I. Examination Study Strategies and Resources

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3 Professional Review Guide for the CCS Examination, 2012 Edition Patricia J. Schnering, RHIA, CCS Toni Cade, MBA, RHIA, CCS, FAHIMA Lisa M. Delhomme, MHA, RHIA Lauralyn Kavanaugh-Burke, DrPH, RHIA, CHES Vice President, Editorial: Dave Garza Director of Learning Solutions: Matthew Kane Managing Editor: Marah Bellegarde Executive Editor: Rhonda Dearborn Product Manager: Amy Wetsel Editorial Assistant Lauren Whalen Vice President, Marketing: Jennifer McAvey Executive Marketing Manager: Wendy Mapstone Senior Marketing Manager: Nancy Bradshaw Marketing Coordinator: Piper Huntington Production Manager: Andrew Crouth Senior Content Project Manager: Kenneth McGrath Senior Art Director: Jack Pendleton 2013 Delmar, Cengage Learning ALL RIGHTS RESERVED. No part of this work covered by the copyright herein may be reproduced, transmitted, stored, or used in any form or by any means graphic, electronic, or mechanical, including but not limited to photocopying, recording, scanning, digitizing, taping, Web distribution, information networks, or information storage and retrieval systems, except as permitted under Section 107 or 108 of the 1976 United States Copyright Act, without the prior written permission of the publisher. CPT copyright 2011 American Medical Association. All rights reserved. Applicable FARS/DFARS Restrictions apply to Government Use. Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein. For product information and technology assistance, contact us at Cengage Learning Customer & Sales Support, For permission to use material from this text or product, submit all requests online at Further permissions questions can be ed to Library of Congress Control Number: ISBN 10: ISBN 13: Delmar Executive Woods 5 Maxwell Drive Clifton Park, NY USA Cengage Learning products are represented in Canada by Nelson Education, Ltd. For your course and learning solutions, visit delmar.cengage.com Purchase any of our products at your local college store or visit our corporate website at cengage.com Notice to the Reader Publisher does not warrant or guarantee any of the products described herein or perform any independent analysis in connection with any of the product information contained herein. Publisher does not assume, and expressly disclaims, any obligation to obtain and include information other than that provided to it by the manufacturer. The reader is expressly warned to consider and adopt all safety precautions that might be indicated by the activities described herein and to avoid all potential hazards. By following the instructions contained herein, the reader willingly assumes all risks in connection with such instructions. The publisher makes no representations or warranties of any kind, including but not limited to, the warranties of fitness for particular purpose or merchantability, nor are any such representations implied with respect to the material set forth herein, and the publisher takes no responsibility with respect to such material. The publisher shall not be liable for any special, consequential, or exemplary damages resulting, in whole or part, from the reader's use of, or reliance upon, this material. Printed in United States of America

4 I. Examination Study Strategies and Resources Patricia J. Schnering, RHIA, CCS

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6 FORMAT OF THE EXAMINATION Examination Study Strategies and Resources 3 The examination questions and cases developed for the examinations are based on specifications currently referred to as domains and task statements. A complete copy of these entry-level specifications is provided in the AHIMA Candidate Handbook. The handbook and additional information on the examination are available for downloading in PDF format on the AHIMA Web site ( The examination consists of three sections. Although the exam is one continuous test with a time limit of 4 hours for completion, each section must be completed before moving to the next section. Section 1 of the Examination consists of 81 multiple-choice coding questions. These require that only one answer per question is accepted. Of the 81 multiple-choice questions 60 are scored and 21 are unscored. Section 2 of the Examination consists of 8 multiple-response items (6 scored and 2 unscored). These multiple-response questions require more than one answer per question. There will be directions giving the number of answers needed for each question. (Example: Choose 3 of the 5 responses.) Section 3 of the Examination consists of 12 coding cases covering inpatient and outpatient services. There will be 6 outpatient cases and 6 inpatient cases. As explained in the introduction, the cases will contain the exact number of boxes needed to provide codes for entering on the computer screen. The general format of the exam is primarily designed to engage your problem-solving and critical thinking skills. These types of questions require you to translate what you have learned and apply it to a situation. There are sample questions and cases provided on the AHIMA Web site ( so that you can experience the testing situation. How to Use This Book We suggest you answer the multiple-choice questions and code the case studies in the review section of the book before taking the mock examination. It will give you a baseline to begin your CCS Examination preparation. Your strengths and weaknesses will become more apparent, allowing you to plan your study time more effectively and focus on your problem areas. After working through the review questions and case studies in the book, take the mock examination. It will provide you an opportunity to assess your speed in answering multiple-choice questions and in coding cases.

7 4 Chapter I STUDY STRATEGIES Theoretically, material learned thoroughly after one study session will fade predictably with time. After one day, the average person retains only 80% of what was learned. Ultimately, he or she will remember about 30% of the material originally learned. That is why you are relearning information that you acquired over a period of years. Your aim is to achieve maximum recall through effective review. BEGIN BY BUILDING YOUR STUDY STRATEGIES First, develop your individual study program Write the exam topics and subjects in a list. Outline the chapters in your coding textbooks, and review the sections in your code books. Pinpoint your weakest subjects. Pause at each chapter outline and recall basic points. Do you draw a blank, recall them more or less, or do you feel comfortable with your recall? By using this approach, you can see where you stand. Then, weigh the importance of each subject How are the topics emphasized in the examination competencies, textbooks, professional journal articles, coding guidelines, and coding books? Take a look at the top MS-DRGs and APCs. Try to pick out concepts that would make good examination questions. Personalize your list of the topics in the order that you plan to study them Avoid trying to make a head-on attack by giving equal time and attention to all topics. Reorganize your list of the topics in the order that you plan to study them. Use the outline you have made to identify your weakest topics. Determine which topics you believe will require a significant amount of study time and which will only require a brief review. Your list will give you a clear mental picture of what you need to do and will keep you on track. Some experts suggest that you begin your plan with your strongest topics and concentrate on your weaknesses as you get closer to your exam date. That way they will be fresh in your mind. Use your list: Your list will give you a clear mental picture of what you need to learn and will keep you on track. There are three additional advantages to a list. 1. It builds your morale as you steadily cross off items that you have completed as you monitor your progress. 2. Glancing back at the list from time to time serves to reassure you that you are on target. 3. You can readily see that you are applying your time and effort where they are most needed. Keep the list conspicuously in view. Carefully plan your pre-exam study time and stick to your plan. Go to the exam like a trained and disciplined runner going to a marathon event! Design a 10-week study program: Make your study process a systematic review of all topic categories, followed by achieving mastery of strategically selected subjects within the topic categories. To facilitate this effort, we recommend that you design a 10-week study program. You should plan on spending an average of 10 to 12 hours per week studying. The idea is to study smart, not to bulldoze through tons of material in a haphazard way. Schedule study time: You have to be deliberate about making sure that you develop and stick to a regular study routine. Find a place where you can study, either at home or at the library. How you schedule your study time during the week is an individual decision. However, we recommend that you avoid all-nighters and other unreasonably long study sessions. The last thing you want to do is burn yourself out by working too long and too hard at one time. Try to do a little bit at a time, and maintain a steady pace that is manageable for you.

8 Examination Study Strategies and Resources 5 Consider a study group: Everyone has his or her own particular study style. Some people prefer to study alone; others work best in a group. Regardless of your preference, we strongly recommend that you take advantage of group study at least some of the time. Studying with others can prove very helpful when working through your weakest areas. Each member of the study team will bring strengths and weaknesses to the table, and all can benefit from the collaboration. So, even if you are a solitary learner, you may occasionally want to work with a group for those topics you find more challenging. If you do not have easy access to a study group for the examination, you may want to study with other HIM professionals over the Internet. The AHIMA Communities of Practice (CoP) on the Internet is an excellent avenue to find others who are in the same position. Increase your endurance: Preparing for a major exam is similar to preparing for a marathon athletic event. Know the time allotted for your certification examination. Then, use your study process to slowly build up your concentration time until you can focus your energy for the appropriate period of time. This is like the runner who begins jogging for 30 minutes and builds up to 1 hour, then 1½ hours, and so on, and gradually increases the endurance time to meet the demands of the race. Try this strategy; it could work for you! Go to the exam like a trained and disciplined runner going to a marathon event! Sample Study Schedule Week 1 Week 2 Week 3 Use your references to review for the concepts in domains I, VI, VII, and VIII of the competencies for the CCS exam. Domain I: Health Information Documentation Domain VI: Data Quality and Management Domain VII: Information and Communication Technologies Domain VIII: Privacy, Confidentiality, Legal and Ethical Issues Answer the questions in the Health Data Content and Structure Chapter in this book. Use your references to review for clinical vocabularies and terminologies and for pathophysiology including anatomy and physiology, pharmacology, and laboratory testing. These questions fall into domain I. Answer the questions in the Medical Science chapter. Use your references to review for tasks in domains II, III, IV, V, and IX. Domain II: Diagnosis Coding Domain III: Procedure Coding Domain IV: Regulatory Guidelines and Reporting Requirements for Acute Care (Inpatient) Services Domain V: Regulatory Guidelines and Reporting Requirements for Outpatient Services Domain IX: Compliance Study the Coding Review section on ICD-9-CM and CPT coding concepts in this book. Answer the questions in the Billing and Reimbursement chapter. Answer the questions in the Classification and Secondary Data Sources chapter. Gather and review references for competencies in domain II and domain IV. Reference examples include: ICD-9-CM Coding Book Volumes 1 3 Coding conventions (These can be found in the front of the ICD-9-CM code book.) ICD-9-CM Coding Guidelines (Check for the current one at ICD-9-CM Coding Clinics (published by AHA) Professional Journals (e.g. Journal of AHIMA)

9 6 Chapter I Study the Coding Review section on ICD-9-CM coding in this book. Answer the questions in the ICD-9-CM Coding chapter. Week 4 Gather and review references for domain II and domain V. Review the references on the CPT Coding rules. Review the references on the CPT Evaluation and Management Guidelines. Review Documentation Guidelines for Evaluation and Management Services, CPT Assistant (May 1997) as well as information in other CPT Assistant issues. Review the references on the CPT Surgery section and remaining CPT sections, including using modifiers. Use this review guide by studying the Coding Review section (outpatient coding concepts). Answer the questions in the CPT Coding chapter of this review guide. Week 5 & Week 6 Week 7 & Week 8 Week 9 & Week 10 Work the case studies provided in the book. Continue working on the case studies. Continue your review of ICD-9-CM and CPT materials. Answer the questions in the Mock Examinations for Section 1 and Section 2 of the CCS examination. Work the Mock Examination Cases for Section 3 of the CCS examination. Use your references to continue your review of ICD-9-CM and CPT materials. Do an overall coding review and look over areas of weakness for a final review.

10 STUDY RESOURCES Examination Study Strategies and Resources 7 Don t spend time trying to memorize something you do not understand. The main issue is to understand the materials so that you can use the knowledge in a practical way. Search for additional information that will help make the subject clearer to you. There are four basic sources of information: books, people, educational programs/colleges, and Internet resources. Books and other written resources A different textbook may use another style of presentation that you are more receptive to and may be all you need to gain a better insight into the subject. It can offer a fresh point of view, provide relief from boredom, and encourage critical thinking in the process of comparing the texts. There are a variety of books and workbooks available to use in studying for your coding certification. Periodical literature in the field provides well-written articles that may open up the subject to you and turn your study into an adventure in learning. AHIMA publishes authoritative and insightful information on every aspect of coding. In addition to the ongoing coding articles in the Journal of AHIMA, Advance for Health Information Professionals has a special series of articles called CCS Prep! The magazine, For the Record, has articles on coding in each issue. Sometimes an article can help put the subject material into practical perspective and pull it together so that you gain a deeper understanding. Don t forget to use the Coding Clinics and CPT Assistant to refresh your memory and learn more about specific coding guidelines. All of these publications will help you keep updated on new information on coding issues that may be incorporated into the exams. Take advantage of the local college library by using reserved materials specifically set aside for HIM student study purposes. Your HIM community Interaction with others can be truly beneficial in keeping you motivated and on track. Professional contacts can also be helpful in your study effort. Most people in our field are eager to share their knowledge and are flattered by appeals for information. Schedule a conference with the director of the HIM/Coding program at your local college or university. These educators may have current information and resources you are not aware of. Talking to those who have recently taken the examination can also be of great assistance. Collaboration with other test applicants can reveal fresh viewpoints, stimulate thought by disagreement, or at least let you see that you are not alone in your quest. Organize study groups, and set aside specific times to work together. This interaction can be truly beneficial in keeping you motivated and on task. Classes, workshops, and seminars and coding teleconferences Classes, workshops, seminars, and coding teleconferences can present opportunities to learn and review the subject matter in a new light and keep you updated on changes. Take advantage of any coding review sessions available in your area. Internet resources In this dynamic, changing environment, the most up-to-date materials may not be available in a book. Do not overlook the power of AHIMA s Web site. The AHIMA resources online are extensive and quite easy to access at In addition, the Communities of Practice (CoPs) are a phenomenal source of contact with HIM professionals and other students preparing for the examination on a myriad of subjects. AHIMA is available online for members. You may find other examination applicants to work with by using . There are innumerable resources for coding and reimbursement on the Internet. Just be aware that you may want to verify the information as it is only as good as the source.

11 8 Chapter I Some Suggested Study Resources Include: 1. MANDATORY: AHIMA Candidate Handbook for the CCS Examination 2. MANDATORY: ICD-9-CM Code Book (refer to instructions from AHIMA for the appropriate version) 3. MANDATORY: Official ICD-9-CM Guidelines for Coding and Reporting is available online at or 4. Coding Clinic for ICD-9-CM (past issues from the last 3 to 4 years) 5. MANDATORY: AMA CPT Code Book (refer to instructions from AHIMA for the appropriate version) 6. HCPCS Level II Code Book (refer to instructions from AHIMA for the appropriate version) 7. Documentation Guidelines for Evaluation and Management Services, CPT Assistant (May 1997) as well as information in other CPT Assistant issues 8. Professional journal articles on coding Journal of AHIMA Advance for Health Information Professionals For the Record 9. Medical dictionaries (Check for latest edition.) 10. Coding class, seminar, and workshop notes and tests 11. Study groups/partners 12. On-the-job experience 13. Examination review sessions 14. Review books written for the CCS examinations 15. Various online resources. For online coding practice sites as well as those for information and Internet interaction with others, visit the following examples: MANDATORY: MANDATORY: HIM textbooks and Class textbooks: There is a large variety of textbooks for HIM and coding available on the market. Both Cengage Delmar Learning ( and AHIMA ( have a variety of HIM products. For example, see the partial listing of books available through Delmar Cengage Learning. Those resources marked MANDATORY are essential for you to have in order to prepare for the examination.

12 Examination Study Strategies and Resources 9 Contact Information for Resources for CCS Examination Review Studies ICD-9-CM Code Book with October 2011 updates INGENIX, 5032 W. Amelia Earhart Drive; Salt Lake City, UT 84116; Phone: (800) Official ICD-9-CM Guidelines for Coding and Reporting Central Office on ICD-9-CM of the American Hospital Association (AHA) Phone: (312) or it can be accessed online at the Web site for National Center for Health Statistics (NCHS): Coding Clinic for ICD-9-CM American Hospital Association Phone: (312) CPT Code Book 2012 American Medical Association (AMA) Phone: (800) ; Fax: (312) HCPCS II, Code Book 2012 Edition American Medical Association Phone: (800) AMA CPT Assistant American Medical Association Phone: (800) ; Fax: (312) Documentation Guidelines for E & M Coding Published May 1995 and revised November 1997 by American Medical Association (AMA) and Centers for Medicare and Medicaid Services (CMS). Printed in the CPT Assistant May 1997 and November Online at Centers for Medicare and Medicaid Services: AHIMA has developed a series of HIM and coding resources. To place an order: call (800) For additional resources and information about the coding certification examinations, visit the AHIMA Web site at Ingenix (now called OptumInsight) has an array of coding, reimbursement, and compliance products. Phone: INGENIX. Visit its Web site at Delmar Cengage Learning has a multitude of HIM products. In addition, it has partnered with Ingenix (OptumInsight) so that you can order your Ingenix (OptumInsight) resources through Delmar Cengage Learning also. For a complete list, contact: Cengage Learning, Inc. esales@cengage.com Web site: Phone: (800)

13 10 Chapter I The following is a partial listing of Cengage products for Health Information Code It! (3rd Edition) Green, Michelle A. A Guide to Health Insurance Billing (Includes Ingenix Trial Printed Access Card and Premium Web Site Printed Access Card) Moisio, Marie A. Basic Allied Health Statistics and Analysis Koch, G. Case Studies for Health Information Management McCuen, Charlotte; Sayles, Nanette; and Schnering, Patricia Coding Basics: Medical Billing and Reimbursement Fundamentals Richards, Cynthia Coding Basics: Understanding Medical Collections Rimmer, Michelle Coding for Medical Necessity in the Physician Office Kelly-Farwell, Deborah and Favreau, Cecile Coding Surgical Procedures: Beyond the Basics Smith, Gail I. Coding Workbook for the Physician s Office Covell, Alice Comparative Health Information Management Peden, Ann Essentials of Health Information Management Principles and Practices (2nd Edition) Green, M. A. and Bowie, M. J. Essentials of Healthcare Compliance Safian, Shelly Ethics Case Studies for Health Information Management Grebner, Leah Guide to Coding Compliance Becker, Joanne M. Health Services Research Methods Shi, L. HIPAA for Medical Office Personnel Krager, Dan and Krager, Carole ICD-10: A Comprehensive Guide: Education, Planning and Implementation Dawlish, Carline ICD-10-CM Diagnostic Coding System: Education, Planning and Implementation Dagleish, Carline ICD-10-PCS Coding System: Education, Planning and Implementation Dagleish, Carline Legal and Ethical Aspects of Health Information Management McWay, Dana C. Medical Terminology for Insurance and Coding Moisio, Marie A. Today s Health Information Management: An Integrated Approach McWay, D. C.

14 Cengage products for Health Information (continued) Understanding Health Insurance: A Guide to Billing and Reimbursement Green, Michelle A. and Rowell, Jo Anne Understanding Hospital Billing and Coding: A Worktext Diamond, Marsha S. Understanding ICD-9-CM: A Worktest Bowie, Mary Jo and Schaffer, Regina M. Understanding ICD-9-CM Coding Bowie, Mary Jo and Schaffer, Regina M. Understanding ICD-10-CM and ICD-10-PCS: A Worktext Bowie, Mary Jo and Schaffer, Regina M. Understanding Medical Coding: A Comprehensive Guide Johnson, S. L. and McHugh, C. S. Understanding Procedural Coding: A Worktext Bowie, Mary Jo and Schaffer, Regina M. Using the Electronic Health Record in the Healthcare Provider Practice Eichenwald Maki, Shirley and Petterson, Bonnie Examination Study Strategies and Resources 11 For additional information on these Health Information resources, visit Delmar Cengage Learning at

15 12 Chapter I A SUMMARY OF TIPS FOR ORGANIZING YOUR TIME AND MATERIALS 1. Make a list of exam topics. Review the major topic categories and determine what your areas of strength are and what areas are in need of improvement. 2. Focus on your weaknesses. Using the list, identify your weaknesses. It is natural to spend time on the areas where you feel confident. However, it is important to spend more time and energy studying your areas of weakness. Remember, every question counts toward that passing score! 3. Set up a realistic study schedule. Refer to the sample schedule provided in this book and customize it to meet your needs. Consider having a study group that meets regularly. 4. Organize and review all of the following items. a. The latest AHIMA Candidate Handbook for the Examination b. Official Coding Guidelines for Inpatient and Outpatient Services c. Coding textbooks and any coding course syllabi, outlines, class notes, and tests d. Coding books e. Coding Clinic from the past 3 4 years f. CPT Assistant from the past 3 4 years g. Professional journal articles on documentation, reimbursement, and coding issues h. List of pertinent Web sites for research and review 5. Organize and enter valuable coding information directly into your code books. You will not be allowed to have loose materials in your books. However, information that is permanently attached or written into the code book is acceptable. 6. Practice taking timed tests. One of the best ways to study for an examination is to take tests. Practice answering questions and working coding cases as much as possible. Time yourself so that you become accustomed to taking, on the average, less than 1 minute per each multiple-choice question. Work the cases striving for completing a case in less than 14 minutes. Work with your watch in front of you. 7. MANDATORY! Read the certification guide. Carefully read the latest AHIMA Candidate Handbook for the certification exam you are taking. If anything in the Certification Guide is unclear, seek assistance from AHIMA. You are held accountable for the important information, deadlines, and instructions addressed in this material.

16 Examination Study Strategies and Resources 13 THE DAY BEFORE AND THE MORNING OF THE EXAM 1. Know the exam location. If there are several testing sites, make sure you have the correct directions to the correct center. Going to the wrong address for a test and then having to hustle to get to the right testing center is very stressful. 2. Avoid studying the night before the exam. Last-minute studying tends to increase your anxiety level. However, you may want to allocate a small amount of time to review any information that you feel you must look at one more time. 3. Organize in advance all the materials you need to take with you to the exam. Review the candidate handbook carefully, and be sure to have all the items that are required, especially the admission card, proof of identity, and your code books. 4. Get a good night s sleep. Taking a 4-hour test with little rest the night before may prevent you from having the energy and stamina you need to complete the exam. 5. Have a healthy meal before your exam. Four hours is a long time to go on an empty stomach. Try to eat a nutritious meal, for instance, cereal and fruit, bagel and fruit or juice, or a meal with protein such as cheese and crackers or eggs and toast. You need something to give you energy to keep going. Take a healthy snack bar to munch on if you get hungry and need to take a short break at the testing center. 6. Dress comfortably. Plan for possible variations in room temperature. Dressing in layers may prove helpful if the room is too cold or too hot for you. 7. Arrive early. Allow yourself plenty of time so that you arrive at the test site early. Take a practice drive. If the exam test site is a great distance from your home, spend the night before the examination in a nearby hotel or motel.

17 14 Chapter I TAKING THE EXAMINATION You have stuck to your study schedule and have conditioned yourself to be in the best physical and mental shape possible. Now comes the moment of truth : the examination pops up on the screen before your eyes. Every paratrooper knows that, in addition to having a parachute, one must know how to open it. You have mastered the major topics and you have the parachute. Now, you need to utilize good test-taking techniques to apply the knowledge you have gained; open the parachute! Section 1 (81 multiple-choice questions) and Section 2 (8 multiple-select questions) of the Examination 1. Taking the practice test. Prior to starting the exam, you will be given a chance to practice taking an examination on the computer. Time will be allotted for this practice test; however, you may quit the practice test and begin the actual exam when you are comfortable with the computerized testing process. 2. Read all directions and questions carefully. Try to avoid reading too much into the questions. Be sensible and practical in your interpretation. Read ALL of the possible answers because the first one that looks good may not be the best one. Some test takers read the question only, then try to formulate an answer before he/she reads the choices, then looks for a choice that matches his/her first mental response. 3. Scan the screen quickly for general question format. Like the marathon runner, pace yourself for the distance. A good rule of thumb is about 1 minute per each multiple-choice question. You will be responsible for checking your time throughout the exam. For example, at question 30, about one-half hour will have elapsed, etc. 4. Coming back to questions. Some people answer all questions in the section that they are certain of first. Then they go back through that section of the exam a second time to answer any questions they were uncertain about. Others prefer not to skip questions, but make their best choice on encountering each question and go on. Both can be good approaches; choose the one that works best for you. You can mark questions that you have left unanswered and/or those questions you may want to review. Before you sign off of that section of the exam or run out of time, you have the ability to go back to those questions for a final review. 5. Answer all the questions. For both sections 1 and 2 of the exam, there is no penalty for guessing, but you must enter an answer for every response required before moving on the next section of the exam. 6. Process of elimination. Use deductive reasoning and the process of elimination to arrive at the most correct answer. Some questions may have more than one correct answer. You will be asked to select the best possible answer based on the information presented. 7. Determine what is being asked. If the question is written in a scenario format, first identify the question being asked and then review the entire question for the information needed to determine the correct answer or answers. 8. Use all the time available to recheck your answers. However, avoid changing your answers unless you are absolutely certain it is necessary. Second-guessing yourself often results in a wrong answer. All of that practice in taking multiple-choice exams will pay off here. 9. You MUST complete Section 1 of the examination before moving on to Section 2. Sections 1 and Section 2 must be completed before moving on to Section 3 of the examination.

18 Examination Study Strategies and Resources 15 Section 3 of the Examination: Medical Record Coding Cases 1. Taking the practice test. Prior to starting the exam, you will be given a chance to practice taking an examination on the computer. Time will be allotted for this practice test; however, you may quit the practice test and begin the actual exam when you are comfortable with the computerized testing process. 2. Follow the procedures given in the Candidate Handbook for coding the test cases. Do not use hospital, regional, or insurance standards that may differ from those used in the national examination directions. The test will be scored using the coding procedures given. 3. Read all abstracts completely. Identify the qualifying words and statements. 4. Try to avoid reading too much into the information given. Be sensible and practical in your interpretation. Do not make any assumptions. Points are deducted for inappropriate codes. 5. Carefully review ancillary reports. Ancillary reports may or may not contain information that is pertinent to the coding of the case. Do not assign codes for abnormal findings listed on ancillary reports unless the physician documents clinical significance. 6. Only the codes themselves are considered in scoring. Carefully check the computer screen to verify that you have entered the codes for a given case abstract into the spaces provided for that case. 7. Use all the time available to recheck your codes and make sure your answer form has been filled in correctly. However, avoid changing your answers unless you are absolutely certain it is necessary. Second-guessing yourself often results in a wrong answer. 8. The first code for inpatient cases should be the principal diagnosis. Then list any additional diagnoses that are appropriate. The additional diagnoses do not need to be sequenced in any special order, unless coding rules stipulate otherwise. 9. The first diagnosis code for outpatient cases should be the first listed diagnosis. Then list any additional diagnoses that are appropriate. The additional diagnoses do not need to be sequenced in any special order, unless coding rules stipulate otherwise. AFTER THE EXAMINATION After taking the examination, it is time to reclaim your life and focus on your career. Plan a special reward for yourself at some point after the exam. Schedule a family vacation or a relaxing weekend get-away. Just find some way of being good to yourself. You certainly deserve it! You have worked hard, so relish your success.

19 16 Chapter I PAT S EXAM EXPERIENCE The CCS examination was a moment of truth for me. Some people asked me what I was going to do if I failed the examination. Now there is something to give you nightmares to co-author an exam review book and then FLUNK the exam! That was when I decided to borrow a line from the movie True Lies, fear is not an option, and adapted it for my own motto failure is not an option. There were many days and nights when I doubted that I had what it takes. When I felt really fearful and uncomfortable, I made myself look back over the years of going to classes and all of the coding practice. I had completed all the courses required. I had studied hard and long in each one of them. I had made good grades. In fact, I graduated with honors. I was studying virtually every day to prepare for the exam. What more could I do? ABSOLUTELY NOTHING! Therefore, if I had done the best I could and I was doing the best I could, then the worry was just taking up space in my head. I told myself there was no way I could fail the exam. This was a routine that I had to repeat, sometimes several times a day when the doubt would creep in. Positive attitudes can and will make the pretest jitters disappear. If you feel you can t do this, tell yourself that you have done it and that this is just one more test! I had prepared myself. I had taken many, many, many tests successfully before. This one is JUST ONE MORE! The night before the test, I tried to study just a little, but I just could not concentrate. I gave up trying to cram more information into my head and went to bed. The next morning at the testing center, I had coffee while we waited for the room to be prepared. One of the students milling around commented that she had failed the CCS examination twice before and hoped to pass it this time. I was really nervous then because this person had over 10 years of experience of coding in a hospital setting next to my measly experience. There were a lot of very nervous people there. I had to remind myself to keep thinking: I think I can. I think I can. I tried my best not to panic. After waiting what seemed like forever to start the exam, we were finally told to open the booklet for Part I and begin. I panicked at the first question. I could not understand what it asked. I had to stop, take a deep breath, and relax. I went to the next question, and was able to answer it quickly. I went back to the first question and it looked simple! I found myself going down the page breezing along and answering the questions. Then, I gasped as I thought, What if I am not going fast enough? I stopped, looked at the question number, checked the time and figured that I was answering them in about 1 minute each. Right on schedule. So, I calmed myself down and got back to business. Before I knew it, I had answered all the questions. I even had enough time to go back and review the ones I was not sure about. One of the most difficult parts of the exam is the length of time sitting. I did take one break in the middle of the exam to use the restroom and walk around for a minute to clear my head. Part I was the easy part. I was very adept at taking multiple-choice question exams. Part II with the coding cases was my hardest section. I found that I wasn t completing the cases in 13 to 14 minutes, so I needed to speed up to finish the exam. It was really hard for me not to mull over each case. When the exam was over, I was relieved, to say the least. For months it had been hanging over my head, and now IT WAS OVER! I left not knowing if I had passed the examination or not. But, no matter what the results were, I had done the best I could, and I was still a winner! Do the best you can and you will pass the exam too. YOU CAN DO IT! Affirmation: I can handle anything on the exam one question at a time. ~ Kathy DeAngelo, 1995