In order to ensure that medical services of all kinds can be properly classified, the medical profession has developed a comprehensive codification system for the many diseases and conditions for which people seek treatment. This complex system, which has been evolving for well over a century, is currently known as the ICD-10. In an attempt to be as precise as possible, the ICD-10 contains codes for all common and uncommon diseases and medical conditions.
While medical coders are not expected to memorize the approximately 68,000 codes found in the ICD-10, they are expected to understand the system and most importantly, how it applies to medical billing practices. In short, medical coders interpret physicians’ notes and “translate” them into recognized medical and billing codes. Notably, these codes, rather than physicians’ notes, ultimately determine what medical procedures will be reimbursed. While the ICD-10 plays a key role in medical coders’ work, they are also expected to be familiar with two other manuals: CPT (Current Procedural Terminology) and HCPCS (Healthcare Common Procedure Coding System) Level II.
Structure of the AAPC CPC Examination
The AAPC CPC (American Academy of Professional Coders Certified Professional Coder) exam consists of 150 multiple-choice questions. Test takers have 5 hours and 40 minutes to complete the exam. Unlike many other certification exams, the CPC exam is an open book exam. In fact, test takers must bring copies of the ICD-10, CPT and HCPCS manuals to the exam.
The exam consists of 17 different content areas and each content area consists of eight to ten questions. In what follows, we break down each content area. We begin, by providing some general tips on how to prepare for this unique and challenging certification exam.
What to Expect and How to Prepare
The AAPC CPC covers many topics. As a result, it is important to have a clear plan as you prepare for the exam. Among other things be certain to:
• Familiarize yourself with how to access information in all three manuals (the ICD-10, CPT and HCPCS). You’re not being tested on your ability to memorize thousands of codes but rather on your ability to locate these codes in an accurate and expedient manner.
• Bring all three manuals to the test—if you don’t, you’re bound to fail!
• You are permitted to bookmark frequently used sections of the manuals, so do so as you prepare for the exam. You are also permitted to make marginal notes on your manual copies.
• Since you won’t need a perfect score to pass, if a question is particularly long and complex, skip it and move on to the next question. Aim to answer at least 80% of the questions correctly, because you’ll need 70% to pass the actual exam.
Content Area 1: 10,000 Series CPT
Expect ten questions on the subject of surgical procedures performed on the integumentary system. By definition, the integumentary system is an organ that protects the body from damage; skin, nails and hair are all part of this system. On the exam, you may also come across questions concerned with cysts. You should understand the system’s function, parts and connection to disease.
Content Area 2: 20,000 Series CPT
Be prepared to respond to at least ten questions on the topic of surgical procedures performed on the musculoskeletal system, including those parts of the system located in the head, neck, back, spine, abdomen, shoulder, arm, hand, fingers, pelvis, hip, leg foot and toes.
Content Area 3: 30,000 Series CPT
There will also be a total of ten questions concerned with surgical procedures carried out on the following four systems:
• Respiratory system (e.g., nose, larynx and lungs)
• Cardiovascular system (e.g., heart, arteries and veins)
• Hemic and lymphatic systems (e.g., spleen and lymph nodes and channels)
• Mediastinum and diaphragm
Content Area 4: 40,000 Series CPT
Ten questions will focus on surgical procedures performed on the digestive system, which includes lips, mouth, palate, salivary glands, esophagus, stomach, intestines, appendix, rectum, anus, liver, biliary tract, pancreas, abdomen, peritoneum, and omentum.
Content Area 5: 50,000 Series CPT
Also, expect to encounter ten questions concerned with surgical procedures carried out on the following four systems and situations:
• Urinary system (e.g., kidneys, balder and urethra)
• Male reproductive system (e.g., penis, testis, scrotum and spermatic cord)
• Female reproductive system (e.g., vulva, vagina and uterus)
• Maternity and delivery
• Endocrine system (e.g., thyroid gland, pancreas, and adrenal glands)
Content Area 6: 60,000 Series CPT
Be prepared to respond to ten questions pertaining to surgical procedures performed on the nervous system (e.g., brain, spine and extracranial and peripheral nerves).
Content Area 7: Evaluation and Management
The questions grouped under “evaluation and management” focus on the types of services provided in special departments and/or under special conditions. In this section, expect to find questions that test your knowledge of the following topics:
• Office/Other Outpatient
• Hospital Observation
• Hospital Inpatient
• Emergency Department
• Critical Care
• Nursing Facility
• Domiciliary and Rest Homes
• Home Services
• Prolonged Services
• Case Management
• Care Plan Oversight
• Preventive Medicine
• Non-Face-to-Face Services
• Special E/M
• Newborn Care
• Neonatal and Pediatric Critical Care and Intensive Care
• Complex Chronic Care Coordination
• Transitional Care Management
Content Area 8: Anesthesia
Anesthesia, one of the most expensive parts of medicine, is a distinct content area on the AAPC CPC. Be prepared to respond to questions on reporting, qualifying circumstances, physical status modifiers, and anesthesia for surgical, diagnostic and obstetric services.
Content Area 9: Radiology
There will be ten questions on radiology, including specific questions on diagnostic radiology and ultrasounds, mammography, bone and joint studies, oncology and nuclear medicine broadly defined.
Content Area 10: Laboratory Pathology
Another key content area concerns laboratory pathology; on this section of the exam, be prepared to respond to questions on any of the following topics:
• Organ and Disease Panels
• Drug Testing
• Therapeutic Drug Assays
• Evocation Testing
• Molecular Pathology
• Hematology and Coagulation
• Anatomic Pathology
• Cytogenetic Studies
• Surgical Pathology
• In vivo and Reproductive
Content Area 11: Medicine
The test will also present ten questions on topics in medicine pertaining to any of the following specific knowledge areas:
• Noninvasive Vascular Studies
• Allergy and Immunology
• Central Nervous System Assessments
• Health and Behavior Assessments
• Therapeutic and Diagnostic Administration
• Chemotherapy Administration
• Photodynamic Therapy
• Physical Medicine and Rehabilitation
• Medical Nutrition
• Osteopathic Manipulative Treatment
• Chiropractic Manipulative Treatment
• Patient Education and Training
• Non-Face-to-Face Nonphysician Services
• Moderate Sedation
Content Area 12: Medical Terminology
Expect eight questions on medical terminology pertaining to systems of the human body (e.g., be prepared to respond to questions about parts and functions of the circulatory system and parts and functions of the skeletal system).
Content Area 13: Anatomy
Prepare for eight questions on anatomy in relation to all systems in the human body.
Content Area 14: ICD-10-CM/Diagnosis
Ten questions will focus on ICD-10’s official guidelines for coding and reporting and on diagnosis questions; notably, diagnosis questions may also appear elsewhere on the exam.
Content Area 15: HCPCS Level II
Five questions will focus on modifiers (two-digit codes that modify another service or procedure), supplies, medications and professional services for Medicare patients.
Content Area 16: Coding Guidelines
Six questions will focus on the ICD-10’s official guidelines for coding and reporting and on CPT coding guidelines and notes. Once again, this means you should know as much as possible about both of these manuals.
Content Area 17: Compliance and Regulatory
Finally, five questions will focus on compliance and regulations. As a result, be prepared to answer questions on at the following subjects:
• Services covered under Medicare Parts A, B, C, and D
• HIPAA (Health Insurance Portability and Accountability Act)
• NCCI (National Correct Coding Initiative) Edits
• NCD/LCD (National Coverage Determinations/Local Coverage Determinations)
• ABNs (Advance Beneficiary Notice of Noncoverage)
• RVUs (Relative Value Units), which are part of Medicaid’s reimbursement formula for physicians
• How to apply coding to payment policies
• How to identify and report fraud and abuse
You should plan to study for the AAPC CPC exam for at least two months. The more you know without having to utilize the books during the exam, the better. You’ll ensure that you finish all of the questions in the allotted time frame to achieve the highest possible score. Try out Pocket Prep’s AAPC CPC exam prep app and study in conjunction with the AAPC textbooks!