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

Coding specialist – physician-based professionals perform coding in physician offices, group practices, multi-specialty clinics, or specialty centers. The CCS-P certification exam assesses mastery-level proficiency in coding of health services delivery beyond the hospital setting. 

CCS-Ps: 

  • Review patient records and assign numeric codes for each diagnosis and procedure 
  • Possess in-depth knowledge of the CPT® coding system and familiarity with the ICD-10-CM and HCPCS Level II coding systems 
  • Are experts in health information documentation, data integrity, and quality 
  • Play a critical role in a health provider's business operations, often as liaison to insurance companies or the government for expense reimbursement 

Eligibility Requirements

Candidates must meet one of the following eligibility requirements to sit for the CCS-P examination:  

  • Complete courses in all the following topics: anatomy & physiology, pathophysiology, pharmacology, medical terminology, reimbursement methodology, intermediate/advanced ICD diagnostic coding, and procedural coding and medical services (CPT®/HCPCS)
  • Minimum of two (2) years of related coding experience directly applying codes; or 
  • Hold the CCA® credential plus one (1) year of coding experience directly applying codes; or 
  • Hold a coding credential from another certifying organization plus one (1) year of coding experience directly applying codes; or  
  • Hold a CCS®, RHIT®, or RHIA® credential 

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About the CCS-P Exam

Certified Professionals and Pass Rates 

As of 12/31/19, there were 4,995 certified CCS-P professionals. 

Year 

Exam 

# First Time Testers 

Pass Rate First Time Testers 

2019* 

CCS-P 

357 

64% 

2018* 

CCS-P 

323 

70% 

2017 

CCS-P 

311 

73% 

*U.S. and Canada results only 

Exam Specifications 

The CCS-P is a timed exam. Candidates have four hours to complete the exam. The total number of questions on the exam range between 115 and 140 total items. The exam consists of two sections, a Multiple-Choice Section and a Medical Scenario Section (evaluation and management, surgery, medicine). The exam is given in a computer-based format. 

AHIMA exams contain a variety of questions or item types that require you to use your knowledge, skills, and/or experience to select the best answer. Each exam includes scored questions and pre-test questions randomly distributed throughout the exam. Pre-test questions are NOT counted in the final results. 

The passing score for the CCS-P is set at 300, as are all AHIMA exams and programs. 

Competencies for CCS-P fall into five domains. Each domain accounts for a specific percentage of the total questions on the certification exam. See the Exam Content Outline below for greater detail. 

Certified Coding Specialist – Physician Based (CCS-P) Exam Content Outline (Effective 7/1/20)

Download Exam Content Outline

Tasks: 

  1. Given a scenario, review medical record documentation and accurately assign ICD-10-CM codes based on the documentation
  2. Apply ICD-10-CM conventions and guidelines to accurately code to the highest level of specificity

Tasks: 

  1. Given a scenario, review medical record documentation and accurately assign CPT®/HCPCS codes based on the documentation
  2. Given a scenario, interpret Evaluation & Management (E&M) coding guidelines
  3. Given a definition, assign appropriate modifiers
  4. Apply CPT®/HCPCS guidelines to sequence procedure codes
  5. Apply CPT®/HCPCS manual instructions to select correct code(s)
  6. Apply knowledge of National Correct Coding Initiative (NCCI) edits and guidelines

Tasks: 

  1. Differentiate and apply physician-based coding rules based on federal, state, and third-party guidelines
  2. Determine appropriate primary authoritative source to determine correct coding

Tasks: 

  1. Given a scenario, determine if a query is appropriate based on existing documentation and apply a non-leading, ethical query
  2. Evaluate medical records to determine documentation that is permissible to support code assignment 
  3. Apply ethical coding standards (OIG, CMS, AHIMA, etc.)
  4. Ensure medical record signature requirements are met
  5. Given a scenario, audit medical records for compliance with coding and documentation rules
  6. Apply knowledge of risk adjustment in ICD-10-CM
  7. Demonstrate an understanding of HIPAA privacy and security regulations
  8. Given a scenario, develop and deliver education for providers and ancillary staff
  9. Identify place of service
  10. Given a scenario, ensure incident to billing guidelines are met where applicable

Tasks: 

  1. Apply knowledge of claims development and filing processes
  2. Apply knowledge of insurance response (remittance advice, Explanation of Benefits)
  3. Demonstrate an understanding of Resource Based Relative Value Scale (RBRVS)
  4. Link diagnosis code(s) to procedure code correctly

Mandatory Code Books

On test day, all candidates must bring the correct codebooks to the test center. Candidates who do not have the correct codebooks will not be allowed to test and forfeit their exam fees. The full list of allowable codebooks are can be found in the PDF below.

2020 List of Allowable Code Books

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