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CCS Competency and Exam Specifications

Certified Coding Specialist (CCS)

 
Competency Statements

A certification examination is based on an explicit set of competencies. These competencies were determined by job analysis surveys of hospital-based coders (for the CCS exam) and physician-based coders (for the CCS-P exam). The competencies are subdivided into domains, subdomains, and tasks as shown in the tables below. Examinations test only content pertaining to the following competencies.

 
Number of Questions
 
RE
AP
AN
Total
I. HEALTH INFORMATION DOCUMENTATION
3
5
0
8
  1. Interpret health record documentation using knowledge of anatomy, physiology, clinical disease processes, pharmacology, and medical terminology to identify codeable diagnoses and/or procedures
  2. Determine when additional clinical information is needed to assign the diagnosis and/or procedure code(s)
  3. Consult with physicians and other healthcare providers to obtain further clinical information to assist with code assignment
  4. Consult reference materials to facilitate code assignment
  5. Identify patient encounter type to assign codes (e.g., inpatient versus outpatient)
  6. Identify the etiology and manifestation(s) of clinical conditions
 
 
 
 
II. DIAGNOSTIC CODING GUIDELINES
5
7
0
12
  1. Select the diagnoses that require coding according to current coding and reporting requirements for inpatient services
  2. Select the diagnoses that require coding according to current coding and reporting requirements for hospital-based outpatient services
  3. Interpret conventions, formats, instructional notations, tables, and definitions of the classification system to select diagnoses, conditions, problems, or other reasons for the encounter that require coding
  4. Sequence diagnoses and other reasons for encounter according to notations and conventions of the classification system and standard data set definitions [e.g., Uniform Hospital Discharge Data Set (UHDDS)]
  5. Determine if signs, symptoms, or manifestations require separate code assignments
  6. Determine if the diagnostic statement provided by the healthcare provider does not allow for more specific code assignment (e.g., fourth or fifth digit)
  7. Recognize when the classification system does not provide a precise code for the condition documented (e.g., residual categories and/or non-classified syndromes)
  8. Assign supplementary code(s) to indicate reasons for the healthcare encounter other than illness or injury
  9. Assign supplementary code(s) to indicate factors other than illness or injury that influence the patient’s health status
  10. Assign supplementary code(s) to indicate the external cause of an injury, adverse effect, or poisoning
 
 
 
 
III. PROCEDURAL CODING GUIDELINES
5
7
0
12
  1. Select the procedures that require coding according to current coding and reporting requirements for inpatient services
  2. Select the procedures that require coding according to current coding and reporting requirements for hospital-based outpatient services
  3. Interpret conventions, formats, instructional notations, and definitions of the classification system and/or nomenclature to select procedures/services that require coding
  4. Sequence procedures according to notations and conventions of the classification system/nomenclature and standard data set definitions (e.g., UHDDS)
  5. Determine if more than one code is necessary to fully describe the procedure/service performed
  6. Determine if the procedural statement provided by the healthcare provider does not allow for a more specific code assignment
  7. Recognize when the classification system/nomenclature does not provide a precise code for the procedure/service
 
 
 
 
IV. REGULATORY GUIDELINES AND REPORTING REQUIREMENTS FOR INPATIENT HOSPITALIZATIONS
2
2
6
10
  1. Select the principal diagnosis, principal procedure, complications and comorbid conditions and other significant procedures that require coding according to UHDDS definitions and official coding guidelines
  2. Evaluate the effect of code selection on Diagnosis Related Group (DRG) assignment
  3. Verify DRG assignment based on Prospective Payment System (PPS) definitions
 
 
 
 
V. REGULATORY GUIDELINES AND REPORTING REQUIREMENTS FOR HOSPITAL-BASED OUTPATIENT SERVICES
2
6
2
10
  1. Apply guidelines for bundling and unbundling of codes
  2. Apply outpatient PPS reporting requirements:
    1. Modifiers
    2. CPT versus HCPCS II
    3. Medical necessity (i.e., linking diagnosis to procedure/service)
    4. Evaluation and Management code assignment
  3. Select the reason for encounter, pertinent secondary conditions, primary procedure and other significant procedures that require coding
  4. Verify APC assignment based on OPPS definitions
 
 
 
 
VI. DATA QUALITY
1
1
3
5
  1. Assess the quality of coding from an array of data (e.g.,reports)
  2. Educate physicians and staff regarding reimbursement methodologies and documentation rules and regulations related to coding
  3. Participate in the development of institutional coding policies to ensure compliance with official coding rules and guidelines
  4. Analyze health record documentation for quality and completeness of coding (e.g., inclusion or exclusion of codes)
  5. Review health record documentation to substantiate claims processing and appeals (e.g., codes, discharge disposition, patient type, charge codes)
  6. Analyze edits from the Correct Coding Initiative (CCI) and Outpatient Code Editor (OCE)
 
 
 
 
VII. DATA MANAGEMENT
1
2
0
3
  1. Manage accounts (e.g., unbilled, denied, suspended)
  2. Recognize UB-92 data elements
  3. Identify Charge Description Master (CDM) issues (e.g., revenue codes, units of service, CPT/HCPCS, text descriptions, modifiers)
  4. Identify accounts subject to the 72-hour rule
  5. Identify hospital-based outpatient accounts subject to the “to/from” dates of service edits
  6. Identify cases needed for health record reviews (e.g., committee, clinical pertinence, research)
  7. Analyze case mix index data
 
 
 
 
TOTAL
 
 
 
60



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