Wiki Preparing for the CPC exam and I am extremely confused regarding guidelines in the CPT coding book. I hope someone can help.

[Skirchberger]

I am very confused, and I am hoping that someone on here can assist me.

I am currently studying to prepare for my upcoming CPC exam, and I am using an AAPC study guide in addition to reading through my coding books, however, the study guide seems to be giving me much more information than is in the CPT coding book...in fact, it is giving me additional guidelines that are not found in the CPT coding book.

For example, according to the study guide CPT code 52234 includes biopsy but yet, I find absolutely NO mention of that information in any of the coding guidelines in the CPT coding book. This is EXTEMELY confusing to me because I was under the impression that ALL the coding guidelines would be included in the coding books! So, does this mean that there is a fair amount of guidelines that are not in the coding books? And if so, is there a way I can pull up a list of guidelines NOT found in the coding books so I can try to write them in the books? We can only have the coding books with us for the exam, and not knowing these added guidelines will cause me to fail the exam.

Thanks in advance.

 

[xXxPARAGONxXx]

I am very confused, and I am hoping that someone on here can assist me.

I am currently studying to prepare for my upcoming CPC exam, and I am using an AAPC study guide in addition to reading through my coding books, however, the study guide seems to be giving me much more information than is in the CPT coding book...in fact, it is giving me additional guidelines that are not found in the CPT coding book.

For example, according to the study guide CPT code 52234 includes biopsy but yet, I find absolutely NO mention of that information in any of the coding guidelines in the CPT coding book. This is EXTEMELY confusing to me because I was under the impression that ALL the coding guidelines would be included in the coding books! So, does this mean that there is a fair amount of guidelines that are not in the coding books? And if so, is there a way I can pull up a list of guidelines NOT found in the coding books so I can try to write them in the books? We can only have the coding books with us for the exam, and not knowing these added guidelines will cause me to fail the exam.

Thanks in advance.

The CPT code discusses tumor resection.

52234 Cystourethroscopy, with fulguration (including cryosurgery or laser surgery) and/or resection of; SMALL bladder tumor(s) (0.5 up to 2.0 cm)

Resection is surgery to remove tissue or part or all of an organ.
Biopsy is is a procedure to remove cells, tissue or fluid for examination by a medical pathologist.

In 52234, the resected tissue is a tumor, and standard of care dictates that every resected tumor must be sent to pathology for gross and/or microscopic examination. Therefore, the resection in 52234 is, in fact, a biopsy.

Any time you see a CPT code discuss tumor or tissue resection, you should understand that the biopsy is integral and should not be reported separately.

Also note the following (p. I-5 of the attachment):

Providers/suppliers shall only report a biopsy separately when pathologic examination results in a decision to immediately proceed with a more extensive procedure (e.g., excision, destruction, removal) on the same lesion; or when performed on a separate lesion.

In this case, the biopsy was integral to the procedure. The biopsy results were not the cause for proceeding with the procedure itself.

Having taken the CPC test myself on 3/28/24, and passed first time, I can say that if you do your practice study exams (preferably all 3), read the study guide, you should do well. I also did Practicode, and although I failed, it taught me a lot, including how to code E/M (which knowing is essential to doing well on the exam). Practicode has its shortcomings, but overall, I believe it helped more than it hurt.

Also, I can say, at least for myself, when I took the test, every answer was found by using the books. There was no need for me to ever think outside the books, so to speak. I think you will find relief by knowing that. Yes, the study guide includes things outside the books, but I don't think you will have to worry about that. The study guide does not accurately reflect the material on the test.

Knowing how to search the Indexes will help you more than anything. So, if you have a question, focus on finding the keyword and looking it up as fast as you can using the Index. My books don't have anything written in them. No markings; no highlighting; nothing. I also finished with about an hour to spare, if I recall. (86% score)

AAPC does not want you nor expect you to memorize codes. It wants you to become proficient at the basics, first and foremost. If you don't know a code by heart, do you know the basic steps to finding it? That is what this test focuses on. (Also, the ICD-10 Guidelines are very important to know. But again, if you don't know them by heart, know where they are so you can access them quickly.)

 

[Skirchberger]

The CPT code discusses tumor resection.

52234 Cystourethroscopy, with fulguration (including cryosurgery or laser surgery) and/or resection of; SMALL bladder tumor(s) (0.5 up to 2.0 cm)

Resection is surgery to remove tissue or part or all of an organ.
Biopsy is is a procedure to remove cells, tissue or fluid for examination by a medical pathologist.

In 52234, the resected tissue is a tumor, and standard of care dictates that every resected tumor must be sent to pathology for gross and/or microscopic examination. Therefore, the resection in 52234 is, in fact, a biopsy.

Any time you see a CPT code discuss tumor or tissue resection, you should understand that the biopsy is integral and should not be reported separately.

Also note the following (p. I-5 of the attachment):



In this case, the biopsy was integral to the procedure. The biopsy results were not the cause for proceeding with the procedure itself.

Having taken the CPC test myself on 3/28/24, and passed first time, I can say that if you do your practice study exams (preferably all 3), read the study guide, you should do well. I also did Practicode, and although I failed, it taught me a lot, including how to code E/M (which knowing is essential to doing well on the exam). Practicode has its shortcomings, but overall, I believe it helped more than it hurt.

Also, I can say, at least for myself, when I took the test, every answer was found by using the books. There was no need for me to ever think outside the books, so to speak. I think you will find relief by knowing that. Yes, the study guide includes things outside the books, but I don't think you will have to worry about that. The study guide does not accurately reflect the material on the test.

Knowing how to search the Indexes will help you more than anything. So, if you have a question, focus on finding the keyword and looking it up as fast as you can using the Index. My books don't have anything written in them. No markings; no highlighting; nothing. I also finished with about an hour to spare, if I recall. (86% score)

AAPC does not want you nor expect you to memorize codes. It wants you to become proficient at the basics, first and foremost. If you don't know a code by heart, do you know the basic steps to finding it? That is what this test focuses on. (Also, the ICD-10 Guidelines are very important to know. But again, if you don't know them by heart, know where they are so you can access them quickly.)

Hi there!! Thanks so very much for this very informative and extremely helpful response Wow!!! You obviously know what you are doing so it is no surprise that you did so well on the exam!!! Big congratulations for that!!!

Just out of curiosity, did you have prior medical knowledge? And if so, do you think that may have played a factor in you doing so well on the exam? I really have absolutely no medical experience at all. I am literally coming from years of call center work...very far from the medical field...LOL.

Anyway, I once again thank you for this major help with this! It was driving me crazy for days...LOL. I feel kind of foolish that I did not know that now. I guess I have a lot to learn....LOL.

Thanks also for the added advice about taking the practice exams. By the way, when you suggest I take all 3 are you referring to the practice exams that AAPC included in our accounts? Like I said, I am just curious?

Well, thanks once again! I really truly appreciate it!!

 

[xXxPARAGONxXx]

Just out of curiosity, did you have prior medical knowledge? And if so, do you think that may have played a factor in you doing so well on the exam? I really have absolutely no medical experience at all. I am literally coming from years of call center work...very far from the medical field...LOL.

[Edit: Long story short, yes, 20 years of medical experience: 6 military; 14 civilian. I would say I learned most about coding in my current position, but it has been very minimal contact with coding. But, what minimal contact it is, I make the most of it by learning and researching.]

I appreciate your compliment, but I know very little when it comes to everything there is to know about coding. There is A LOT of information out there. But, I love learning, so I'm happy there being so much to learn. It prevents me from getting bored.

Anyway, yes, medical background helps tremendously. You're obviously going to have an uphill battle with no medical field experience. If I were in your shoes, I would enroll in local community college for an Associate's in Health Information Technology. Then, take the CPC exam after you get your degree. That two years of schooling will help you gain essential medical knowledge.

Anyway, I once again thank you for this major help with this! It was driving me crazy for days...LOL. I feel kind of foolish that I did not know that now. I guess I have a lot to learn....LOL.

That's okay. How would you have known? And it hit me, too, just like it did you. That is why I am letting you know now, so you're not dismayed, because I felt that exact same way. It's not a good feeling.

Thanks also for the added advice about taking the practice exams. By the way, when you suggest I take all 3 are you referring to the practice exams that AAPC included in our accounts?

Yes, that would be those three practice exams. I'm not sure if there are any other ones available through AAPC.

Well, thanks once again! I really truly appreciate it!!

You're welcome. You have the whole internet at your disposal. Learn new things every day. The knowledge will accumulate. By the way, you probably get two test attempts, right? Maybe you want to use one attempt to just get an idea of what is on the test. I know there are many who do that, that way they have a better idea of what questions will actually be asked on the test. Something to consider.

You can always message me if you have coding questions, especially about study material. I'll do my best to help!

 

[Skirchberger]

[Edit: Long story short, yes, 20 years of medical experience: 6 military; 14 civilian. I would say I learned most about coding in my current position, but it has been very minimal contact with coding. But, what minimal contact it is, I make the most of it by learning and researching.]

I appreciate your compliment, but I know very little when it comes to everything there is to know about coding. There is A LOT of information out there. But, I love learning, so I'm happy there being so much to learn. It prevents me from getting bored.

Anyway, yes, medical background helps tremendously. You're obviously going to have an uphill battle with no medical field experience. If I were in your shoes, I would enroll in local community college for an Associate's in Health Information Technology. Then, take the CPC exam after you get your degree. That two years of schooling will help you gain essential medical knowledge.



That's okay. How would you have known? And it hit me, too, just like it did you. That is why I am letting you know now, so you're not dismayed, because I felt that exact same way. It's not a good feeling.



Yes, that would be those three practice exams. I'm not sure if there are any other ones available through AAPC.


You're welcome. You have the whole internet at your disposal. Learn new things every day. The knowledge will accumulate. By the way, you probably get two test attempts, right? Maybe you want to use one attempt to just get an idea of what is on the test. I know there are many who do that, that way they have a better idea of what questions will actually be asked on the test. Something to consider.

You can always message me if you have coding questions, especially about study material. I'll do my best to help!

Hi there.... thanks again for the follow-up response! And the great added advice too! It is great advice but to be honest...I wish I could afford to go to college like that but unfortunately, I can't.

And to be honest, again, the only reason that I can even do this at all is due to a scholarship that I received otherwise I would never be able to afford this either. ...and yes, I have 2 attempts but I need to use that by the end of July if I want my scholarship to pay for it. I have actually wanted to do this for about 15 years now but only had the opportunity now... I was drawn to it because of the work@home options, and it being considered a quicker thing to learn but I am a bit disappointed to find out that I am going to have alot in store for me, as you say. I was really under the impression that it was considered a fast/quicker skill to learn but between my experience with studying and what you have said I can see that I may have been mistaken.

So with that said, do you not think that the course that is offered here is enough? I took a virtual course and did well with it but as I said, based on my studying so far, I can see that this exam is going to be extremely involved and much more intense than the course I already took, however, either way, I will give it my best shot. since it is free to me, I have nothing to lose at this point and I am hoping I will just luck out despite my lack of experience.

Anyway, thanks for confirming that I was not the only one stumped on that question... Also, thanks for confirming the practice tests that you were suggesting I take. I am definitely planning on doing that!!

Well, thanks again for all the advice and congrats once again on that terrific store!

 

[xXxPARAGONxXx]

So with that said, do you not think that the course that is offered here is enough?

I think it's possible to pass CPC without a medical background. The more resources you use in studying (study guide, practice tests, etc.), the better. I have no doubt that you can do it if you put your mind to it.

 

[Skirchberger]

I think it's possible to pass CPC without a medical background. The more resources you use in studying (study guide, practice tests, etc.), the better. I have no doubt that you can do it if you put your mind to it.

Thanks and I sure hope you are right!