Certified Professional Coder (CPC®)
A Certified Professional Coder has proven by rigorous examination and experience that they know how to code, rationales for why particular codes are used and can do so both efficiently and effectively. A CPC® can review and adjudicate coding of services, procedures and diagnoses on medical claims in the physician-office setting, thus improving the finances and operational efficiency of the practice.
The CPC®'s abilities include:
- Proficiency in adjudicating claims for accurate medical coding for diagnoses, procedures and services in physician-based settings
- Proficiency across a wide range of services, which include evaluation and management, anesthesia, surgical services, radiology, pathology and medicine
- Sound knowledge of medical coding rules and regulations including compliance and reimbursement. A trained medical coding professional can better handle issues such as medical necessity, claims denials, bundling issues and charge capture
- Knowing how to integrate medical coding and reimbursement rule changes into a practice's reimbursement processes
- Knowledge of anatomy, physiology and medical terminology necessary to correctly code provider diagnosis and services
Locate/Schedule an Exam Prepare for Exam
The CPC® Exam
- 150 multiple choice questions (proctored)
- 5 1/2 hours
- 1 free retake
The CPC® 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 billing professional medical services to insurance companies. It is designed to evaluate a physician practice coder’s knowledge of the following:
- Anesthesia
- Radiology
- Medicine
- Nervous
- Endocrine
- Digestive
- Urinary
- Musculoskeletal
- Evaluation and Management
- Anatomy and Physiology
- Mediastinum & Diaphragm
- Practice Management
- Male/Female Genital
- Hemic & Lymphatic
- Maternity & Delivery
- Eye & Ocular Adnexa
- ICD-9-CM
- HCPCS Level II
- Coding Guidelines
- Medical Terminology
- Pathology
- Integumentary
- Respiratory
- Laboratory
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.
List of Approved Manuals
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
- We recommend having an associate’s degree.
- Pay examination fee at the time of application submission.
- Maintain current membership with the AAPC.
- New members must submit membership payment with examination application.
- Renewing members must be current at the time of application submission as well as when results are sent.
- Starting in January 2009 all exams will be reported with exact scores. The CPC® exam will report the top three areas of weakness.
A CPC® must have at least two years medical coding experience and maintain yearly renewal as well as submit 36 Continuing Education Units (CEUs) 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. Consequently, 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 Apprentices (CPC-A, CPC-H-A and/or CPC-P-A).
CPC®, CPC-H®, or CPC-P® Apprentice Status: Apprentices are required to submit the annual CEUs while completing the coding work experience requirement. The apprentice will receive a certificate from the AAPC for CPC, CPC-H or CPC-P Apprentice. The official credential designations for these certifications are CPC-A, CPC-H-A and CPC-P-A.
Requirements for Removal of Apprentice Designation: At least two recommendation letters verifying two years of on-the-job experience using the CPT®, ICD-9-CM or HCPCS Level II code sets. At least one letter must be from a supervisor outlining your coding experience and amount of time in that capacity.
OR
A minimum 80-hour coding course AND one letter verifying one year of on-the-job coding experience from a supervisor. Proof of education may be sent in the form of a letter from the instructor stating the amount of instruction hours or a certificate of completion stating the amount of instruction hours.