProvider decides
Query vs Code
Query
- Unclear
- Supported gap
- Neutral choices
Code
- Documented
- Supported
- Guideline matched
Clarify vs assign
Documentation Picker
- Missing specificity→Query(Support exists)
- Conflicting notes→Query(Clarify)
- Clinical indicators→Query(No diagnosis)
- Unsupported code→Remove code(No support)
- Provider documented→Assign code(Guidelines)
- Leading query→Revise query(Neutral)
Compliance Controls
- Support
- Documentation backs code
- Discrepancy
- Code conflicts record
- Ethics
- Truthful coding
- Query
- Clarify documentation
- Audit
- External review
- Education
- Provider feedback
- Updates
- Current code changes
- Chargemaster
- Revenue item list
Query Basics
- Issue
- Clear gap
- Indicators
- Record evidence
- Choices
- Reasonable options
- Other
- Alternate response
- Unable
- Cannot determine
- Neutral
- Non-leading
- Conflict
- Clarify first
- Unsupported
- Do not code
Encoder vs CAC
Encoder
- Code navigation
- Manual verification
- Guideline prompts
CAC
- Auto suggestions
- Text analysis
- Coder validates
Navigate vs suggest
EHR Tools
- EHR
- Electronic record
- Encoder
- Code navigation
- Grouper
- Payment logic
- CAC
- Suggested codes
- HIM system
- Record workflow
- PM system
- Practice billing
- Audit trail
- Change history
- Validation
- Coder duty
Privacy Lock
Minimum access; authorized release; secure transfer
Need to knowVerify recipientEncrypt e-docs
Privacy vs Security
Privacy
- Use rules
- Disclosure limits
- Patient data
Security
- Access controls
- Encryption
- Safeguards
Rules vs protections
Privacy Picker
- Need access→Minimum necessary(Role based)
- Release PHI→Authorization(Verify recipient)
- Send e-docs→Secure transfer(Encrypt)
- Possible breach→Report issue(Policy)
- Old records→Retention policy(Then destroy)
- Shared workstation→Log out(Protect access)
Privacy Controls
- HIPAA
- Privacy baseline
- Confidentiality
- Protect patient data
- Minimum necessary
- Smallest access
- Authorization
- Approved release
- Password
- Access control
- Encryption
- Protect e-docs
- Secure site
- Safe transfer
- Destruction
- Proper disposal
Common Traps
Codebook year
2026 after May 1 ≠ Wrong books forfeit
Pretest items
Randomly mixed ≠ Not identified
Rule-out diagnosis
Inpatient may code ≠ Outpatient symptoms only
Clinical indicators
Support query ≠ Do not diagnose
Index reliance
Index starts ≠ Guidelines decide
CAC output
Software suggests ≠ Coder validates
Modifier 59
Distinct service ≠ Documentation required
Minimum necessary
Need-based access ≠ Curiosity prohibited
Denial work
Review support ≠ Resubmit correctly
Last Minute
- 1.Weights: 30-34 classification
- 2.Reimbursement: 21-25
- 3.Records: 13-17
- 4.Compliance: 12-16
- 5.Tech/privacy: 6-10 each
- 6.Bring 2026 CM/PCS/CPT
- 7.Principal equals inpatient
- 8.First-listed equals outpatient
- 9.PCS table validates
- 10.NCCI pairs; MUE units
- 11.Query unclear supported gaps
- 12.Minimum necessary always
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