The CCS (Certified Coding Specialist) is a medical coding and health-information credential awarded by AHIMA.
AHIMA publishes the official exam outline, eligibility rules and fees — see AHIMA's official page before you book.
Twenty CCS (Certified Coding Specialist) questions, with the answers hidden until you want them — covering Diagnosis Coding, Procedure Coding Outpatient, Compliance, Documentation and more. They are real cards from our 1009-card deck, not the 30 on the free preview page, so you can use both. Work through them cold, then use your score below to decide what to study next. AHIMA publishes the official exam outline — check it for the real blueprint.
20
Questions here
1009
Total CCS cards
$7
Full access
Answer each one before opening it. Keep score as you go.
Pt admitted with acute pyelonephritis and acute cholecystitis. Both conditions are treated with IV antibiotics and surgical consultation. The workup and therapy provided for both are equal. According to 2026 ICD-10-CM guidelines, how is the principal diagnosis selected?
Show answer →Per Guideline II.C, if two or more diagnoses equally meet the criteria for principal diagnosis (based on circumstances of admission, workup, and therapy), and no other sequencing direction exists, any one may be sequenced first. Exam Strategy: AHIMA often tests this by providing two acute conditions that are both aggressively managed. If the documentation doesn't prioritize one, either can be first is the rule. Note: If one was treated significantly more than the other, that one should be PDX.
A patient is admitted with a localized UTI. On day 2, the physician documents Sepsis due to UTI. How should this be sequenced based on the Official Coding Guidelines?
Show answer →When sepsis is not present on admission (POA N) but develops during the encounter, the localized infection (UTI, N39.0) is sequenced as the Principal Diagnosis (PDX). Sepsis (A41.9) is reported as a secondary diagnosis. Exam Strategy: AHIMA tests sequencing heavily. If sepsis is POA, it is usually PDX. If it develops after admission, the reason for admission (localized infection) remains PDX. Common Distractor: Choosing A41.9 as PDX regardless of POA status. Always check the timing of the sepsis documentation relative to admission.
A 2-day-old neonate is diagnosed with sepsis due to Group B Streptococcus. What is the correct code assignment?
Show answer →1. P36.0 (Sepsis of newborn due to group B streptococcus) Rationale: For sepsis of a newborn, codes from category P36 (Newborn sepsis) must be used. These codes include both the sepsis and the causative organism. You do not use A41.x codes for neonatal sepsis. Exam Strategy: AHIMA tests the age-specific nature of coding. P36 codes are for congenital sepsis (present at birth or within the neonatal period). If the sepsis is documented as congenital or neonatal, avoid A41.9. Also, do not add B95.1 as a secondary code because P36.0 is a combination code.
A patient is admitted for treatment of Pneumocystis jirovecii pneumonia (PCP). The physician documents the patient has HIV disease. What is the principal diagnosis and sequencing?
Show answer →PDX: B20 (HIV disease). SDX: B59 (Pneumocystosis). Rationale: Per Guideline I.C.1.a.2.a, when a patient is admitted for an HIV-related condition, B20 is sequenced as the principal diagnosis, followed by additional codes for the manifestations (in this case, PCP). AHIMA Exam Tip: Even if the pneumonia is the acute reason for the admission and the reason for the encounter, the HIV code (B20) must take precedence as the PDX for all HIV-related admissions.
A 15-week pregnant patient is known to be HIV-positive but has never had an AIDS-defining illness. She is admitted for an unrelated acute UTI. Sequence the appropriate codes.
Show answer →1. O23.42 (Unspecified infection of urinary tract in pregnancy, 2nd trimester). 2. O98.712 (HIV disease complicating pregnancy, 2nd trimester). 3. Z21 (Asymptomatic HIV status). Rationale: Chapter 15 codes (Pregnancy) always take sequencing priority. When a pregnant patient has HIV, a code from subcategory O98.7- is mandatory. Because the reason for the visit is an unrelated complication (UTI), that pregnancy code is PDX, followed by the HIV pregnancy code (O98.7-) and the HIV status (Z21). Never sequence Z21 before an O-code.
A 28-week pregnant patient with AIDS-related Kaposi's Sarcoma of the skin is admitted for treatment of the lesion. Sequence the diagnosis codes correctly.
Show answer →1. O98.713 (HIV disease complicating pregnancy, 3rd trimester). 2. B20 (HIV disease). 3. C46.0 (Kaposi's sarcoma of skin). Rationale: Sequencing hierarchy for HIV in pregnancy: 1. Pregnancy complication code (O98.7-). 2. HIV disease code (B20). 3. The specific HIV-related condition (Kaposi's). Guideline I.C.15.a.1 states Chapter 15 codes always have priority. Guideline I.C.1.a.2.g confirms that the HIV manifestation (C46.0) is sequenced after B20.
A patient at 32 weeks gestation is admitted with acute respiratory failure due to COVID-19. What is the correct sequencing of the diagnosis codes?
Show answer →O98.513 (Other viral diseases complicating pregnancy, third trimester) is sequenced first, followed by U07.1 (COVID-19) and J96.01 (Acute respiratory failure with hypoxia). Per Guideline I.C.15.s, Chapter 15 codes take sequencing priority over other codes from the classification. COVID-19 is an exception to the general rule that U07.1 is usually PDX. Clinical Pearl: Always check the trimester; 32 weeks is the third trimester. CCS exams frequently test Chapter 15 sequencing priority.
A patient presents for a follow-up of HTN and DM. The physician notes the patient has stable COPD but does not provide treatment or evaluation for it. How many problems addressed are counted for MDM under 2026 guidelines?
Show answer →Only 2 (HTN and DM). For a problem to be addressed, the physician must evaluate or treat the condition at that encounter. Simply noting a condition in the history or problem list without management or assessment does not count toward MDM complexity. **CCS Tip:** AHIMA often tests the distinction between history and addressed. If the physician writes COPD-stable, continue meds from Pulmonologist, it is addressed. If it's just in the PMH list, it's not.
A physician evaluates a patient with an exacerbation of chronic bronchitis. They decide to continue the current prescription of Prednisone and Albuterol. Does this meet the Prescription Drug Management criteria for Moderate Risk?
Show answer →Yes. Prescription drug management includes the decision to initiate, discontinue, or *continue* a medication. The documentation must show evidence of the physician's evaluation of the drug's effectiveness or side effects. **Clinical Pearl:** The risk is based on the physician's management, not just the patient taking the drug. **CCS Tip:** AHIMA frequently uses continued meds as a distractor; remember that management equals risk, even if no new script is written.
A patient presents for a 99215 visit. The physician spends 65 mins. If the patient is a Medicare beneficiary, how is the prolonged service reported using G2212?
Show answer →Only 99215 is reported. No prolonged service units are billed. Rationale: For Medicare (G2212), the prolonged service code only starts when the *maximum* time of the level 5 code is exceeded by at least 15 minutes. 99215 Max Time = 54 mins. Threshold for G2212 = 54 + 15 = 69 mins. Since 65 < 69, G2212 cannot be billed. CCS Tip: This is a major trap. CPT 99417 (non-Medicare) uses the *minimum* time (40+15=55), while HCPCS G2212 (Medicare) uses the *maximum* time (54+15=69).
A CCS identifies that a colleague is intentionally unbundling CPT codes to bypass NCCI edits for outpatient claims. After discussing it with the colleague, the behavior continues. What is the next ethical step per AHIMA Standards?
Show answer →According to Standard 6, the coder must report unethical practices. The coder should follow the facility's internal compliance reporting hierarchy (e.g., supervisor, then compliance officer). If the issue remains unaddressed and involves fraudulent activity, external reporting may be necessary. Strategy: The CCS exam emphasizes internal first. Always try to resolve issues through the organization's compliance plan before going to outside agencies.
A coder fails to review the October 1st ICD-10-CM/PCS code updates and continues using deleted codes, causing numerous denials. Does this constitute an ethical violation under AHIMA standards?
Show answer →Yes. Standard 4 requires coders to Advance coding knowledge and practice through continuing education. Maintaining professional competence is an ethical obligation. Using outdated codes reflects a failure to maintain the standards of the profession and compromises data integrity. Strategy: Remember that ethics isn't just about not lying; it's also about the duty to be competent and current with annual regulatory changes.
A patient undergoes a complex spinal fusion that begins at 10:00 PM on May 14th and concludes at 3:00 AM on May 15th. Which Date of Service (DOS) should be reported for the surgical procedure code?
Show answer →The Date of Service (DOS) is May 14th. Rationale: For procedures that span across midnight, the date the procedure began is the DOS reported for the CPT or ICD-10-PCS code. This consistency ensures that the surgical service aligns with the anesthesia start time and the preoperative documentation. Clinical Pearl: If a patient has multiple procedures during the same operative session spanning midnight, all codes should typically share the start date of the session. CCS examiners look for your ability to differentiate between the date of service and the date of documentation/completion.
A patient is admitted for a hip fracture (POA: Y) and develops a Stage 3 Pressure Ulcer (POA: N) during the stay. How does the ulcer affect MS-DRG assignment?
Show answer →Stage 3 and 4 pressure ulcers are Hospital-Acquired Conditions (HAC). If the condition is not Present on Admission (POA: N), it is excluded from acting as an MCC or CC for MS-DRG assignment. The case will be paid as if the MCC/CC were not present. This prevents increased payment for complications occurring in-hospital. CCS Tip: Always verify POA status; a Y would allow the CC/MCC to count, while N or U for a HAC-listed code will not.
Under what specific circumstances can a Yes/No query format be used compliantly in the 2026 coding environment?
Show answer →Yes/No queries are restricted to: 1) Clarifying Present on Admission (POA) status, 2) Resolving conflicting documentation (e.g., two different specialists), 3) Clarifying a due to link between documented conditions, and 4) Confirming a diagnosis already mentioned in the record but lacks specificity. Rationale: Yes/No queries cannot be used to introduce a brand-new diagnosis. CCS Tip: AHIMA often tests the linkage rule—Yes/No is perfect for Is the anemia due to the CKD? but not for Does the patient have Acute Blood Loss Anemia? if not already stated.
A surgeon performs an ultrasound-guided needle aspiration of a symptomatic cyst in the right lobe of the liver. What is the root operation for this procedure?
Show answer →Root Operation: Drainage (9). Rationale: Aspiration of a cyst involves the removal of fluid (contents) from a body part or a localized area. Per ICD-10-PCS guidelines, Drainage is the appropriate root operation for both diagnostic and therapeutic aspirations of fluids. Tip: The approach would be Percutaneous (3) and the qualifier would be Diagnostic (X) if a sample is sent for pathology. Always look for the qualifier X in the 7th character for biopsies performed via drainage.
A sentinel lymph node biopsy is performed where one specific axillary lymph node is entirely removed for pathological examination. Root operation?
Show answer →The correct root operation is Resection (T) with Qualifier Diagnostic (X). Rationale: In ICD-10-PCS, individual lymph nodes are considered distinct body parts. If an entire lymph node is removed, the root operation is Resection. If only a portion of a node were taken, it would be Excision. Clinical Coding Tip: For biopsies, ICD-10-PCS Guideline B3.4a states that Diagnostic (Qualifier X) is used for Excision, Extraction, or Drainage procedures that are biopsies. However, for a Resection, no Diagnostic qualifier is used (the qualifier is 'No Qualifier' or 'Z'). Correction: Per PCS tables, Resection does NOT have a diagnostic qualifier. You simply code Resection of the specific lymph node.
A patient undergoes a complex procedure involving three different CPT codes: 00840, 00880, and 00940. How should the coder report the base units for this anesthesia session?
Show answer →For multiple procedures performed during a single anesthesia session, report ONLY the anesthesia code with the highest base unit value. Do NOT sum the base units of all procedures. Total time for all procedures is reported under that single code. Clinical Pearl: This mirrors the highest value rule in CPT. Exception: Add-on codes (like +01968) are reported in addition to the primary code. CCS Tip: Watch for distractors that suggest adding base units together; this is a common trap on the exam.
PSI 12 (Perioperative Pulmonary Embolism or Deep Vein Thrombosis) is part of the HAC PSI 90 composite. Which of the following is a RECENT exclusion for this measure in the 2026 guidelines?
Show answer →Exclusions include patients with a principal diagnosis of PE or DVT, or cases where the PE/DVT was present on admission (POA Y). Hard Detail: Also excluded are patients who did not undergo a major operating room procedure (since it is a perioperative measure) and patients with certain hypercoagulable states or specific trauma. CCS Tip: AHIMA often tests exclusions. If a patient is admitted *for* a DVT (Principal Dx), they cannot be flagged for PSI 12, even if they have surgery and the DVT persists.
A patient is admitted for a thoracentesis to treat a malignant pleural effusion. The patient has known stage IV breast cancer with metastases to the pleura. What is the correct sequencing for the principal diagnosis?
Show answer →The Malignant Pleural Effusion (J91.10) is coded first, followed by the secondary neoplasm of the pleura (C78.2) and the primary breast cancer (C50.919). Rationale: Per ICD-10-CM Guideline I.C.2.c.1, when the treatment is directed toward the secondary site, the secondary site is designated as the principal diagnosis. However, for pleural effusion, the code for the effusion itself is listed first when it is the reason for the encounter, followed by the malignancy. AHIMA Distractor: Do not code the primary cancer first if the focus is purely the secondary site or its complications.
17–20 correct
Strong. Move to the hardest material and timed drilling rather than re-reading topics you already know.
12–16 correct
A normal mid-prep score. Work the topics you missed one at a time — the topic pages below are built for exactly that.
Under 12 correct
Early days. Go topic by topic instead of taking more mixed tests: pick your weakest area below and drill it until the questions feel routine.
Diagnosis Coding questions
Free CCS practice on this topic →
Procedure Coding Outpatient questions
Free CCS practice on this topic →
Compliance questions
Free CCS practice on this topic →
Documentation questions
Free CCS practice on this topic →
Reimbursement questions
Free CCS practice on this topic →
Provider Queries questions
Free CCS practice on this topic →
Procedure Coding Inpatient questions
Free CCS practice on this topic →
Procedure Coding questions
Free CCS practice on this topic →
CPT Anesthesia questions
Free CCS practice on this topic →
Liked the free cards?
Try free first. Pay once only if it helps you study.
One-time payment · less than 1¢ per card · 30-day money-back guarantee
Try 30 free CCS cards firstIt is 20 real question-and-answer cards from our 1009-card CCS deck, mixed across topics so it feels like the breadth of the exam. It is not the official AHIMA exam and is not endorsed by AHIMA — for the official outline and any official practice material, go to AHIMA directly.
Use the bands on this page as study guidance, not as a pass mark: we do not publish a passing score for the CCS because AHIMA sets it, and it can change. Confirm the current standard in the official handbook.
No — deliberately. The 30 cards on the free CCS preview page and these 20 questions do not overlap, so you get 50 free questions across the two pages.
A one-time $7 for all 1009 cards — no subscription, lifetime access, and a 30-day money-back guarantee if it does not help.
Eligibility rules, fees, question counts and passing standards are set by the certifying body and change over time. Always confirm them at the source before you apply or schedule your exam — our flashcards are practice material, not the official handbook.