Certified Coding Specialist (CCS®)
Coding specialists are skilled in classifying medical data from patient records, often in a hospital setting but also in a variety of other healthcare settings. The CCS credential demonstrates a practitioner's tested skills in data quality and accuracy as well as mastery of coding proficiency.
The CCS certification is a natural progression for professionals experienced in coding inpatient and outpatient records. Coding specialists create coded data used by hospitals and medical providers to obtain reimbursement from insurance companies or government programs such as Medicare and Medicaid. Researchers and public health officials also use this data to monitor patterns and explore new interventions.
CCSs:

  • Review patients’ records and assign numeric codes for each diagnosis and procedure.
  • Possess expertise in the ICD-10-CM and CPT® coding systems.
  • Are versed in medical terminology, disease processes, and pharmacology concepts.

Certified Coding Specialist (CCS) Exam Content Outline (Effective 7/1/2020) Domain 1 – Coding Knowledge and Skills (51.9%) Tasks:

  • Certified Coding Specialist (CCS) Exam
  • Apply diagnosis and procedure codes based on provider's documentation in the health record
  • Determine principal/primary diagnosis and procedure
  • Apply coding conventions/guidelines and regulatory guidance
  • Apply CPT®/HCPCS modifiers to outpatient procedures
  • Sequence diagnoses and procedures
  • Apply present on admission (POA) guidelines
  • Address coding edits
  • Assign reimbursement classifications
  • Abstract pertinent data from health record
  • Recognize major complication/co-morbidity (MCC) and complication and co-morbidity (CC)

Domain 2 – Coding Documentation (10.1%)

  • Tasks:
  • Review health record to assign diagnosis and procedure codes for an encounter
  • Review and address health record discrepancies Domain
  • Provider Queries (8.9%)

Provider Queries (8.9%)

  • Tasks:
  • Determine if a provider query is compliant
  • Analyse current documentation to identify query opportunities Domain

Regulatory Compliance (29.1%)

  • Tasks
  • Ensure integrity of health records
  • Apply payer-specific guidelines
  • Recognize patient safety indicators (PSIs) and hospital-acquired conditions (HACs) based on documentation
  • Ensure compliance with HIPAA guidelines
  • Ensure adherence to AHIMA's Standards of Ethical Coding
  • Apply the Uniform Hospital Discharge Data Set (UHDDS)