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100+ Free CCS Practice Questions

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Per PCS guideline B3.4a, when a procedure's intended root operation is not completed, code:

A
B
C
D
to track
2026 Statistics

Key Facts: CCS Exam

107

Total Items

97 scored + 10 pretest

4 hrs

Exam Time

AHIMA

84%

First-Time Pass Rate

2025 data

$299

Member Fee

$399 non-member

~36,925

Active Certificants

AHIMA

The AHIMA CCS (Certified Coding Specialist) is the flagship hospital inpatient coder credential. 107 MCQ items (97 scored + 10 pretest) over 4 hours. Fee $299 member / $399 non-member. ~36,925 active certificants with 84% first-time pass rate (2025). Heavy emphasis on ICD-10-CM PDX selection, ICD-10-PCS root operations, MS-DRG assignment, and CC/MCC capture.

Sample CCS Practice Questions

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

1A patient is admitted with chest pain. After workup, the physician documents that the chest pain is due to a confirmed acute non-ST elevation myocardial infarction (NSTEMI). Per UHDDS, what is the correct principal diagnosis?
A.Chest pain (R07.9)
B.Acute NSTEMI (I21.4)
C.Coronary artery disease (I25.10)
D.Acute coronary syndrome (I24.9)
Explanation: Per UHDDS, the principal diagnosis is the condition established after study to be chiefly responsible for occasioning the admission. The confirmed NSTEMI (I21.4) is established after study and is the cause of the chest pain.
2An inpatient is admitted with severe sepsis due to a urinary tract infection (UTI) with associated acute kidney injury. Which is the correct PDX sequencing?
A.UTI first, then sepsis, then AKI
B.Sepsis (A41.9) first, followed by R65.20 severe sepsis, UTI, and AKI
C.AKI first, then sepsis, then UTI
D.R65.20 severe sepsis first, then sepsis, UTI, AKI
Explanation: Per ICD-10-CM Official Guidelines, when severe sepsis is present on admission and meets PDX criteria, code the underlying systemic infection first (A41.9), then R65.20 (severe sepsis), then any associated acute organ dysfunction (AKI), then the localized infection (UTI).
3A POA indicator of 'W' for a diagnosis code on an inpatient claim signifies what?
A.Diagnosis was present on admission
B.Diagnosis was not present on admission
C.Documentation is insufficient to determine if condition was present on admission
D.Provider is unable to clinically determine whether condition was present on admission
Explanation: Per CMS POA reporting guidelines, 'W' means the provider has documented that they are clinically unable to determine whether the condition was present on admission.
4A patient is admitted for repair of a fractured femur sustained in a fall at home. While inpatient, the patient develops a stage III pressure ulcer of the sacrum. The pressure ulcer's POA indicator should be:
A.Y - Present on admission
B.N - Not present on admission
C.U - Unknown
D.W - Clinically undetermined
Explanation: The pressure ulcer developed during the inpatient stay (after admission), so the POA indicator is 'N'. This is significant because stage III/IV pressure ulcers acquired during admission are HACs that affect MS-DRG payment.
5A patient is admitted with possible pulmonary embolism. Workup is inconclusive, and the discharge diagnosis remains 'possible PE.' For inpatient coding, how is this coded?
A.Code only the symptoms (e.g., chest pain, dyspnea)
B.Code the possible PE as if it were established
C.Code R69 - illness, unspecified
D.Query the physician but do not code anything until clarified
Explanation: Per ICD-10-CM Official Guidelines Section II.H, for inpatient settings, conditions documented at discharge as 'possible,' 'probable,' 'suspected,' 'likely,' or 'still to be ruled out' are coded as if the condition existed. (Note: this rule differs for outpatient coding.)
6A patient is admitted with acute systolic (congestive) heart failure exacerbation due to non-compliance with prescribed loop diuretics (not due to financial hardship). Which codes capture this scenario, properly sequenced?
A.I50.21 (acute systolic CHF), Z91.120 (intentional underdosing for financial hardship)
B.I50.20 (unspecified systolic CHF), Z91.19
C.I50.9 (heart failure unspecified), Z91.128
D.I50.21 (acute systolic CHF), T50.1X6A (underdosing of loop diuretics, initial), Z91.128 (noncompliance for other reason)
Explanation: When a patient does not take a medication as prescribed and an adverse condition results, code the condition first (I50.21 acute systolic CHF), then the underdosing T-code (T50.1X6A for loop diuretic, initial encounter), and the noncompliance Z-code (Z91.128 if not intentional due to financial hardship).
7A trauma patient is admitted following a motor vehicle accident with multiple injuries: closed traumatic brain injury with loss of consciousness 45 minutes, fractured pelvis, and lacerated spleen requiring splenectomy. Which is sequenced as principal diagnosis?
A.The injury that required the most resources (spleen laceration)
B.Traumatic brain injury, since the head is most critical
C.Pelvic fracture, since orthopedic injuries always sequence first
D.Whichever injury is documented as the focus of treatment - typically the most severe injury
Explanation: Per ICD-10-CM Guidelines, when multiple injuries occur, sequence the most severe injury (as determined by the provider and the focus of treatment) first. There is no automatic rule by body system; documentation drives sequencing.
8A patient with a known history of breast cancer (treatment completed 3 years ago, no current disease) is admitted for a left hip fracture due to a fall. Which code best represents the cancer history?
A.C50.912 - Malignant neoplasm of unspecified site of left female breast
B.Z85.3 - Personal history of malignant neoplasm of breast
C.D49.3 - Neoplasm of unspecified behavior of breast
D.Do not code; cancer history is not relevant to this admission
Explanation: When primary cancer treatment is complete and no current disease exists, assign a personal history code (Z85.3 for breast cancer history). This may affect care decisions and is appropriate to report as a secondary diagnosis.
9A patient is admitted with type 2 diabetes mellitus with diabetic chronic kidney disease stage 4. Long-term insulin use is not documented. Which codes are required?
A.E11.9 only
B.E11.22 and N18.4
C.E11.21 and N18.4
D.E11.22, N18.4, and Z79.4
Explanation: Diabetes with CKD requires the combination code (E11.22) plus a code from N18 to specify the CKD stage (N18.4 = stage 4). Z79.4 is for long-term insulin use - not stated here, so it isn't required.
10A patient is admitted with metabolic encephalopathy due to hyponatremia. The provider documents both conditions clearly. For an inpatient admission specifically aimed at treating both, sequencing should be:
A.G93.41 (metabolic encephalopathy) as PDX, E87.1 (hyponatremia) as secondary
B.E87.1 (hyponatremia) as PDX, G93.41 (metabolic encephalopathy) as secondary
C.Either may be sequenced first per the circumstances of admission and provider documentation
D.G93.40 (encephalopathy unspecified) as PDX only
Explanation: When two conditions equally meet the definition of principal diagnosis, the coder may sequence either condition first per ICD-10-CM Guidelines Section II.B. Both are documented and both prompted admission.

About the CCS Exam

AHIMA's flagship hospital inpatient coder credential. Validates expertise in ICD-10-CM diagnosis coding (UHDDS principal diagnosis selection, POA indicators, sequencing rules), ICD-10-PCS procedure coding (7-character structure, 31 root operations), MS-DRG and APR-DRG assignment, CC/MCC capture, hospital outpatient CPT/HCPCS, AHIMA/ACDIS-compliant provider queries, and inpatient compliance/audit risks (HACs, two-midnight rule, OIG focus areas).

Questions

107 scored questions

Time Limit

4 hours

Passing Score

Scaled

Exam Fee

$299 AHIMA member / $399 non-member (AHIMA)

CCS Exam Content Outline

25%

ICD-10-CM Inpatient Diagnosis Coding

PDX (UHDDS), POA, sequencing, sepsis, AKI, encephalopathy, HF, MI

25%

ICD-10-PCS Procedure Coding

7-character structure, 31 root operations, CABG, joint replacement, mechanical ventilation

15%

MS-DRG Assignment & Reimbursement

MDC, CC/MCC, relative weight, CMI, HACs

10%

CPT/HCPCS Outpatient Coding

E/M (2023), surgery, radiology, pathology, modifiers

10%

Coding Guidelines & Conventions

ICD-10-CM Official Guidelines, AHA Coding Clinic

15%

Compliance, HIPAA & Audit

AHIMA Standards of Ethical Coding, OIG audit work plan, MAC/RAC

How to Pass the CCS Exam

What You Need to Know

  • Passing score: Scaled
  • Exam length: 107 questions
  • Time limit: 4 hours
  • Exam fee: $299 AHIMA member / $399 non-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

CCS Study Tips from Top Performers

1Master UHDDS PDX selection: 'condition established after study chiefly responsible for occasioning admission'
2Memorize CC/MCC examples: sepsis (MCC), AKI N17.x (CC), aspiration pneumonia (MCC), encephalopathy (MCC), severe PCM E43 (MCC), acute respiratory failure (MCC)
3Know the 31 ICD-10-PCS Med/Surg root operations and key distinctions (Excision vs Resection; Bypass vs Reposition; Replacement vs Supplement)
4Understand POA Y/N/U/W and HAC implications: stage 3/4 pressure injury, falls, CAUTI, CLABSI, foreign body retained = non-payment when N
5Complete at least 100 practice questions before scheduling your exam

Frequently Asked Questions

What's the difference between AHIMA CCS and AAPC CPC?

Both are coder credentials. AHIMA CCS focuses on hospital INPATIENT coding (ICD-10-CM PDX selection, ICD-10-PCS, MS-DRG). AAPC CPC focuses on PHYSICIAN OFFICE coding (CPT, E/M, ICD-10-CM diagnosis). Both are recognized by employers; some coders hold both. AAPC CIC is a closer competitor — also inpatient hospital coder. CCS is broader, including hospital outpatient + inpatient.

What is the CCS pass rate?

AHIMA reported an 84% first-time pass rate in 2025 — relatively high for a coder credential. Active certificants total ~36,925. Most candidates have prior coding experience or hold an entry-level credential like CCA before attempting CCS.

What ICD-10-PCS knowledge is essential?

Master the 7-character structure (Section, Body System, Root Operation, Body Part, Approach, Device, Qualifier) and the 31 Medical/Surgical root operations. Distinguish Excision (portion) vs Resection (entire body part), Bypass vs Reposition, Replacement vs Insertion, Drainage vs Extraction. Common procedures: CABG, hysterectomy, joint replacement (0SRC0J9 or similar), mechanical ventilation 5A1945Z.

How should I study for the CCS?

Plan 100-150 hours over 12-16 weeks. Focus heaviest on ICD-10-CM PDX selection per UHDDS, ICD-10-PCS root operations, and MS-DRG assignment with CC/MCC capture (sepsis MCC, AKI CC, encephalopathy MCC, severe PCM MCC, acute respiratory failure MCC). Use the ICD-10-CM Official Guidelines for Coding and Reporting + AHA Coding Clinic + AHIMA's CCS exam content outline.