Foundations
11%of exam
ICD-10-CM
5%of exam
SequencingConventionsGuidelinesSpecificity
CPT Services
28%of exam
Surgery
36%of exam
IntegumentaryMusculoskeletalDigestiveCardioApproach
Claim Logic
20%of exam
Quick Facts
- Exam
- CPC
- Credential
- Certified Professional Coder
- Owner
- AAPC
- Questions
- 100 MCQ
- Time
- 4 hours
- Pass
- 70%
- Format
- Online or center
- Books
- CPT ICD HCPCS
- CEUs
- 36 per two years
Terminology
- Root
- Core body part
- Prefix
- Before root
- Suffix
- Condition/procedure
- -itis
- Inflammation
- -ectomy
- Surgical removal
- Hyper-
- Excessive/high
- Hypo-
- Low/deficient
- Brady-
- Slow
Anatomy
- Superior
- Toward head
- Inferior
- Toward feet
- Anterior
- Front side
- Posterior
- Back side
- Medial
- Toward midline
- Lateral
- Away midline
- Proximal
- Near origin
- Distal
- Farther away
Compliance
- Medical necessity
- Reasonable necessary service
- FCA
- False claims
- AKS
- Kickback referrals
- Stark
- Self-referral
- HIPAA
- PHI privacy
- ABN
- Medicare notice
- Audit
- Documentation review
- Query
- Clarify record
ICD Check
Index starts; tabular wins.
IndexTabularNotesLaterality
Excludes1 vs Excludes2
Excludes1
- Mutually exclusive
- Do not code
- Same condition
Excludes2
- Not included
- May code
- Separate condition
Never vs maybe
ICD Guidelines
- First-listed
- Encounter reason
- Code first
- Underlying first
- Use additional
- Add detail
- Excludes1
- Never together
- Excludes2
- May coexist
- NOS
- Unspecified
- NEC
- Other specified
- Laterality
- Side required
Screening vs Diagnostic
Screening
- No symptoms
- Preventive reason
- Z code often
Diagnostic
- Signs/symptoms
- Problem workup
- Findings matter
Prevent vs evaluate
E/M MDM
MDM rides problems, data, risk.
ProblemsDataRisk
MDM vs Time
MDM
- Problems
- Data
- Risk
Time
- Provider work
- Same date
- Threshold met
Complexity vs minutes
E/M Picker
- Office visit→MDM/time
- Procedure same day→-25(Separate E/M)
- Postop unrelated→-24(Global period)
- Consult request→Consult codes(Report back)
- Critical illness→Critical care(Time based)
- Preventive visit→Preventive E/M
- Prolonged service→Add-on(Threshold met)
- Staff-only work→Not provider time
E/M
- New patient
- No three-year service
- Established
- Prior three-year service
- MDM
- Problems/data/risk
- Time
- Date provider time
- -25
- Separate E/M
- -24
- Unrelated postop E/M
- Consult
- Request/opinion/report
- Critical care
- Time-based intensity
Anesthesia Formula
Base plus time, then modifiers.
BaseTimeStatusQualifying
Anesthesia
- Base units
- Procedure value
- Time units
- Start to stop
- Physical status
- P1-P6
- Qualifying
- Special circumstances
- AA
- Personally performed
- QK
- Medical direction
- QS
- MAC service
- Conversion factor
- Payment multiplier
Radiology Path/Lab
- -26
- Professional component
- -TC
- Technical component
- Contrast
- Descriptor driver
- Bilateral
- Check descriptor
- Panel
- All components met
- Specimen
- Path code driver
- Screening
- Preventive reason
- Diagnostic
- Problem evaluation
Surgery Coding
- Approach
- Open/scope/percutaneous
- Site
- Exact anatomy
- Laterality
- Right/left/bilateral
- Depth
- Layer documented
- Size
- Measure required
- Closure
- Repair type
- Global
- Postop package
- Add-on
- Never standalone
Case Order
Facts, codes, modifiers, edits.
AbstractAssignModifyValidate
CPT vs HCPCS
CPT
- Procedures
- Physician services
- Numeric codes
HCPCS
- Supplies/drugs
- DME/transport
- Alphanumeric codes
Service vs item
Code Set Picker
- Diagnosis statement→ICD-10-CM
- Office procedure→CPT
- Physician service→CPT
- Supply/drug/DME→HCPCS
- Special circumstance→Modifier
- Bundled pair→NCCI
- Too many units→MUE
- Missing detail→Query
HCPCS
- A codes
- Transport/supplies
- E codes
- DME
- J codes
- Drugs
- L codes
- Orthotics/prosthetics
- G codes
- Temporary services
- Units
- Descriptor quantity
- DME
- Home medical equipment
- Ambulance
- Origin/destination
-25 vs -59
-25
- E/M only
- Same-day procedure
- Separate work
-59
- Non-E/M
- Distinct service
- Edit override
Visit vs procedure
Case Workflow
- Read scenario→Abstract facts
- Find diagnosis→ICD index
- Confirm diagnosis→Tabular
- Find service→CPT index
- Check descriptor→CPT section
- Need supply→HCPCS
- Same-day services→Modifiers
- Before final→Edits/guidelines
Modifiers + Edits
- -59
- Distinct service
- XE
- Separate encounter
- XS
- Separate structure
- XP
- Separate practitioner
- XU
- Unusual service
- NCCI
- Code-pair edits
- MUE
- Unit limits
- Column 2
- Bundled component
Bundled vs Separate
Bundled
- Included work
- Column 2
- No separate pay
Separate
- Distinct work
- Modifier support
- Documentation proves
Included vs distinct
Common Traps
Higher Pay
Documented code ≠ Highest reimbursement
Modifier Shortcut
Supported modifier ≠ Automatic override
Codebook Lookup
Tabular confirmation ≠ Index-only coding
Same-Day E/M
Separate E/M work ≠ Routine procedure work
Drug Units
Descriptor units ≠ Vial count
Surgery Detail
Approach/site/depth ≠ Procedure title only
Last Minute
- 1.Bring current codebooks
- 2.Confirm every tabular note
- 3.E/M equals MDM/time
- 4.Modifiers need documentation
- 5.NCCI before separate billing
- 6.HCPCS units match descriptor
- 7.Surgery: site/approach/depth
- 8.ICD first-listed drives necessity
- 9.Answer all 100 questions
- 10.Flag long cases early
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