• 92 questions

AHIMA CCS Practice Test

Unofficial practice for the Certified Coding Specialist exam, in the five domains of AHIMA's published outline.

Which codes identify the services paid under the hospital outpatient prospective payment system?

Pick an answer, then press Check answer. Then you see Correct or Not quite, with the reason. Keys: 1 to 4 pick, Enter checks.

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Exam mode: 50 questions, 112 minutes.

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Unofficial practice questions, not affiliated with the American Health Information Management Association (AHIMA). Bank checked October 9, 2026.

The real exam, as AHIMA describes it

Questions
107
Time limit
240 minutes
Retakes
With a new application and fee, after a wait of at least 30 days.
Scored
97 scored items and 10 pretest items that are not scored, mixed through the exam.
Passing score
300, on AHIMA's score scale. A scaled score is neither a percent nor a number correct.
Domains
Coding knowledge and skills 39 to 41%; coding documentation, regulatory compliance 18 to 22% each; provider queries, information technologies 9 to 11% each.
Medical scenarios
Inpatient, outpatient and emergency department, one third each.
Code books
One ICD-10-CM, one ICD-10-PCS and one CPT code book from the approved list: the 2026 editions for exams from May 1, 2026.
Where
On a computer in a Pearson VUE testing center. Results are given when the exam ends.

Checked October 9, 2026 against AHIMA, Certified Coding Specialist (CCS) page, Exam Specifications, with the CCS Exam Content Outline (effective 05/01/2024) and the Candidate Guide. Rules change, so confirm with the agency itself before your test.

AHIMA's own CCS page

Next step ICD-10-CM practice examMedical terminology practice test

All 92 questions

Coding knowledge and skills (Domain 1) 36

  • 42 CFR 412.60 classes a discharge into a DRG from the principal diagnosis, secondary diagnoses, procedures performed, age, sex and which other item? 42 CFR 412.60(c)(1)
  • A bypass is made from the ileum to the transverse colon. In the ICD-10-PCS code, which is the body part (fourth character) and which is the qualifier? ICD-10-PCS Official Guidelines for Coding and Reporting, 2027, guideline B3.6a
  • A cancer of the colon is first diagnosed on day 3 of an admission for bowel obstruction. Which POA indicator does the cancer take? ICD-10-CM Official Guidelines for Coding and Reporting, FY 2027, Appendix I, Assigning the POA Indicator
  • A claim line is denied by a PTP edit. The two services were done at the same site in the same encounter. May a modifier be added so that the line pays? NCCI Policy Manual for Medicare Services, 2026, Chapter I, Section E
  • A diagnostic procedure was performed for the principal diagnosis, and a procedure for definitive treatment was performed for a secondary diagnosis. Which is the principal procedure? ICD-10-PCS Official Guidelines for Coding and Reporting, 2027, Selection of Principal Procedure
Show all 92 questions (87 more)

Coding knowledge and skills (Domain 1), continued

  • A laparoscopic removal of the appendix is converted to an open removal. How is it coded in ICD-10-PCS? ICD-10-PCS Official Guidelines for Coding and Reporting, 2027, guideline B3.2d
  • A laparoscopic removal of the spleen ends with the port incision extended to take the spleen out. Which approach value is coded? ICD-10-PCS Official Guidelines for Coding and Reporting, 2027, guideline B5.2b
  • A newborn is transferred on day 2 to a second hospital for heart surgery. May the second hospital report a code from category Z38, Liveborn infants? ICD-10-CM Official Guidelines for Coding and Reporting, FY 2027, Section I.C.16.a.2
  • A patient has outpatient surgery for an inguinal hernia and is then placed in observation for a complication. What is the first-listed diagnosis? ICD-10-CM Official Guidelines for Coding and Reporting, FY 2027, Section IV.A.2
  • A patient is admitted with a stage 2 pressure ulcer of the sacrum that progresses to stage 3 during the stay. How is the ulcer coded? ICD-10-CM Official Guidelines for Coding and Reporting, FY 2027, Section I.C.12.a.6
  • A patient is admitted with acute respiratory failure caused by an overdose of a sedative taken in error. Which is sequenced first? ICD-10-CM Official Guidelines for Coding and Reporting, FY 2027, Sections I.C.10.b.1 and I.C.19.e.5.b
  • A patient is treated in the emergency department, develops atrial fibrillation there, and the order for inpatient admission is written afterward. Which POA indicator does the atrial fibrillation take? ICD-10-CM Official Guidelines for Coding and Reporting, FY 2027, Appendix I, General Reporting Requirements
  • A patient with documented bone metastases is admitted only for control of the cancer pain. Which code is the principal diagnosis? ICD-10-CM Official Guidelines for Coding and Reporting, FY 2027, Section I.C.6.b.5
  • A patient with known osteoporosis is seen in the emergency department with a wrist fracture after a minor fall that would not usually break a healthy bone. Which kind of code reports the fracture? ICD-10-CM Official Guidelines for Coding and Reporting, FY 2027, Section I.C.13.d.2
  • A planned laparoscopic removal of the gallbladder is stopped after the scope is in and the abdomen has been viewed, before anything else is done. Which root operation is coded? ICD-10-PCS Official Guidelines for Coding and Reporting, 2027, guideline B3.3
  • A secondary diagnosis is on the CC list but is closely related to the principal diagnosis. What can the CC Exclusion List do to it? ICD-10 MS-DRG Definitions Manual, Version 44.0, Defining the MS-DRGs
  • Acute bleeding from a stomach ulcer is stopped by cutting out the part of the stomach that holds the ulcer. Which root operation is coded? ICD-10-PCS Official Guidelines for Coding and Reporting, 2027, guideline B3.7
  • An inpatient's final diagnosis reads "acute pancreatitis versus acute cholecystitis". How are the two coded? ICD-10-CM Official Guidelines for Coding and Reporting, FY 2027, Section II.D
  • An NCCI PTP edit carries a Correct Coding Modifier Indicator of 0. What does that mean? NCCI Policy Manual for Medicare Services, 2026, Chapter I, Section E
  • Diverticulitis of the colon is present on admission, and a perforation with abscess develops on hospital day 3. One code reports the diverticulitis with perforation and abscess. Which POA indicator is assigned? ICD-10-CM Official Guidelines for Coding and Reporting, FY 2027, Appendix I, Codes That Contain Multiple Clinical Concepts
  • For MS-DRG grouping, every ICD-10-CM diagnosis code is placed in one of three levels by its effect as a secondary diagnosis. Which three? ICD-10 MS-DRG Definitions Manual, Version 44.0, Defining the MS-DRGs
  • In an ICD-10-PCS coronary artery bypass code, what does the body part value identify? ICD-10-PCS Official Guidelines for Coding and Reporting, 2027, guideline B3.6b
  • In one operation a surgeon takes a diagnostic excision from a kidney mass and then, on the frozen section result, cuts out the whole kidney. What is coded in ICD-10-PCS? ICD-10-PCS Official Guidelines for Coding and Reporting, 2027, guideline B3.4b
  • No procedure relates to the principal diagnosis. A definitive treatment and a diagnostic procedure were both performed for a secondary diagnosis. Which is the principal procedure? ICD-10-PCS Official Guidelines for Coding and Reporting, 2027, Selection of Principal Procedure
  • One note in an inpatient record documents alcohol abuse and another documents alcohol dependence. What is coded? ICD-10-CM Official Guidelines for Coding and Reporting, FY 2027, Section I.C.5.b.2
  • Part 2 of the CC Exclusion List holds diagnosis codes that count as an MCC only under one condition. Which condition? ICD-10 MS-DRG Definitions Manual, Version 44.0, Defining the MS-DRGs
  • The provider documents that it cannot be clinically determined whether a pressure ulcer was present at admission. Which POA indicator is assigned? ICD-10-CM Official Guidelines for Coding and Reporting, FY 2027, Appendix I, Reporting Options
  • Sutures and a temporary post-operative wound drain are used in an open excision. How do they affect the device character of the ICD-10-PCS code? ICD-10-PCS Official Guidelines for Coding and Reporting, 2027, guideline B6.1b
  • Two procedures in a PTP edit pair are performed on separate organs in one session, and the edit allows a modifier. Which HCPCS modifier means "separate structure"? NCCI Policy Manual for Medicare Services, 2026, Chapter I, Section E
  • Under Medicare's inpatient prospective payment system, the hospital's base payment rate is multiplied by what to pay a case? CMS, Acute Inpatient PPS
  • What does a Medically Unlikely Edit (MUE) limit? NCCI Policy Manual for Medicare Services, 2026, Chapter I, Section A
  • What is an NCCI procedure-to-procedure (PTP) edit? NCCI Policy Manual for Medicare Services, 2026, Chapter I, Section A
  • Which codes identify the services paid under the hospital outpatient prospective payment system? 42 CFR 419.2(a)
  • The whole sigmoid colon is cut out, and ICD-10-PCS has a body part value for the sigmoid colon. Which root operation applies? ICD-10-PCS Official Guidelines for Coding and Reporting, 2027, guideline B3.8
  • Within one APC group, the highest geometric mean cost of a service may generally be no more than how many times the lowest? 42 CFR 419.31(a)(1)
  • Within what time after admission must a provider document a condition for it to count as present on admission? ICD-10-CM Official Guidelines for Coding and Reporting, FY 2027, Appendix I, Timeframe for POA Identification and Documentation

Coding documentation (Domain 2) 18

  • A history and physical notes that the patient "drinks beer on weekends". No provider links the drinking to any disorder or medical condition. Is a code for alcohol use, unspecified, assigned? ICD-10-CM Official Guidelines for Coding and Reporting, FY 2027, Section I.C.5.b.3
  • A kidney transplant recipient has stage 3 chronic kidney disease documented. Nothing in the record mentions rejection, failure or another transplant complication. What is coded? ICD-10-CM Official Guidelines for Coding and Reporting, FY 2027, Section I.C.14.a.2
  • A nurse's note gives a body mass index of 41. No provider documents obesity or any other weight diagnosis. Is a BMI code assigned? ICD-10-CM Official Guidelines for Coding and Reporting, FY 2027, Section I.B.14
  • A patient is admitted with acute respiratory failure and an acute myocardial infarction. The record does not show whether the two were equally responsible for the admission. What should the coder do? ICD-10-CM Official Guidelines for Coding and Reporting, FY 2027, Section I.C.10.b.3
  • A patient on a mechanical ventilator develops pneumonia. The provider documents "pneumonia" and nothing more. May J95.851, ventilator associated pneumonia, be assigned? ICD-10-CM Official Guidelines for Coding and Reporting, FY 2027, Section I.C.10.d.1
  • A patient writes on an intake form that she lacks transport to appointments. When may that self-reported information support a code for a social determinant of health? ICD-10-CM Official Guidelines for Coding and Reporting, FY 2027, Section I.B.14
  • A record documents "low back pain" and does not describe it as acute, chronic, post-thoracotomy, postprocedural or neoplasm-related. Is a code from category G89 assigned? ICD-10-CM Official Guidelines for Coding and Reporting, FY 2027, Section I.C.6.b.1
  • A record documents a pressure ulcer of the heel with no documentation at all of its stage. Which kind of code is assigned? ICD-10-CM Official Guidelines for Coding and Reporting, FY 2027, Section I.C.12.a.2
  • A record leaves it unclear whether a deep vein thrombosis was present when the patient was admitted. Who resolves that before the POA indicator is reported? ICD-10-CM Official Guidelines for Coding and Reporting, FY 2027, Appendix I, General Reporting Requirements
  • A social worker's note documents that an inpatient is homeless. No provider mentions it. May the code for homelessness be assigned from that note? ICD-10-CM Official Guidelines for Coding and Reporting, FY 2027, Section I.B.14
  • The admission note states that a sacral pressure ulcer is completely healed. Which pressure ulcer code is assigned? ICD-10-CM Official Guidelines for Coding and Reporting, FY 2027, Section I.C.12.a.4
  • After how long does the ICD-10-CM guideline say that pain becomes chronic pain? ICD-10-CM Official Guidelines for Coding and Reporting, FY 2027, Section I.C.6.b.4
  • An emergency department record documents COPD and acute bronchitis. The physician does not document an exacerbation. Does the infection by itself support coding an acute exacerbation? ICD-10-CM Official Guidelines for Coding and Reporting, FY 2027, Section I.C.10.a.1
  • An operative report describes a procedure in words that plainly match an ICD-10-PCS root operation, though the surgeon never uses the PCS term. Must the coder query the surgeon? ICD-10-PCS Official Guidelines for Coding and Reporting, 2027, guideline A11
  • Hemiplegia of the left side is documented. The record does not say which side is dominant, the patient is not ambidextrous, and the classification gives no default. Which default applies? ICD-10-CM Official Guidelines for Coding and Reporting, FY 2027, Section I.C.6.a
  • On what may a code for alcohol dependence "in remission" be based? ICD-10-CM Official Guidelines for Coding and Reporting, FY 2027, Section I.C.5.b.1
  • The provider documents a fractured radius without naming the side. A nurse's note records the left arm. May the left side be coded? ICD-10-CM Official Guidelines for Coding and Reporting, FY 2027, Section I.B.13
  • The surgeon's operative note says left knee, and the physical therapist's note says right knee. What should the coder do? ICD-10-CM Official Guidelines for Coding and Reporting, FY 2027, Section I.B.13

Provider queries (Domain 3) 9

  • A multiple choice query offers a diagnosis that is not yet in the record, with the supporting clinical indicators cited from the record. Is that leading the provider? ACDIS and AHIMA, Guidelines for Achieving a Compliant Query Practice (2022 Update), Written Queries
  • A physician answers a query aloud in a hallway conversation. What is needed before the answer can be coded? ACDIS and AHIMA, Guidelines for Achieving a Compliant Query Practice (2022 Update), Verbal Queries
  • A written query ends with the sentence "Documenting this condition would raise the DRG weight." Is the query compliant? ACDIS and AHIMA, Guidelines for Achieving a Compliant Query Practice (2022 Update), General Query Guidelines
  • After surgery an inpatient's hemoglobin falls from 12 to 7 and two units of blood are given. No provider documents a diagnosis for it. What is the compliant next step? ACDIS and AHIMA, Guidelines for Achieving a Compliant Query Practice (2022 Update), General Query Guidelines; ICD-10-CM Official Guidelines, FY 2027, Section III.B
  • In which queries is the answer option "unable to determine" required? ACDIS and AHIMA, Guidelines for Achieving a Compliant Query Practice (2022 Update), General Query Guidelines
  • Laboratory values point to a condition that no provider has documented. May a yes/no query ask whether the patient has that condition? ACDIS and AHIMA, Guidelines for Achieving a Compliant Query Practice (2022 Update), Written Queries
  • Nothing in the current encounter points to heart failure, but last year's record documents it. May a query about heart failure rest on last year's record alone? ACDIS and AHIMA, Guidelines for Achieving a Compliant Query Practice (2022 Update), Role of Prior Encounters in Queries
  • The treating surgeon is slow to answer. May the query be sent to the hospital's physician advisor to answer in the surgeon's place? ACDIS and AHIMA, Guidelines for Achieving a Compliant Query Practice (2022 Update), Who Is Queried?
  • Which answer option must every multiple choice query include? ACDIS and AHIMA, Guidelines for Achieving a Compliant Query Practice (2022 Update), General Query Guidelines

Regulatory compliance (Domain 4) 19

  • A hospital's own outpatient department performs diagnostic tests on a Medicare patient two days before that hospital admits the patient. Where are the tests billed? 42 CFR 412.2(c)(5)
  • A manager tells a coder to add a diagnosis code that the record does not support, so that a claim pays more. What do the AHIMA Standards of Ethical Coding call for? AHIMA Standards of Ethical Coding (2016 version)
  • A patient asks for an accounting of disclosures of her health information. Which disclosures need not be listed? 45 CFR 164.528(a)(1)
  • A physician admits a Medicare patient expecting a stay of three midnights, and the factors are documented. The patient is transferred out after one night. May the stay still be paid as inpatient under Part A? 42 CFR 412.3(d)(1)(ii)
  • A selected hospital-acquired condition is coded as a secondary diagnosis and was not present on admission. How does Medicare pay the case? CMS, Hospital-Acquired Conditions (Present on Admission Indicator)
  • For a selected hospital-acquired condition, which two POA indicators let CMS pay the CC/MCC DRG? CMS, Hospital-Acquired Conditions, Coding
  • For at least how long must a hospital keep medical records, in original or legally reproduced form, under 42 CFR 482.24? 42 CFR 482.24(b)(1)
  • How long does a covered entity have to act on an individual's request for access to the record, before any extension? 45 CFR 164.524(b)(2)
  • To which of these does the HIPAA minimum necessary requirement not apply? 45 CFR 164.502(b)(2)
  • To which settings do the definitions of the Uniform Hospital Discharge Data Set (UHDDS) now apply? ICD-10-CM Official Guidelines for Coding and Reporting, FY 2027, Section II
  • To whom do the AHIMA Standards of Ethical Coding apply? AHIMA Standards of Ethical Coding (2016 version)
  • Under 42 CFR 412.3, an inpatient admission is generally appropriate for Medicare Part A payment when the admitting physician expects hospital care to cross how many midnights? 42 CFR 412.3(d)(1)
  • Under 42 CFR 482.24, a hospital's system of coding and indexing medical records must allow timely retrieval by what? 42 CFR 482.24(b)(2)
  • Under the HIPAA code set standards, which code set do hospitals report for procedures on hospital inpatients? 45 CFR 162.1002(c)(3)
  • Under the Medicare conditions of participation, every hospital medical record entry must be legible, complete, dated, timed and what else? 42 CFR 482.24(c)(1)
  • Under the Privacy Rule's list of identifiers to remove for de-identified data, which part of a date of admission may stay? 45 CFR 164.514(b)(2)(i)(C)
  • Which agency develops the Patient Safety Indicators, and what data do its Quality Indicators use? AHRQ, AHRQuality Indicators
  • Which is one of the three tests that the Deficit Reduction Act of 2005 sets for a condition on the hospital-acquired condition list? CMS, Hospital-Acquired Conditions (Present on Admission Indicator)
  • Which of these is one of the 14 hospital-acquired condition categories that CMS lists? CMS, Hospital-Acquired Conditions (Present on Admission Indicator)

Information technologies (Domain 5) 10

  • A breach of unsecured protected health information affects 120 patients. When must the covered entity notify the Secretary of HHS? 45 CFR 164.408(c)
  • A laptop is stolen. Its patient files were encrypted by a method named in HHS guidance, so they cannot be read. Is this a breach that requires notification? 45 CFR 164.402
  • An outside coding company that works as a hospital's business associate discovers a breach of unsecured protected health information. Whom must it notify? 45 CFR 164.410(a)(1)
  • Computer-assisted coding (CAC) software generates a query to a provider automatically. Which standards does that query have to meet? ACDIS and AHIMA, Guidelines for Achieving a Compliant Query Practice (2022 Update), Query Technology
  • How does the federal health IT office tell an electronic medical record (EMR) from an electronic health record (EHR)? Office of the National Coordinator for Health IT, What are Electronic Health Records (EHRs)?
  • MS-DRG grouper software sorts hospital discharges into groups. Under 42 CFR 412.60, to how many DRGs is one discharge assigned, however many conditions were treated? 42 CFR 412.60(c)(2)
  • Patient records are sent by mistake to an outside party with no right to them. Under the breach notification rule, how is the incident treated unless a risk assessment shows a low probability that the information was compromised? 45 CFR 164.402
  • Software flags a possible query in a record. Who remains responsible for telling a legitimate query opportunity from an inappropriate trigger? ACDIS and AHIMA, Guidelines for Achieving a Compliant Query Practice (2022 Update), Query Technology
  • What does the Medicare Code Editor (MCE) do? CMS, Definitions of Medicare Code Edits, Version 44.0
  • Which of these does the Medicare Code Editor flag on an inpatient claim? CMS, Definitions of Medicare Code Edits, Version 44.0

How this list was compiled: Our own questions, written to the five domains of the Certified Coding Specialist (CCS) Exam Content Outline, effective 05/01/2024, that the American Health Information Management Association (AHIMA) publishes (https://www.ahima.org/media/ecklaulp/css-exam-content-outline-1-1.pdf, linked from https://www.ahima.org/certification-careers/certifications-overview/ccs, read 2026-10-09): Domain 1 Coding Knowledge and Skills 39-41%, Domain 2 Coding Documentation 18-22%, Domain 3 Provider Queries 9-11%, Domain 4 Regulatory Compliance 18-22%, Domain 5 Information Technologies 9-11%. The bank holds 36, 18, 9, 19 and 10 questions. Every fact was read on 2026-10-09 in the public source the question names: the ICD-10-CM Official Guidelines for Coding and Reporting, FY 2027 (https://www.cms.gov/files/document/fy-2027-icd-10-cm-coding-guidelines.pdf) and the ICD-10-PCS Official Guidelines, 2027 (https://www.cms.gov/files/document/2027-official-icd-10-pcs-coding-guidelines.pdf), with every guideline passage also found in the FY 2026 and 2026 editions that the exam's 2026 code books carry; the NCCI Policy Manual for Medicare Services, 2026, Chapter I; the ICD-10 MS-DRG Definitions Manual and the Definitions of Medicare Code Edits, Version 44; CMS pages on hospital-acquired conditions, the POA indicator and the inpatient prospective payment system; federal regulations on ecfr.gov (42 CFR 412.2, 412.3, 412.60, 419.2, 419.31, 482.24; 45 CFR 162.1002 and Part 164); the AHRQ Quality Indicators page; the federal health IT office's page on electronic health records; the practice brief Guidelines for Achieving a Compliant Query Practice (2022 Update) of ACDIS and AHIMA; and the AHIMA Standards of Ethical Coding (2016 version). Licence: Questions, choices and explanations are original work of this site.

How it works

This free AHIMA CCS practice test has 92 questions of our own in the five domains of the Certified Coding Specialist exam. Unofficial: not affiliated with or endorsed by the American Health Information Management Association (AHIMA).

Read the full guide

What the exam covers

AHIMA's CCS Exam Content Outline, effective May 1, 2024 and read October 9, 2026, has five domains. The largest, coding knowledge and skills, covers code assignment, sequencing, present on admission rules, coding edits and DRG and APC payment. Regulatory compliance covers HIPAA, hospital-acquired conditions, ethical coding and the UHDDS.

Where the answers come from

Each answer names its public source: the ICD-10-CM and ICD-10-PCS Official Guidelines, CMS manuals, federal rules on ecfr.gov, and the query brief and ethical coding standards that AHIMA publishes. Guideline answers hold in both the 2026 and 2027 editions.

Timing

Exam mode asks 50 questions in 112 minutes, the pace of the real exam: 107 questions in four hours.

  • The real exam also has medical scenarios from inpatient, outpatient and emergency department records. Practice those with your own code books.
  • Codes and guidelines change each October 1. Check which code book year AHIMA lists for your exam date.

Questions and answers

Is there a CCS practice exam free online?

Yes. This one is free with no sign-up, and every sample question shows the right answer with a short reason and the section of its public source.

How many questions are on the CCS exam?

107: 97 scored items and 10 pretest items that do not count, mixed through the exam. Candidates have four hours, by AHIMA's CCS page.

What is the passing score for the CCS exam?

AHIMA gives the passing score as 300, on its own score scale. A result here is the number right only and is not a forecast of that score.

Can you use code books on the CCS exam?

Yes, and they are required: three books from AHIMA's approved list. A candidate who comes without the correct books is not allowed to test and forfeits the exam fee.

Is this the official AHIMA practice test for the CCS?

No. AHIMA sells its own exam preparation books and an online course with practice exams. This is a separate bank, and no question in it was taken or reworded from AHIMA's exam or its preparation products.

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