Certified Coding Associate (CCA) Exam Content Outline - Effective date 5/1/2022 - Clinical Classification Systems - Reimbursement Methodologies - Health Records and Data Content - Compliance - Information Technologies - Confidentiality & Privacy

Sep 26, 2026

Eligibility and exam structure for the Certified Coding Associate (CCA) credential effective 5/1/2022. Candidates must hold a high school diploma or equivalent and are recommended to have relevant coding experience or complete approved coding and related training. The exam content outline covers six domains: clinical classification systems, reimbursement methodologies, health records and data content, compliance, information technologies, and confidentiality and privacy, including code assignment, guideline application, claim evaluation, data abstraction, audit readiness, EHR workflows, and HIPAA-aligned safeguards.

LanguageEnglish

CategoryExam

FormatPDF

Pages2

Reading Time5 min

AccessFree to download

Eligibility Requirements

Exam Content Outline

Domain 1– Clinical Classification Systems

Domain 2– Reimbursement Methodologies

Domain 3 – Health Records and Data Content

Domain 4 – Compliance

Domain 5– Information Technologies

Domain 6– Confidentiality & Privacy

Certified Coding Associate (CCA) Eligibility Requirements (Effective date 5/1/2022) Candidates must have a high school diploma or equivalent to sit for the CCA examination. While not required, at least one of the following is recommended: • 6 months coding experience directly applying codes; • Completion of an AHIMA approved coding program (PCAP Program); • Completion of other coding training program to include anatomy & physiology, medical terminology, basic ICD diagnostic/procedural and basic CPT® coding. Certified Coding Associate (CCA) Exam Content Outline (Effective date 5/1/2022) Domain 1– Clinical Classification Systems (30-34%) Tasks: 1. Interpret healthcare data for code assignment 2. Incorporate clinical vocabularies and terminologies used in health information systems 3. Abstract pertinent information from medical records 4. Consult reference materials to facilitate code assignment 5. Apply inpatient coding guidelines 6. Apply outpatient coding guidelines 7. Apply physician coding guidelines 8. Assign inpatient codes 9. Assign outpatient codes 10. Assign physician codes 11. Sequence codes according to healthcare setting 12. Determine an Evaluation and Management (E/M) Level (history, exam, medical decision making, or time) 13. Use of appropriate modifiers Domain 2– Reimbursement Methodologies (21-25%) Tasks: 1. Sequence codes for appropriate reimbursement 2. Link diagnoses and CPT® codes according to payer specific guidelines 3. Understand DRG methodology 4. Understand APC methodology 5. Evaluate NCCI edits 6. Reconcile NCCI edits 7. Validate medical necessity using LCD and NCD 8. Understand claim form types 9. Communicate with financial departments 10. Evaluate claim denials 11. Process claim denials 12. Communicate with the physician to clarify documentation 13. Knowledge of Hierarchical Condition Categories (HCC) and risk adjustment 14. Application of CPT guidelines around bundling and unbundling Domain 3 – Health Records and Data Content (13-17%) Tasks: 1. Retrieve medical records 2. Analyze medical records quantitatively for completeness 3. Analyze medical records qualitatively for deficiencies 4. Perform data abstraction 5. Request patient-specific documentation from other sources (ancillary depts., physician’s office, etc.) 6. Retrieve patient information from master patient index 7. Educate providers on health data standards 8. Interpret coding data reports 9. Understand the different components of the medical record Domain 4 – Compliance (12-16%) Tasks: 1. Identify discrepancies between coded data and supporting documentation 2. Validate that codes assigned by provider or electronic systems are supported by proper documentation 3. Perform ethical coding 4. Clarify documentation through ethical physician query 5. Research latest coding changes for fee/charge ticket and chargemaster 6. Implement latest coding changes for fee/charge ticket and chargemaster 7. Educate providers on compliant coding 8. Assist in preparing the organization for external audits Domain 5– Information Technologies (6-10%) Tasks: 1. Navigate throughout the EHR 2. Utilize encoding and grouping software 3. Utilize practice management and HIM systems 4. Utilize CAC software that automatically assigns codes based on electronic text 5. Validate the codes assigned by CAC software Domain 6– Confidentiality & Privacy (6-10%) Tasks: 1. Ensure patient confidentiality (HIPAA, state regulations, etc. ) 2. Educate healthcare staff on privacy and confidentiality issues 3. Recognize and report privacy issues/violations 4. Maintain a secure work environment 5. Utilize passcodes/passwords 6. Access only minimal necessary documents/information 7. Release patient-specific data to authorized individuals 8. Protect electronic documents/protected health information (PHI) through encryption 9. Transfer electr

FAQs

What are the CCA eligibility requirements effective 5/1/2022?

Candidates must have a high school diploma or equivalent to sit for the CCA examination. Recommended preparation includes at least 6 months of coding experience or completion of an AHIMA-approved PCAP coding program, or other coding training covering anatomy & physiology, medical terminology, and basic ICD and CPT coding.

What topics are covered in Domain 1– Clinical Classification Systems?

Domain 1 focuses on interpreting healthcare data for code assignment, using clinical vocabularies, abstracting information from medical records, applying inpatient/outpatient/physician coding guidelines, assigning and sequencing codes, and determining E/M levels plus modifiers.

How does the exam assess reimbursement and compliance?

Domain 2 tests sequencing codes for reimbursement, linking diagnoses to CPT codes by payer guidelines, DRG and APC understanding, NCCI edits evaluation and reconciliation, medical necessity validation via LCD/NCD, claim denial processing, and HCC risk adjustment and bundling/unbundling. Domain 4 assesses identifying documentation-code discrepancies, ethical coding, physician query for clarification, staying current with coding changes, compliant coding education, and readiness for external audits.

Sep 26, 2026

Uploaded by Nguyễn Văn Học