Coding Knowledge
39-41%of exam
Coding Documentation
18-22%of exam
Provider Queries
9-11%of exam
Regulatory Compliance
18-22%of exam
Information Technologies
9-11%of exam
Quick Facts
- Exam
- CCS
- Owner
- AHIMA
- Questions
- 107 total
- Scored
- 97 scored
- Pretest
- 10 unscored
- Time
- 4 hours
- Pass
- 300 scaled
- Delivery
- Pearson VUE center
- Codebooks
- 2026 CM/PCS/CPT
- Fee
- $299/$399
Setting First
INPT=CM+PCS | OP/ED=CM+CPT
INPT: principalOP: first-listedED: final dx
CM vs PCS
ICD-10-CM
- Diagnoses
- All settings
- Provider dx
ICD-10-PCS
- Inpatient procedures
- Seven characters
- Root operation
Diagnosis vs inpatient procedure
Source Picker
- Diagnosis code→ICD-10-CM(All settings)
- Inpatient procedure→ICD-10-PCS(Facility)
- Outpatient procedure→CPT(Facility)
- Supply/drug/service→HCPCS(Level II)
- Code-pair edit→NCCI(PTP)
- Unit limit→MUE(Medically unlikely)
- Inpatient payment→DRG(MCC/CC)
- Outpatient payment→APC(OPPS)
Exam Control
- Total
- 107 items
- Scored
- 97 items
- Pretest
- 10 random
- Time
- Four hours
- Pass
- 300 scaled
- Review
- Flag allowed
- Site
- Pearson VUE
- Retake
- 30-day wait
PCS Seven
Section-System-Root-Part-Approach-Device-Qualifier
Root: objectiveApproach: accessDevice: remains
Inpatient vs Outpatient
Inpatient
- Principal dx
- PCS procedures
- Uncertain allowed
Outpatient
- First-listed dx
- CPT/HCPCS
- No rule-out
Admission vs encounter
Scenario Picker
- Admitted inpatient→CM + PCS(Principal dx)
- Outpatient surgery→CM + CPT(First-listed)
- ED visit→CM + CPT(Final dx)
- Observation→Outpatient rules(First-listed)
- Ruled out outpatient→Symptoms(No confirmed dx)
- Uncertain inpatient→Code as documented(Discharge)
Blueprint Weights
- Coding
- 39-41%
- Documentation
- 18-22%
- Queries
- 9-11%
- Compliance
- 18-22%
- Technology
- 9-11%
- Inpatient
- 33.3% scenarios
- Outpatient
- 33.3% scenarios
- ED
- 33.3% scenarios
Excision vs Resection
Excision
- Part removed
- Biopsy common
- Diagnostic qualifier
Resection
- All removed
- Complete body part
- No partial
Part vs all
Codebooks
- CM
- Diagnosis coding
- PCS
- Inpatient procedures
- CPT
- Outpatient procedures
- HCPCS
- Supplies/drugs/services
- NCCI
- Edit pairs
- MUE
- Unit limits
- DRG
- Inpatient payment
- APC
- Outpatient payment
Modifier 59 vs 51
59
- Distinct service
- Unbundle support
- NCCI focus
51
- Multiple procedures
- Same session
- Sequencing focus
Distinct vs multiple
CM Sequencing
- Principal Dx
- After-study reason
- First-listed
- Outpatient reason
- Secondary Dx
- Affects care
- Symptoms
- No definitive dx
- Integral symptom
- Usually not separate
- Combination code
- Use when available
- Sequela
- Residual first
- Laterality
- Match documentation
PCS Build
- Seven chars
- All required
- Index
- Table locator
- Table
- Valid code source
- Root op
- Procedure objective
- Body part
- Precise target
- Approach
- Access route
- Device
- Remains after
- Qualifier
- Extra meaning
PCS Root Ops
- Excision
- Cut out part
- Resection
- Cut out all
- Extraction
- Pull out
- Drainage
- Take fluids
- Bypass
- Alter route
- Restriction
- Partially close
- Occlusion
- Completely close
- Replacement
- New substitute
- Supplement
- Reinforce part
- Control
- Stop bleeding
Outpatient Coding
- First-listed
- Visit reason
- Uncertain dx
- Do not code
- Rule-out
- Code symptoms
- CPT notes
- Read parentheticals
- Modifier 25
- Separate E/M
- Modifier 59
- Distinct service
- RT/LT
- Body side
- Medical necessity
- Coverage support
Documentation Checks
- Provider note
- Diagnosis authority
- Operative report
- Procedure detail
- Discharge summary
- Final picture
- Pathology
- Tissue confirmation
- Laterality
- Side support
- Timing
- POA support
- Status
- Active/history
- Conflict
- Clarify before coding
Query Neutral
Issue + indicators + neutral choices
No leadingInclude unableSupport from record
Query vs Code
Query
- Unclear documentation
- Clinical indicators
- Neutral choices
Code
- Provider documented
- Source supported
- Guideline matched
Clarify vs assign
Query Picker
- Conflicting notes→Query provider(Clarify)
- Missing specificity→Query provider(Support exists)
- Clinical indicators only→Query provider(No diagnosis)
- Unsupported diagnosis→Do not code(No support)
- Leading answer→Reject query(Compliance risk)
- Reasonable choices→Compliant query(Neutral)
Query Elements
- Reason
- Clear issue
- Indicators
- Clinical support
- Choices
- Reasonable options
- Other
- Alternate answer
- Unable
- Cannot determine
- Neutral
- Non-leading wording
- Source
- Record facts
- Impact
- Coding clarity
POA Codes
Y yes | N no | U unknown | W undetermined
Y: presentN: hospital-acquiredU: insufficientW: undetermined
PSI vs HAC
PSI
- Safety indicator
- Quality signal
- Documentation driven
HAC
- Hospital acquired
- POA sensitive
- Payment impact
Quality vs payment
Compliance Controls
- HIPAA
- Privacy/security
- UHDDS
- Discharge data
- Ethics
- Truthful coding
- Payer policy
- Coverage rules
- PSI
- Safety indicator
- HAC
- Hospital-acquired condition
- Completeness
- All required data
- Accuracy
- Supported codes
POA Indicators
- Y
- Present on admission
- N
- Not present
- U
- Insufficient documentation
- W
- Clinically undetermined
- Exempt
- POA not required
- Timing
- Admission moment
- HAC risk
- Payment impact
Tech Accountability
Encoder helps; grouper groups; coder owns
Encoder: navigationGrouper: paymentCAC: suggestions
Encoder vs Grouper
Encoder
- Find codes
- Guideline prompts
- Coder verifies
Grouper
- Groups payment
- DRG/APC impact
- Depends codes
Code help vs payment
Tech Picker
- Find codes→Encoder(Verify)
- Payment group→Grouper(DRG/APC)
- Suggested codes→CAC(Validate)
- Legal record→EHR(Source)
- Change proof→Audit trail(Integrity)
Tech Tools
- EHR
- Source record
- Encoder
- Code navigation
- Grouper
- Payment grouping
- CAC
- Suggested codes
- Audit trail
- Change history
- Interface
- System exchange
- HITECH
- Health IT law
- Validation
- Coder responsibility
CAC vs Coder
CAC
- Suggests codes
- Text driven
- Needs review
Coder
- Applies guidelines
- Validates support
- Owns accuracy
Suggestion vs accountability
Common Traps
Codebook year
2026 after May 1 ≠ Wrong books forfeit
Index vs table
Index locates ≠ Table validates
Principal vs first-listed
Inpatient after study ≠ Outpatient visit reason
Uncertain diagnosis
Inpatient may code ≠ Outpatient does not
Clinical indicators
Support query ≠ Do not diagnose
CAC output
Software suggests ≠ Coder validates
Modifier use
Edit allowed ≠ Documentation supports
POA impact
Timing matters ≠ HAC risk follows
Last Minute
- 1.Weights: 39-41 coding
- 2.Documentation + compliance: 18-22 each
- 3.Queries + tech: 9-11 each
- 4.Scenarios split three ways
- 5.Books: CM, PCS, CPT
- 6.Inpatient: principal + PCS
- 7.Outpatient: first-listed + CPT
- 8.ED: final dx matters
- 9.Index locates; table validates
- 10.Query unclear supported documentation
- 11.Never code from indicators alone
- 12.Software suggests; coder owns
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