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Certified Professional Coder-Payer (CPC-P®)

CPC-P

More private and public payers (health plans) are recognizing the value of employing certified coders to process and analyze medical claims for payment. The CPC-P® credential meets the growing demand for certified coders in a payer environment. Additionally, those with the CPC-P® earn 66% more than non-credentialed coders.

The CPC-P® demonstrates a coder’s aptitude, proficiency and knowledge of coding guidelines and reimbursement methodologies for all types of services from the payer's perspective. Contributing developers include Dr. Marc Lieb, M.D., J.D., Susan Goldsmith, CPC, as well as a number of other well-known CPC-Ps in the payer community. Claims reviewers, utilization management, auditors, benefits administrators, billing service, provider relations, contracting and customer service staff can each benefit their practice with the CPC-P® credential.

The CPC-P® certification exam certifies that the successful candidate has the knowledge and skills to adjudicate provider claims effectively. The exam will test the examinee’s basic knowledge of coding-related payer functions with emphasis on how those functions differ from provider coding. The relationship between coding and payment functions will be explored in depth.

The CPC-P Exam

  • 150 multiple choice questions (proctored)
  • 5 hours and 40 minutes to finish the exam
  • One free retake
  • $350 ($290 AAPC Students)
  • Open code book (manuals)

The CPC-P® exam tests coding accuracy and reimbursement methodologies. The CPC-P® tests the examinee understands of medical terminology, anatomy and CPT®, HCPCS Level II and ICD-10-CM coding concepts. The reimbursement methodologies sections test physician reimbursement, inpatient payment systems, outpatient payment systems, health insurance concepts and HIPAA.

The CPC-P® exam thoroughly covers:

  • 5 questions
  • 1995 and 1997 E/M Documentation Guidelines
  • ICD-10-CM Official Guidelines for Coding and Reporting
  • CPT® coding guidelines and parenthetical notes
  • 10 questions
  • Medical terminology for all systems in the human body
  • 15 questions
  • ICD-10-CM Official Guidelines for Coding and Reporting
  • Diagnoses for all the chapters included in ICD-10-CM
  • Diagnosis questions will also appear in other sections of the exam from the CPT® categories
  • 14 questions
  • Evaluation and Management
    • Office/Other Outpatient
    • Hospital Observation
    • Hospital Inpatient
    • Consultations
    • Emergency Department
    • Critical Care
    • Nursing Facility
    • Domiciliary and Rest Homes
    • Home Services
    • Prolonged Services
    • Case Management
    • Care Plan Oversight
    • Preventive Medicine
    • Non-Face-to-Face Services
    • Special E/M
    • Newborn Care
    • Neonatal and Pediatric Critical Care and Intensive Care
    • Complex Chronic Care Coordination
    • Transitional Care Management
  • Anesthesia
    • Time reporting
    • Qualifying Circumstances
    • Physical Status Modifiers
    • Anesthesia for surgical, diagnostic, and obstetric services
  • Surgery
    • Procedures for each of the systems
      • Integumentary
      • Musculoskeletal
      • Respiratory
      • Cardiovascular
      • Hemic and Lymphatic
      • Mediastinum and Diaphragm
      • Digestive
      • Urinary
      • Male Reproductive
      • Female Reproductive
      • Maternity and Delivery
      • Endocrine
      • Nervous
  • 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
    • Biofeedback
    • Dialysis
    • Gastroenterology
    • Ophthalmology
    • Otorhinolaryngology
    • Cardiovascular
    • Noninvasive Vascular Studies
    • Pulmonary
    • Allergy and Immunology
    • Endocrinology
    • Neurology
    • Genetics
    • Central Nervous System Assessments
    • Health and Behavior Assessments
    • Hydration
    • Therapeutic and Diagnostic Administration
    • Chemotherapy Administration
    • Photodynamic Therapy
    • Dermatology
    • Physical Medicine and Rehabilitation
    • Medical Nutrition
    • Osteopathic Manipulative Treatment
    • Chiropractic Manipulative Treatment
    • Patient Education and Training
    • Non-Face-to-Face Nonphysician Services
    • Moderate Sedation
  • 10 questions
  • Modifiers
  • Supplies
  • Medications
  • Procedures performed on Medicare patients
  • 15 questions
  • Proper modifier use with NCCI edits
  • Proper CPT® modifier use
  • Proper HCPCS Level II modifier use
  • 15 questions
  • Adjudication determination based on codes submitted
  • OPPS Payment Methodology
    • APCs
    • Revenue codes
    • Status Indicators
    • Payment Indicators
    • Condition codes
    • Calculation of proper payments (an excerpts from Addendum B is provided on the exam)
  • 20 questions
  • Adjudication determination based on codes submitted
  • Apply proper coding according to payment policies
  • Provider reimbursement models (eg, fee for service, capitation)
  • Determine proper payment based on patient's insurance coverage
  • Surgical global package
  • RBRVS
  • Unbundling
  • NCCI Edits
  • 20 questions
  • Determine proper payment based on patient's insurance coverage
  • Adjudication determination
  • Length of stay
  • MS-DRG
  • 3 questions
  • Transaction and Code Set Standards
  • Privacy
  • Security
  • 13 questions
  • Services covered by Medicare Parts A, B, C, and D
  • Types of insurance (eg, HMO, PPO, HSA)
  • Services covered by Medicaid
  • Non-covered services
  • Coinsurance
  • Copayment
  • Deductible
  • Clean claims

Approved Manuals for Use During Examination

  • CPT® Books (AMA standard or professional edition ONLY). No other publisher is allowed.
  • Your choice of ICD-10-CM (Exams will test ICD-10 effective January 1, 2016).
  • Your choice of HCPCS Level II.

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, CPC-P and COC 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-10-CM or HCPCS Level II manuals or through careful reasoning.

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:

  • 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-10-CM Easy Coder

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 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).

A CPC-P must have at least two years medical coding experience (member's with an apprentice designation are not required to have two years medical coding experience.) 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.

Due to the level of expertise required of medical coders, AAPC expects certified coders to be able to perform not only in an exam setting but also in the real world. In addition to passing the certification exam, coders will also be required to demonstrate on-the-job coding experience. Those who pass the CPC, COC (formerly CPC-H) and/or CPC-P exams but have not yet met this requirement will be designated as an Apprentice (CPC-A, CPC-H-A and/or CPC-P-A) on their certificate.

CPC-A, COC-A (formerly CPC-H-A), or CPC-P-A Status: Members with an Apprentice designation are still required to submit annual CEUs while completing the coding job requirement.

Requirements for Removal of Apprentice Designation:

To remove your apprentice designation via on-the-job experience, you must obtain and submit two letters of recommendation verifying at least two years of on-the-job experience (externships accepted) using the CPT®, ICD-10-CM, or HCPCS Level II code sets. One letter must be on letterhead from your employer*, the other may be from a co-worker. Experience includes time coding for a previous employer and prior to certification. Both letters are required to be signed and will need to outline your coding experience and amount of time in that capacity. Download our Apprentice Removal Template for easier submission. Letterhead and signatures are still required when using this template.

OR

Submit proof showing completion of at least 80 contact hours of a coding preparation course (not CEUs) AND one letter, on letterhead, signed from your employer verifying one year of on-the-job experience (externships accepted) using the CPT®, ICD-10-CM, or HCPCS Level II code sets.

Send proof of education in the form of a letter from an instructor on school letterhead stating you have completed 80 or more contact hours, a certificate/diploma stating at least 80 contact hours, or an unofficial school transcript.

Proof of education or experience isn’t necessary to sit for the exam. It should only be submitted (via fax or as a scanned attachment to an email) once ALL apprentice removal requirements have been met.

Please allow 2-4 weeks for processing.

* Employers can only verify time spent coding with their organization. Proof of experience letters may be from previous employers, current employers, or a combination of both.

AAPC
2233 S Presidents Dr.
Salt Lake City, UT  84120

Phone: 800-626-2633
Fax: 801-236-2258
Email: apprenticeremovals@aapc.com

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

* Medical Coding Salary