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CCS-P Competency Statements and Exam Specifications

Certified Coding Specialist--Physician-based (CCS-P)

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	2	8	2	10
Interpret health record documentation to identify diagnoses and conditions for code assignment Interpret health record documentation to identify procedures or services for code assignment Determine if sufficient clinical information is available to assign one or more diagnosis codes Determine if sufficient clinical information is available to assign one or more procedure or service codes Consult with physicians or other healthcare providers when additional information is needed for coding and/or to clarify conflicting or ambiguous information Consult reference materials to facilitate code assignment Identify the etiology and manifestation(s) of clinical conditions
II. CODING	5	7	13	25
Assign ICD-9-CM code by applying "Diagnostic Coding and Reporting Guidelines for Outpatient Services (Hospital-Based and Physician Office)" Interpret ICD-9-CM conventions, formats, instructional notations, tables, and definitions to select diagnoses, conditions, problems, or other reasons for the encounter that require coding Interpret CPT and HCPCS II guidelines, format, and instructional notes to select services, procedures, and supplies that require coding Assign CPT code(s) for procedures and/or services rendered during the encounter Assign codes to identify Evaluation and Management (E/M) services Recognize if an unlisted code must be assigned Exclude from coding, those procedures that are component parts of another reported procedure code Code for the professional vs. technical component when applicable Assign HCPCS II codes Append modifiers to procedure or service codes when applicable
III. REIMBURSEMENT METHODS AND REGULATORY GUIDELINES	2	8	2	12
Apply global surgical package concept to surgical procedures Apply bundling and unbundling guidelines (e.g., National Correct Coding Initiative [NCCI]) Interpret health record documentation to identify diagnoses and conditions for code assignment Apply reimbursement methods for billing or reporting (e.g., OIG, CMS (HCFA), Federal Register) Link diagnosis code to the associated procedure code for billing or reporting Evaluate payer remittance or payment (e.g., EOB, EOMB) reports for reimbursement and/or denials Interpret Local Medical Review Policies (LMRP) or payer policies to determine coverage Process claim denials and/or appeals
IV. DATA QUALITY	2	8	3	13
Validate assigned diagnosis and procedure codes supported by health record documentation Validate assigned Evaluation and Management codes based on health record documentation using the E/M guidelines Assess the quality of coding and billing using routinely generated reports Verify that the data on the claim form correctly reflect the services provided Verify that the data on the claim form correctly reflect the conditions managed or treated during the encounter Validate the accuracy of the required data elements on the claim form Conduct coding and billing audits for compliance and trending Determine educational needs for physicians and staff on reimbursement and documentation rules and regulations related to coding Participate in the development of coding and billing policies and procedures for reporting professional services Evaluate payer remittance or payment (e.g., EOB, EOMB) reports for data quality
TOTALS	11	29	20	60

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