CPC exam: FAQs

A medical coder reviews medical records and translates medical procedures, diagnosis, products, supplies, and services into codes submitted to insurance carriers or government payers on a claim. They need to know medical terminology and anatomy, how to review medical records and understand clinical notes, abstract important information, and determine the appropriate codes. Sometimes they become detectives. When there is a denial due to coding, a coder is consulted and sleuths to help get the claim paid.

Being a medical coder means you are knowledgeable, analytical, a critical thinker, detail-oriented, organized, and determined. These traits will help you to get your physicians paid properly, be compliant with coding and billing rules and regulations, and maximize revenue for your healthcare organization.

After a patient visits a physician, they document their evaluation, the patient's conditions and diagnosis, and performed procedures or treatment. The medical coder will translate the documentation into alphanumeric CPT^®, ICD-10-CM, and HCPCS Level II codes. A medical biller then makes sure all necessary information is on the claim (including the correct demographic, insurance, and coding information) and submits it to the insurance carrier or government payer agency. The biller receives the payment and posts it or addresses denial issues. If there is a denial because of a coding reason, the coder steps in to assist in resolving the denial. Coders and billers work together to ensure doctors receive proper payment in providing patient care.

Healthcare policy changes rapidly, and coding requires life-long learning, education, and constantly improving your skills. CPT^®, ICD-10, and HCPCS Level II code sets change yearly. To stay current, you must do researching of payer policies, government regulations, and coding updates. The Centers for Medicare & Medicaid Services (CMS) and Medicare administrative contractors (MACs) have a daily or weekly list-serve or email blasts with the most up-to-date information. These are the resources you will use to ensure you are choosing the correct and most current codes for doctor's visits.

Sometimes you will meet with physicians to explain how they can improve documentation to capture proper coding for their services. It's a good idea to attend AAPC local chapter meetings, payer meetings, conferences, and webinars to stay educated and as current as possible to help you address coding issues with clinical staff and to better understand the nuances of coding.

Know the lingo. Medical coding requires you to have a strong foundation in medical terminology and anatomy. You need to know body parts, commonly used conditions and medical procedures, acronyms, clinical terms. That way, you can more easily decipher physician notes and how to code them.

The CPC^® certification validates proficiency in the correct application of CPT^®, HCPCS Level II procedure and supply codes, and ICD-10-CM diagnosis codes used for coding and billing for medical claims in a physician's office. Students new to the healthcare industry should start with medical terminology and anatomy. Students with previous clinical experience or who have taken medical terminology and anatomy can start the comprehensive coding course.

Experienced coders can take the Certified Professional Coder (CPC^®) exam review, which is an 8-hour online review, focusing on the competencies tested on the CPC^® exam, most missed coding concepts, and test strategies. This is an excellent review regardless of where you received your education.

There are study guides, which include additional practice test questions to help you gain confidence in what you know and understand what you don't know. After that, you can take practice exams, which provide exam questions that mimic the certification exam for the CPC^®. Practice exams are 5 hours and 40 minutes and will help you gauge your time for the actual certification exam.

After you pass the exam, you will have the "Apprentice" status after your name until you have two years of real hands on coding experience under your belt. Here's how to remove it:

• The first year you can complete a comprehensive coding course (minimum of 80 hours) to receive one year toward the two years' experience requirement to remove the apprentice designation.
• The second-year requirement can be accomplished by working one year on the job in a coding-related position or completing Practicode, which includes 660 operative and progress notes that provide real coding cases.
• Complete two years of hands-on experience in a coding-related career position.

AAPC has resources to help with your career search through their online Job Search tool to help you find a job in medical coding. Network with other like-minded coders by going to local chapter meetings, join AAPC Forums, and AAPC's official Facebook page.

Usually you need to have some experience in the field to land a remote position. Coding-at-home positions are usually staffed with experienced coders. When starting out, working closely with other coders and under direct supervision will help with your success. Most entry-level coders work better onsite, until they become proficient in coding processes and are confident at working independently.