Test Anxiety? Take Back Control with Tactical Tips

When you prepare yourself and have a test-taking strategy, panic subsides.

By Melissa Kirshner, CPC, CRC, CPC-I, AAPC Fellow
For many, the pressure and stress of passing the Certified Professional Coder (CPC®) exam manifests itself in physical and emotional ways. For example, I had horrible dreams every night leading up to it. I’d cautiously open the testing booklet to question one, and it would be a long operative report that we all dread. I’d skip to question two, only to find another long operative report. I’d thumb through the entire test booklet, which were all long operative reports. At this point in the nightmare, I’d be in a complete panic. And then, I’d wake up.
I’d remind myself: I know this and how to work these long, complex cases. I know the tricks to feel more confident. And then, I’d get back to studying.
I share this dream with my students, along with tips for studying to help alleviate their test anxiety.
Rest assured, the CPC® exam is not all long, complex operative reports. It’s about applying your knowledge and understanding of guidelines to the information presented and choosing the best available answer. There are techniques you can use on the exam to answer questions quickly and confidently, without having every code and every guideline memorized.
Here’s what I tell my students …

Eliminate Answers

Look at the answers first, before ever reading the question. This will help you to learn if the focus of the question is CPT®, ICD-10-CM, HCPCS Level II, modifiers, etc. And using what you know about guidelines, you may be able to eliminate answers before ever reading the question.
Example 1: Guidelines for debridement instruct, “In multiple wounds, sum the surface area of those wounds that are at the same depth.” Knowing this instruction, you can confidently look at answers such as these and eliminate two:

A. 11042

B. 11042, 11042, 11045

C. 11042, 11045 x 2

D. 11042 x 2, 11045 x 2

The instruction is to add together wounds of the same depth. Looking at the codes:
11042     Debridement, subcutaneous tissue (includes epidermis and dermis, if performed); first 20 sq cm or less
+11045       each additional 20 sq cm, or part thereof (List separately in addition to the code for primary procedure)
Examinees must know the guideline and know not to report 11042 twice. It only applies to the first 20 sq cm of subcutaneous tissue debrided. Anything over 20 sq cm is reported with 11045, so answers B and D can be eliminated. And now, read the case knowing to look only for the size of wound debrided. Either 1-20 sq cm (answer A) or 41-60 sq cm (answer C).
Example 2: Many students dread the evaluation and management (E/M) questions. When presented with an E/M exam question, it’s easy to freeze with worry about how to level the service based on a long passage of information. Again, let’s start with the answers:

A. 99203

B. 99213

C. 99243

D. 99253

These represent, in order, a new patient office/outpatient visit, an established patient office/outpatient visit, an outpatient consultation, and an inpatient consultation. Now that you know the codes represent four distinct classifications of codes, it’s easier to go back and read the question. The question begins, “Dr. Smith is asked by the patient’s primary care provider to consult on the cardiovascular status of his patient in the intensive care unit.” Without reading further into the question, you can confidently answer D, level 3 inpatient consultation.
The same thought process can be applied to a variety of questions on the CPC® exam.

Time-saving Tips: Do not start the exam by looking up answers in the index. Do not get bogged down in the details of the question.

Prepare Your Testing Materials

Your materials should be well prepared for the exam. To do this, make sure you have the index tabbed in all three books. Although it’s not recommended to start in the index to look up codes during the exam, the index is extremely valuable if you encounter unfamiliar terms.
Go directly to the tabular section of the books to view codes. You may find it beneficial to have notes and reminders written down with your codes. Because there is not enough time on the exam to re-read guidelines, you’ll need to either know them very well or have guideline reminders written with the codes.
Example 3: In the 2018 CPT® code book, the instructions for Excision – Benign Lesion are printed on page 79, but the codes are printed on page 80. The instructions say, “Report separately each benign lesion excised,” and, “Repair by intermediate or complex closure should be reported separately.” These are two important guidelines you need to know when coding excisions. Consider making abbreviated notes on the pages where the codes are. Armed with this information, you’re better prepared to read the question.
In ICD-10-CM, I teach all of my students to watch for the red coding codes. As you read the guidelines, check the tabular section for the codes referenced. Look to see if there is a red note under the code, which will help guide you during the exam. If there isn’t a note, but there’s something worth noting, write it down in the margin.
Example 4: ICD-10-CM coding guideline I.C.2.c.1 instructs that when treating anemia associated with malignancy, and the treatment is for anemia only, to sequence the malignancy first followed by the code for anemia, such as D63.0 Anemia in neoplastic disease. In checking the tabular section for D63.0, a red note instructs you to code first associated neoplasm. In contrast, coding guidelines I.C.1.a.2.a and I.C.1.a.2.b cover the sequencing of patients with human immunodeficiency virus infection and acquired immune deficiency syndrome (AIDS/HIV). Checking the tabular section for code B20 Human immunodeficiency virus [HIV] disease, the guidelines for sequencing are not preprinted there. This is a good place to add a note with sequencing guidance to help you move quickly during the exam.
I also suggest underlining or highlighting note differences in codes as you prepare your books. Color code in a way that works for you:

• Highlight modifier instructions.
• Underline or circle anatomy terms.
• Circle terms such as with and without.
• Use the margins around the codes to indicate approach, intention (insert, remove, replace).

Example 5: In the Radiology section, clearly indicate in margins the differences in codes such as CT, CTA, MRI, MRA, and underline or highlight the different anatomical designations. Make it very easy to see differences in codes quickly because time matters.

Practice, Practice, Practice

To help you with time, be sure to practice. The CPC® exam is part knowledge and part timing. Not only do you need to understand and apply guidelines, you must do so quickly. Five hours, 40 minutes sounds like a long time to answer 150 questions, but most examinees use the majority, if not all, of the allotted time.
Treat each practice exam as though it were the real test:

• Set a timer.
• Avoid distractions.
• Only have your reference materials out.
• Turn the cell phone and computer off.

Once you’re done with the practice exam, check your answers and note where you struggled. Review those areas. Use the rationales to understand why your answer was incorrect. Make additional notes in your reference materials to help you the next time you encounter something similar. If you run out of time, work on employing more of the test-taking strategies.
Some instructors and examinees also recommend breaking the exam down into sections. When you time yourself during practice, you’ll find you have about 2 minutes per question — some will take you longer, some you’ll answer more quickly. One suggestion is to estimate 30 questions per hour. At the end of one hour, stop and move to the next 30 questions, whether you’re done with the initial 30. If you stick to 30 questions per hour, you’ll have time at the end of the test to return to those unanswered questions.
Practice helps you to sit for the exam and answer the questions with confidence.

Lead with Your Strengths

To pass the CPC® exam, you must score 70 percent or higher. That means, out of 150 questions, you may miss 45 questions and still pass. Every question on the exam is worth the same amount of points, whether the question is a single line or a long operative report. Some instructors recommend answering those sections where you are most confident first. Get your easier points first and leave the harder questions for the end. Do not spend too long focusing on a single question. If a question is too long or too complicated, skip it; however, do not leave questions unanswered at the end of the test. When you have 10 minutes left, go back and put any answer down for those unanswered questions. A guess is better than leaving it blank.
These strategies will help you to complete the CPC® exam with more confidence. Good luck!

For more guidance on taking the CPC® exam, read these articles on AAPC’s Knowledge Center:

Testing Tips for Determining E/M Levels
Tips to Pass AAPC’s CPC Exam

Melissa Kirshner, CPC, CRC, CPC-I, AAPC Fellow, is executive director of a physician organization in Southeast Michigan. She has more than 30 years of healthcare experience in billing, coding, compliance, education, and software development. As a certified PMCC instructor, she teaches billing and coding classes to prepare students for the CPC® exam. Kirshner is a founding member of the Novi, Mich., local chapter, and serves as treasurer.

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