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In ICD-10-CM, what is the principal diagnosis for an inpatient admission?

The condition established after study to be chiefly responsible for occasioning the admission

The most severe condition the patient has at discharge

The first diagnosis documented in the medical record

The condition requiring the most resources during the stay

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2026 Statistics

Key Facts: CIC Exam

70%

Passing Score

AAPC

5h 40m

Exam Duration

AAPC

80-120 hrs

Study Time

Recommended

$55K-$70K

Median Salary

AAPC 2024 Survey

Total Questions + Cases

60 MC + 10 cases

$399-$499

Exam Fee

AAPC

The AAPC CIC exam tests inpatient coding proficiency across 60 multiple-choice questions and 10 coding cases in 5 hours 40 minutes. You need 70% to pass. The exam is open-book (ICD-10-CM, ICD-10-PCS, and other code manuals allowed). CIC-certified coders earn a median salary of $55,000–$70,000 (AAPC 2024 Salary Survey), with experienced hospital coders exceeding $80,000. AAPC membership ($190/year) is required.

Sample CIC Practice Questions

Try these sample questions to test your CIC exam readiness. Each question includes a detailed explanation. Start the interactive quiz above for the full 100+ question experience with AI tutoring.

1In ICD-10-CM, what is the principal diagnosis for an inpatient admission?

A.The condition established after study to be chiefly responsible for occasioning the admission

B.The most severe condition the patient has at discharge

C.The first diagnosis documented in the medical record

D.The condition requiring the most resources during the stay

Explanation: The principal diagnosis is defined by the Uniform Hospital Discharge Data Set (UHDDS) as the condition established after study to be chiefly responsible for occasioning the admission of the patient to the hospital for care. This is not necessarily the most severe condition or the first documented — it is the reason the patient was admitted.

2A patient is admitted with chest pain. After workup, the physician documents the diagnosis as acute STEMI of the left anterior descending artery. Which ICD-10-CM code is the principal diagnosis?

A.I21.02 — ST elevation myocardial infarction involving left anterior descending coronary artery

B.R07.9 — Chest pain, unspecified

C.I25.10 — Atherosclerotic heart disease of native coronary artery

D.I21.9 — Acute myocardial infarction, unspecified

Explanation: When a patient is admitted with a symptom (chest pain) and a definitive diagnosis is established after study (acute STEMI of the LAD), the definitive diagnosis becomes the principal diagnosis. The symptom code R07.9 is not reported separately when the definitive diagnosis is confirmed. Code I21.02 specifically identifies the STEMI involving the LAD artery.

3What does the 7th character in an ICD-10-CM injury code represent?

A.The type of encounter (initial, subsequent, or sequela)

B.The laterality of the injury

C.The severity of the injury

D.The anatomical site of the injury

Explanation: In ICD-10-CM, the 7th character extension for injury codes identifies the type of encounter: A for initial encounter, D for subsequent encounter, and S for sequela. This character is required for accurate coding and indicates the phase of treatment, not the number of times the patient has been seen.

4Which ICD-10-CM guideline applies when two or more diagnoses equally meet the definition of principal diagnosis?

A.Either condition may be sequenced first as the principal diagnosis

B.The condition requiring the most resources must be sequenced first

C.The condition diagnosed first must be sequenced first

D.The condition with the highest DRG reimbursement must be sequenced first

Explanation: Per ICD-10-CM Official Guidelines Section II, when two or more diagnoses equally meet the definition for principal diagnosis as determined by the circumstances of the admission and the diagnostic workup, either may be sequenced first. The coder should not select based on reimbursement but based on the clinical circumstances.

5A patient is admitted for chemotherapy and also has metastatic liver cancer from a primary colon malignancy. What is the principal diagnosis?

A.Z51.11 — Encounter for antineoplastic chemotherapy

B.C78.7 — Secondary malignant neoplasm of liver and intrahepatic bile duct

C.C18.9 — Malignant neoplasm of colon, unspecified

D.C80.1 — Malignant (primary) neoplasm, unspecified

Explanation: When the purpose of the admission is solely to administer chemotherapy, immunotherapy, or external beam radiation therapy, the appropriate Z code (Z51.11 for chemotherapy) is sequenced as the principal diagnosis. The codes for the malignancies being treated are reported as secondary diagnoses per ICD-10-CM Official Guidelines Section I.C.2.

6In ICD-10-PCS, what does the root operation 'Excision' mean?

A.Cutting out or off, without replacement, a portion of a body part

B.Cutting out or off, without replacement, all of a body part

C.Taking out or off a device from a body part

D.Physically taking out or off all or a portion of a body part by use of force

Explanation: Excision (root operation B) is defined as cutting out or off, without replacement, a portion of a body part. This is distinguished from Resection (root operation T), which involves cutting out or off all of a body part. The key distinction is 'portion' versus 'all' of the body part. Excision is one of the most commonly reported root operations in inpatient coding.

7How many characters are in a complete ICD-10-PCS code?

A.7

B.5

C.6

D.8

Explanation: All ICD-10-PCS codes are exactly 7 characters long. Each character represents a specific aspect of the procedure: (1) Section, (2) Body System, (3) Root Operation, (4) Body Part, (5) Approach, (6) Device, and (7) Qualifier. No code is longer or shorter than 7 characters, and placeholder character 'Z' is used when a character position has no applicable value.

8In ICD-10-PCS, which approach is defined as 'cutting through the skin or mucous membrane and any other body layers necessary to expose the operative site'?

A.Open

B.Percutaneous

C.Percutaneous Endoscopic

D.Via Natural or Artificial Opening

Explanation: The Open approach in ICD-10-PCS is defined as cutting through the skin or mucous membrane and any other body layers necessary to expose the site of the procedure. Percutaneous involves entry through the skin by puncture or minor incision. Understanding approach definitions is critical because the approach character directly affects ICD-10-PCS code selection.

9What is the root operation for a total hip replacement in ICD-10-PCS?

A.Replacement

B.Revision

C.Supplement

D.Resection

Explanation: Replacement (root operation R) is defined as putting in or on biological or synthetic material that physically takes the place and/or function of all or a portion of a body part. A total hip replacement puts in a synthetic joint that replaces the function of the native hip joint. Supplement adds to an existing body part, while Revision corrects a malfunctioning or displaced device.

10Which ICD-10-PCS root operation is used when the objective of a procedure is to stop or attempt to stop postprocedural or other acute bleeding?

A.Control

B.Repair

C.Occlusion

D.Restriction

Explanation: Control (root operation 3) is defined as stopping, or attempting to stop, postprocedural or other acute bleeding. This root operation is specifically for controlling bleeding and is distinct from Repair (restoring a body part to its normal function) or Occlusion (completely closing an orifice or lumen). Control is coded to the anatomical region rather than a specific body part.

About the CIC Exam

The AAPC CIC (Certified Inpatient Coder) exam validates proficiency in assigning ICD-10-CM diagnosis codes and ICD-10-PCS procedure codes for hospital inpatient services. It covers MS-DRG assignment, compliance, and regulatory requirements. Open-book format with code manuals allowed.

Questions

70 scored questions

Time Limit

5 hours 40 minutes

Passing Score

70%

Exam Fee

$399 (AAPC)

CIC Exam Content Outline

65%

Coding Cases (ICD-10-CM/PCS)

10 inpatient coding cases with fill-in-the-blank code assignment

Inpatient Payment Methodologies

MS-DRG/APR-DRG assignment, grouper logic, and reimbursement

Medical Record and Documentation

Health record components, documentation standards, and queries

Inpatient Coding (Multiple Choice)

ICD-10-CM/PCS guidelines, conventions, and code assignment

Regulatory and Payer Requirements

CMS regulations, medical necessity, and coverage determinations

Compliance

OIG guidance, fraud and abuse laws, audits, and ethics

Medical Terminology and Anatomy

Body systems, disease processes, and pharmacology

Outpatient Payment Methodologies

APC system and outpatient prospective payment

How to Pass the CIC Exam

What You Need to Know

Passing score: 70%
Exam length: 70 questions
Time limit: 5 hours 40 minutes
Exam fee: $399

Keys to Passing

Complete 500+ practice questions
Score 80%+ consistently before scheduling
Focus on highest-weighted sections
Use our AI tutor for tough concepts

CIC Study Tips from Top Performers

1Master ICD-10-PCS root operations — know the definitions and distinctions between Excision, Resection, Repair, Replacement, and other root operations

2Tab and highlight your code manuals extensively — efficient navigation saves critical time on coding cases

3Practice coding from real operative reports and discharge summaries to build speed and accuracy

4Know MS-DRG assignment logic — understand how principal diagnosis, procedures, complications, and comorbidities affect DRG grouping

5Study ICD-10-CM Official Guidelines for Coding and Reporting, especially chapters on diseases of the circulatory, respiratory, and musculoskeletal systems

6Complete at least 100 practice questions and 20+ coding cases before scheduling your exam

Frequently Asked Questions

What is the AAPC CIC exam format?

The CIC exam consists of 60 multiple-choice questions and 10 inpatient coding cases (fill-in-the-blank). You have 5 hours and 40 minutes to complete the entire exam. Each coding case may have 5-15 possible code answers, and each answer is weighted equally. The exam is open-book — you may use ICD-10-CM, ICD-10-PCS, and other approved code manuals.

What score do I need to pass the CIC exam?

You need a score of 70% or higher to pass the CIC exam. The exam uses scaled scoring across both the multiple-choice and coding case sections. Focus your preparation on the coding cases, which make up approximately 65% of your total score. Consistent practice with real inpatient records and code manuals is essential.

How hard is the CIC exam?

The CIC exam is considered one of the more challenging AAPC coding exams because it tests both knowledge (multiple choice) and practical application (coding cases). The coding cases require you to abstract diagnoses and procedures from clinical documentation and assign correct ICD-10-CM and ICD-10-PCS codes under time pressure. Most candidates study 80-120 hours over 8-16 weeks.

Is the CIC exam open book?

Yes, the CIC exam is open-book. You may bring your own ICD-10-CM, ICD-10-PCS, and other code manuals to the exam. For online proctored exams, you may use physical books. Tabbing and highlighting your code books is strongly recommended — efficient navigation can save significant time on the 10 coding cases.

What is the difference between CIC and CCS certifications?

Both CIC (AAPC) and CCS (AHIMA) certify inpatient coding competency, but they differ in format and focus. The CIC has 60 multiple-choice questions plus 10 coding cases and is open-book. The CCS has 91 multiple-choice questions plus 7 coding cases and is also open-book. Both test ICD-10-CM/PCS coding. CIC is administered by AAPC; CCS by AHIMA. Both are widely recognized by employers.

How much does the CIC exam cost?

The CIC exam costs $399 for a single attempt or $499 for two attempts (recommended for first-time test takers). AAPC membership is required and costs $190 per year if not already a member. Total first-time cost ranges from $589 to $689. The exam can be taken online with a live proctor or at a Pearson VUE testing center.

What are the CIC exam eligibility requirements?

There are no strict prerequisites to sit for the CIC exam, but AAPC recommends at least 2 years of inpatient coding experience or completion of an AAPC-approved training program. You must be an AAPC member ($190/year). If you pass without the required experience, you receive an apprentice designation until you complete 2 years of on-the-job coding experience.

How long should I study for the CIC exam?

Plan for 80-120 hours of study over 8-16 weeks. Spend the majority of your time (about 40%) practicing ICD-10-PCS procedure coding, as this is the most challenging component. Dedicate another 30% to ICD-10-CM diagnosis coding and 30% to payment methodologies, compliance, and documentation. Practice with full coding cases weekly.