1. Earning a Coding Credential June 25, 2009 10 am -12 MDST Irene Mueller, EdD, RHIA MT-NC Tele-Video Montana Hospital Association Spring 2009

2. Objectives At the end of the workshop, participants will be able to –Describe the benefits of earning a coding credential –List the three AHIMA coding credentials –Describe the differences among the AHIMA coding credentials –Describe how to earn and maintain an AHIMA coding credential –Develop a personal plan for exam preparation –Have a detailed resource list

3. Schedule 10 am – 10:05 –Overview of session 10:05 – 10:50 pm –AHIMA Coding Credentials –CCA Exam Information 10:50 – 11 am Break 11 - 11:45 am –Preparation planning –Test-taking tips 11:45- 12:00 pm –Questions

4. Credential vs Certification Certification –a nongovernmental agency or association’s process to recognize competency of individuals who meet certain qualifications, that results in a credential. Credential –attests to someone’s knowledge or authority. Credentials could be a LEO’s badge; a letter of introduction; a Ph.D. in physics; or a CCA. Designation –the letters someone uses after their name (CCS, RHIA, M.D., CPA).

5. Benefits of earning a coding credential Personal –Demonstrates you have needed coding knowledge and skills and you are an exceptional individual in your field –Notifies employers, coworkers, and laypersons that you have a competency level in carrying out your daily duties –Makes you a better, more competitive candidate for employment and promotion/advancement –More likely to receive higher compensation from employers

6. Other Benefits Employers –know they’ve hired productive, knowledgeable individuals –gain insight on potential employees during the hiring process –are increasingly requiring coding certification for employment Consumers –protected from threat of incompetent or unfit practitioners

7. AHIMA Coding Credentials All of these credentials –Indicate that an individual successfully passed a national certification exam –Indicate understanding of coding applications, including: Medical terminology, Disease processes, and Pharmacology

8. AHIMA Coding Credentials Certified Coding Associate (CCA) –Entry-level Inpatient and Outpatient ICD-9-CM and CPT Certified Coding Specialist (CCS) –ICD-9-CM and CPT surgery coding systems –Advanced coding and analysis skills of experienced coders –Usually employed an inpatient (hospital) healthcare setting Certified Coding Specialist-Physician-based (CCS-P) –ICD-9-CM, CPT, and HCPCS Level II coding systems –Advanced coding and analysis skills of experienced coders –Usually employed in physician offices, group practices, multi- specialty clinics, and specialty centers

9. Coding Credentials in MT Montana Coders from 8/07 through 3/09 –CCA – 8; CCS – 2; CCS-P 0 This workshop focuses on the CCA CCAs: –“Exhibit a level of commitment, competency, and professional capability usually absent in a newcomer –Demonstrate a commitment to the coding profession –Distinguish themselves from non-credentialed coders and those holding credentials from other organizations less demanding of the higher level of expertise required to earn AHIMA certification.”

10. Certification Process Eligibility requirements Exam Logistics –Handbook –Locations/ID –Required code books –Passing Score Exam Questions –Levels –Competencies

11. CCA Exam Eligibility “CCA examination candidates must have a high school diploma from a United States high school or an equivalent educational background. It is strongly recommended that candidates have at least six months experience in: –A healthcare organization applying ICD-9-CM and CPT coding conventions and guidelines, OR Have completed an AHIMA-approved coding certificate program OR Have completed another formal coding training program.”

12. CCA Candidate Handbook 2009 –One handbook for all exams Listed in Resources Essential reading for exam success Logistical details, forms, etc.

13. AHIMA EXAM APPLICATION CHECKLIST “Read Candidate Guide Apply for exam Submit all paperwork necessary –transcripts, resume, other documentation Upon receipt of authorization to test (ATT), read it completely Schedule exam with Prometric Verify materials needed at the testing center Verify time and date of exam”

14. MT Test Sites for CCA PROMETRIC TEST CENTER 2225 BROADWATER CO-LOCATED W/ SYLVAN LEARNING CTR BILLINGS, MT 59102 Phone: (406) 656-4646 Site Code: 3700 PROMETRIC TEST CENTER 1075 N RODNEY ST. SUITE 110 HELENA, MT 59601 Phone: (406)443-9205 Site Code: 3702

15. ND CCA Test Sites PROMETRIC TEST CENTER 212 WEST CENTURY AVENUE CENTURY AVENUE PARK PLAZA BISMARCK, ND 58503 Phone: 701-224-1171 Site Code: 4301 PROMETRIC TEST CENTER 901 - 28TH STREET S FARGO, ND 58103 Phone: (701356-9000 Site Code: 4300

16. WY CCA Test Sites PROMETRIC TEST CENTER 951 WERNER CT. SUITE 285 CASPER, WY 82601-1309 Phone: (307) 472-0030 Site Code: 5000

17. Test Sites Try to find out about the site before scheduling Is it busy? Noisy? Distracting?

18. Prometric Site $30 fee for Test Drive Could be good investment Reduce Anxiety Also –FAQs Information at: –http://www.prometric.com/AHIMA/default.htm

19. ID on Day of Test Identification Requirements (ID) requirements to test – Need BOTH of the following –Primary form of ID with candidate’s signature and picture –Secondary form of ID with candidate’s signature The name on IDs must be the same as name on application Without 2 acceptable forms of ID, candidates will NOT be allowed to test and will FORFEIT the application fee Prometric reserves the right to stop a candidate from taking the exam if any question about validity of IDs

20. Forms of ID Acceptable primary IDs = valid, non- expired with candidate’s photograph and signature –Driver’s license –State ID card –Government ID card (military ID card, etc.) –Passport Acceptable 2 ary IDs = valid, non-expired with candidate’s printed name and signature –Credit or debit card –Student ID card –Employee ID card

21. Unacceptable ID Examples of unacceptable ID: –Expired driver’s license/passport –Social security card –Library card –Marriage certificate –Voter’s registration card –Club membership card –Public aid card –Temporary driver’s license –Video club membership card –Traffic citation (arrest ticket) –Fishing/Hunting license

22. Exam Fees Exam Member Non-Member CCA $ 205 $ 260 CCS $ 320 $ 405 CCS-P $ 320 $ 405

23. CCA Exam Questions 100 questions (90 count, 10 being tested) 2 hours maximum to answer Avg - 1 minute and 12 seconds per question

24. Question Resources Every question on certification examinations must be referenced to a valid, credible, and current resource. The most commonly used are listed in the Resources at the end of this PPT. You probably already have access to some

25. CCA Exam Code Books Beginning March 31, 2009, candidates MUST bring their 2009 ICD-9-CM Volumes 1 - 3 code book AND the 2009 CPT code book to the test center –Only the AMA CPT code book is permitted HCPCS II code books and ICD-9-CM code books containing HCPCS national level II codebooks are NOT permitted Candidates without the required 2009 codebooks will not be permitted to test and will forfeit their application fee. http://www.ahima.org/certification/documents/Allowable_Code_Books_CCA_09_Ver01_002.doc

26. Exam Competencies A certification examination is based on explicit set of competencies They are determined via a job analysis study conducted of practitioners The competencies are subdivided into domains, sub-domains, and tasks The CCA Exam tests only content pertaining to the following competencies

27. CCA and ICD 10 CCAs at time of transition will not be required to retake the exam –Per conversation with AHIMA Will probably have to complete CEUs in ICD10 to maintain

28. CCA Competency Statements Effective March 2006 Domain 1: Health Records and Data –Collect and maintain health data –Analyze health records to assure that documentation supports the patient's diagnosis and procedures, reflects progress, clinical findings and discharge status –Request patient-specific documentation from other sources (e.g., ancillary departments; physicians office; etc.) –Apply clinical vocabularies and terminologies used in the organization's health information systems

29. CCA Competency Statements Effective March 2006 Domain 2: Health Information Requirements and Standards –Evaluate the accuracy and completeness of the patient record as defined by organizational policy and external regulations and standards –Monitor compliance with organization-wide health record documentation guidelines –Report compliance findings according to organizational policy –Assist in preparing the organization for accreditation, licensing and/or certification surveys

30. CCA Competency Statements Domain 3: Clinical Classification Systems –Use electronic applications (e.g., encoders) –Assign principal diagnosis (Inpatient) or first listed diagnosis (Outpatient) –Assign secondary diagnosis & procedure codes using ICD-9-CM official coding guidelines including complications and co-morbidities (CC) –Assign principal & 2 ary procedure(s) using CPT coding guidelines –Assign appropriate HCPCS codes –Identify discrepancies between coded data & supporting documentation –Use reference materials to facilitate code assignment

31. CCA Competency Statements Effective March 2006 Domain 4: Reimbursement Methodologies –Validate the data collected for appropriate reimbursement –Validate Diagnosis Related Groups (DRGs) –Validate Ambulatory Payment Classifications (APCs) –Comply with the National Correct Coding Initiative –Verify the National and Local Coverage Determinations (NCD/LCD) for medical necessity

32. CCA Competency Statements Effective March 2006 Domain 5: Information and Communication Technologies –Use personal computer to ensure data collection, storage, analysis and reporting of information –Use common software applications (e.g., word processing; spreadsheets; e-mail; etc.) in the execution of work processes –Use specialized software in the completion of HIM processes

33. CCA Competency Statements Effective March 2006 Domain 6: Privacy, Confidentiality, Legal, and Ethical Issues –Apply policies & procedures for access and disclosure of PHI –Release patient-specific data to authorized individuals –Apply ethical standards of practice –Recognize &report privacy issues/problems –Protect data integrity and validity using software or hardware technology

34. CCA Sample Questions Not currently available at AHIMA.org as of 6/18/09

35. Levels of Questions All computer-based examinations –CCA, RHIT, RHIA, CHPS –four-option, multiple-choice questions written at 3 cognitive levels: –recall, –application, and –analysis. These levels represent an organized way to identify the performance that practitioners will utilize on the job Recall Application Analysis

36. CCA Question Levels DomainRecallApplicationAnalysisTotal 1511218 257113 3524332 47209 54105 637315 Total2952990

37. Recall Level Type of Thinking Recall (RE) ReasonMeasure memory Performance Required ID terms, facts, methods, proc. ID basic concepts, theories, principles, and processes. Ex: JC standards require a complete H&P on the record for operative patients. Does this report have a time requirement? A.Yes, w/in 8 hrs of surgery B. No, if dictated pre surgery C. Yes, prior to surgery D. Yes, w/in 24 hrs post surgery

38. Application Level Type of Thinking Application (AP) ReasonTo measure simple interpretation of limited data. Performance Required Apply concepts & principles in new ways; Recognize data relationships; Apply laws & theories to situations; Calculate mathematical solutions; Interpret charts & translate graphic data; Classify items; Interpret information.

39. Application Example A stapedectomy is a common treatment for –A. Atherosclerosis –B. Multiple sclerosis –C. Otosclerosis –D. Scoliosis

40. Analysis Level Type of Thinking Analysis (AN) Purposemeasure application of knowledge in solving a specific problem & assembling elements into a meaningful whole Performance Required Select appropriate solution for responsive action; revise P&P or plan; evaluate solution, case scenario, report, or plan; compare solutions, plans, ideas, or aspects of a problem; evaluate information or a situation; perform multiple calculations to arrive at one answer.

41. Analysis example A coder reviews the following chargemaster information. Which of the following errors is depicted in this report? A. unbundled revenue codes B. revenue code incorrect for specified CPT code C. invalid CPT code(s) D. upcoding

42. CCA Exam Process Computerized testing –Will be able to review questions before submitting file –Any add’l information needed to complete questions will be on the screen in testing software Statistical formulas Nat’l Focus –Focus on federal laws, legal issues appropriate in all 50 states HI Systems and Biomedical Sciences –Questions spread throughout other categories –Part of general HIM knowledge base Question topics are mixed throughout exam –Must switch gears quickly

43. CCA pass rate/passing score 1/1/08-6/30/08 –64% of exam takers passed Passing Score ? –55/90 (changes slightly over time) The current passing scale score for the CCA examination is 300 out 400 –On AHIMA site as of 6/18/09 –http://www.ahima.org/certification/documents/CERT_ ScaleScoringFAQ_000.doc

44. Credential Maintenance Completion of Acceptable CEUs During a Two-Year Period (Cycle) –Individuals with a minimum of one associate-based AHIMA credential must complete 20 CEUs plus an annual self-assessment for each coding credential. –Each mandatory annual coding self-assessment is worth 5 CEUs. Eighty percent of all continuing education units must be earned within the HIM Domain.HIM Domain –To receive credit, activities must be completed within the assigned cycle period. All cycles begin on January 1 and end on December 31 the following year. Emailed AHIMA 5/31 re: # of CEUs for CCA alone

45. Credential Maintenance If you only held an CCA certification you would be required to submit 20 CEU's per reporting period. –Per email from AHIMA, 6/1/09

46. Break Time

47. Exam Preparation Study Strategies –Need to relearn – things fade –Maximum recall via effective review Set timeframe for review (# of weeks) –10-15 hours per week –Study smart! Topic List (Gap analysis) –Review competencies –How much do you know/remember? –Review strongest areas first, then move to weaknesses – they will be freshest for exam –Put list in order that you will study topics in

48. Exam Preparation USE your list! –Gives clear picture, Keeps you on track –Motivates as you complete topics –Reassures you are on target –Know you are putting time and effort where needed Keep list in view! –Plan pre-exam study time –Stick to plan –Schedule Study time Find place to study –Home, library, work –Avoid long sessions –Study group if possible

49. Exam Preparation Focus on weaknesses, every answer counts Organize/review resources –Certification Guidebook –Class notes, tests, exams –Reference books, Code books, Text books –Official Guidelines, CPT Asst, Coding Clinic Increase endurance –Concentration for longer times – 2 hours –Practice timed tests, in computer format –Have watch in front of you (avg. 1 min/question)

50. Model Study Guide 1st weekResources Review Health Data Content, Req, Stds Info/Communication Technologies Privacy, Conf. Legal/Ethica Issues Focus on Health Data 2 nd weekResources Review Med Terms Anatomy and Physiology Patho-physiology Focus on Lab tests and Drugs

51. Model Study Guide 3 rd weekResources Review HC Regulatory requirements Focus on Classification Systems and 2ndary Data sources 4 th weekResources review Billing and Reimbursement Focus on Reimbursement and Billing

52. Model Study Guide 5 th weekResources review ICD-9-CM Inpt Coding Guidelines ICD-9-CM Outpt Coding Guidelines Do a coding review Focus on ICD-9-CM coding questions 6 th weekContinue ICD-9-CM coding review, focusing on weakest areas Coding process (Inpt/Outpt) MR content areas CCs, etc.

53. Model Study Guide 7 th weekContinue ICD-9-CM Coding Review Official Guidelines (Inpt/Outpt) Code Book Conventions V-code main terms, NEC/NOS, etc. 8 th weekResources review CPT/HCPCS coding Focus on CPT coding Coding Rules Common errors in Dr payments

54. Model Study Guide 9 th weekReview CPT/HCPCS coding CPT Code Book Format Types of codes, Symbols, Modifiers Index, Appendices, E&M, Focus on weak areas 10 th weekReview ICD/CPT weak areas Take Mock exam Review any weak areas

55. Becoming “Test Wise” Test success includes –Knowledge of the subject –Test taking skills –Management of test anxiety See additional materials

56. “TRUTH” about Test Taking 1.Test-taking skills can be learned 2.Test-taking skills make a difference 3.Good preparation reduces anxiety 4.Attitudes does make a difference 5.Always answer easy questions first

57. “TRUTH” about Test Taking 7.Failure to plan to pass the exam = planning to fail the exam 8.Usually your first hunch is your best 9.Educated guessing is better than guessing randomly 10.The only thing that stands between you and passing the exam is YOU 11.No amount of “tips and tricks” replaces content knowledge

58. Successful Test Takers 1.Good time management - pace yourself 2.Read questions carefully 3.Take the question at face value 4.Read directions and questions carefully, identifying key words 5.Read and consider all four options carefully

59. Successful Test Takers 6.Unless 100% sure a MC answer is wrong, DON’T change it 7.Avoid applying preset solutions 8.Know when and how to guess i.e., process of elimination 9.Use the exam as a resource 10.When done, go back and make sure all questions have been answered

60. Successful Test Takers Analyze their exams for patterns –Review before beginning, time management and strategy –Read carefully, follow directions & key words –Know vocabulary / acronyms –Consider all answer options –Review before submission

61. Reading Questions Read each question carefully Underline the key words Note any unfamiliar terms Note anything you don’t understand about the question

62. MC Question Construction ITEM Stem In a terminal digit filing system, with all records in the system, which record numbers fall directly before and after record number 25-31-99 Distracter A24-31-98 and 26-31-00 Distracter B25-30-98 and 26-32-99 Distracter C24-30-99 and 26-32-00 Correct D24-31-99 and 26-31-99

63. Example Questions Now, let’s look at the process

64. Recall 1.A health record abstractor, who needed to locate the microscopic descriptions of tissue excised during surgery would be most likely to find this information in the: A.Recovery room record B.Pathology report C.Operative report D.Discharge summary

65. Application 2. Patient data collection requirements vary according to health care setting. A data element you would expect to be collected in the MDS but NOT in the UHDDS would be: A.personal identification B.cognitive patterns C.procedures and dates D.principal diagnosis

66. Application 3. A bee stung little Bobby. He experiences itching, erythema and respiratory distress caused by laryngeal edema and vascular collapse. In the emergency department, Bobby is diagnosed with: A.allergic rhinitis B.allergic sinusitis C.anaphylaxic shock D.asthma

67. Application 4. For continuity of care, ambulatory care providers are more likely than providers of acute care services to rely on the documentation found in the: A.interdisciplinary patient care plan B.discharge summary C.transfer record D.problem list

68. Application 5. As a concurrent record reviewer for an acute care facility, you have asked Dr. Quinn to provide an updated H&P for one of her recent admissions. Dr. Quinn pages through the MR to a copy of an H&P performed in her office a week before admission. You tell Dr. Quinn: A.a new H&P is required for every inpatient admission B.that you apologized for not noticing the H&P …. C.the H&P copy is acceptable as long as she documents any interval changes D.JCAHO standards can’t be met unless she documents an H&P after each admission

69. Math Problem Cullowhee General Hospital Coder Productivity – Week of 12/28/08 Emp #InptOutptOP Obs or ER 4251203516 426488995 42780924 4286510916

70. Math Problem The performance standard for coders is 28-33 workload units/day. Workload unit (WU) standards are: –Inpt record = 1 WU –Outpt surgical procedure record =.75 WU –OP observation/Emergency =.50 WU What percentage of the coders are meeting the standard? A. 100%B. 75% C. 50% D 25%

71. Math problem process Inpt # + (OP x.75) + (OP Ob/ER x.5) = weekly total Weekly total/5 = Daily Avg Compare Daily Avg to Standard

72. Math Problem Cullowhee General Hospital MS-DRG Report MS-DRG Identifier Relative Weight# of Pts w/MS- DRG A1.23412 B3.12210 C2.16519 D5.11816

73. Math Problem Based on the sample MS-DRG report, what is the Case-Mix Index (CMI) for this facility? A. 0.204193 B. 2.965807 C. 11.639 D. 57

74. Math Problem Process Need to know formula for CMI –Total RW / # of discharges = CMI –Total RW = RW x # d/c for each MS-DRG Add all MS-DRG RWs for time period together (1.234 x 12) + (3.122 x 10) + (2.165 x 19) + (5.118 x 16) = 14.808 + 31.22 + 41.135 + 81.888 = 169.051 # of D/C = 57 169.051/57 = 2.965807 = B

75. Coding Problems Can you determine the answer without coding /minimal coding? –Process of elimination Pt in ER with 2 left arm lacerations, one 7 cm, one 9 cm, both layered closures A. 12045 B. 12035 C. 12002, 12004 D. 12004 Which coding guideline applies? Which 2 answers can be eliminated before you use your CPT code book?

76. Coding Problem Vaginal delivery of a full-term liveborn infant. Pt undergoes episiotomy with repair and post-delivery elective tubal ligation. Code ICD-9-CM for dx and procedures. A. 650, V25.2, V27.0, 73.6, 66.32 B. 648.91, V27.0, 73.6, 66.32 C. 650, V27.0, 66.32 D. 650, V25.2, 73.59, 66.32 Which answers can be eliminated based on coding guidelines?

77. Coding Answer Process Meets Definition of normal delivery = 650 Elective sterilization = V25.2 Outcome of Delivery = V27.0 A is answer

78. Coding Problem A co-worker complained of sudden onset of chest pain and was admitted. A MI was ruled out. You would code A. the MI as if it were established. B.both the MI and the chest pain, in this order C.as an impending MI. D. only the chest pain. What coding guideline applies?

79. Taking the CCA Exam Strategies –Before –During

80. Day Before/Morning of Exam Know Location –Stay in local motel night before, drive to site Don’t study night before Organize in advance! –Review candidate handbook –Pack all required books, documents –Comfortable attire –Have a snack available (high carb, low-fat) Get a good night’s sleep Eat well before test –High carb, low-fat, lean protein, - not too much –Brain runs on glucose! Get there early!

81. Test regulations You are allowed to bring soft ear plugs or center- supplied tissues in the test room. You must not bring any personal/unauthorized items into the testing room. Such items include but are not limited to: –outerwear, hats, food, drinks, purses, briefcases, notebooks, pagers, watches, cellular telephones, recording devices, and photographic equipment. Weapons are not allowed at any Prometric Testing Center. You will be asked to empty and turn your pockets inside out prior to every entry into the test room to confirm that you have no prohibited items.

82. Test Procedures A photo will be taken of you and printed on your score report that you will receive at the end of the test No reference or study materials may be brought into the examination room You will be able to make notes on a dry- erase board during the exam

83. Test Procedures Prohibited items will not be allowed into the examination room. Prohibited items include, but are not limited to the following: calculators, pagers, cell phones, electronic digital devices (PDAs, watches), recording or photographic devices, weapons, briefcases, computers or computer bags, and handbags or purses. Calculator will be on-screen – know how to use! Eating, drinking, or smoking is prohibited in the test center.

84. Your Code Books Code books with tabs, handwritten notations, or comments are allowed BUT must be free of any notes containing coding rules and guidelines from other reference materials (for example, Coding Clinic, CPT Assistant, and similar materials). The testing center staff reserves the right to deny code books that contain excessive writing and information that may give the candidate an unfair advantage. Post-It Notes and any loose materials are not allowed.

85. During Exam Take the practice test –Get comfortable with process, environment Carefully read all directions/questions –Don’t 2 nd guess, read into, assume, think of your specific facility’s procedures –Read ALL possible answers Pace yourself, keep an eye on time (on computer) Answer ALL the questions –Use process of elimination –Go back to questions, can mark ? you want to go back to ID what is being asked (higher level ?) Use all the time available to recheck answers –DO NOT change, unless you realize you misread ?

86. During Exam Don’t panic, freeze, or give up If question leaves you blank, go on –You will remember, or future question will remind you If all else fails, use your “last resort” –Pick one answer (B or C), and use it consistently

87. Coding for ORLive Othropaedics Carpal Tunnel (Decompression of Medial Nerve) –354.0, 04.43, 64721 Anterior Cervical Discectomy –722.0 OR 722.71 (if w/myelopathy) –80.51, 81.02, 81.62 –63075 –22554-51 –22845 +code –20931 +code

88. Coding for ORLive Othropaedics Hip and Knee Replacement –No operation, no codes ACL Reconstruction –844.2, 81.45, 29888 –Code for harvesting autograft???

89. Question Resources 2009 ICD-9-CM Professional for Hospitals, Vol. 1, 2 & 3 (Ingenix) Basic Current Procedural Terminology (CPT) and HCPCS Coding, 2009 edition Basic ICD-9-CM Coding (2009 Edition) CPT Professional Edition 2009 (AMA) CPT Standard Edition 2009 (AMA) Coders' Desk Reference for Procedures, 2009 (Ingenix) Coding Clinic for ICD-9-CM (AHA Press)

90. Question Resources Documentation for Medical Records, 2009 Documentation for Ambulatory Care, 2001 Electronic Health Records: A Practical Guide for Professionals and Organizations, 4th ed. HIPAA in Practice: The Health Information Manager's Perspective, 2004 Health Information Management,10th Edition, 1994 (Physician’s Record Co.) Health Information Management Compliance: A Model Program for Healthcare Organizations, 4th Ed, 2007

91. Question Resources Health Information Management Technology: An Applied Approach, 2nd Ed, 2007 Health Information: Management of a Strategic Resource, 3rd Edition, 2007 (Elsevier) ICD-9-CM Coding Handbook, 2009 (AHA Press) ICD-9-CM Diagnostic Coding and Reimbursement for Physician Services, 2009 edition (2010 edition available in July 2009) Legal Aspects of Health Information Management, 2nd Ed, 2003 (Delmar) Merck Manual of Diagnosis and Therapy, 18th Ed, 2006 (Merck Publishing)

92. Question Resources Pathophysiology: Concepts and Applications for Health Care Professionals, 3rd Ed, 2004 (McGraw- Hill) Principles of CPT Coding, 5th Ed, 2005 (AMA) Procedural Coding and Reimbursement for Physician Services: Applying Current Procedural Terminology (CPT) and HCPCS, 2009 edition Quality and Performance Improvement in Healthcare: A Tool for Programmed Learning, 4th Ed Statistical Applications for Health Information Management, 2nd Ed Stedman's Medical Dictionary, 28th Ed, 2005

93. Resources About Certification –http://www.ahima.org/certification/about.asphttp://www.ahima.org/certification/about.asp CCA Exam Information –http://www.ahima.org/certification/cca.asphttp://www.ahima.org/certification/cca.asp 2009 Certification Candidate Guide –http://www.ahima.org/certification/documents/ 2009Handbook.pdf Examination Preparatory Arena –http://www.ahima.org/certification/examprep/

94. Resources Professional Review Guide for the CCA Examination. Delmar. –2009 ed. –2008 ed.

95. Resources Prometric site –http://www.prometric.com/AHIMA/default.htm