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Certified Inpatient Coder (CIC)

The new inpatient medical coding certification standard, CIC (Certified Inpatient Coder), is the only certification dedicated exclusively to inpatient hospital/facility coding. The CIC validates expert level knowledge and experience in abstracting information from the medical record for ICD-10-CM and ICD-10-PCS coding, and specialized payment knowledge in MS-DRGs and Inpatient Prospective Payment Systems (IPPS). Invest in your future with the CIC certification—certified coders earn 40% more than non-credentialed coders.

CICs have demonstrated:

  • Expertise in medical record review to abstract information required to support accurate inpatient coding
  • Expertise in assigning accurate ICD-10 medical codes for diagnoses and procedures performed in the inpatient setting
  • Superior knowledge of current rules, regulations, and issues regarding medical coding, compliance, and reimbursement under MS-DRG and IPPS systems
  • Strong 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
  • Solid understanding of anatomy, physiology, and medical terminology required to correctly code facility services and diagnoses
  • Understanding of outpatient reimbursement methodologies (OPPS)

The CIC Exam

  • 60 multiple choice questions and 10 inpatient cases fill in the blank (proctored)
  • 5 hours and 40 minutes to finish the exam
  • One free retake
  • $350 ($290 AAPC Students)
  • Open code book (manuals)

The CIC examination consists of questions regarding the correct application of ICD-10-PCS procedure codes and ICD-10-CM diagnosis codes used for coding and billing inpatient facility/hospital services to insurance companies.

The CIC exam thoroughly covers:

  • 10 multiple choice questions
  • Recognize the limitations of EHR and how downtime is handled
  • Identify documentation deficiencies caused by copy/paste and use of templates
  • Understand HIPAA security and privacy
  • Understand the reporting requirements under MDS
  • Demonstrate proper procedure for addendums and alterations to the medial record
  • Identify components of the medical record
  • Identify the length of time the provider has to document services
  • Understand the requirement for timely documentation
  • Recognize and properly code for procedures performed at the bedside
  • Understand the reporting requirements under UHDDS
  • Understand Joint Commission (JC) requirements for documentation
  • 5 multiple choice questions
  • Understand medical terminology and anatomy
  • Understand pathophysiology to capture correct codes and identify documentation deficiencies
  • Recognize medications and conditions/diagnoses they are used to treat
  • 10 multiple choice questions
  • Identify benefits of Computer Assisted Coding (CAC)
  • Explain what natural language processing is and which departments in the hospital use it
  • Apply Coding Clinic guidance to inpatient coding
  • Identify correct ICD-10-CM and ICD-10-PCS codes for cases done
  • Identify proper procedure to look up DRG (eg, book, grouper)
  • Understand emerging roles for inpatient coders (DRG validator, auditor)
  • Identify conditions POA and use of indicators
  • 13 multiple choice questions
  • Recognize proper procedure for compliance with the 2 Midnight Rule and certification requirements
  • Understand different bill types
  • Identify information found in a charge master
  • List examples of auto population of services using a charge master
  • Explain requirements to maintain and monitor the chargemaster
  • Understand the role each department plays in chargemaster maintenance
  • Understand the 72 hour rule (24 hour for other types of inpatient services) and how services occurring prior to admit are reported
  • Identify different types of disposition and the impact on coding
  • Calculate base payments for DRGs
  • Identify elements needed to determine DRG assignment
  • Understand what is supported in the DRG (eg, services performed at another facility)
  • Understand different types of DRGs (eg, APR-DRG)
  • Understand Medicare Code Edits
  • Understand different inpatient types
  • Understand guidelines for selecting the principle diagnosis for different inpatient facilities
  • Explain impact of readmissions in a 30 day period
  • Explain when to rebill inpatient claim as an outpatient claim
  • Identify data submitted on a UB-04
  • 5 multiple choice questions
  • Identify differences between outpatient and inpatient payment methodologies
  • Explain coding requirements under OPPS: Pass through payments
  • Explain coding requirements under OPPS: APCs and Status Indicators
  • 9 multiple choice questions
  • Review LCD/NCD and apply the policy to inpatient coding
  • Identify services covered by Medicare Parts A, B, C, D
  • Explain proper execution of the ABN and HINN
  • Review private payer policy and apply to inpatient payment
  • Identify precertification requirements
  • 8 multiple choice questions
  • Explain external payer audits process and responsibilities of hospital staff
  • Explain internal audits and how they relate to compliance plans
  • Know how to interact with auditors during an onsite audit
  • Identify audit targets on the OIG work plan
  • Explain the CERT audit process and requirements for response to a request for records
  • Understand the PEPPER report and how it is utilized.
  • Identify examples of fraud and abuse
  • Explain the MAC audit process
  • Identify services approved for audit by the RAC auditors
  • Explain the Medicare appeal process and discuss requirements at each level
  • Explain the RAC audit process and requirements for response to a request for records
  • 10 inpatient cases fill in the blank
  • Code the ICD-10-CM and ICD-10-PCS codes for 10 inpatient cases

Approved Manuals for Use During Examination

  • We recommend you bring both the 2016 ICD-10-CM and the 2016 ICD-10-PCS manuals into the exam with you.

Note:

Electronic devices with an on/off switch (cell phones, smart phones, tablets, etc.) are not allowed into the examination room. Failure to comply with this policy may result in disqualification of your exam.

Any officially published errata for these manuals may also be used. No other manuals are allowed. Each code set is updated annually; it is essential that examinees use the current calendar year's coding manuals when taking the certification exam. Questions on the CPC, CIC and COC tests do not require the use of any other outside material.

Individuals with a solid understanding of coding and reimbursement fundamentals, anatomy and terminology should be able to answer each examination question through application of the ICD-10-CM and ICD-10-PCS codebooks or through careful reasoning and recall.

Approved Exam 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:

  • ICD-10-CM Easy Coder

Medical Coding Certification Requirements

While there is no experience requirement, we strongly recommend that the candidate have at least two years of experience in inpatient coding or an inpatient coding course.

Please be aware that this is a difficult, high-level examination which is not meant for individuals with little, limited or no inpatient coding experience or training.

  • 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 have a current membership at the time of submission and when exam results are released.
  • All exams will be reported with exact scores and areas of study (65% or less).

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.

Have a Question? Call 877-290-0440 or have a career counselor call you.

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