Certified Professional Coder-Hospital Outpatient (CPC-H®)

Outpatient ambulatory coder jobs are trending faster than ever before. As physicians move away from private practice and join hospital groups, career opportunities in Outpatient Facilities such as Ambulatory Surgical Centers or hospital outpatient billing and coding departments are opening for coders. The CPC-H® exam validates your specialized payment knowledge needed for these jobs in addition to your CPT®, ICD-9, and HCPCS Level II coding skills. Invest in your future with the CPC-H® certification.

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 (emergency department visits, outpatient clinic visits, same day surgeries, diagnostic testing (radiology and laboratory) and outpatient therapies (physical therapy, occupational therapy, speech therapy and chemotherapy))
  • 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 UB04
  • Correctly completing a CMS 1500 for ASC services and UB04 for outpatient services, including the appropriate application of modifiers
  • Knowledge of anatomy, physiology and medical terminology commensurate with ability to correctly code provider services and diagnoses
  • A working knowledge in the assignment of ICD-9-CM codes from Volumes 1 & 2

Note: ICD-9-CM Vol 3 and DRG code assignment (inpatient coding) are not tested during the CPC-H exam

The CPC-H Exam

  • 150 multiple choice questions (proctored)
  • 5 hours and 40 minutes to finish the exam
  • One free retake
  • $300 ($260 for AAPC Students)
  • Open code book (manuals)

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 and freestanding ASC services to insurance companies.

The CPC-H® exam thoroughly covers:

Medical Terminology

  • 10 questions
  • Medical terminology for all systems in the human body

Anatomy

  • 10 questions
  • Anatomy for all systems in the human body

Coding Guidelines

  • 5 questions
  • ICD-9-CM Official Guidelines for Coding and Reporting
  • CPT® coding guidelines and parenthetical notes
  • Modifier use

Payment Methodologies

  • 20 questions
  • Services covered by Medicare Parts A, B, C, and D
  • Medicare as a secondary payer
  • Requirements for completion of UB04 claim form
  • Requirements for completion of CMS 1500 claim form
  • OPPS Payment Methodology
    • APCs
    • Revenue codes
    • Status Indicators
    • Payment Indicators
    • Condition codes
    • Calculation of proper payments (excerpts from Addendum B and Addendum AA are provided on the exam)
  • IPPS Payment Methodology
    • Elements needed to determine MS-DRGs
    • Code sets required for inpatient claims
    • Reimbursement for teaching hospital setting
    • Change masters

Compliance

  • 5 questions
  • NCDs/LCDs
  • HIPAA
  • ABNs

ICD-9-CM Volumes I and II

  • 30 questions
  • ICD-9-CM Official Guidelines for Coding and Reporting
  • Diagnoses for all the chapters included in ICD-9-CM
  • Diagnosis questions will also appear in other sections of the exam from the CPT® categories

CPT®

  • 20 questions
  • Evaluation and Management
    • Emergency Department
    • Outpatient Clinics
    • Observation
    • Critical Care
  • Surgery
    • Procedures approved for outpatient hospital facilities
    • Procedures approved for ASC facilities
  • Radiology
    • Diagnostic Radiology
    • Diagnostic Ultrasound
    • Radiologic Guidance
    • Mammography
    • Bone and Joint Studies
    • Radiation Oncology
    • Nuclear Medicine
  • Laboratory/Pathology
    • Organ and Disease Panels
    • Drug Testing
    • Therapeutic Drug Assays
    • Evocation/Supression Testing
    • Consultations
    • Urinalysis
    • Molecular Pathology
    • MAAA
    • Chemistry
    • Hematology and Coagulation
    • Immunology
    • Transfusions
    • Microbiology
    • Anatomic Pathology
    • Cytopathology
    • Cytogenetic Studies
    • Surgical Pathology
    • In vivo and Reproductive
  • Medicine
    • Immunizations
    • Psychiatry
    • Dialysis
    • Gastroenterology
    • Ophthalmology
    • Otorhinolaryngology
    • Cardiovascular
    • Noninvasive Vascular Studies
    • Pulmonary
    • Neurology
    • Central Nervous System Assessments
    • Hydration
    • Therapeutic and Diagnostic Administration
    • Chemotherapy Administration
    • Physical Medicine and Rehabilitation
    • Patient Education and Training
    • Non-Face-to-Face Nonphysician Services
    • Moderate Sedation

HCPCS Level II Coding

  • 10 questions
  • Modifiers
  • Supplies
  • Medications
  • Procedures performed on Medicare patients

Surgery Cases

  • 40 questions
  • Procedures approved for outpatient hospital facilities
  • Procedures approved for ASC facilities

* Medical Coding Salary