The CPC Exam Overview

The CPC (Certified Professional Coder) exam is administered by the AAPC (American Academy of Professional Coders) to those that meet their eligibility requirements. According the AAPC website the following is required in order to even take the exam.

1. Associates degree (Recommended)

2. Submit application and pay fees

3. Be a current member of the AAPC:

  • If you are a new member you must submit a membership fee along with the examination application.
  • Renewal members must have an updated membership when they submit their exam application and when their test results are released

The costs to become a member of the AAPC are as follows:

  • $125 for individual
  • $70 for students (you must not currently have certification)
  • The costs for renewal are the same as above.

4. Schedule a test date

The CPC exam itself will include 150 questions that are multiple choices. The topics covered will include:

  • Methods of medical coding
  • Coding systems
  • Coding procedures

The exam itself covers a variety of subjects so it would be wise on your part during the review process to split the material into different groups. This will make it possible for you to identify which areas that you may need to spend most of your time to. The cost for the Certified Professional Coder exam is $300 for non-students and $260 for current medical coding students. If you fail the exam (hopefully you won’t), you are allotted only one free retake. Any times after that you will have to pay the initial exam fee all over again. In order to set you exam date you will need to either contact the AAPC at 1-800-626-2633.
examsWhile you will need to study all areas of the test below are some of the main areas to pay just a little extra attention to include medical anatomy, terminology and physiology. These are crucial to the process of coding. You will need to have an in-depth understanding of both and be able to accurately code and identify the doctor or health care provider’s services and their diagnosis. You will also need to have an understanding of the systems within the body aside from the body’s structure itself:

  • Cardiovascular
  • Digestive
  • Endocrine
  • Musculoskeletal
  • Nervous system
  • Respiratory system
  • Skeletal
  • Urinary

The best method to use to prepare for the physiology and anatomy questions on the exam is to correspond the medical terms to the system of part of the body. Make or find a diagram of the body without labels and as you identify the parts and systems write it in on your diagram.

Next come the coding systems, the exam will contain (according to the AAPC website) questions that concern the application of coding for:

  • Diagnosis
  • Procedures
  • Physician based services
  • Billing services to the insurance company

The systems that will be covered include:

  • Level 2 Healthcare Common Procedure Coding System supply codes and procedures
  • International Statistical Classification of Diseases and Related Health Problems (ICD-9-CM)

You will need to study the methods for each and identify why the different systems are utilized and understand the range of services in which they are used. In addition to the above you will want to review the guidelines and the separate divisions that surround each of the different systems.

Lastly (but certainly not least) you will need to review:

  • Coding
  • Regulations
  • Compliance
  • Reimbursement

As a professional coder you must understand that all codes must comply to the certain guidelines from a legal and federal stand point, and regulations set down by healthcare providers and insurance agencies. The following agency standards will need to be reviewed:

1. American Medical Association (AMA)

2. Center for Medicare and Medicaid Services (CMS)

3. Institute for Safe Medication Practices

4. Joint Commission on Accreditation of Healthcare

The Certified Professional Coder (CPC) exam will test your ability as a coder to locate and make correction to any inaccuracy’s found on the claims prior to submission, your ability to handle insurance related issues like claim rejections. Use flashcards to write down some medical billing terminology you may encounter:

  • Eligible Payment Amount
  • CMS-1500 Billing Form
  • Submitter ID
  • Medical Necessity
  • Internal Control Number (ICN)
  • Bundling
  • Prospective Payment System (PPS)
  • Revenue Code
  • Charge Capture

You will want to review insurance policies and what the differences managed care plans and indemnity. While the CPC exam may be difficult it is not impossible to pass and once you so you will be more than on your way to rewarding career as a medical billing and coding specialist.