By Patricia Maccariella-Hafey, RHIA, CCS, CCS-P
A warm welcome and congratulations for those of you who plan to take the certified coding associate (CCA) examination this year, offered by the American Health Information Management Association (AHIMA). This article will help you to prepare for the examination. It is also designed to help those coding professionals who want to brush up on their basic coding skills. New coders who earn the CCA will immediately demonstrate their competency in the field, even if they don't have much job experience. Earning a CCA demonstrates a commitment to coding even for those who are new in the field. The CCA should be viewed as the starting point for an individual entering a new career as a coder. The certified coding specialist (CCS) and/or CCS-P (physician-based) exams demonstrate the mastery level skills that the CCA would strive for to advance his or her career.
Examinations are computer-administered and are available Monday through Friday, excluding holidays, at AMP Assessment Centers geographically located throughout the United States. You will need to bring both an ICD-9-CM and CPT coding book to the exam with you. Check the AHIMA CCA Web site below for which version you will be coding from. The version will depend on when you take the CCA exam. No calculators or other reference materials are allowed in the testing center. At this time, the CCA exam is a 2-hour test with 100 multiple-choice questions. The current passing score for the CCA is 58 out of 90 scored items. See http://www.ahima.org/certification/cca.cfm for more details on the test process itself and changes to passing scores.
In this article, we will offer you some general coding tips for preparing for the CCA examination. There are three major competency areas for the CCA exam:
I. Health Data Content, Requirements, and Standards
II. Clinical Classification Reimbursement Methodologies
III. Information Technology and Healthcare Delivery.
We are going to emphasize the actual coding competencies in this article.
If you are not yet a member of AHIMA, it is fruitful to join. The "Communities of Practice" (https://www.ahimanet.org/COP/) offer specific coding community discussions, official coding advice/guidelines and other information pertinent to coding. It is a wealth of information and I encourage everyone to join and participate. However, be careful to take any postings and verify them against official sources. Most of the time, the postings include the official source and is provided by the person posting the message. Resources are included on the COP subject main page. Now on to the tips!
Preparation Tips and Suggestions
1. Organize your study schedule now. Choose a testing date and get all appropriate paperwork started as outlined in the CCA guide at www.ahima.org/certification/cca.guide.pdf. Formulate a plan and get it onto paper. An outline is an excellent study schedule tool. Organize an outline by the week or month, adding what topic and how long you plan to spend studying the topic (i.e., Week 1/23-1/29 2005, Coding Conventions: 4-8 hours). By keeping and sticking to an outline, you will be able to keep track of areas you need further review in. Crossing off each outline item as it is completed will give you a sense of accomplishment as well.
2. Study the 2004-05 CCA Certification Guide from AHIMA. The guide is online at the web address above in #1. The guide tells you everything you need to know about taking the examinations, including deadlines and instructions. Read the entire guide from cover to cover. Pay particular attention to the three competency areas and the format for the questions. You will be able to view all the information you need to take the examination from the AHIMA Web site. There is also a sample online test to take to prepare you for what to expect at exam time. I encourage everyone to take this online mock test to become familiar with the online exam.
3. Sign up now for any review seminars before the examinations. Pre-exam seminars can be wonderful refreshers before you take the test. Contact your state health information management (HIM) association for a list of schools or local associations that may be holding one of these. If your state's association does not have a list, check with a neighboring state. A college offering HIM courses is a good source too. Check online resources and "chats" regarding the upcoming examinations.
4. Use codebooks instead of encoders. When studying for the exams, it is imperative that actual books be used. Encoders will not be allowed for test taking. In addition, familiarity with the actual code books will enable you to be a more efficient coder. Encoders were designed to be used by those already familiar with the coding systems and with the actual coding books, both ICD-9-CM and CPT.
5. Time yourself when coding cases. Both quality and productivity matter on the examination. You will need to increase your speed if you are taking more than 1.2 minutes per question. This is based on 100 cases to be answered in 120 minutes. Be sure to time yourself on inpatient, outpatient surgery, emergency room, physician office and clinic cases, as a combination of these cases in multiple-choice format could be on the test. You will not believe how much this will help you when taking the exam.
In addition, if you are unsure of an answer, many people who take tests report that their first thought or inclination is usually the correct one. Going back and changing answers when it is not based on solid recall can be tricky.
6. Study with a buddy or a group. You should set a goal to study with another person or a group at least twice before exam time if possible. Sharing study methods and problem areas helps to build your knowledge base prior to examination time. It is also an opportunity to learn from others what you yourself may not know, and to share your knowledge. Spread the word and identify others in your area taking the test and organize study parties. You can also organize a "chat" session on many ISPs and utilize Web sites to gather names of other folks interesting in "chat" sessions or e-mailing study tips.
7. Become familiar with common medications. Medication knowledge is a must in coding and in test preparation. Medications may be used in multiple-choice questions. Knowing the more commonly prescribed medications and their indications will help at exam time. Plan to study new ones each month. Also, be wary that different medications can sometimes be regional, as in the case of antibiotic use. You may see one type being used on the east coast and another on the west coast. In addition, some medications, such as Lanoxin, can be used to treat several conditions (i.e., heart failure, atrial fibrillation, PSVT, etc.) Know your suffixes on medications to easily tell what type it is.
8. Study the ICD-9-CM and CPT coding conventions. If you are not familiar with the basics, you will not be able to answer more difficult coding questions. What do connecting words indicate in ICD-9-CM? What types of exclusion notes are there in ICD-9-CM? What does "separate procedure" mean in CPT? Be sure you know the conventions like the back of your hand.
9. Study "Faye Brown's ICD-9-CM Coding Handbook" and AHIMA's "Basic ICD-9-CM Coding 2005" by Lou Ann Schraffenberger for ICD-9-CM questions. Both of these texts are must haves and essential for study preparations. Be sure to get the copies "with answers" if you have not previously owned these books. They offer mock coding scenarios, which allow you to test and time yourself. See study materials below.
10. Study AHIMA's "Basic CPT/HCPCS Coding 2005 Edition with Answer Key" by Gail I Smith for CPT questions. This text also has quizzes and coding scenarios. All of the AHIMA books are available here: https://imis.ahima.org/orders/productByCategory.cfm?t=1
11. Purchase study guides and take mock examinations. Taking mock tests will help prepare you for the exams by getting your mind in the testing mode. The books listed in #9-10 above will allow you to do that. In addition, we recommend other study guides such as the "Professional Review Guide for the CCA Examination" offered by PRG Publishing (Professional Review Guides Inc., P.O. Box 528, St. Petersburg, Florida 33731; 888-383-7741, www.prgpublishing.com/CCAReviewGuide.htm
This book has many case studies, multiple choice questions and mock examinations to practice from for all of the competency areas for the CCA.
12. Study modifier usage. Study modifier usage as outlined in your CPT Book in appendix A. Remember that modifiers for hospital (facility) use are different than the modifiers used by physician offices. Both are listed in appendix A. Be sure you pay attention to the type of case you have before answering the question.
13. Study the Official ICD-9-CM Guidelines for Coding and Reporting. I have saved the biggest tip for last. These guidelines supplement the coding conventions in ICD-9-CM. They are available to download free from here if you do not have them: www.cdc.gov/nchs/datawh/ftpserv/ftpicd9/ftpicd9.htm#guidelines. They include both the inpatient and outpatient/physician office guidelines for ICD-9-CM. The guidelines are developed by the four cooperating parties consisting of the American Hospital Association (AHA), AHIMA, the Centers for Medicare and Medicaid Services (CMS) and National Center for Health Statistics (NCHS). The guidelines give guidance in reporting situations where the ICD-9-CM index and tabular does not provide direction. The version cited here were revised Dec. 15, 2003 and were effective October 1, 2003. An update to these should be available now.
These guidelines are official and should be the guidelines you follow over any other guidelines except the ICD-9-CM book itself. You should incorporate each section into your overall study outline. The guidelines are the basis of all ICD-9-CM coding rules.