Certified Outpatient Coder (COC®) - Certification Exam

With physicians choosing to join hospital groups over private practices, the need for certified outpatient coders continues to escalate, making COC certification an even smarter career move.

By passing the COC exam, employers recognize your mastery of outpatient hospital coding, including working knowledge of Ambulatory Payment Classifications (APCs), payment status indicators, and MS-DRGs. Students who earn their COC credential go on to report outpatient services in a variety of settings, such as:

  • Hospital Emergency Departments
  • Outpatient Hospital Clinics
  • Outpatient Therapy Departments
  • Outpatient Cancer Centers
  • Dialysis Services
  • Outpatient Radiology Departments
  • Ambulatory Surgery Centers

How Much Does a COC Earn?

Outpatient coders report procedures, services, equipment, and supplies provided to patients on behalf of both the physician and the outpatient facility. As this requires expertise in multiple payment systems, COCs are well compensated, earning an average salary of $62,846 per year, which makes the COC one of the highest paid core credentials. If you're thinking about becoming a certified outpatient coder, you can learn more about COC salaries in your area with our salary calculator.

Obtaining a COC credential shows you have:

  • Proficiency in assigning accurate medical codes for diagnoses, procedures and services performed in the outpatient setting (emergency department visits, outpatient clinic visits, same day surgeries, diagnostic testing (radiology and laboratory), and outpatient therapies (physical therapy, occupational therapy, speech therapy, and chemotherapy)
  • Proficiency across a wide range of services, including evaluation and management, anesthesia, surgical services, radiology, pathology, and medicine
  • Knowledge of coding rules and regulations along with proficiency on issues regarding medical coding, compliance, and reimbursement under outpatient grouping systems. COCs can better handle issues such as medical necessity, claims denials, bundling issues, and charge capture.
  • The 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
  • Correctly completing a CMS 1500 for ASC services and UB04 for outpatient services, including applying appropriate modifiers
  • Knowledge of anatomy, physiology, and medical terminology commensurate with ability to correctly code provider services and diagnoses
  • A working knowledge in assigning ICD-10-CM codes from Volumes 1 and 2


ICD-10-PCS and DRG code assignment (inpatient coding) are not tested during the COC exam.

The COC Exam

  • 100 multiple choice questions (proctored)
  • 4 hours to finish the exam
  • Open code book (manuals)

The COC® exam consists of questions regarding the correct application of CPT®, HCPCS Level II procedure and supply codes and ICD-10-CM diagnosis codes used for coding and billing outpatient facility/hospital and freestanding ASC services to insurance companies.

The COC® exam covers:

  • 7 questions
  • Medical terminology for all systems in the human body
  • 7 questions
  • Anatomy for all systems in the human body
  • 3 questions
  • ICD-10-CM Official Guidelines for Coding and Reporting
  • CPT® coding guidelines and parenthetical notes
  • Modifier use
  • 13 questions
  • Services covered by Medicare Parts A, B, C, and D
  • Medicare as a secondary payer
  • Requirements for completion of UB-04 claim form
  • Requirements for completion of CMS-1500 claim form
  • OPPS Payment Methodology
    • APCs
    • Revenue codes
    • Status Indicators
    • Payment Indicators
    • Condition codes
    • Calculation of proper payments (excerpts from Addendum B and Addendum AA are provided on the exam)
  • IPPS Payment Methodology
    • Elements needed to determine MS-DRGs
    • Code sets required for inpatient claims
    • Reimbursement for teaching hospital setting
    • Charge description masters (CDM)
  • 3 questions
  • NCDs/LCDs
  • ABNs
  • 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
  • 13 questions
  • Evaluation and Management
    • Emergency Department
    • Outpatient Clinics
    • Observation
    • Critical Care
  • Surgery
    • Procedures performed in outpatient hospital facilities
    • Procedures performed in ASC facilities
  • 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
    • Dialysis
    • Gastroenterology
    • Ophthalmology
    • Otorhinolaryngology
    • Cardiovascular
    • Noninvasive Vascular Studies
    • Pulmonary
    • Neurology
    • Central Nervous System Assessments
    • Hydration
    • Therapeutic and Diagnostic Administration
    • Chemotherapy Administration
    • Physical Medicine and Rehabilitation
    • Patient Education and Training
    • Non-Face-to-Face Nonphysician Services
    • Moderate Sedation
  • 7 questions
  • Modifiers
  • Supplies
  • Medications
  • Procedures performed on Medicare patients
  • 22 questions
  • Procedures approved for outpatient hospital facilities
  • Procedures approved for ASC facilities

Ten cases will test your ability accurately code medical record documentation, from a facility perspective, using CPT®, ICD-10-CM, and HCPCS Level II. The cases will cover 10000 series, 20000 series, 30000 series, 40000 series, 50000 series, 60000 series, medicine, radiology, and pathology and laboratory. Medical terminology, anatomy, compliance, and regulatory information may also be tested in the cases.

Exam Book Bundle 2022 (CPT®, HCPCS, ICD-10-CM)

AMA CPT® Professional 2022 - Now Shipping
HCPCS Level II Expert 2022 - Now Shipping
ICD-10-CM Complete Code Set 2022 - Now Shipping
Retail: $359.99   Save: $130.00 (36%)
Non-Member: $259.99
Member: $229.99

Exam Bundle includes the AMA CPT® Professional, ICD-10-CM Expert, and HCPCS Level II Expert — the three code books students need for nearly every AAPC exam, including AAPC’s Certified Outpatient Coder (COC) exam.

Approved Code Books for Use During the COC Exam

Because code sets are updated annually it’s essential to use books published in the same year as exam.

Confirm what reference materials are allowed during the COC certification exam and note that officially published errata for any of the code books above may also be referenced during the COC exam.


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 note that the COC exam is rigorous and not intended for individuals lacking COC training or equivalent coding experience.

  • Maintain annual AAPC membership
    • If you haven’t become an AAPC member, you must do so prior to scheduling your COC exam.
    • Renewing members must have a current membership to sit for a certification exam.
  • Earning the COC designation requires two years — or the equivalent — medical coding experience. If you have not submitted proof of 2 years’ experience, a COC-A designation will be awarded.
  • Certified coders are required to complete 36 Continuing Education Units (CEU's) every two years. For CEU requirements please see our  CEU Information page.


An overall score of 70% or higher is required to pass the certification exam. If you don’t pass the COC exam, you will be notified of the categories/areas of study with sub-scores of 65% or lower to help your prepare to retake the exam. 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.

COC® Apprentice

When you pass the COC exam, you receive your COC-A credential, which signifies apprenticeship standing. You remain an apprentice until you fulfill the 2-year experience requirement, at which time you will submit proof of meeting the requirement, and your A will be removed.

Options for meeting the 2-year experience required for full COC standing include:

  • 1.
    Two years of on-the-job experience using the CPT®, ICD-10-CM, or HCPCS Level II code sets.

    To show proof, you must obtain and submit two letters of recommendation verifying two years of on-the-job experience using the specified code sets.

    • One of the two letters must be from your employer on company letterhead.
    • The second letter may come from a colleague or a previous employer.

    Your experience, as well, can include time you have coded for a previous employer, or prior to certification.

    Download our apprentice removal template for easier submission. Letterhead and signatures are still required when using this template.

  • 2.
    Completion of at least 80 contact hours of a coding preparation course equates with one year of coding experience.

    Submitting proof of your participation in an 80-hour medical coding course deducts one year from the two years of experience required to graduate from COC-A to COC.

    Proof of education can take 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.

  • 3.
    Completion of the COC-A Practicode online program — which consists of three modules, each containing 200 cases — equates with one year of coding experience.

    Submitting proof of completing the COC-A Practicode module deducts one year from the two years of experience required to graduate from COC-A to COC. This program may be completed while training for your certification exam or after.

    Proof of 80 contact hours of a medical coding preparation course may be combined with the completion of COC-A Practicode to fulfill the two years of experience required to graduate to COC. As well, either of these may be combined with one year of on-the-job experience, verified by one signed letter from your employer on letterhead.

Proof of education or experience should be submitted (via scanned email attachment or fax) only once  ALL  apprentice removal requirements have been met. Please allow 2-4 weeks for processing.

Email: apprenticeremovals@aapc.com

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