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 1/2 hours
  • 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

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