Taking the CIC® exam

Who should take the CIC exam?

To ensure you're prepared to pass the exam the first time, we recommend taking the CIC Training Course beforehand.

If you've completed the training course and have a solid understanding of medical terminology, anatomy, and pathophysiology, take advantage of the opportunity to showcase your expertise with the CIC certification. Earning this credential can boost your earning potential and set you apart from uncertified candidates.

What to expect on exam day

The exam has a total of 40 multiple-choice questions and 7 cases that test the ability to read and accurately code a medical record. If you have taken the training course, studied hard, and are familiar with how to use your ICD-10-PCS and ICD-10-CM code books, the test will be demanding, but not difficult.

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 expertise.

You’ll have four hours to complete the exam. 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 coding scenarios to test application of ICD-10-PCS procedure codes and ICD-10-CM diagnosis codes. The end of the exam has seven 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 — your choice of ICD-10-PCS and ICD-10-CM code books.

Passing grades

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

Breakdown of the CIC exam

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

Medical Record and Healthcare Documentation Guidelines (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

Medical Terminology, Anatomy and Pathophysiology (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

Inpatient Coding (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 DRGs (e.g., book, grouper)

• Explain emerging roles for inpatient coders (DRG validator, auditor)

• Identify conditions POA and use of indicators

Inpatient Payment Methodologies (9 multiple choice questions)

• Recognize proper procedure for compliance with the two-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 (e.g., services performed at another facility)

• List and explain different types of DRGs (e.g., 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

Outpatient Payment Methodology (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

Regulatory and Payer Requirements (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

Compliance (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 used

• 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

Coding Cases (7 cases; fill-in-the-blank questions)

• Code the ICD-10-CM and ICD-10-PCS codes for seven inpatient cases

• Each case will have anywhere from 5-15 possible answers. Each answer is weighted the same.