Free AHIMA CCA Practice Test
Here are 45 original, unofficial practice questions for the AHIMA Certified Coding Associate (CCA) exam, spread across its six domains the way the official outline weights them. This is a short sample, not a full-length exam.
Practice questions
Clinical classification systems (questions 1–15)
Question 1 of 45
A patient is discharged from an acute care hospital on February 12, 2026. The record documents hypertension and chronic kidney disease, stage 4. The provider doesn't link the two conditions and doesn't say they're unrelated. No heart disease is documented. Which codes are correct?
Show answer and explanation — CCA-01
Correct answer: D. I12.9, N18.4
ICD-10-CM presumes hypertension and CKD are related, so you assign a code from category I12 even when the provider doesn't connect them. I12.9 covers CKD stages 1 through 4 (or unspecified). Add N18.4 to show the stage.
Why not the others
- A. I10 ignores the built-in presumption that CKD with hypertension is hypertensive CKD.
- B. Leaving out the hypertensive CKD code drops half the picture.
- C. I12.0 is for stage 5 CKD or end-stage renal disease, not stage 4.
Rule to review: ICD-10-CM Section I.C.9.a.2 (hypertensive CKD)
Source: FY2026 ICD-10-CM Official Guidelines, Section I.C.9.a.2 (pp. 50–51); FY2026 ICD-10-CM Tabular List, I10 and I12.0/I12.9 (PDF p. 522), N18.4 (PDF p. 1030)
Question 2 of 45
A patient is admitted to an acute care hospital on March 3, 2026, for sepsis due to E. coli and an E. coli urinary tract infection, both present on admission. The provider documents no acute organ dysfunction and doesn't document severe sepsis. Which code is the principal diagnosis?
Show answer and explanation — CCA-02
Correct answer: D. A41.51
When the reason for admission is sepsis and a localized infection, the systemic infection goes first and the localized infection follows. A41.51 is sepsis due to E. coli.
Why not the others
- A. The UTI (N39.0) is the localized infection, so it's sequenced after the sepsis.
- B. The organism is documented, so the unspecified-organism code is less accurate.
- C. This record does not support severe sepsis: no sepsis-associated acute organ dysfunction is documented. An R65.2- code can never be principal.
Rule to review: ICD-10-CM Section I.C.1.d (sepsis)
Source: FY2026 ICD-10-CM Official Guidelines, Sections I.C.1.d.1.a–b and I.C.1.d.3–4 (pp. 23–25); FY2026 ICD-10-CM Tabular List, A41.51 and A41.9 (PDF p. 18), N39.0 (PDF p. 1038), R65.2/R65.20 (PDF p. 1272)
Question 3 of 45
At a scheduled visit, a physician adjusts medications for the patient's type 2 diabetes and hypertension and documents that management. During the same visit, the physician notices a skin lesion, decides to remove it, and performs a minor procedure. How should the evaluation and management (E/M) service be reported to Medicare?
Show answer and explanation — CCA-03
Correct answer: A. Report the E/M with modifier 25, plus the procedure
Deciding to do a minor procedure is part of that procedure's payment. Here, the documented medication management is significant and separately identifiable from the lesion procedure, so the E/M is reported with modifier 25 attached to the E/M code.
Why not the others
- B. Modifier 25 goes on the E/M service, not on the procedure.
- C. The decision to perform the minor procedure and its usual pre- and postoperative work are included. A significant, separately identifiable E/M service is reportable.
- D. Modifier 59 is a last-resort modifier for distinct procedures, used only when no more descriptive modifier fits. Modifier 25 is the one built for this situation.
Rule to review: Modifier 25 and the decision for minor procedures
Question 4 of 45
An acute care hospital inpatient's discharge summary, dated February 20, 2026, says: "Probable community-acquired pneumonia; treated with IV antibiotics." The chest x-ray report says "possible infiltrate." What do you code for the pneumonia?
Show answer and explanation — CCA-04
Correct answer: C. J18.9
For this hospital inpatient admission, a diagnosis documented as probable at the time of discharge is coded as if it existed. J18.9 is pneumonia, unspecified organism.
Why not the others
- A. R91.8 describes an abnormal lung finding, but it does not replace the discharge diagnosis in this hospital inpatient case.
- B. R05.9 describes cough, which is not documented here. The probable pneumonia is coded under the hospital inpatient rule.
- D. The guideline already tells you what to do. You don't need the word removed.
Rule to review: ICD-10-CM Section II.H (uncertain diagnosis, inpatient)
Source: FY2026 ICD-10-CM Official Guidelines, Section II.H (p. 109); FY2026 ICD-10-CM Tabular List, J18.9 (PDF p. 625), R05.9 (PDF p. 1240), R91.8 (PDF p. 1285)
Question 5 of 45
A physician office note from February 10, 2026, reads: "Cough for 5 days. Suspected pneumonia; chest x-ray ordered, result pending." What do you code for this visit?
Show answer and explanation — CCA-05
Correct answer: A. R05.9
In outpatient settings you don't code diagnoses documented as suspected or probable. You code to the highest level of certainty, which here is the cough. R05.9 is cough, unspecified.
Why not the others
- B. Pneumonia isn't established, so it can't be coded in an outpatient setting.
- C. There's no x-ray result yet, so there's no abnormal finding to code.
- D. Adding the unconfirmed pneumonia is still wrong, even alongside the symptom.
Rule to review: ICD-10-CM Section IV.H (uncertain diagnosis, outpatient)
Source: FY2026 ICD-10-CM Official Guidelines, Sections IV.H (p. 114) and I.A.18 (p. 12); FY2026 ICD-10-CM Alphabetic Index, Cough (PDF p. 310); Tabular List, R05.9 (PDF p. 1240), J18.9 (PDF p. 625), R91.8 (PDF p. 1285)
Question 6 of 45
An inpatient was admitted for two conditions that equally meet the definition of principal diagnosis, based on the circumstances of admission, the workup and the treatment. Nothing in the Index, the Tabular List or the guidelines directs the order. What's correct?
Show answer and explanation — CCA-06
Correct answer: A. Either one may be sequenced first
When two or more diagnoses equally meet the criteria and nothing else directs the order, any one of them may be sequenced first.
Why not the others
- B. The guidelines don't make the provider's listing order binding here.
- C. There's no rule that chronic conditions go first.
- D. A symptom isn't put ahead of the established diagnoses that explain it.
Rule to review: ICD-10-CM Section II.C
Source: FY2026 ICD-10-CM Official Guidelines, Section II.C (p. 108)
Question 7 of 45
On March 9, 2026, the provider documents type 2 diabetes mellitus with diabetic gastroparesis. Which codes, in which order, are correct?
Show answer and explanation — CCA-07
Correct answer: D. E11.43, K31.84
The Index sends type 2 diabetes with gastroparesis to E11.43, and diabetic gastroparesis is listed under that code. K31.84 has a "code first" note for the underlying disease, and the Excludes2 note at K31 lets the two codes be reported together.
Why not the others
- A. This leaves out the diabetes entirely.
- B. This breaks the "code first" instruction at K31.84; the diabetes code comes first.
- C. E11.9 is diabetes without complications, but a diabetic complication is documented.
Rule to review: Code first notes; Excludes2
Source: FY2026 ICD-10-CM Official Guidelines, Sections I.A.12.b and I.A.13 (pp. 10–11); FY2026 ICD-10-CM Alphabetic Index, Diabetes, type 2, with gastroparesis (PDF p. 407); Tabular List, E11.43 (PDF p. 213), E11.9 (PDF p. 214), K31 Excludes2 (PDF p. 672), K31.84 code-first note (PDF p. 673)
Question 8 of 45
A patient with type 2 diabetes is seen on February 18, 2026. She's on a long-term regimen of both insulin and metformin, an oral hypoglycemic. Which long-term drug therapy codes are assigned?
Show answer and explanation — CCA-08
Correct answer: C. Z79.4 and Z79.84
When a patient takes both insulin and an oral hypoglycemic, the guideline says to assign both Z79.4 (insulin) and Z79.84 (oral hypoglycemic drugs).
Why not the others
- A. This leaves out the oral medication.
- B. This leaves out the insulin.
- D. Z79.85 is for injectable non-insulin antidiabetic drugs, and none is documented.
Rule to review: ICD-10-CM Section I.C.4.a.3
Source: FY2026 ICD-10-CM Official Guidelines, Section I.C.4.a.3 (p. 40); FY2026 ICD-10-CM Tabular List, Z79.4 (PDF p. 2037), Z79.84 and Z79.85 (PDF p. 2039)
Question 9 of 45
A patient with type 2 diabetes who takes metformin long term is admitted for pneumonia on March 2, 2026. During the stay she gets insulin only temporarily, to control her blood glucose. She goes home on metformin alone. Which long-term drug therapy codes apply?
Show answer and explanation — CCA-09
Correct answer: B. Z79.84 only
Z79.4 isn't assigned when insulin is given temporarily to bring a type 2 patient's blood sugar under control during an encounter. Her ongoing metformin still supports Z79.84.
Why not the others
- A. Temporary insulin doesn't count as long-term insulin use.
- C. This codes the temporary insulin and drops the real long-term drug.
- D. She does take a long-term diabetes drug, so a Z79 code applies.
Rule to review: ICD-10-CM Section I.C.4.a.3
Source: FY2026 ICD-10-CM Official Guidelines, Section I.C.4.a.3 (p. 40); FY2026 ICD-10-CM Tabular List, Z79.4 (PDF p. 2037) and Z79.84 (PDF p. 2039)
Question 10 of 45
In the ICD-10-CM Tabular List, what does an Excludes1 note mean?
Show answer and explanation — CCA-10
Correct answer: C. The excluded code is never reported with the code above the note, except when the two conditions are unrelated
Excludes1 means "not coded here." The two codes aren't used together. The guidelines make one exception: when the two conditions are unrelated to each other.
Why not the others
- A. That's the definition of Excludes2.
- B. That describes a "code first" note.
- D. That describes a "use additional code" note.
Rule to review: ICD-10-CM Section I.A.12
Source: FY2026 ICD-10-CM Official Guidelines, Section I.A.12.a–b (pp. 9–10)
Question 11 of 45
On March 16, 2026, four weeks after a closed fracture of the distal right radius (type not specified), the patient returns to the orthopedic clinic for a routine cast check. Healing is on schedule. Which 7th character completes S52.501-?
Show answer and explanation — CCA-11
Correct answer: B. D
Character A is for encounters while the patient is getting active treatment. D is for encounters after active treatment, during routine healing. The full code is S52.501D.
Why not the others
- A. Active treatment is finished; this is a routine healing check.
- C. S is for sequelae: residual effects that remain after the acute phase of the injury has ended.
- D. Codes in category S52 need a 7th character to be valid.
Rule to review: ICD-10-CM Section I.C.19.a
Source: FY2026 ICD-10-CM Official Guidelines, Sections I.C.19.a (pp. 77–78) and I.B.10 (p. 14); FY2026 ICD-10-CM Tabular List, category S52 seventh-character instructions (PDF p. 1432) and S52.501 (PDF p. 1438)
Question 12 of 45
During an inpatient hospital admission on February 24, 2026, a surgeon performs a laparoscopic cholecystectomy and removes the entire gallbladder. It isn't hand-assisted and isn't converted to an open procedure. Which ICD-10-PCS root operation and approach apply?
Show answer and explanation — CCA-12
Correct answer: A. Resection, Percutaneous Endoscopic
Cutting out all of a body part is Resection; cutting out a portion is Excision. Reaching and viewing the site through small incisions with a scope is the Percutaneous Endoscopic approach, value 4 in the 5th character. The code is 0FT44ZZ.
Why not the others
- B. Excision is for cutting out only a portion of a body part.
- C. The procedure was laparoscopic, not open.
- D. Extraction means pulling or stripping out by force.
Rule to review: ICD-10-PCS B3.8 and approach definitions
Source: 2026 ICD-10-PCS Official Guidelines, introduction (p. 1) and B3.8 (p. 8); 2026 ICD-10-PCS Code Tables and Index, table 0FT (pcs_2026.pdf, PDF p. 471); definitions for Excision, Extraction, Resection, and Percutaneous Endoscopic
Question 13 of 45
During an inpatient hospital admission, a surgeon cuts out a portion of an axillary lymph node and sends it to pathology to establish a diagnosis. How is this classified in ICD-10-PCS?
Show answer and explanation — CCA-13
Correct answer: C. Excision with the qualifier Diagnostic
Biopsies are coded to Excision, Extraction or Drainage with the qualifier Diagnostic. Cutting out a portion of tissue is Excision.
Why not the others
- A. Extraction is removal by force, as in a bone marrow biopsy.
- B. Only part of the node was removed, and a biopsy needs the Diagnostic qualifier.
- D. This leaves off the qualifier that marks the procedure as a biopsy.
Rule to review: ICD-10-PCS B3.4a
Source: 2026 ICD-10-PCS Official Guidelines, B3.4a (p. 6); 2026 ICD-10-PCS Code Tables and Index, table 07B (pcs_2026.pdf, PDF p. 301), axillary lymphatic body parts and Diagnostic qualifier
Question 14 of 45
A supplier furnishes a wheelchair for a Medicare patient to use at home. Which code set identifies the wheelchair itself?
Show answer and explanation — CCA-14
Correct answer: B. HCPCS Level II
HCPCS Level II codes are alphanumeric and identify products, supplies and services that aren't in CPT. That includes durable medical equipment used outside a physician's office, such as a wheelchair for home use.
Why not the others
- A. CPT describes procedures and services, not equipment like this.
- C. ICD-10-PCS is for inpatient hospital procedures.
- D. ICD-10-CM codes diagnoses, not items.
Rule to review: HCPCS Level I vs Level II
Source: CMS, Healthcare Common Procedure Coding System (HCPCS)
Question 15 of 45
An established patient is seen in the office. The physician documents 42 minutes of total qualifying physician E/M time on the date of the encounter and picks the level based on time. Which code is reported?
Show answer and explanation — CCA-15
Correct answer: D. 99215
Office E/M levels can be picked by medical decision making or by total practitioner time on the date of the encounter. For established patients, the time that must be met or exceeded is 10, 20, 30 and 40 minutes for 99212 through 99215. At 42 minutes, 99215 is met. Confirm the thresholds in the E/M guidelines of your CPT 2026 book.
Why not the others
- A. 99212 needs only 10 minutes, well under what was documented.
- B. 99213 needs 20 minutes; the visit exceeded that and a higher level is met.
- C. 99214 has a 30-minute minimum, but 42 minutes meets the 40-minute minimum for 99215.
Rule to review: E/M level selection by time
Source: CMS MLN Evaluation and Management Services Guide (May 2026), Table 3 (p. 15) and time-based level selection (p. 24); AMA CPT Assistant, Special Edition: October 2024, Table 1 (p. 6), established-patient office/outpatient E/M time thresholds
Reimbursement methodologies (questions 16–25)
Question 16 of 45
Two Medicare inpatients have the same principal diagnosis and no procedures. One is assigned to a higher-weighted MS-DRG in the same family. What most likely explains the difference?
Show answer and explanation — CCA-16
Correct answer: C. That case had a documented, coded secondary diagnosis that counts as a CC or MCC
Many MS-DRG families are split into severity levels: with an MCC (major complication or comorbidity), with a CC (complication or comorbidity), or without either. Secondary diagnoses drive that split. Not every family has all three levels.
Why not the others
- A. Charges aren't a grouping input.
- B. Length of stay doesn't decide the MS-DRG.
- D. Physician specialty doesn't affect MS-DRG assignment.
Rule to review: MS-DRG severity (CC/MCC)
Source: CMS MLN, Medicare Payment Systems (Acute Care Hospital Inpatient)
Question 17 of 45
Medicare pays for many hospital outpatient department services through Ambulatory Payment Classifications (APCs). Which payment system uses APCs?
Show answer and explanation — CCA-17
Correct answer: D. Outpatient Prospective Payment System (OPPS)
CMS assigns the items and services paid under the hospital OPPS to payment groups called APCs.
Why not the others
- A. IPPS pays inpatient stays through MS-DRGs.
- B. Home health has its own separate system.
- C. The Physician Fee Schedule pays professional services, not APC groups.
Rule to review: OPPS and APCs
Source: CMS MLN, Medicare Payment Systems (Hospital Outpatient)
Question 18 of 45
A hospital bills Medicare for its own facility services in the outpatient department. Which claim format applies?
Show answer and explanation — CCA-18
Correct answer: B. 837I / CMS-1450 (UB-04)
Institutional providers such as hospitals use the 837I electronic format; the paper version is the CMS-1450, also called the UB-04.
Why not the others
- A. The 837P and CMS-1500 are for professionals and suppliers.
- C. A place-of-service code doesn't turn a professional claim into an institutional one.
- D. Modifier 25 has nothing to do with the claim type.
Rule to review: Institutional vs professional claims
Source: CMS MLN006926, 837I and Form CMS-1450; CMS MLN006976, CMS-1500 and 837P
Question 19 of 45
A Medicare NCCI procedure-to-procedure (PTP) edit pair has a modifier indicator of 0. What does that mean?
Show answer and explanation — CCA-19
Correct answer: C. No NCCI-associated modifier can bypass the edit
Indicator 0 means NCCI-associated modifiers can't be used to bypass the edit.
Why not the others
- A. That describes indicator 1.
- B. Indicator 9 is used for pairs whose deletion date is the same as their effective date, so in practice they don't apply. That isn't indicator 0.
- D. With a 0 indicator, the column 2 code isn't separately payable when billed with the column 1 code.
Rule to review: NCCI PTP modifier indicators
Source: 2026 Medicare NCCI Policy Manual, Chapter I (p. I-14)
Question 20 of 45
What is a Medically Unlikely Edit (MUE)?
Show answer and explanation — CCA-20
Correct answer: C. The maximum units of service for a HCPCS/CPT code that the same provider reports for the same patient on the same date on the vast majority of appropriately reported claims
That's how CMS defines an MUE. Its adjudication indicator determines whether units are checked by claim line or summed for the date of service; an MUE is not always an absolute daily maximum.
Why not the others
- A. That describes coverage or medical-necessity logic.
- B. That's a procedure-to-procedure (PTP) edit.
- D. That's a Local Coverage Determination (LCD).
Rule to review: MUE definition
Source: 2026 Medicare NCCI Policy Manual, Chapter I (pp. I-4, I-28–I-29)
Question 21 of 45
Which statement correctly tells a Local Coverage Determination (LCD) apart from a National Coverage Determination (NCD)?
Show answer and explanation — CCA-21
Correct answer: B. A Medicare Administrative Contractor (MAC) issues an LCD for its own jurisdiction; an NCD is national
NCDs are national Medicare coverage policy. LCDs are decisions by a MAC that apply in its jurisdiction when there is no NCD or when the contractor needs to clarify an NCD. An LCD cannot contradict an NCD.
Why not the others
- A. This reverses the two.
- C. CMS issues NCDs and MACs issue LCDs; the OIG doesn't write coverage policy.
- D. LCDs are Medicare contractor decisions, not limited to Medicare Advantage.
Rule to review: NCD vs LCD
Source: CMS Medicare Coverage Database, LCD Info and NCD Info
Question 22 of 45
For a planned outpatient service under Original Medicare, when should a provider give the patient an Advance Beneficiary Notice of Noncoverage (ABN, form CMS-R-131)?
Show answer and explanation — CCA-22
Correct answer: A. Before furnishing an item or service Medicare usually covers but may not pay for in this case because it isn't considered reasonable and necessary
The ABN goes to the patient in advance, early enough for them to make an informed choice about getting the service and possibly paying for it.
Why not the others
- B. After a denial is too late; the point is advance notice.
- C. Routine use for every service isn't the purpose.
- D. This ABN applies to eligible Original Medicare outpatient items and services; inpatient hospitals use other approved noncoverage notices.
Rule to review: ABN purpose and timing
Source: Medicare Claims Processing Manual, Chapter 30, Sections 50.1, 50.2.1 and 50.3; CMS, Fee-for-Service Advance Beneficiary Notice of Noncoverage
Question 23 of 45
Under the CMS-HCC risk adjustment model, diagnoses from a base year are used to predict costs for the next year. What does that mean for coding a patient's chronic conditions?
Show answer and explanation — CCA-23
Correct answer: D. A chronic condition needs to be documented and coded from a qualifying encounter in the applicable data-collection year to be considered for the following payment year's risk score
The model uses that base year's diagnoses, from acceptable sources such as hospital inpatient, hospital outpatient and physician encounters, to predict the next year's costs. If a condition isn't documented and coded that year, it doesn't feed the next year's score. A prior year's code does not automatically carry forward, and not every chronic condition maps to a payment HCC.
Why not the others
- A. Each year's prediction rests on that base year's diagnoses.
- B. HCCs map from ICD-10-CM diagnosis codes, not CPT codes.
- C. Hospital outpatient and physician data are also acceptable sources.
Rule to review: CMS-HCC base-year model
Source: CMS Medicare Managed Care Manual, Transmittal 118 (September 19, 2014), Chapter 7 Sections 40 and 120.1.1; Chapter 8 Section 50; CMS CY 2026 Rate Announcement (April 7, 2025), Attachment III Section O, p. 75
Question 24 of 45
A coder reports separate codes for a vaginal hysterectomy and a bilateral salpingo-oophorectomy done in the same operative session, even though a single code describes both. What is this?
Show answer and explanation — CCA-24
Correct answer: A. Unbundling
Reporting several codes when one comprehensive code describes the services is unbundling, and NCCI prohibits it. CMS uses this exact procedure combination as its example.
Why not the others
- B. Upcoding is reporting a higher level of service or severity than the documentation supports.
- C. No modifier makes splitting a comprehensive code acceptable.
- D. An MUE is a limit on units of service, not on code combinations.
Rule to review: Unbundling
Source: 2026 Medicare NCCI Policy Manual, Chapter I (pp. I-4–I-5)
Question 25 of 45
Medicare denies a claim for an outpatient test for lack of medical necessity. On review, the coder finds the ordering provider documented a diagnosis that supports the test, but the claim reported a less specific diagnosis. What should happen next?
Show answer and explanation — CCA-25
Correct answer: D. Correct the claim to the documented diagnosis, then follow the payer's corrected-claim, reopening or appeal process
Codes have to be supported by the health record. Here the record supports the more specific diagnosis, so the right fix is to correct the claim and follow the payer's process. For Medicare, clerical errors generally go through reopening or the applicable claim-adjustment process rather than an appeal.
Why not the others
- A. This picks a diagnosis to fit coverage instead of reflecting the record. That misrepresents the patient's condition.
- B. Asking for a specific covered diagnosis is a leading request, and the documentation already supports the test.
- C. The claim can legitimately be corrected, so writing it off skips the appropriate correction process.
Rule to review: Documentation-supported coding
Source: AHIMA Standards of Ethical Coding (2016), Standards 3 and 5, Guideline 5.3; Medicare Claims Processing Manual, Chapter 34, Sections 10.4–10.4.1, pp. 5–6
Health records and data content (questions 26–32)
Question 26 of 45
A patient's history and physical (H&P) was done 20 days before an elective inpatient hospital admission for surgery. Under the CMS hospital Conditions of Participation, what else is required?
Show answer and explanation — CCA-26
Correct answer: A. An updated exam noting any changes, completed and documented within 24 hours after admission, but before surgery or a procedure requiring anesthesia services
An H&P can be completed and documented up to 30 days before admission or within 24 hours after, but before surgery or a procedure requiring anesthesia services. If it was done within the 30 days before admission, an updated exam must also be completed and documented within 24 hours after admission and before the procedure.
Why not the others
- B. The 30-day window still requires the update note.
- C. No full new H&P is required, and there's no 72-hour rule here.
- D. The update comes at admission, not after discharge.
Rule to review: 42 CFR 482.22(c)(5)
Source: 42 CFR 482.22(c)(5)(i)-(ii)
Question 27 of 45
Under the CMS hospital Conditions of Participation, when must the operative report be written or dictated?
Show answer and explanation — CCA-27
Correct answer: B. Immediately following surgery
The operative report must be written or dictated immediately following surgery and signed by the surgeon.
Why not the others
- A. Discharge timing has nothing to do with this rule.
- C. Thirty days is the record-completion limit, not the operative report rule.
- D. The rule isn't tied to recovery-room discharge and isn't limited to inpatients.
Rule to review: 42 CFR 482.51(b)(6)
Source: 42 CFR 482.51(b)(6)
Question 28 of 45
An HIM technician reviews a discharged record to confirm that every required report is present and every entry is signed. What kind of review is this?
Show answer and explanation — CCA-28
Correct answer: B. Quantitative analysis
Quantitative analysis checks a record for completeness: are the required documents there, and are entries authenticated?
Why not the others
- A. AHIMA lists qualitative analysis for deficiencies separately from the quantitative completeness check described here.
- C. Abstraction selects pertinent information from the medical record; this question describes checking that required record components are present.
- D. CDI review looks at whether the documentation is clinically accurate and specific.
Rule to review: Record analysis types
Source: AHIMA CCA Exam Content Outline, Domain 1 task 3 and Domain 3 tasks 2–4; 42 CFR 482.24(c)(1); AHIMA Clinical Documentation Improvement Toolkit (2016), What Is CDI? and What Are the CDI Goals?, pp. 6–7
Question 29 of 45
Under the CMS hospital Conditions of Participation, within what period after discharge must the final diagnosis be recorded and the medical record completed?
Show answer and explanation — CCA-29
Correct answer: C. 30 days
The rule requires the final diagnosis and completion of the medical record within 30 days following discharge. A hospital's own policy can be stricter.
Why not the others
- A. Twenty-four hours is the H&P timing rule, not record completion.
- B. No federal 14-day completion rule exists, though a hospital may set one.
- D. Sixty days goes past the federal limit.
Rule to review: 42 CFR 482.24(c)(4)(viii)
Source: 42 CFR 482.24(c)(4)(viii)
Question 30 of 45
A unit has four Medicare discharges with MS-DRG relative weights of 1.2, 0.8, 2.5 and 1.5. What is the case mix index?
Show answer and explanation — CCA-30
Correct answer: C. 1.50
Case mix index is the sum of the DRG weights divided by the number of discharges: (1.2 + 0.8 + 2.5 + 1.5) / 4 = 6.0 / 4 = 1.50.
Why not the others
- A. That's just the first case's weight, not the average.
- B. 1.35 is the median weight (halfway between 1.2 and 1.5). CMI uses the average.
- D. That's the sum of the weights. You still have to divide by the four discharges.
Rule to review: Case mix index
Source: CMS, Case Mix Index files
Question 31 of 45
A patient is admitted with abdominal pain. After study, the physician determines that acute appendicitis caused the admission, and an appendectomy is performed. What is the principal diagnosis?
Show answer and explanation — CCA-31
Correct answer: A. Acute appendicitis
The principal diagnosis is the condition established after study to be chiefly responsible for the admission. "After study" is the key phrase: the condition the workup found replaces the admitting symptom.
Why not the others
- B. Abdominal pain was the admitting symptom, but the workup found its cause.
- C. These aren't two equal diagnoses; the pain was explained by the appendicitis.
- D. An appendectomy is a procedure, not a diagnosis.
Rule to review: UHDDS principal diagnosis
Source: FY2026 ICD-10-CM Official Guidelines, Section II introduction (p. 107)
Question 32 of 45
Under 42 CFR 482.24(c)(1), every hospital medical record entry must be:
Show answer and explanation — CCA-32
Correct answer: D. Legible, complete, dated, timed and authenticated
Those five requirements apply to all patient medical record entries. Entries can be written or electronic, and they're authenticated by the person responsible for providing or evaluating the service.
Why not the others
- A. Typing and witnessing aren't requirements; entries can be handwritten or electronic.
- B. The regulation doesn't set a one-hour rule.
- C. The person responsible for the service authenticates the entry, not only the attending.
Rule to review: 42 CFR 482.24(c)(1)
Source: 42 CFR 482.24(c)(1)
Compliance (questions 33–38)
Question 33 of 45
An inpatient's lab results show a low potassium level. The provider never mentions it, orders no further tests and gives no treatment. What should the coder do?
Show answer and explanation — CCA-33
Correct answer: B. Don't code it
Abnormal findings aren't coded unless the provider indicates they're clinically significant. A query makes sense when the provider ordered more tests or treatment for the finding, which didn't happen here.
Why not the others
- A. Coders don't diagnose from lab values.
- C. A finding code still needs the provider to indicate it matters.
- D. A query isn't automatic for every abnormal value; the clinical record must support the need for clarification.
Rule to review: ICD-10-CM Section III.B
Source: FY2026 ICD-10-CM Official Guidelines, Section III.B (p. 111); AHIMA/ACDIS, Guidelines for Achieving a Compliant Query Practice (2026 Update), Section VI, pp. 17–18
Question 34 of 45
Which physician query is compliant?
Show answer and explanation — CCA-34
Correct answer: C. A nonleading multiple-choice query that lists the clinical indicators (hemoglobin drop, transfusion given) with their record sources and clinically supported options, including "other, please specify"
A compliant query doesn't lead the provider toward a particular answer. It presents relevant clinical indicators, offers clinically supported options and, for multiple choice, allows an alternative response such as "other, please specify."
Why not the others
- A. Queries must never mention reimbursement impact.
- B. Offering one option chosen for payment is leading.
- D. Steering the physician to the coder's preferred diagnosis is leading, whatever the format.
Rule to review: AHIMA/ACDIS compliant query practice
Question 35 of 45
A dietitian documents a BMI of 41 for a nonpregnant 45-year-old inpatient receiving obesity treatment. The attending physician documents morbid obesity. What may be coded?
Show answer and explanation — CCA-35
Correct answer: D. The obesity diagnosis plus the BMI code, with BMI as a secondary code
Other clinicians, such as a dietitian, may document the BMI, but the patient's provider has to document the related diagnosis. Here they did. BMI codes are reported only as secondary codes.
Why not the others
- A. The BMI value can come from another clinician.
- B. BMI codes can only be secondary.
- C. The provider-documented obesity is the diagnosis; BMI alone isn't enough.
Rule to review: ICD-10-CM Section I.B.14
Question 36 of 45
A supervisor tells a coder to add a complication that isn't documented because "it's probably there and it improves the DRG." What should the coder do?
Show answer and explanation — CCA-36
Correct answer: B. Refuse; codes must be supported by documentation, and misrepresenting data to raise reimbursement is unethical
Codes have to be clearly supported by the health record. Adding an undocumented condition to raise payment misrepresents the patient's clinical picture.
Why not the others
- A. Being told to do it doesn't make unsupported coding acceptable.
- C. Flagging it doesn't change that the code isn't supported.
- D. The patient isn't the source for diagnoses; the provider's documentation is.
Rule to review: AHIMA Standards of Ethical Coding
Source: AHIMA Standards of Ethical Coding (2016), Standards 3 and 5, Guideline 5.3
Question 37 of 45
A hospital is updating the CPT codes in its chargemaster for the annual CPT release. When does the annual CPT update take effect?
Show answer and explanation — CCA-37
Correct answer: B. January 1
The AMA's annual CPT code set takes effect January 1. Some Category III and vaccine codes are released early, outside that cycle.
Why not the others
- A. October 1 is the main annual ICD-10-CM and ICD-10-PCS update date, not the annual CPT effective date.
- C. April 1 can bring a smaller ICD-10 update, not the annual CPT release.
- D. July 1 isn't the annual CPT effective date.
Rule to review: Annual code set update dates
Source: AMA, CPT 2027 code set release (effective January 1); CMS, ICD-10 codes page; AMA, The CPT code process, When approved changes take effect (updated January 22, 2026)
Question 38 of 45
A patient has type 2 diabetes and peripheral neuropathy. The provider explicitly documents that the neuropathy is caused by prior chemotherapy, not by diabetes. Should the diabetic polyneuropathy combination code be assigned?
Show answer and explanation — CCA-38
Correct answer: A. No; the provider clearly states the conditions are unrelated
The "with" convention presumes a causal link only until the documentation clearly says the conditions are unrelated. Here it does.
Why not the others
- B. The provider explicitly ruled out a diabetes-related cause here, so the presumed link does not apply.
- C. Adding a chemotherapy code doesn't fix assigning a link the provider ruled out.
- D. There's nothing unclear or conflicting to query.
Rule to review: ICD-10-CM Section I.A.15
Source: FY2026 ICD-10-CM Official Guidelines, Section I.A.15 (p. 11)
Information technologies (questions 39–41)
Question 39 of 45
What does MS-DRG grouper software do?
Show answer and explanation — CCA-39
Correct answer: D. Assigns the MS-DRG from the principal diagnosis, secondary diagnoses, procedures and a few other data elements
CMS classifies cases into MS-DRGs from the principal diagnosis, up to 24 additional diagnoses and up to 25 procedures. Age, sex and discharge status matter for a small number of MS-DRGs.
Why not the others
- A. That's computer-assisted coding (CAC).
- B. That's claim-editing software.
- C. The master patient index lives in the HIM or registration system.
Rule to review: MS-DRG classification
Question 40 of 45
Computer-assisted coding (CAC) software suggests a pneumonia code because the final documentation for an outpatient encounter says "rule out pneumonia," with no confirmed pneumonia diagnosis. What should the coder do?
Show answer and explanation — CCA-40
Correct answer: A. Check it against the documentation and guidelines, then reject it, because uncertain outpatient diagnoses aren't coded
CAC suggestions still have to be validated. In an outpatient setting, a "rule out" diagnosis isn't coded; report the documented condition, symptoms or other reason for the visit at the highest degree of certainty.
Why not the others
- B. A software suggestion does not establish that a code is appropriate. The coder must validate it against the documentation and coding rules.
- C. The unconfirmed pneumonia still can't be coded, even with a symptom code.
- D. Code validation is a coding responsibility, not a billing one.
Rule to review: CAC validation; ICD-10-CM Section IV.H
Source: AHIMA Standards of Ethical Coding (2016), Guideline 9.2; FY2026 ICD-10-CM Official Guidelines, Section IV.H (p. 114)
Question 41 of 45
An encoder returns a code after a term search. Before finalizing it, what do the ICD-10-CM guidelines require?
Show answer and explanation — CCA-41
Correct answer: D. Using both the Alphabetic Index and the Tabular List, checking the code and its instructional notes in the Tabular
The guidelines say you have to use both the Index and the Tabular List when locating and assigning a code. The Tabular holds the notes that can change the answer.
Why not the others
- A. Software output doesn't replace the required Tabular check.
- B. Last year's code may have changed; you code from the edition in effect.
- C. CPT is a different code set.
Rule to review: ICD-10-CM Section I.B.1
Source: FY2026 ICD-10-CM Official Guidelines, Section I.B.1 (p. 12)
Confidentiality and privacy (questions 42–45)
Question 42 of 45
A hospital sends a patient's records to the specialist who is treating the patient. Does HIPAA's minimum necessary standard apply to this disclosure?
Show answer and explanation — CCA-42
Correct answer: A. No; disclosures to a health care provider for treatment are exempt
The minimum necessary standard doesn't apply to disclosures to, or requests by, a health care provider for treatment. Internal uses of PHI are a separate question and still follow role-based limits.
Why not the others
- B. The rule lists treatment disclosures as an exception.
- C. Psychotherapy notes have their own authorization rules; they aren't what this exception is about.
- D. A patient's objection isn't what triggers the standard.
Rule to review: 45 CFR 164.502(b)(2)(i)
Source: 45 CFR 164.502(b)(2)(i); HHS: Minimum Necessary Requirement, exceptions and internal access
Question 43 of 45
A patient asks for access to her medical records. Under HIPAA, how long does the covered entity have to act on the request?
Show answer and explanation — CCA-43
Correct answer: B. 30 days, with one extension of up to 30 days if it is unable to act and gives a written reason and completion date within the first 30 days
The covered entity must act within 30 days of receiving the request. If unable to act in that time, it may take one extension of up to 30 more days by telling the patient in writing, within the first 30 days, the reason for the delay and the date it will complete its action on the request. State law can set a shorter deadline.
Why not the others
- A. Ten days isn't the federal HIPAA standard.
- C. Sixty days is only possible with the one extension, not as the starting deadline.
- D. Ninety days exceeds anything the rule allows.
Rule to review: 45 CFR 164.524(b)(2)
Source: 45 CFR 164.524(b)(2); 45 CFR 160.202, more stringent state-law access rights; 45 CFR 160.203(b), state-law exception to preemption
Question 44 of 45
A covered entity discovers a breach of unsecured protected health information affecting 120 patients. Under HIPAA, assuming no law-enforcement delay under 45 CFR 164.412, what is the outer deadline for notifying the affected individuals?
Show answer and explanation — CCA-44
Correct answer: C. 60 calendar days after discovery
Individuals must be notified without unreasonable delay and in no case later than 60 calendar days after the breach is discovered. Sixty days is a ceiling, not a target.
Why not the others
- A. HIPAA does not set a 10-business-day deadline for notifying affected individuals.
- B. Thirty days is not HIPAA's outer deadline for notifying affected individuals.
- D. This mixes up reporting to HHS for breaches affecting fewer than 500 people with individual notification. HHS reporting is due within 60 days after the end of the calendar year in which the breach was discovered.
Rule to review: 45 CFR 164.404(b); law-enforcement delay under 45 CFR 164.412
Source: 45 CFR 164.404(b); 45 CFR 164.408(c); 45 CFR 164.412
Question 45 of 45
Under the federal information blocking rules (45 CFR Part 171), which of these is an "actor"?
Show answer and explanation — CCA-45
Correct answer: D. A health care provider
The rule defines actors as health care providers, health IT developers of certified health IT, and health information networks or exchanges.
Why not the others
- A. A patient requesting her own records is who the rules protect, not an actor.
- B. A licensing board isn't among the defined actors.
- C. A coding student isn't among the defined actors.
Rule to review: 45 CFR 171.102
Source: 45 CFR 171.102
Using this practice set
Every question has the answer, why the other choices are wrong, and the guideline or rule behind it. Keep your 2026 ICD-10-CM, ICD-10-PCS and CPT books open, because some questions need them, just like the real exam.
Want timed practice? Answer in order, don't look at explanations or go back, and give yourself about 49 minutes. That's an editorial pacing target calculated from 115 minutes × 45 ÷ 105, not an official time allowance for this set.
Score and review your answers
Count your correct first answers out of 45, then fill in how you did in each domain. If you opened an explanation before choosing, mark that item as reviewed and leave it out of your correct count; keep the denominator at 45.
| Domain | Questions | Your correct |
|---|---|---|
| Clinical Classification Systems | 15 (1–15) | |
| Reimbursement Methodologies | 10 (16–25) | |
| Health Records and Data Content | 7 (26–32) | |
| Compliance | 6 (33–38) | |
| Information Technologies | 3 (39–41) | |
| Confidentiality & Privacy | 4 (42–45) | |
| Total | 45 |
Your score describes these 45 practice questions only. It isn't an AHIMA scaled score, and it doesn't predict whether you'll pass. The real exam reports a scaled score from 100 to 400, with 300 passing, and there's no reliable way to convert a practice percentage into that scale. A domain with three or four questions gives limited practice feedback, not a precise readiness measurement.
Here's how to make your misses count:
- Reread the explanation and open the source linked under it.
- Write the rule in your own words.
- Find one more example of that rule in your code book or the source, then retry the question later.
- Treat lucky guesses like misses. If you guessed right, check that you can explain the rule.
A short error log helps you spot patterns. Copy this table and add a row for each miss or guess:
| Question | Why I missed it | Rule or source to review | What I'll do differently |
|---|---|---|---|
| Example: Question 5 (CCA-05) | Coded "suspected pneumonia" at an office visit | ICD-10-CM Section IV.H | Check the setting before applying an uncertain-diagnosis rule |
| Blank error-log row 1 | |||
| Blank error-log row 2 |
If one domain keeps showing up in your log, that's your next study block. It's easy to spend most of your prep on code lookup, but Domains 2 through 6 together make up about two-thirds of the outline.
How the real CCA exam works
| Topic | What AHIMA says |
|---|---|
| Questions | 105: 90 scored and 15 unscored pretest questions, mixed together so you can't tell which is which (AHIMA CCA page) |
| Time | A 2-hour appointment: 5 minutes for the confidentiality agreement, then 1 hour 55 minutes for the instructions and questions. There are no scheduled breaks, and the clock keeps running if you step out (AHIMA certification FAQ) |
| Moving through the exam | One way only. You can't go back to an earlier question, change an answer or flag a question for review (AHIMA CCA page) See the navigation note above for the dated official guidance. |
| Question type | Traditional multiple choice: four options, one correct answer (About AHIMA certification exams) |
| Scoring | Scaled from 100 to 400; 300 passes. There's no penalty for guessing, so answer every question (About AHIMA certification exams) |
| Code books | Open book. For exams on or after May 1, 2026: one 2026 ICD-10-CM book and one 2026 ICD-10-PCS book from AHIMA's approved list, plus the AMA CPT 2026 Professional Edition. Bring the wrong books and you can't test, and you forfeit your fee (2026 required code book list) |
| Where you test | At a Pearson VUE test center. The CCA isn't offered online (Pearson VUE: AHIMA) |
| Fee | $199 for AHIMA members, $299 for non-members; a retake costs the same (AHIMA CCA page) |
| Domains | Clinical Classification Systems 30–34%, Reimbursement Methodologies 21–25%, Health Records and Data Content 13–17%, Compliance 12–16%, Information Technologies 6–10%, Confidentiality & Privacy 6–10% (CCA exam content outline, effective May 1, 2022) |
Because you can't go back, practice committing to an answer and moving on. The pace works out to about 66 seconds per question (115 minutes ÷ 105 questions), and that includes reading the instructions and the time you spend in your books. That's why the Index-then-Tabular habit needs to be automatic before test day.
Your code books can have handwritten notes, but not coding rules copied from other references such as Coding Clinic. Post-it notes, loose pages and handmade tabs aren't allowed (AHIMA Candidate Guide, p. 13). Check your books' ISBNs against AHIMA's list before test day.
Common questions
How hard is the CCA? AHIMA reports a first-time pass rate of 62% in 2025 (2,101 first-time testers), 67% in 2024 (2,490 first-time testers) and 70% in 2023 (2,445 first-time testers) (AHIMA CCA page). These are annual first-time cohorts, not a prediction for an individual candidate. The format adds pressure: you work with three books open and can't revisit an answer.
Are these real CCA questions? No. Castleport Test Prep wrote them from AHIMA's public content outline and the official coding guidelines and federal rules linked under each answer. These are fictional study scenarios, not actual exam questions, and we don't use recalled ones.
What score on this test means I'm ready? This practice set can't establish that. Use it to find the domains and rules you miss, fix those, and keep practicing on fresh questions.
Which code year are the answers based on? The 2026 code sets, matching the books AHIMA requires for exams on or after May 1, 2026. The encounter dates in the coding questions fall in early 2026 for that reason. When AHIMA publishes a new required book list, check which editions apply to your exam date.
Should I guess if I'm stuck? Yes. AHIMA doesn't deduct points for wrong answers, and on the real exam you can't come back later.
If I fail, how soon can I retest? Submit a new application and pay the full fee again. AHIMA requires at least 30 days after an unsuccessful attempt before approving the retake application, and you cannot schedule until a new Authorization to Test letter is issued (AHIMA CCA page).
CCA or CPC? The CCA (AHIMA) covers hospital and physician coding plus records, compliance and privacy topics (CCA content outline). The CPC (AAPC) centers on professional and outpatient coding (AAPC CPC overview). Our medical billing and coding certification comparison lays out the differences.
Keep practicing
- Done with this set and also weighing the CPC? Try the free CPC practice test.
- Comparing credentials before you register? See the medical billing and coding certification comparison.
- Ready to apply? Start from AHIMA's CCA page, and check the 2026 required code book list against your test date.
Sources
Exam facts
- AHIMA: Certified Coding Associate (CCA)
- AHIMA: CCA Exam Content Outline (effective May 1, 2022)
- AHIMA: CCA 2026 Exam Required Code Books (effective May 1, 2026)
- AHIMA: Certification FAQs
- AHIMA: About Certification Exams
- AHIMA: Candidate Guide
- Pearson VUE: AHIMA
Coding and policy references used in the answers
- FY2026 ICD-10-CM Official Guidelines for Coding and Reporting
- CDC/NCHS FY2026 ICD-10-CM Tabular List and Alphabetic Index (official ZIP)
- 2026 ICD-10-PCS Official Guidelines and 2026 ICD-10-PCS Code Tables and Index (official ZIP)
- 2026 Medicare NCCI Policy Manual, Chapter I
- CMS MLN: Evaluation and Management Services Guide (May 2026) and AMA CPT Assistant: E/M time thresholds (October 2024, Table 1)
- CMS MLN: Medicare Payment Systems and MS-DRG Classifications and Software
- CMS MLN claim guides: 837P/CMS-1500 and 837I/CMS-1450
- Medicare Claims Processing Manual, Chapter 30 (ABN), CMS FFS ABN, Chapter 34 (claim correction and reopening) and Medicare Coverage Database
- Medicare Managed Care Manual, Chapters 7 and 8 (risk adjustment) (Transmittal 118, September 2014) and CY 2026 Rate Announcement, Attachment III Section O
- CMS: HCPCS, CMS: ICD-10 codes, CMS: Case Mix Index, AMA: CPT code set release and AMA: the CPT code process
- Hospital Conditions of Participation: 42 CFR 482.22, 42 CFR 482.24, 42 CFR 482.51
- HIPAA and information blocking: 45 CFR 164.502, 164.524, 164.404, 164.408, 164.412, 171.102
- AHIMA/ACDIS: Guidelines for Achieving a Compliant Query Practice (2026 Update)
- AHIMA: Clinical Documentation Improvement Toolkit (2016, pp. 6–7)
- AHIMA Standards of Ethical Coding (2016)
Last verified: October 22, 2026. On that date we checked the exam facts above against AHIMA's CCA page, content outline, FAQ, exam overview page, 2026 code book list and Pearson VUE's AHIMA page. We also checked each answer against the source linked beneath it. AI-assisted tools supported drafting and editing; these were source and editorial checks, not a credentialed professional review. See how we check exam-prep claims.
Castleport Test Prep is an independent exam prep publisher. We are not affiliated with, endorsed by or approved by the American Health Information Management Association (AHIMA) or its Commission on Certification for Health Informatics and Information Management (CCHIIM). Exam and credential names are used to identify their subjects, and trademarks belong to their respective owners. These practice questions are original and unofficial; they aren't actual exam questions.