Certified Inpatient Coder (CIC®) - Certification Exam

The inpatient medical coding credential, Certified Inpatient Coder (CIC), is the only certification exclusively specialized in hospital and facility inpatient coding. The CIC validates mastery in abstracting information from the medical record for ICD-10-CM and ICD-10-PCS coding. It also represents expert knowledge of Medicare Severity Diagnosis Related Groups (MS-DRGs) and the Inpatient Prospective Payment System (IPPS).

Passing the CIC exam qualifies you to work in the rapidly changing medical coding and billing environment of hospital inpatient facilities. Students who earn their CIC credential go on to report services provided to patients requiring inpatient admission in settings that include general hospitals (acute care facilities), skilled nursing facilities (SNFs), critical access hospitals (CAHs), teaching hospitals, inpatient rehab facilities (IRF), and long-term care hospitals (LTCHs).

How Much Does a CIC Earn?

Inpatient coding differs from physician-based coding in that it focuses on services provided by the facility, rather than on services provided by the physician. CICs use ICD-10-CM codes to report inpatient diagnoses but follow coding guidelines that differ from outpatient guidelines. CICs also assign patients to one of several hundred MS-DRGs, which factors into reimbursement for patients covered by this system. The national average salary for CIC professionals is $57,936 annually, with an approximately 7% yearly increase.

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 system and IPPS
  • 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 Inpatient Prospective Payment System (IPPS) reimbursement methodologies

The CIC Exam

  • 40 multiple choice questions and 7 inpatient cases fill-in-the-blank questions (proctored)
  • 4 hours to finish the exam
  • 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:

  • 7 multiple choice questions
  • Recognize the limitations of EHR and how downtime is handled
  • Identify documentation deficiencies caused by copy/paste and use of templates
  • Explain HIPAA security and privacy
  • Define the reporting requirements under MDS
  • Demonstrate the proper procedure for addendums and alterations to the medial record
  • Identify components of the medical record
  • Identify the requirement for timely documentation
  • Recognize and properly code for procedures performed at the bedside
  • List the reporting requirements under UHDDS
  • Identify Joint Commission (JC) requirements for documentation
  • 3 multiple choice questions
  • Define and apply medical terminology and anatomy
  • Identify pathophysiology to capture correct codes and identify documentation deficiencies
  • Recognize medications and conditions/diagnoses they are used to treat
  • 7 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)
  • Explain emerging roles for inpatient coders (DRG validator, auditor)
  • Identify conditions POA and use of indicators
  • 9 multiple choice questions
  • Recognize proper procedure for compliance with the 2 Midnight Rule and certification requirements
  • Define 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
  • Define the role each department plays in chargemaster maintenance
  • Explain 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
  • Define what is supported in the DRG (eg, services performed at another facility)
  • List and explain different types of DRGs (eg, APR-DRG)
  • Identify Medicare Code Edits
  • Define different inpatient types
  • Explain and apply guidelines for selecting the principal 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
  • 3 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
  • 6 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
  • 5 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
  • Explain 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
  • 7 inpatient cases fill-in-the-blank
  • Code the ICD-10-CM and ICD-10-PCS codes for 7 inpatient cases
  • Each case will have anywhere from 5-15 possible answers. Each answer is weighted the same.

Approved Manuals for Use During the CIC Certification Exam

Any officially published errata for the above code books may also be referenced during the CIC exam. No other manuals are allowed.

Confirm reference materials allowed during the CIC certification exam prior to test day.

CIC Exam Book Bundle 2022 (ICD-10-CM, ICD-10-PCS)

ICD-10-PCS Complete Code Set 2022 - Now Shipping
ICD-10-CM Complete Code Set 2022 - Now Shipping
Retail: $239.99   Save: $120.00 (50%)
Non-Member: $149.99
Member: $119.99

CIC exam bundle includes the ICD-10-CM Expert and ICD-10-PCS Expert medical coding books, making it optimal for clinical coders specializing in inpatient coding.

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.

Medical Coding Certification Requirements

Please be aware that this is a difficult, high-level exam and not intended for individuals lacking CIC certification training or equivalent inpatient coding experience.

With training and/or experience, you should possess the required understanding of inpatient coding and reimbursement fundamentals, as well as anatomy and medical terminology, to answer exam question through careful reasoning, recall, and reference of ICD-10-CM and ICD-10-PCS code books.

Additional Requirements

If you haven’t become an AAPC member, you must do so prior to scheduling your CIC exam. Renewing AAPC members are also required to have a current membership to sit for the CIC certification exam.

An overall score of 70% or higher is required to pass the certification exam.

  • If you don’t pass, the areas of study/categories with a score of 65% or less will be provided for your preparation to retest. The areas of study reported reflect scores based on the number of questions in each category/section of the exam.

All AAPC certification exams exclusively measure proficiencies relating to the one credential named in the exam. To earn additional medical coding credentials will require you to pass additional certification exams.

CEU Requirement: Certified coders are required to complete 36 Continuing Education Units (CEU's) every two years. For CEU requirements please see our CEU Information page.

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