AHIMA CCA Exam 2026: 105 Questions You Can't Go Back To

On the AHIMA CCA exam, every answer is final. You cannot flag a question for review, you cannot skip ahead and come back, and once you answer a question, you cannot return to it. That rule comes straight from AHIMA's own exam specifications, and it should change how you practice.

The Certified Coding Associate is the entry-level medical coding credential from AHIMA, the American Health Information Management Association. What sets it apart is scope. The CCA spans both inpatient and outpatient coding, so you work in three code sets: ICD-10-CM for diagnoses, ICD-10-PCS for hospital inpatient procedures, and CPT. It is computer based, and you take it at a Pearson VUE test center.

The exam is one hundred five multiple choice questions in two hours. Only ninety of them are scored. The other fifteen are pretest questions, mixed in at random, and you are never told which ones they are. So every question gets your full effort. Two hours for one hundred five questions is about sixty-eight seconds each, with no second pass at the end.

AHIMA states the passing score as three hundred. That is a scaled score, not a count of correct answers. There are only ninety scored questions, so three hundred cannot mean three hundred right. Ignore any prep site that turns it into an exact number of questions you can miss.

Now the rule that costs people their exam fee. The CCA is an open code book exam, and the books are not optional. For exams from May first, 2026, you must bring three 2026 books: one ICD-10-CM book and one ICD-10-PCS book from AHIMA's approved list, plus the AMA's CPT Professional Edition. Test center staff check that your books match the approved list. Bring the wrong edition, and you are not allowed to test, and you forfeit your fee.

Eligibility is simple. You need a high school diploma. AHIMA recommends, but does not require, six months of coding experience or a coding training program. Once you are approved, you have one hundred twenty days to schedule. The exam costs one hundred ninety-nine dollars for AHIMA members and two hundred ninety-nine for everyone else. If you fail, a retake means a new application, the same fee, and a wait of at least thirty days.

Here is the number worth knowing before you book. AHIMA publishes its first time pass rates: seventy percent in 2023, sixty-seven percent in 2024, and sixty-two percent in 2025. Roughly four in ten first time testers did not pass last year. This is not an exam to take on a hunch.

What is tested comes in six weighted domains. Clinical classification systems, the actual coding, is the biggest, at thirty to thirty-four percent. Reimbursement methodologies is next, at twenty-one to twenty-five percent: DRGs, APCs, NCCI edits, medical necessity and denials. Together that is more than half the exam. Information technologies and confidentiality and privacy are the smallest, at six to ten percent each.

And here is the key insight. Because the CCA covers inpatient coding, the same words can be coded differently depending on the setting. Uncertain diagnoses are the clearest example, and knowing which setting you are coding for decides the answer.

Let us try a practice question from the Quibank CCA bank. A short-term acute care hospital discharge summary lists probable pneumonia, with no confirmation anywhere in the record. How is it coded for the inpatient stay? A, code the signs and symptoms only. B, code pneumonia as though it were established. C, code the condition plus a code showing it was not confirmed. D, query the provider, because probable cannot be coded in any setting.

The answer is B. The inpatient guidelines say a diagnosis documented at discharge as probable, suspected, likely, or still to be ruled out is coded as if it existed. But move the same patient to a physician office, and the rule flips. In outpatient settings, uncertain diagnoses are not coded. You code to the highest degree of certainty, which is usually the symptom.

Question two. An operative note is headed excision of the left upper lung lobe, and the body of the note says the entire left upper lobe was removed. Which root operation is coded? A, Excision, because the surgeon's wording governs. B, Resection, because the whole left upper lobe was cut out. C, Excision, because only part of the lung was removed. D, Detachment.

The answer is B, Resection. ICD-10-PCS has a specific body part value for each lung lobe, and Resection means all of a body part was cut out. The surgeon's heading does not decide the root operation. You map what was actually done to the PCS definitions. Read the body of the note, not the title.

To prepare: one, practice in single passes with no going back, at about sixty-eight seconds a question, because that is how test day works. Two, learn the conventions and definitions, like Excludes1 versus Excludes2, and the root operations, not memorized code values; the code sets change every year. Three, weight your time to coding and reimbursement, more than half the exam. Four, practice with the exact 2026 books you will carry in, so your tabs and your speed are ready.

To recap. One hundred five questions, two hours, no going back. A scaled passing score of three hundred. Three 2026 code books, checked before you test. First time pass rates have fallen to sixty-two percent.

Free CCA practice, in English, Chinese and Spanish, is at quibank.com. The link is in the description.