AHIMA CCA Exam Prep
The Certified Coding Associate (CCA) is AHIMA's entry-level coding exam: 105 four-option questions in a two-hour appointment, scored on a scale where 300 passes. This AHIMA CCA exam prep guide includes what to study first, a 6-week plan, and 16 original practice questions with explanations.
Start here: same words, different coding rule
Original, unofficial exercise.
A provider writes "probable pneumonia" as the final diagnosis in two different encounters:
- Case A: A completed acute-care hospital inpatient admission, coded for the facility. At discharge, the diagnosis is still documented as probable pneumonia.
- Case B: A physician office visit. The note records cough and fever with probable pneumonia, and nothing is confirmed by the end of the visit.
Should both encounters report pneumonia as if it were confirmed?
Answer and explanation: No. In Case A, the inpatient rule applies: an uncertain diagnosis still documented at discharge is coded as if it existed (ICD-10-CM Guidelines Section II.H, p. 109). In Case B, the outpatient rule applies: don't code "probable," "suspected" or "rule out" diagnoses. Code what is certain for that visit, here the cough and fever (Section IV.H, p. 114). The words were identical. The setting decided the answer.
This is the kind of decision the CCA rewards. Before you answer any coding question, run this three-step check:
- Setting and documentation: inpatient, outpatient or physician office, and what does the final note actually say?
- Governing rule: which guideline, convention or payer rule controls this situation, and where is it in your books?
- Your error: if you missed it, write down the exact rule you skipped, not just "got it wrong."
What the CCA tests: your priority map
AHIMA's CCA content outline (effective May 1, 2022) splits the exam into six domains. The percentages are AHIMA's share of exam questions. The last two columns are our study advice.
| Domain | Share of the exam | Drill first | Common trap |
|---|---|---|---|
| 1. Clinical Classification Systems | 30–34% | ICD-10-CM guidelines, ICD-10-PCS root operations, CPT section rules, E/M level selection, modifiers | Using one rule for every setting. Inpatient and outpatient diagnosis rules differ. |
| 2. Reimbursement Methodologies | 21–25% | MS-DRGs vs APCs, NCCI edits, NCD/LCD medical necessity, denials, HCC basics | Treating "a modifier is allowed" as "a modifier is supported" |
| 3. Health Records and Data Content | 13–17% | Record completeness, authentication, abstraction, master patient index, coding reports | Using the wrong denominator in a rate |
| 4. Compliance | 12–16% | Compliant queries, ethical coding, chargemaster updates, audit prep | Writing a query that steers the provider |
| 5. Information Technologies | 6–10% | EHR navigation, encoder vs grouper, validating computer-assisted coding | Accepting a software suggestion without checking the record |
| 6. Confidentiality & Privacy | 6–10% | HIPAA minimum necessary, release of information, retention and destruction, information blocking | Forgetting the treatment exception |
Domains 1 and 2 together make up at least half the exam. Weight your time that way, then shift hours toward whatever your practice misses show.
Your 6-week CCA study plan
Assumptions: six sessions a week of about 75 minutes (roughly 7.5 hours a week, 45 hours total). This plan suits someone who has finished coding training or has about six months of coding experience, which is AHIMA's recommended background. It is our editorial plan, not an AHIMA requirement, and it doesn't guarantee a result.
Typical session: 10 minutes recalling the last session from memory, 45 minutes of study or lookup drills in your code books, and 20 minutes of practice plus updating your error log (template below). Use the on-page questions, worked examples and drills with your required code books; the default schedule needs no separate question bank.
| Week | Sessions | End-of-week check |
|---|---|---|
| 1 · Setup and ICD-10-CM foundations | 1. Match your three books to AHIMA's ISBN list. Read the content outline. Take the 16 practice questions below cold and log every miss. 2. ICD-10-CM conventions (Section I.A). Do the Index-to-Tabular drill. 3. General guidelines I.B: signs and symptoms, integral conditions, combination codes. Work the hypertension and CKD example. 4. Sections II–IV: inpatient vs outpatient rules. Redo questions 1–2. 5. Chapter guidelines for your two weakest chapters. 6. Explain five rules aloud from memory, then check them against the guidelines. | You can locate the guideline sections used in Questions 1–2 and explain when each applies. |
| 2 · ICD-10-CM depth and ICD-10-PCS | 1–2. Chapter guidelines for selected areas (for example diabetes, neoplasms, injuries and 7th characters, sepsis). 3. PCS structure: seven characters and the Tables. Do the PCS table drill. 4. Root operations, especially Excision vs Resection. Redo question 3. 5. PCS body part and approach guidelines. 6. Rework the opening two-setting activity, Questions 1–3, and the hypertension/CKD example with the answers covered. Write the setting, governing rule and supported result for each, then check your reasoning and log errors. | Every PCS answer you give names its root operation definition. |
| 3 · CPT, E/M and modifiers | 1. CPT section guidelines and conventions in your CPT book. 2. Office and outpatient E/M: level by medical decision making or by time. Redo question 4. 3. Modifiers, including 25. Redo question 5. Do the CPT rule-family drill. 4. Bundling and unbundling, with NCCI basics as a bridge to Week 4. 5. Rework Questions 4–5 and the CPT rule-family drill. Explain why each incorrect option fails, then locate the controlling instructions in your CPT book. 6. Recall session plus error log review. | You can explain when an E/M service is separately reportable on a procedure day. |
| 4 · Reimbursement | 1. Inpatient payment: MS-DRGs and what drives them. Redo questions 6 and 9. 2. Outpatient payment: APCs under OPPS. 3. NCCI procedure-to-procedure edits and modifier indicators. Redo question 7. 4. National and local coverage decisions and medical necessity. Redo question 8. 5. Claim form types, denials and how to work them, and HCC risk adjustment basics. 6. Use Questions 7–8 as the claim-review exercise. Check what the documentation supports, whether an edit applies, whether a modifier is supported, and whether coverage still needs to be established. Write what each check can and can't tell you. | You can say which payment system, edit or policy applies to a given claim. |
| 5 · Records, compliance, IT and privacy | 1. Record content rules and authentication. Redo question 10. 2. Completeness reviews, abstraction, master patient index, coding data reports. Redo question 11. 3. Compliant queries and ethical coding. Redo questions 12–13. 4. EHR navigation, encoders, groupers and computer-assisted coding. Redo question 14. 5. Minimum necessary, release of information, retention and destruction, information blocking. Redo questions 15–16. 6. Mixed recall across Domains 3–6. | Mark the outline tasks you have reviewed and identify any remaining topics for further study. |
| 6 · Rehearsal and repair | 1. Cover the answers and work the 16 on-page questions in about 18 minutes. Use the rest of the session to explain your choices and locate the rules you could not recall. 2. Review every miss against its source. 3. Rework your two most common error types. 4. Repeat the three code book drills. Review your questions in a different order and explain the rejected options before checking the answers. 5. Retake these 16 questions under time (about 18 minutes at exam pace). Remembered answers don't count as proof, so explain each one. 6. Logistics: books, two IDs, Authorization to Test dates, test center route. | You can explain your answers, not just recognize them. |
Optional full-length rehearsal: if you already have a 105-question practice set, you can combine two 75-minute review sessions into one 150-minute block: 115 minutes for instructions and questions and 35 minutes for initial review. This page contains 16 questions, not a full-length exam. Repeating these questions checks your retention of these examples; it does not measure performance on an unfamiliar exam.
Adjusting the plan
- Experienced coder short on time: fold Weeks 1–3 into two weeks and keep Weeks 4–6 (about 5 weeks), or cut harder only where your Week 1 misses show you're already solid.
- New to coding or shaky on terminology and anatomy: build those foundations before using this as exam review, then run the same plan at half pace over 12 weeks. Extra time does not turn this review into a complete coding curriculum.
- Same mistake twice: replace a reading session with the matching drill and a source-backed explanation.
- Exam date is close: spend what time you have on your actual error types and on the book and test-day checklist. A shorter plan isn't proof you're ready.
Error log (copy this)
| Question or drill | Domain | My reasoning | The specific error | Governing rule and source | What I'll do differently | Review date |
|---|---|---|---|---|---|---|
| Example: Q1 | 1 | Coded pneumonia because the patient was in a hospital | Treated observation as inpatient | ICD-10-CM IV.H, p. 114 | Check admission status before applying any diagnosis rule | |
| Blank error-log row 1 | ||||||
| Blank error-log row 2 |
Practice: 16 original CCA questions
These are original, unofficial questions written by Castleport Test Prep for practice. They are not AHIMA items. They match the CCA's conventional format (four options, one correct answer) but don't cover every outline task. Your score here is feedback on these 16 questions only. It can't be converted to AHIMA's scaled score and doesn't predict your result. Coding questions follow the FY2026 ICD-10-CM and 2026 ICD-10-PCS rules that match the exam's required 2026 books.
Domain 1: Clinical Classification Systems
Question 1 (CCA-01). A patient completes a hospital outpatient observation stay and is never admitted as an inpatient. The final documentation records cough and fever with "possible pneumonia." No diagnosis is confirmed, and the cough's duration isn't documented. Which diagnosis codes should be reported?
- A. J18.9 Pneumonia, unspecified organism, because the care took place in a hospital
- B. R05.9 Cough, unspecified, and R50.9 Fever, unspecified
- C. J18.9, R05.9 and R50.9
- D. No diagnosis codes until the pneumonia is confirmed or ruled out
Show answer and explanation
Answer: B. Observation is an outpatient service, so the outpatient rule controls. Don't code a diagnosis documented as "possible" or "probable." Code to the highest degree of certainty for the encounter, here the documented symptoms. A applies the inpatient rule just because the patient was in a hospital building. C codes the unconfirmed condition alongside its symptoms. D leaves the encounter with no reason for the visit, even though the symptoms are documented and reportable. Source: ICD-10-CM Guidelines FY2026, Section IV.A.2 (p. 112) and IV.H (p. 114); official 2026 Tabular List and Index (ZIP), entries J18.9, R05.9 and R50.9.
Question 2 (CCA-02). An inpatient's final diagnosis is acute appendicitis. The record also documents right lower quadrant abdominal pain and nausea at presentation. The provider describes both symptoms as routine manifestations of the appendicitis. How should the symptoms be handled?
- A. Code the appendicitis and both symptoms
- B. Sequence the abdominal pain first, then the appendicitis
- C. Code the appendicitis only
- D. Code only the symptoms, because they were documented first
Show answer and explanation
Answer: C. Signs and symptoms that routinely come with a disease aren't coded separately unless the classification says otherwise. Symptoms that are not routinely associated with a disease may still be coded when present; that is not the situation described here. A adds integral symptoms. B puts a symptom ahead of the confirmed condition it belongs to. D ignores the established diagnosis. Source: ICD-10-CM Guidelines FY2026, I.B.4–6 (p. 13).
Question 3 (CCA-03). Through an open thoracotomy, the surgeon removes the patient's entire right upper lobe of the lung. Which ICD-10-PCS root operation applies?
- A. Excision
- B. Extraction
- C. Detachment
- D. Resection
Show answer and explanation
Answer: D. Resection is coded when all of a specific body part is cut out or off without replacement. The right upper lung lobe has its own body part value, so this is Resection, not Excision of a less specific body part. Excision removes only a portion of a body part without replacement. Extraction pulls or strips out by force. Detachment is cutting off all or part of an extremity. Source: ICD-10-PCS Official Guidelines 2026, B3.8 (p. 8); official 2026 PCS Tables, Index and Definitions (ZIP), Table 0BT and the Medical and Surgical definitions.
Question 4 (CCA-04). For an established-patient office visit, the physician spends 10 minutes reviewing outside lab results before seeing the patient, 15 minutes with the patient, and 8 minutes documenting in the EHR afterward, all on the same date. A medical assistant spends 10 minutes rooming the patient and taking vitals. All physician time relates to this E/M service; none is spent on a separately reported service. If the visit level is chosen by time, how many minutes count?
- A. 15
- B. 25
- C. 43
- D. 33
Show answer and explanation
Answer: D. Since January 1, 2021, most office and outpatient E/M levels are selected by medical decision making or by total time on the date of the encounter. Total time is the physician's or other qualified health professional's face-to-face and non-face-to-face work that day, including preparing and documenting. Clinical staff time and time spent on separately reported services don't count. 10 + 15 + 8 = 33. A counts only face-to-face time. B leaves out documentation. C adds the medical assistant's time. Sources: AMA E/M office visit changes, level-selection slides; CMS MLN Evaluation and Management Services, May 2026, pp. 23–25; CGS Medicare E/M documentation guidelines, selecting the level by time.
Question 5 (CCA-05). For a Medicare claim, the documentation supports a significant, separately identifiable E/M service performed on the same day as another procedure. Where is modifier 25 appended?
- A. To the procedure code
- B. To both the procedure code and the E/M code
- C. To every E/M code billed on a day when any other service occurs
- D. To the qualifying E/M code
Show answer and explanation
Answer: D. Modifier 25 goes on the E/M code to show the E/M service was significant and separately identifiable from the other service. A puts it on the wrong code. B duplicates it. C drops the requirement that the E/M service actually be separately identifiable. Source: CMS NCCI FAQ Library, Modifiers, question 5.
Domain 2: Reimbursement Methodologies
Question 6 (CCA-06). Which pairing correctly matches a Medicare acute-care inpatient stay paid under the inpatient prospective payment system (IPPS) and hospital outpatient services paid under the outpatient prospective payment system (OPPS)?
- A. Inpatient: APC · Outpatient: MS-DRG
- B. Inpatient: CMS-HCC · Outpatient: physician fee schedule RVUs
- C. Inpatient: MS-DRG · Outpatient: APC
- D. Inpatient and outpatient: MS-DRG
Show answer and explanation
Answer: C. Under IPPS, Medicare classifies inpatient stays into MS-DRGs. Under OPPS, CMS groups clinically comparable outpatient services with similar resource use into Ambulatory Payment Classifications (APCs). A reverses them. CMS-HCCs are risk-adjustment categories, and RVUs price professional services, so B mixes in other systems. D ignores the setting. Sources: CMS MS-DRG Classifications and Software; 42 CFR 419.31(a)(1); CMS Part C program background; 42 CFR 414.20.
Question 7 (CCA-07). Two procedures reported for the same patient on the same date hit an active Medicare NCCI procedure-to-procedure edit with a modifier indicator of 1. The documentation doesn't show the separate session, site or other circumstance that an NCCI-associated modifier would require. What should the coder do?
- A. Report the services as the documentation supports, without adding a modifier just to get past the edit
- B. Append any NCCI-associated modifier, because indicator 1 guarantees separate payment
- C. Change the diagnosis so the second procedure looks medically necessary
- D. Report both codes without a modifier, because indicator 1 means the edit doesn't apply
Show answer and explanation
Answer: A. An indicator of 1 means an NCCI-associated modifier may bypass the edit under appropriate circumstances. It doesn't create those circumstances. If the record doesn't support them, a modifier isn't justified. B turns conditional permission into a guarantee. C changes clinical reporting to get paid. D misreads the indicator: the edit still applies. Source: CMS NCCI FAQ Library, Procedure-to-Procedure Edits, question 10.
Question 8 (CCA-08). A Medicare Administrative Contractor (MAC) publishes a local coverage determination (LCD) for its jurisdiction that sets medical-necessity coverage criteria for a lab test. A national coverage determination (NCD) also exists for the same test. Which statement is correct?
- A. This MAC policy is a local coverage determination (LCD); it applies only in that MAC's jurisdiction and can't conflict with the NCD
- B. The MAC's policy applies nationwide because it is more detailed
- C. The coder should follow whichever policy pays more
- D. A valid diagnosis code on the claim guarantees coverage
Show answer and explanation
Answer: A. CMS issues NCDs, which apply nationally and bind the MACs. An LCD is a MAC's coverage determination for its own jurisdiction. It can add detail where national policy is silent but can't contradict it. B removes the local boundary. C substitutes payment for the governing policy. D confuses a valid code with a covered service. Sources: CMS, Medicare Coverage of Items and Services; Medicare Coverage Database, LCD and Article descriptions.
Question 9 (CCA-09). According to CMS, which reported information does the MS-DRG Grouper use to classify a Medicare inpatient stay?
- A. The principal diagnosis, up to 24 additional diagnoses and up to 25 procedures, plus age, sex and discharge status for a small number of MS-DRGs
- B. CPT codes and modifiers from the physician's claim
- C. APC status indicators from the outpatient claim
- D. The E/M level of the admitting physician's visit
Show answer and explanation
Answer: A. These are the inputs CMS lists for MS-DRG classification, which is why principal diagnosis selection and complete secondary diagnoses matter so much for inpatient coding. CPT codes, modifiers and E/M levels drive professional billing. APC status indicators belong to the outpatient system. Source: CMS MS-DRG Classifications and Software.
Domain 3: Health Records and Data Content
Question 10 (CCA-10). In a hospital that must meet Medicare's Conditions of Participation, a medical record entry is legible, complete, dated and timed. It hasn't been authenticated by the person responsible for the service. What's still missing?
- A. A diagnosis code next to every statement
- B. A copy of the claim attached to the entry
- C. Removal of the date so it can be re-dated at signing
- D. Authentication of the entry
Show answer and explanation
Answer: D. Under 42 CFR 482.24(c)(1), every hospital record entry must be legible, complete, dated, timed and authenticated by the person responsible for providing or evaluating the service. A confuses documentation with coding. B confuses billing with record completion. C removes a required element. Source: 42 CFR 482.24(c)(1). This rule applies to hospitals under the Medicare Conditions of Participation, not to every organization.
Question 11 (CCA-11). In a hypothetical audit, 12 of 80 reviewed records have the same documentation deficiency. What percentage of the reviewed records has the deficiency?
- A. 6.7%
- B. 12%
- C. 15%
- D. 80%
Show answer and explanation
Answer: C. Divide affected records by reviewed records: 12 ÷ 80 = 0.15, or 15%. A reverses the ratio and labels it as a percentage without converting it: 80 ÷ 12 ≈ 6.7, but that inverse ratio is about 666.7%. B treats the count as a percentage. D reports the denominator. The 15% describes only this invented sample. Topic alignment: AHIMA content outline, Domain 3, "Interpret coding data reports."
Domain 4: Compliance
Question 12 (CCA-12). In the current inpatient encounter, the attending physician's progress notes document one diagnosis and a consultant's note documents a conflicting one. Neither provider resolves the conflict. What should the coder do before finalizing the affected diagnosis?
- A. Assign the diagnosis that produces the higher payment
- B. Code the diagnosis in whichever note was written last
- C. Decide which diagnosis is correct from the lab values
- D. Send a nonleading query, typically to the attending physician, that presents the conflicting documentation and relevant clinical indicators and lets the provider choose among clinically reasonable options, including another explanation
Show answer and explanation
Answer: D. The ACDIS/AHIMA query guidelines list conflicting documentation between providers as a reason to query and say the attending should generally be queried. Queries must be nonleading. A multiple-choice query must offer only clinically relevant options and let the provider give another answer. They must never mention reimbursement. A biases the result toward payment. B invents a rule that the later note wins. C has the coder make a clinical diagnosis, which isn't the coder's role. Sources: ACDIS/AHIMA Guidelines for Achieving a Compliant Query Practice (2026 Update), pp. 7, 10, 17–19; ICD-10-CM Guidelines FY2026, I.A.19 (p. 12): "If there is conflicting medical record documentation, query the provider."
Question 13 (CCA-13). A supervisor asks a coder to add a diagnosis that would increase payment. No provider documented it, and the record has no clinical indicators supporting it. What should the coder do?
- A. Add the code, since the supervisor takes responsibility
- B. Report only codes clearly supported by the documentation and decline to add the unsupported diagnosis
- C. Add the code and flag the account for a later audit
- D. Send the provider a query explaining how much more the claim would pay with the diagnosis
Show answer and explanation
Answer: B. AHIMA's Standards of Ethical Coding require assigning and reporting only codes clearly supported by documentation, and refusing to take part in coding that misrepresents data. A query is for unclear or conflicting documentation or for clinical indicators that suggest a condition. There is no documented or clinical basis here for a query to obtain this diagnosis, and a query must never cite payment. A and C knowingly report unsupported data. D is a leading, payment-focused query. Sources: AHIMA Standards of Ethical Coding, standards 3–5; ACDIS/AHIMA query guidelines (2026), pp. 7, 17.
Domain 5: Information Technologies
Question 14 (CCA-14). The record clearly documents a left-sided condition. Computer-assisted coding (CAC) software suggests the matching right-sided code. What should the coder do?
- A. Check the record and the classification, correct the laterality, and validate the final code
- B. Accept the suggestion, because the software reads the whole record
- C. Ask someone to amend the record so it matches the suggested code
- D. Query the provider about laterality, because the software disagreed
Show answer and explanation
Answer: A. A CAC suggestion is a starting point. The coder still checks it against the documentation and the classification, and AHIMA's outline lists validating CAC codes as a CCA task. B skips validation. C changes the evidence to fit a code. D sends an unnecessary query: the record is clear, so there's no documentation question to ask. Sources: AHIMA CCA content outline, Domain 5, tasks 4–5; AHIMA Standards of Ethical Coding, standards 3 and 9.2.
Domain 6: Confidentiality & Privacy
Question 15 (CCA-15). To which of these does the HIPAA minimum necessary standard not apply?
- A. Sending records to another provider who requested them to treat the patient
- B. Sending information to a health plan for payment
- C. Disclosing information to a business associate that handles billing
- D. A coder's internal use of patient information to assign codes
Show answer and explanation
Answer: A. The minimum necessary standard doesn't apply to disclosures to, or requests by, a health care provider for treatment. Other exceptions include disclosures to the patient, uses under the patient's authorization, and disclosures required by law. The payment, billing and internal coding activities in B–D are subject to minimum necessary unless another exception applies. The treatment exception doesn't give every employee access to every record. Source: HHS, Minimum Necessary Requirement (45 CFR 164.502(b), 164.514(d)).
Question 16 (CCA-16). Under Medicare's hospital Conditions of Participation, how long must a hospital keep medical records in their original or legally reproduced form?
- A. At least 2 years
- B. At least 5 years
- C. At least 7 years, under every federal and state rule
- D. Permanently
Show answer and explanation
Answer: B. 42 CFR 482.24(b)(1) sets a minimum of 5 years. State law and other programs can require longer, so a facility's own retention schedule may exceed 5 years. C overstates a single universal rule. A and D don't match the regulation. Source: 42 CFR 482.24(b)(1).
Review your misses
| Missed question | Review this |
|---|---|
| 1–5 | Domain 1 notes below; Weeks 1–3 of the plan |
| 6–9 | Domain 2 notes; Week 4 |
| 10–11 | Domain 3 notes; Week 5, sessions 1–2 |
| 12–13 | Domain 4 notes; Week 5, session 3 |
| 14 | Domain 5 notes; Week 5, session 4 |
| 15–16 | Domain 6 notes; Week 5, session 5 |
With only one to five questions per domain, a miss points you to a rule to review. It isn't a measure of your overall ability in that domain.
Domain-by-domain review notes
Domain 1: Choose the code system, then the rule
ICD-10-CM (diagnoses). Look the term up in the Alphabetic Index, then verify the code in the Tabular List. The Index doesn't always give the full code, and characters such as laterality or a 7th character are only confirmed in the Tabular (Guideline I.B.1, p. 12). Code to the highest specificity documented (I.B.2). Don't add symptoms that are routine for the confirmed condition (I.B.5). When the classification links two conditions with "with" or "in," it presumes they are related unless the provider says otherwise or another guideline requires an explicit link (I.A.15).
Worked example: hypertension with CKD stage 3a. The provider documents hypertension and chronic kidney disease stage 3a and doesn't say they're unrelated. No heart disease or other reportable condition is documented in this example.
- Index: look up Hypertension, with, kidney involvement, which directs you to Hypertension, kidney. Follow with, stage 1 through stage 4 chronic kidney disease: I12.9.
- Tabular: confirm I12.9 and read its note to use an additional code for the CKD stage.
- Guideline: ICD-10-CM presumes a cause-and-effect relationship between hypertension and CKD, so don't report I10 plus a separate CKD code unless the provider documents that the CKD isn't due to hypertension (guideline I.C.9.a.2, pp. 50–51; "with" convention I.A.15).
- Stage: add N18.31, Chronic kidney disease, stage 3a.
Answer: I12.9, N18.31. Confirm both in your 2026 Tabular List. The official 2026 Tabular List and Index (ZIP) contains the Index path, the additional-code instruction at I12.9, and the code-first instruction at N18.
Inpatient vs outpatient. For facility coding of inpatient admissions to short-term, acute-care, long-term-care or psychiatric hospitals, an uncertain diagnosis still documented at discharge is coded as if it existed (Section II.H, p. 109). In outpatient settings, including hospital observation, it isn't: code the signs, symptoms or other reason for the visit (IV.H, p. 114). The opening activity and Question 1 test this.
ICD-10-PCS (inpatient procedures). Every PCS code has seven characters. The Table header supplies characters 1–3; choose characters 4–7 from the same valid row (guideline A9). The root operation is chosen by the objective of the procedure, using its full definition (guideline B3.1a). When a whole body part with its own value is cut out or off without replacement, the root operation is Resection, not Excision (B3.8). 2026 ICD-10-PCS Guidelines.
CPT and E/M. Start with the service family, setting and patient type, then apply that family's rules. For most office and outpatient visits, level is selected by medical decision making or by total physician or qualified health professional time on the date of the encounter, and clinical staff time is excluded (AMA; CMS MLN). A long history or exam doesn't by itself raise the level. The MDM level concept does not apply to code 99211, and time spent on separately reported services is excluded (CGS Medicare). Modifier 25 goes on the E/M code when the E/M service is significant and separately identifiable from the procedure that day (CMS NCCI FAQ).
Three code book drills (learning exercises, not scored questions):
| Drill | Task | You're done when |
|---|---|---|
| Index to Tabular | Use the hypertension/CKD example above. Find it in the ICD-10-CM Index, then in the Tabular List. Write down every instructional note you had to check. | You've recorded the term, the Index entry, the final code and any note that changed your choice. |
| Read a PCS Table | Open any Medical and Surgical Table. Name the seven characters, build one valid code using the Table header and a single row, and say what the root operation's definition requires. | Characters 1–3 match the Table header and characters 4–7 come from the same valid row; you can explain why a valid code isn't automatically the right code for a patient. |
| Find the rule family | In your CPT Professional book, find the office and outpatient E/M level-selection instructions and the guidance on a separately identifiable E/M service on a procedure day. | You can name where each rule lives and how it differs from "a visit and a procedure happened on the same day." |
Domain 2: Connect codes to payment and coverage
Different tools do different jobs:
- MS-DRGs classify Medicare inpatient stays paid under IPPS from the principal diagnosis, up to 24 additional diagnoses and up to 25 procedures, plus age, sex and discharge status for some groups (CMS).
- APCs group clinically comparable outpatient services with similar resource use under OPPS (42 CFR 419.31).
- CMS-HCCs use diagnosis data and demographic information to risk-adjust Medicare Advantage payments, which is why unsupported diagnoses can affect payment (CMS).
- NCCI procedure-to-procedure edits pair a column one and column two code. A modifier indicator of 0 means no NCCI-associated modifier can bypass the edit. An indicator of 1 means a modifier may bypass it, but only when the documentation supports the separate circumstance (CMS NCCI FAQ).
- NCDs and LCDs decide coverage. A valid code isn't the same as a covered service (CMS).
When a claim denies, trace it in order: was the documentation complete, was the code valid and specific, did an edit apply, and does a coverage policy require a particular diagnosis? Each step answers a different question.
Domain 3: Read the record and check the math
Hospital record entries must be legible, complete, dated, timed and authenticated by the responsible person. Under the Medicare hospital Conditions of Participation, a required history and physical must be completed and documented no more than 30 days before or 24 hours after admission or registration, and before surgery or a procedure requiring anesthesia. A preadmission history and physical requires an updated examination within 24 hours after admission or registration and before the procedure. Specified outpatient cases may instead use an assessment under a qualifying hospital policy (42 CFR 482.24(c)(4)(i)(A)–(C)). Completeness reviews look for missing elements. Content reviews look for conflicts and quality problems. For any rate in a coding or audit report, name the numerator and denominator before you calculate.
Domain 4: Clarify documentation without steering it
Query when documentation is conflicting, incomplete, ambiguous or unclear, or when clinical indicators suggest a condition that isn't documented. A compliant query is nonleading and supported by clinical indicators. A multiple-choice query offers only clinically relevant options plus a way for the provider to give another answer. No query should mention reimbursement or quality impact. Yes/no queries aren't used to obtain a new, previously undocumented diagnosis (ACDIS/AHIMA 2026 Update, pp. 7, 10, 12, 17–19). If the record supports nothing to ask about, the ethical answer is to code only what's documented (AHIMA Standards of Ethical Coding).
Domain 5: Validate what the software suggests
An encoder helps you find and select codes. A grouper assigns the payment group, such as an MS-DRG, from coded data. Computer-assisted coding suggests codes from electronic text, and AHIMA's outline expects you to validate those suggestions. Any software output still has to match the record and the classification.
Domain 6: Protect information while allowing appropriate access
Ask who is receiving the information and why. The minimum necessary standard limits most uses and disclosures, but not disclosures to a provider for treatment, to the patient, under the patient's authorization, or as required by law (HHS). The HIPAA Security Rule adds administrative, physical and technical safeguards for electronic protected health information (ePHI), such as access controls and audit records (HHS). Information blocking is a separate federal rule about practices that interfere with access to, exchange of or use of electronic health information, with defined exceptions (ASTP/ONC). Medicare hospitals keep records at least 5 years, and state rules may require longer.
Your books and test-day conditions
The 2026 code book check
For CCA exams delivered on or after May 1, 2026, AHIMA requires three books, and test center staff verify ISBNs (AHIMA 2026 code book list, updated January 13, 2026):
- [ ] One 2026 ICD-10-CM book from AHIMA's approved list, ISBN matched
- [ ] One 2026 ICD-10-PCS book from the approved list, ISBN matched
- [ ] AMA CPT 2026 Professional Edition (ISBN 978-1-64016-322-5), or the listed Professional and QuickRef bundle (ISBN 978-1-64016-332-4). The bundle listing doesn't mean you can use an app in the test room.
- [ ] No Post-it notes or loose papers in any book
- [ ] No handmade tabs
- [ ] Handwritten notes, if any, contain no coding rules copied from other references such as Coding Clinic or CPT Assistant
- [ ] Two valid, unexpired IDs from the accepted lists: a primary ID with your photograph and signature and a secondary ID with your signature; names must match your Authorization to Test
Candidates without the correct books aren't allowed to test and forfeit the exam fee. The note and tab rules come from AHIMA's Candidate Guide (Identification Requirements and Test Center Restrictions). If you're unsure about your setup, ask AHIMA before test day. Use the code book list effective for your exam date. A new clinical code year or a future-dated list does not automatically change the books required for your sitting.
How the exam runs
- Questions: 105 total, 90 scored and 15 unscored pretest questions mixed in. You can't tell which are which, so give every question full effort (AHIMA CCA page).
- Format: conventional CCA questions have four options and one correct answer (About AHIMA Certification Exams).
- Time: a 2-hour appointment: 5 minutes for the confidentiality agreement, then 1 hour 55 minutes for instructions and questions. There are no scheduled breaks, and the clock keeps running if you step out (AHIMA Answers: exam time).
- Pace: 115 minutes across 105 questions averages about 66 seconds each. Instructions also use part of that 115-minute block. Quick recall questions buy time for lookups.
- Moving between questions: AHIMA's scheduling instructions say exams scheduled May 1, 2026 or later allow navigating back and forth between questions (AHIMA Answers: scheduling instructions, Appendix 2, updated February 11, 2026). Some older AHIMA pages still describe a one-way exam, so follow the instructions on your Authorization to Test and on screen.
- Guessing: there's no penalty for a wrong answer, so answer every question (About AHIMA Certification Exams).
- Results: shown immediately, with percent correct by domain (AHIMA results FAQ; Candidate Guide, Appendix D). The passing standard is a scaled score of 300, which isn't a percentage or a set number correct (AHIMA exam scoring).
Before you book
| Topic | What AHIMA and Pearson VUE say |
|---|---|
| Eligibility | High school diploma or equivalent. AHIMA recommends, but doesn't require, six months of coding experience, an AHIMA-approved coding program (PCAP), or other coding training covering anatomy and physiology, medical terminology, and basic ICD and CPT coding. |
| Fee | $199 for AHIMA members, $299 for non-members. A retake costs the same. |
| Applying | Apply and pay through MyAHIMA (apply page). After your application is approved, your Authorization to Test (ATT) should arrive by email within five business days (Candidate Guide, Authorization to Test letters). |
| Scheduling window | You must schedule and take the exam within 120 calendar days of approval. AHIMA advises applying when you're ready, not using the window to prepare (Candidate Guide, Authorization to Test letters). |
| Where | In person at a Pearson VUE test center only. CCA isn't offered by online proctoring (Pearson VUE AHIMA page). |
| Arrival and ID | Arrive 30 minutes early. Both IDs must match your ATT or you'll be turned away and lose the fee. |
| Accommodations | Submit your request and documentation with your application, and don't schedule until you receive AHIMA's confirmation email (AHIMA scheduling instructions). |
| Retake | Submit a new application and fee. AHIMA requires at least 30 days after your last attempt before approving a CCA retake application, and you must receive a new ATT before scheduling (Candidate Guide, Process to Retake Examinations). |
| Keeping the credential | 20 continuing education units (CEUs) plus a recertification fee every 2-year cycle (AHIMA Recertification Guide). |
Sources: AHIMA CCA page unless linked otherwise; AHIMA Certification FAQs.
How hard is the CCA? AHIMA's pass rates
| Year | First-time testers | First-time pass rate |
|---|---|---|
| 2025 | 2,101 | 62% |
| 2024 | 2,490 | 67% |
| 2023 | 2,445 | 70% |
AHIMA reported 7,753 certified CCAs as of December 31, 2025 (AHIMA CCA page). These are cohort rates for first-time testers. They describe past groups, not your chances. About 38% of first-time testers didn't pass in 2025, which is a good reason to practice under exam conditions rather than just reread.
Common questions
Is the CCA open book? Only in the sense that you must bring three approved 2026 code books. No other references are allowed, and notes and tabs in those books are restricted.
Can I take the CCA online? No. CCA is delivered at Pearson VUE test centers. AHIMA offers online proctoring only for CDIP, CHDA and CHPS.
How long should I study? AHIMA doesn't set a study time. Our plan assumes about 45 hours over six weeks for someone with coding training. Adjust it using your Week 1 misses.
What if I don't pass? Use the domain percentages on your score report to choose what to restudy. You may submit a new application and fee during the waiting period, but AHIMA requires at least 30 days after your last attempt before approval and a new ATT before scheduling (Candidate Guide, Process to Retake Examinations).
CCA, CCS or CPC? CCA is AHIMA's entry-level coding credential. It's replaced by CCS or CCS-P once you pass either of those (AHIMA Certification FAQs). CPC is a different credential from a different organization (AAPC).
Sources
- AHIMA, Certified Coding Associate (CCA): exam specifications, pricing, retake, pass rates, required resources.
- AHIMA, CCA Exam Content Outline, effective 05/01/2022, pp. 1–3.
- AHIMA, CCA 2026 Exam Required Code Books, effective 05/01/2026, updated 01/13/2026.
- AHIMA Answers, Scheduling exam instructions and information, updated 02/11/2026, Appendix 2.
- AHIMA Answers, Format and exam time of AHIMA certification exams, updated 12/23/2025.
- AHIMA, About Certification Exams: question format, no guessing penalty, scaled scoring.
- AHIMA, Certification Candidate Guide: Test Center Restrictions.
- AHIMA, Certification FAQs and Apply to Take an Exam.
- AHIMA, Recertification Guide, updated 03/2026.
- Pearson VUE, AHIMA testing information, updated 09/19/2026.
- CDC/NCHS, ICD-10-CM Official Guidelines for Coding and Reporting FY2026; official 2026 Tabular List and Index (ZIP).
- CMS, ICD-10-PCS Official Guidelines for Coding and Reporting 2026; official 2026 Tables, Index and Definitions (ZIP).
- AMA, E/M office visit changes (health plan webinar); CMS MLN, Evaluation and Management Services, May 2026; CGS Medicare, E/M documentation guidelines, April 9, 2024.
- CMS, Medicare NCCI FAQ Library.
- CMS, MS-DRG Classifications and Software; 42 CFR 419.31; CMS, Medicare Part C program background; 42 CFR 414.20.
- CMS, Medicare Coverage of Items and Services; Medicare Coverage Database, LCD and Article descriptions.
- eCFR, 42 CFR 482.24, Medical record services.
- ACDIS and AHIMA, Guidelines for Achieving a Compliant Query Practice (2026 Update).
- AHIMA, Standards of Ethical Coding (2016).
- HHS, Minimum Necessary Requirement and HIPAA Security Rule; ASTP/ONC, Information Blocking.
Last verified October 22, 2026: AHIMA's CCA exam specifications, content outline, 2026 code book list, scheduling and timing instructions, Pearson VUE's AHIMA page, and the teaching sources linked beside each question.
Castleport Test Prep is an independent exam prep publisher. It is not affiliated with, endorsed by, or approved by AHIMA, CCHIIM or Pearson VUE. Exam and credential names identify their subjects; trademarks belong to their respective owners, and CPT is a registered trademark of the American Medical Association. The practice questions and activities on this page are original and unofficial, and this guide doesn't guarantee an exam result.