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How to Balance CCS Exam Prep With ICD-10 Training

As frequent commentators, bloggers, educators, and consultants on various HIM topics, Pamela J. Haney, MS, RHIA, CCS, CIC, COC, and Mary Beth York, CCS, CCS-P, CIC, share their unique perspective.

Q: Many coding training programs are bundling ICD-9-CM coding training with ICD-10 preparation. Do you feel this is an effective approach?

York: I believe that bundling ICD-9-CM coding training with ICD-10 is too confusing for a new coder to try to learn both classification systems simultaneously. I compare it to learning French and Italian at the same time. The conventions of both classifications are basically the same; however, there are a few differences. The level of detail is higher with ICD-10-CM. Once you understand the ICD-9-CM classification system it will be easier to transition to ICD-10-CM.

Q: What about procedure coding?

Haney: ICD-10-PCS is very different from ICD-9-CM procedure coding and the transition is not as easy. I would not recommend new coders tackling ICD-10-PCS initially. I recommend concentrating on ICD-9-CM and the AMA CPT code set. New coders, generally speaking, start as an outpatient coder. ICD-9-CM and the AMA CPT code set are the foundation of hospital outpatient coding.

Q: And CPT? Is it changing also?

York: CPT coding is not changing, nor going away. Demonstration of a strong foundational knowledge in ICD-9-CM and the AMA CPT code set will better position a new coder in the current job market. Strong foundational knowledge of the ICD-9-CM classification system will ease the transition to ICD-10-CM.

Q: According to the AHIMA website, the CCS Exam will continue testing in ICD-9-CM until the ICD-10 coding classification system is officially implemented (scheduled for October 1). What would you recommend?

York: If you are a skilled ICD-9 coder, take advantage of this delay to earn your CCS credential now. However, I do not recommend preparing for the CCS exam at the same time you are learning the ICD-10 code set.

Haney: The CCS credential demonstrates your acute hospital inpatient and outpatient coding skills at a mastery level, and as such, it is a difficult exam to pass successfully.

Q: The CCS exam is known to be a difficult exam to pass. How do you recommend approaching preparation?

York: The CCS certification exam is not designed to trick you; it is designed to test your ability to recall, analyze, and apply the Coding Guidelines to either a multiple-choice question or a case scenario. I do not recommend preparing for the CCS exam at the same time you are learning the ICD-10 code set.

Haney: You will be successful if you are proficient in anatomy and physiology, pathophysiology, pharmacology, medical terminology, and reimbursement methodology. It is also imperative that you A) possess a minimum of two years of acute hospital experience or hold a current credential such as RHIA, RHIT, CCS-P, CCA, or B) have another coding credential from a certifying organization with a minimum of one year of experience coding acute hospital inpatient medical records.

Q: What does successful CCS preparation entail?

Haney: Successful preparation is twofold, as you must:
1. Know the coding guidelines.
2. Know how to use the ICD-9 coding manual skillfully.

York: Sounds simple, but it is a lot of work! Having prepared hundreds of students to take and pass the CCS exam, I have identified the key attributes of a successful CCS exam study plan. Make the most of the time you have to prepare for the exam by following these suggestions:

• Allow eight to 13 weeks for preparation.

• Don’t go it alone. Studying with a buddy and/or group will keep you focused and on track.

• Read the AHIMA Candidate Handbook, which provides specific details of the exam content.

• Study using the ICD-9-CM coding book and not an encoder. The exam is based on your ability to use the book skillfully.

• Read and understand the ICD-9-CM Official Guidelines for Coding and Reporting.

• Review Coding Clinic for ICD-9-CM and AMA’s CPT Assistant. Issues that arise in these publications often appear on the test.

Q: While preparing for the CCS, many candidates are overwhelmed by the sheer size of the exam. What techniques do you recommend to your CCS Exam prep students to help make the exam manageable?

York: It is simply a matter of being very prepared and having a plan of approach. During the exam, follow the basic coding steps for each and every diagnosis and/or procedure:

1. Locate the main term in the ICD-9 index.
2. Identify nonessential modifiers.
3. Review all sub terms.
4. Follow all index instructions.
5. Review selected code in the tabular.
6. Follow all tabular instructions; they can be found at the code, at the three- or two-digit category, and at the beginning of the section or chapter.
7. Assign fifth digits as appropriate.
8. Assign the code.

Failure to follow these steps can and will result in the incorrect code assignment.

Q: At the end of the day, is all the effort to achieve a CCS credential worth it?

York: Having taught several classes and coached many individuals to get their CCS, I have found that preparation is essential and time consuming. But just think—once you pass the CCS exam you will never have to take it again. And a CCS next to your name distinguishes you as a top-level medical coder.

Pamela J. Haney, MS, RHIA, CCS, CIC, COC, is an experienced educator, an AHIMA-approved ICD-10 trainer, and has more than 30 years’ experience as a director of HIM and coding services. She is director of training and education for Libman Education, which offers online and instructor-led courses, including its CCS Exam Prep and online CCA Exam Prep courses.

Mary Beth York, CCS, CCS-P, CIC, has more than 20 years of experience in coding, auditing, and documentation for hospitals ranging from community to teaching hospitals, as well as physician group practices. She teaches Libman Education’s CCS Exam Prep course.