100+ Free CCC Practice Questions

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Question 1

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Unstable angina differs from NSTEMI primarily by:

Occurring only during exercise

Always resolving without treatment

Presence of ST elevation

Absence of elevated cardiac biomarkers (troponin)

to track

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2026 Statistics

Key Facts: CCC Exam

150

Total Items

AAPC

5h 40m

Exam Time

AAPC

$299

AAPC Member Fee

AAPC

70%

Passing Score

AAPC

The AAPC CCC consists of 150 MCQ items over 5h40m with 70% passing. Fee $299 for AAPC members. Master diagnostic and interventional cardiology CPT codes, cath/PCI/EP/structural procedures, ICD-10-CM I-codes, and CMS NCDs (TAVR heart team, ICD criteria).

Sample CCC Practice Questions

Try these sample questions to test your CCC exam readiness. Each question includes a detailed explanation. Start the interactive quiz above for the full 100+ question experience with AI tutoring.

1Which coronary artery primarily supplies blood to the anterior wall of the left ventricle and the anterior two-thirds of the interventricular septum?

A.Right coronary artery (RCA)

B.Left circumflex artery (LCX)

C.Left anterior descending artery (LAD)

D.Posterior descending artery (PDA)

Explanation: The LAD branches from the left main coronary artery and supplies the anterior wall of the left ventricle, the anterior two-thirds of the interventricular septum, and the apex. Occlusion of the LAD often causes anterior wall MI, sometimes called the 'widow maker.'

2The conduction system pathway from atria to ventricles travels in which correct sequence?

A.AV node → SA node → bundle of His → Purkinje fibers

B.SA node → AV node → bundle of His → bundle branches → Purkinje fibers

C.SA node → bundle of His → AV node → Purkinje fibers

D.Bundle of His → SA node → AV node → Purkinje fibers

Explanation: Normal cardiac conduction begins at the SA (sinoatrial) node, the natural pacemaker, then travels through the atria to the AV (atrioventricular) node, then down the bundle of His, splits into right and left bundle branches, and terminates in the Purkinje fibers, which depolarize the ventricular myocardium.

3A patient with HFrEF (heart failure with reduced ejection fraction) has an ejection fraction of what range?

A.55% or greater

B.41-49%

C.40% or less

D.Greater than 70%

Explanation: HFrEF (systolic heart failure) is defined by an LVEF of 40% or less per AHA/ACC and ESC guidelines. HFmrEF (mid-range/mildly reduced) is 41-49%, and HFpEF (preserved/diastolic) is 50% or higher. EF range determines ICD-10-CM I50.2x vs I50.3x coding.

4STEMI is differentiated from NSTEMI on the EKG primarily by:

A.Presence of T-wave inversion only

B.ST-segment elevation in two or more contiguous leads

C.Presence of a U wave

D.PR-segment depression

Explanation: STEMI (ST-elevation myocardial infarction) requires ST-segment elevation in two or more contiguous leads, indicating transmural injury and full-thickness coronary occlusion. NSTEMI shows ST depression or T-wave inversion without persistent ST elevation. The distinction guides emergency reperfusion (PCI) versus medical management.

5Which valve is located between the left atrium and the left ventricle?

A.Tricuspid valve

B.Pulmonic valve

C.Mitral valve

D.Aortic valve

Explanation: The mitral (bicuspid) valve sits between the left atrium and left ventricle. It has two leaflets and prevents backflow during ventricular systole. Mitral regurgitation and mitral stenosis are common valvular conditions; the MitraClip TEER procedure addresses severe mitral regurgitation.

6Atrial fibrillation is characterized on EKG by:

A.Regular R-R intervals with sawtooth flutter waves

B.Absent P waves with irregularly irregular R-R intervals

C.Wide QRS with regular tachycardia

D.Prolonged PR interval greater than 200 ms

Explanation: Atrial fibrillation (I48.x) is identified by the absence of discrete P waves and an irregularly irregular ventricular rhythm. The atria fire chaotically at 350-600 bpm, and the AV node conducts unpredictably. Major risks include thromboembolic stroke, requiring CHA2DS2-VASc-guided anticoagulation.

7Hypertrophic cardiomyopathy (HCM) is best characterized as:

A.Dilation of all four chambers with reduced systolic function

B.Asymmetric thickening of the interventricular septum often causing LVOT obstruction

C.Thinning of the ventricular wall with restrictive filling

D.Right ventricular fibrofatty replacement

Explanation: Hypertrophic cardiomyopathy (I42.1, I42.2) is a genetic disorder causing asymmetric septal hypertrophy, often producing left ventricular outflow tract (LVOT) obstruction and risk of sudden cardiac death. Echocardiography is diagnostic; ICD implantation may be indicated for high-risk patients.

8Which congenital heart defect is described as a hole between the two ventricles allowing left-to-right shunting?

A.Atrial septal defect (ASD)

B.Patent ductus arteriosus (PDA)

C.Ventricular septal defect (VSD)

D.Tetralogy of Fallot

Explanation: VSD (Q21.0) is an opening in the interventricular septum permitting left-to-right shunting of oxygenated blood. It is the most common congenital heart defect. Small VSDs may close spontaneously; large defects require surgical or device closure.

9The 'great vessels' of the heart include which of the following?

A.Aorta, pulmonary artery, superior and inferior vena cava, pulmonary veins

B.Coronary arteries and coronary veins only

C.Carotid and jugular vessels only

D.Renal arteries and veins

Explanation: The great vessels are the major arteries and veins entering and leaving the heart: aorta, pulmonary trunk/arteries, superior vena cava (SVC), inferior vena cava (IVC), and pulmonary veins. Knowledge of these is essential for coding catheterization, transposition (Q20.3), and great-vessel surgery.

10Unstable angina differs from NSTEMI primarily by:

A.Presence of ST elevation

B.Absence of elevated cardiac biomarkers (troponin)

C.Always resolving without treatment

D.Occurring only during exercise

Explanation: Unstable angina (I20.0) and NSTEMI share clinical and EKG features (ischemia, ST depression, T inversion), but NSTEMI shows elevated troponin indicating myocyte necrosis. Unstable angina has normal cardiac biomarkers despite anginal symptoms at rest or with minimal exertion.

About the CCC Exam

AAPC specialty credential for cardiology coders. Validates expertise in cardiology anatomy and disease (CAD, ACS, CHF, arrhythmias, valvular), diagnostic CPT (EKG 93000, echo, stress, Holter, ICD/PPM interrogation), interventional CPT (cardiac cath 93452-93461, PCI 92920-92944, structural TAVR/MitraClip), electrophysiology (EP study, ablation 93653-93657), ICD-10-CM cardiovascular codes, and cardiology-specific bundling (NCCI for cath + ad-hoc PCI).

Questions

150 scored questions

Time Limit

5 hours 40 minutes

Passing Score

70%

Exam Fee

$299 AAPC member (AAPC)

CCC Exam Content Outline

15%

Cardiology Anatomy, Physiology and Diseases

Coronary anatomy, conduction system, CAD/ACS/CHF/arrhythmias/valvular

30%

CPT Cardiology Procedures

EKG, echo (TTE/TEE/stress), Holter, stress test, ICD/PPM interrogation

15%

ICD-10-CM Cardiovascular Codes

I20-I25 ischemic, I50.x heart failure (HFrEF/HFpEF), I48 Afib, I21/I22 MI

15%

Cardiac Cath, EP, and Interventional Coding

LHC/RHC, PCI hierarchy, structural TAVR/MitraClip, EP/ablation, ICD/PPM insertion

10%

Cardiology Modifiers and Bundling

26 professional, TC technical, LT/RT, 51, 59 + X-modifiers, NCCI for cath + PCI

15%

Compliance and Payer Rules

Medicare LCDs for echo/stress/ICD, NCD for PCI, ABN modifiers GA/GZ

How to Pass the CCC Exam

What You Need to Know

Passing score: 70%
Exam length: 150 questions
Time limit: 5 hours 40 minutes
Exam fee: $299 AAPC member

Keys to Passing

Complete 500+ practice questions
Score 80%+ consistently before scheduling
Focus on highest-weighted sections
Use our AI tutor for tough concepts

CCC Study Tips from Top Performers

1Memorize HFrEF/HFpEF distinction: I50.2x systolic (EF ≤40%), I50.3x diastolic (EF ≥50%), I50.4x combined/mid-range; pair with acuity (acute/chronic/acute-on-chronic)

2Master PCI hierarchy: atherectomy > stent > angioplasty; major artery vs add-on branch; STEMI 92941; chronic total occlusion 92943-92944

3Know cardiac cath bundling rules: ad-hoc PCI bundles diagnostic; separate diagnostic intent before intervention may use modifier 59

4Understand TAVR coverage NCD: requires heart team approach (cardiologist + cardiothoracic surgeon), high or prohibitive surgical risk for AS

Frequently Asked Questions

What's the difference between HFrEF and HFpEF?

HFrEF (heart failure with reduced ejection fraction, EF ≤40%) codes to I50.2x (systolic). HFpEF (heart failure with preserved EF, EF ≥50%) codes to I50.3x (diastolic). Mid-range EF 41-49% uses I50.4x. Each subdivides by acuity: I50.21 acute, I50.22 chronic, I50.23 acute on chronic, I50.20 unspec.

Can I bill diagnostic LHC plus PCI same session?

Generally NO — when an ad-hoc PCI is performed, the diagnostic catheterization is bundled into the PCI code. EXCEPTION: if diagnostic LHC was done before final decision to intervene (separate diagnostic intent), modifier 59 with documentation supporting separate procedural service may unbundle. Always document the decision-making timeline.

What is the PCI hierarchy?

PCI codes 92920-92944 follow a hierarchy: code the most intensive intervention first per major artery (LAD, LCX, RCA + branches considered separate vessels). Atherectomy outranks stent outranks angioplasty within the same vessel. Add-on codes 92921, 92925, 92929, 92934, 92938, 92944 for additional branches of same major artery.