AAPC - Advancing the Business of Healthcare

Certified Documentation Expert Outpatient

Taking the CDEO® exam

The examination consists of questions regarding the review of outpatient medical records for accuracy and correct application of CPT®, ICD-10-CM, and HCPCS Level II codes, and quality measures. Examinees must also demonstrate knowledge on proper query procedures and effective communication for documentation improvement. Scroll down to view specifics of what is covered on the exam.

Who should take the CDEO exam?

You should register for the CDEO exam if you’ve completed certification training and/or have experience in clinical documentation improvement and are able to demonstrate an understanding of the proper application of CPT®, ICD-10-CM, and HCPCS Level II codes, and quality measures.

What to expect on exam day

The exam has a total of 100 questions to be answered in four hours. You must answer a minimum of 70 correct to pass. People often wonder if the CDEO exam is hard. We'll say this: If you have taken the training course, studied, and are familiar with your CPT®, ICD-10-CM, and HCPCS Level II code books, the test will be demanding, but not difficult.

Here's a quick overview of what you can expect:

Before you begin the test, take a moment and breathe. You have prepared for this. You have your code books by your side and you know how to use them. This is your opportunity to demonstrate your coding and documentation expertise.

You'll have four hours to finish the exam, giving you approximately 2.4 minutes to answer each of the 100 multiple-choice questions. You can save time by reading the answer choices before reading each question and by saving the more difficult questions for last. It’s important to answer every question, even if you aren’t sure. Your best guess is better than no answer at all.

The questions assess several areas of knowledge, most of which are presented as a review of outpatient medical records to test for accuracy and correct application of CPT®, ICD-10-CM, and HCPCS Level II codes, and quality measures. The end of the exam has 10 cases that test the ability to read and accurately code a medical record.

You will be able to reference approved medical code books during the
exam — the AMA's CPT® Professional Edition, as well as your choice of ICD-10-CM and HCPCS Level II code books. You can also use your choice of E/M audit worksheet and one additional resource of your choice. To be clear, these are the only code books you are allowed to use.

For in-person exams

When you register for the exam, you will be given detailed instructions on where the test will be taken, what time you should arrive, and what you need to bring.

You should arrive at your exam location 30 minutes early. Be sure to bring all necessary items (photo ID, #2 pencils, an eraser, approved books, etc.) and listen carefully as the proctor provides instructions. You will then have the chance to ask any questions. If you are confused or concerned about anything, it’s important to clarify. After all, someone else might be wondering the same thing.

Location: Local chapter or licensed instructor site
Exam format: 100 multiple-choice questions
Time allowed: 4 hours
Proctor to examinee ratio: 1 to 25
Cancellation fee: Must be canceled 21 days prior exam date, service charge of $100
Reschedule fee: Must be rescheduled 21 days prior exam date, service charge of $100
No show fee: $100

Availability: Schedule now

For electronic exams

Our electronic exam is a four-hour live, remote-proctored* examination completed in one sitting and proctored by Examity). After purchasing or transferring your current exam voucher, you’ll receive a Notice to Schedule from our partner, Meazure Learning (formerly Scantron), and will be able to schedule your exam for a date and time convenient to you.

On the day of the exam, you will log into your Meazure Learning account, then connect with your Examity) proctor to complete a security check and take your exam. Your results will be posted within 7-10 business days from the date you complete your exam.

*Electronic exams taken outside of the US will be proctored at a local Testing Center. Please refer to the Test Center FAQs or ask your Career Counselor for more information.

Equipment required: Reliable internet connection and an external webcam that can be positioned to show your face, hands, keyboard, and the area around the keyboard (about 10 inches)
Location: At home in a quiet, private location
Exam format: 100 multiple-choice questions delivered in one sitting
Time allowed: 4 hours
Proctor to examinee ratio: 1 to 2
Cancellation fee: No fee charged if canceled 24 hours in advance
Reschedule fee: No fee charged if rescheduled 24 hours in advance
No show fee: If you do not show up to your scheduled exam OR you do not meet the requirements to take the exam, your exam voucher will be canceled, and you will need to purchase a new voucher in order to take the exam.

Availability: Schedule now

Passing grades

An overall score of 70% or higher is required to pass the certification exam. For a passing score of 70%, you must get at least 70 questions correct. If you incorrectly answer more than 30 questions, you will not pass. If you don’t pass, you will be notified of the categories/areas of study with sub-scores of 65% or less to help you prepare for retesting.

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

Your results will be shared with you online in your My AAPC Account Dashboard under My Exams. You can expect the results within 7-10 business days after taking the exam. Once you have passed, your certificate will be sent to you in the mail.

Materials allowed on the day of the exam

Approved code books

Note: Code sets are updated annually, so it’s essential to use the current calendar year's code books when taking the CDEO certification exam.

Any officially published updates (errata) for the above code books may also be used.

Recommended references: E/M audit worksheet of your choice

Optional reference: One book/reference of your choice


Manual calculators are allowed on all exams (no smartphones, tablets, or smart watches). For electronic exams, an online calculator will be included for use during the exam.

Book notes

Handwritten notes are acceptable in the code books only if they pertain to daily coding activities. Long passages of information are not permitted on the blank pages. Questions from the study guides, practice exams, or the exam itself are prohibited. Altering, whiting out, painting, or printing over any pages within the code books (e.g., marketing pages, table of contents, reference pages, etc.) to supplement information is prohibited.

Book tabs

Tabs may be inserted, taped, pasted, glued, or stapled in the code books so long as the obvious intent of the tab is to earmark a page with words or numbers, not supplement information in the book.

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

Breakdown of the 100-question CDEO exam

Passing the CDEO exam requires you to correctly answer a minimum of 70 questions from the domains below. The exam will rely on a level of understanding that enables you to identify the domain.

Purpose of CDI (5 questions)
These questions will assess your knowledge of holistic, integrated, aggregate use of the medical record, your ability to explain the goal of physician-based clinical documentation improvement, and your understanding of improved patient outcomes as well as health and status.

Provider communication and compliance (10 questions)
These questions will assess your ability to explain how the OIG can assist in determining areas of CDI focus. You will also need to demonstrate your ability to write a non-leading provider query, provide a rationale for queries, and be able to identify strategies for communicating crucial messages.

Clinical conditions (20 questions)
For each of the clinical conditions listed below, the exam will test your understanding of clinical picture, criteria for diagnosis (lab work, radiology, etc.), common medications, common abbreviations, and common treatment profiles, as well as your understanding of documentation requirements necessary for code assignment based on ICD-10-CM guidelines.

  • Aortic aneurysm

  • Amputation

  • Artificial openings

  • Aortic stenosis/sclerosis

  • Adjuvant therapy

  • Burns

  • CAD

  • Congenital versus acquired conditions

  • Anemia (blood loss) polycythemia

  • Crohn's disease

  • Common conditions of the ear

  • Common conditions in pregnancy

  • Cirrhosis

  • Chronic kidney disease

  • Cardiomyopathy

  • Cardiac conduction conditions such as A-fib, sick sinus syndrome

  • Chronic obstructive pulmonary disease, bronchitis, asthma

  • CVA vs. TIA

  • Drug dependence

  • Diabetes

  • Deep vein thrombosis

  • Epilepsy

  • Fractures

  • Heart failure

  • Head injury


  • Hemiplegia

  • Hypertension

  • Active versus history of neoplasm

  • Hypoxia

  • Malnutrition

  • Major depression

  • Metastatic

  • Myocardial infarction

  • Morbid obesity and BMI

  • Neuropathy

  • Parkinson's disease

  • Pathological osteoporosis fractures

  • Pneumonia

  • Common conditions in the perinatal period

  • Pressure ulcers

  • Peripheral vascular disease

  • Rheumatoid arthritis

  • Sepsis

  • Sequelae events (stroke, trauma)

  • Transplant status

  • Venous stasis ulcers

Diagnosis coding (10 questions)
This section will test your ability to identify clinically active versus historical conditions, ensure support documented for etiology and manifestation, apply coding clinic guidance to ICD-10 coding issues, recall ICD-10-CM outpatient coding guidelines, code selected conditions to the highest level of specificity that documentation supports, and select the first listed diagnosis on a claim. 

Documentation requirements (10 questions)
This section will address your ability to properly correct errors and audit requirements of who documented; identify cloned and cut and paste documentation and requirements for a complete medical record; understand requirements for proper use of templates; identify correctly authenticated notes in situations where multiple authors have documented within a note (MA, scribe, provider); demonstrate an understanding of the responsibilities of medical and clinical staff as it relates to documentation, electronic signature requirements versus paper signature requirements, documentation to support billing and coding for supplies (drugs) administered in office, and documentation to support diagnostic tests (labs, radiology, medicine); select the codes from a coding software pick lists; identify clinically valid diagnoses when considering number of conditions managed and treated and identifying "note bloat"; manage problem lists; distinguish between acceptable and unacceptable use of abbreviations within the medical record (legibility); and understand timely completion of medical records.

Payment models (5 questions)
This area will test your understanding of fee-for-service payment methodology, new payment models, and documentation requirements (e.g., bundled payments, value-based payment modifiers); your ability to explain how the HCC risk adjustment model can determine areas of CDI focus; and how documentation affects HCC risk adjustment and patient RAF scores.

Procedure coding (10 questions)
This section will test you on your ability to apply E/M guidelines to determine complexity of medical decision making, CPT® Assistant guidance related to procedure coding, CPT® coding guidelines, and your understanding of significant and separately identifiable when coding multiple E/M services and E/M services with procedures. You also will need to show how analysis of data applies to complexity of medical decision making (interpreted by a physician), that you can evaluate physician documentation to determine complexity of medical decision making, and identify correct use of time in documentation of E/M. Lastly, you will be tested on your knowledge of sick visits reported with preventative visits.

Quality measures (10 questions)
This section will test your understanding of strategies for capturing quality measures within documentation, the requirements for meaningful use, and the purpose of the STARS rating and the domains. You also must be able to demonstrate knowledge of quality measures and other value-based payment systems, identify PQRS measures and proper documentation for support, and identify HEDIS measures.

Cases (10 cases, 20 questions)
For this section, you will need to be able to identify documentation to support codes, identify documentation deficiencies in a medical record, select provider queries applicable to the medical record, select supporting regulations to identify why additional documentation is required, and select the correct codes based on documentation.