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Certified Professional Coder-Hospital (CPC-H®)

The CPC-H® credential designates a coder that has proven by rigorous examination and experience that he/she knows how to code and rationales for why particular codes are used and can do so both efficiently and effectively in an hospital or clinical outpatient setting. A CPC-H® can review and adjudicate coding of services, procedures and diagnoses on medical claims in the outpatient setting, thus improving the finances and operational efficiency of the facility.

The CPC-H®'s abilities in regard to outpatient facility/hospital services include:

  • Proficiency in assigning accurate medical codes for diagnoses, procedures and services performed in the outpatient setting
  • Proficiency across a wide range of services, which include evaluation and management, anesthesia, surgical services, radiology, pathology and medicine
  • Knowledge of coding rules and regulations along with keeping current on issues regarding medical coding, compliance and reimbursement under outpatient grouping systems. A trained coding professional can better handle issues such as medical necessity, claims denials, bundling issues and charge capture
  • Ability to integrate coding and reimbursement rule changes in a timely manner to include updating the Charge Description Master (CDM), fee updates and the Field Locators (FL) on the UB92
  • A working knowledge of AHA Coding Clinic guidelines in the assignment of ICD-9-CM codes from Volumes 1 & 2
  • Correctly completing a UB92, including the appropriate application of modifiers
  • Knowledge of anatomy, physiology and medical terminology commensurate with ability to correctly code provider services and diagnoses

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The CPC-H® Exam

  • 150 multiple choice questions (proctored)
  • 5 hours and 40 minutes to finish the exam
  • 1 free retake

The CPC-H® examination consists of questions regarding the correct application of CPT®, HCPCS Level II procedure and supply codes and ICD-9-CM diagnosis codes used for coding and billing outpatient facility/hospital services to insurance companies. It is designed to evaluate a coder’s knowledge of:

  • Medical Terminology
  • Anatomy
  • Coding Guidelines
  • Payment Methodologies
  • CPT®
  • HCPCS Level II
  • Surgery and Modifiers
  • Code Assignment ICD-9-CM Vols 1 & 2
  • Compliance

Approved Manuals for Use During Examination

  • CPT® Books (AMA standard or professional edition ONLY). No other publisher is allowed
  • Your choice of ICD-9-CM
  • Your choice of HCPCS Level II

In addition, any officially published errata update sheets for these manuals may be used. No other manuals are allowed. Examinees may use current calendar year and/or previous year code books. However, it is strongly suggested that only current manuals be used. Questions on the CPC®, CPC-P® and CPC-H® tests do not require the use of any other outside material.

Individuals with a solid understanding of coding fundamentals, anatomy and terminology should be able to answer each examination question through application of the CPT®, ICD-9-CM or HCPCS Level II manuals or through careful reasoning.

Approved Exam Manuals/Exam Instructions

Non-Approved Manuals for Use During Examination

Due to the advantages of additional information and/or ease of use, the following books cannot be used during the exam:

  • Current Procedural Coding Expert® - Ingenix
  • Procedural Coding Professional - Contexo
  • Procedural Coding Professional - AAPC
  • Procedural Coding Expert - Contexo
  • Procedural Coding Expert - AAPC
  • CPT® Insider's View - AMA
  • CPT® Plus! - PMIC
  • Coders' Choice CPT® - PMIC
  • ICD-9-CM Easy Coder - Unicor

Medical Coding Certification Requirements

  1. We recommend having an associate’s degree.
  2. Pay examination fee at the time of application submission.
  3. Maintain current membership with the AAPC.
    1. New members must submit membership payment with examination application.
    2. Renewing members must have a current membership at the time of submission and when exam results are released.
  4. Effective January 2010 all exams will be reported with exact scores. The CPC-H® exam will report the top three areas of weakness.

A CPC-H® must have at least two years medical coding experience (member's with an apprentice designation are not required two have two years medical coding experience.) Membership is required to be renewed annually and 36 Continuing Education Units (CEU's) must be submitted every two years for verification and authentication of expertise.

Note:
Each examination is separate and distinct from one another. To obtain all certifications, each examination must be taken separately and passed. Continuing Education Unit (CEU) submissions are required for all certifications. For CEU requirements please see our CEU Information page.

Due to the level of expertise required of medical coders, the AAPC expects certified coders to be able to perform not only in an exam setting but also in the real world. In addition to passing the certification exam, coders will also be required to demonstrate on-the-job coding experience before receiving the full credential. Those who pass the CPC®, CPC-H® and/or CPC-P® exams but have not yet met this requirement will be designated as an Apprentice (CPC-A®, CPC-H-A® and/or CPC-P-A®) on their certificate.

CPC-A®, CPC-H-A®, or CPC-P-A® Status: Member's with an Apprentice designation are required to submit the annual CEU's while completing the coding work experience requirement.

Requirements for Removal of Apprentice Designation: Two letters of recommendation verifying 2 years of on the job experience using the CPT®, ICD-9-CM, or HCPCS code sets. One letter must be on letterhead from your employer. Both letters are required to be typed and signed and will need to outline your coding experience and amount of time in that capacity.

OR

A minimum 80 hours of coding education AND one letter on letterhead from your employer verifying one year of on the job experience using the CPT, ICD-9-CM or HCPCS code sets. Proof of education may be sent in the form of a letter from an instructor on school letterhead stating the amount of contact hours earned, a certificate/diploma stating at least 80 contact hours or a school transcript.

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