The Certified Professional Coder CPC exam covers a wide range of topics that are essential for a successful medical coding career. Here is a breakdown of the exam topics or core areas that you need to master in order to become CPC certified fast and easy in 2024:
- Medical Terminology
- Understanding medical terms and their meanings.
- Familiarity with prefixes, suffixes, and root words.
- Anatomy and Physiology
- Comprehensive knowledge of human anatomy and physiology.
- Understanding the functions of different bodily systems.
- ICD-10-CM Codes
- Proficiency in using the ICD-10-CM for diagnosis coding.
- Understanding coding guidelines and conventions.
- CPT Codes
- Knowledge of Current Procedural Terminology (CPT) codes for medical procedures and services.
- Understanding category I, II, and III CPT codes and guidelines.
- HCPCS Level II Codes
- Familiarity with HCPCS Level II codes for supplies, materials, and services not included in CPT codes.
- Coding Guidelines and Regulations
- Understanding guidelines set by the Centers for Medicare & Medicaid Services (CMS).
- Compliance with coding and billing regulations.
- Medical Billing
- Knowledge of the medical billing process, claim submission, reimbursement, and appeals.
- Understanding insurance plans and payer requirements.
- Healthcare Laws and Ethics
- Familiarity with healthcare laws, including HIPAA.
- Understanding ethical standards in coding and billing.
- Modifiers
- Proficiency in using modifiers to indicate special circumstances or alterations in coding.
- Coding Scenarios
- Applying coding knowledge to real-life clinical scenarios.
- Coding for various medical specialties and services.
- Documentation Guidelines
- Understanding the documentation requirements for accurate coding.
- Interpreting medical records to extract relevant coding information.
- Medical Coding Software and Tools
- Familiarity with coding software and electronic health records (EHR) systems.
- Using coding manuals and online resources effectively.
Interview Questions / Practice Questions for CPC Certification Path
Medical Terminology and Anatomy
- Question: Can you explain the importance of understanding medical terminology in coding?
Answer: Understanding medical terminology is crucial in coding because it allows coders to accurately interpret medical records and assign the correct codes. This ensures that healthcare providers are properly reimbursed and that patient records are accurately documented.
- Question: How would you code a diagnosis of “acute myocardial infarction”?
Answer: The ICD-10-CM code for an acute myocardial infarction (heart attack) is I21.9, but the specific code may vary based on the exact type and timing of the infarction.
ICD-10-CM Coding
- Question: What are the main steps you follow when assigning an ICD-10-CM code? Answer: The main steps include:
- Reviewing the medical record thoroughly.
- Identifying the main term in the Alphabetic Index.
- Finding the code in the Tabular List.
- Following any instructional notes.
- Verifying the code for accuracy and specificity.
- Question: Can you provide an example of a coding scenario using ICD-10-CM codes? Answer: Sure! For a patient diagnosed with Type 2 diabetes mellitus with diabetic nephropathy, the correct ICD-10-CM code would be E11.21.
CPT and HCPCS Coding
- Question: What is the difference between CPT and HCPCS codes?
Answer: CPT codes are used to describe medical, surgical, and diagnostic services and are maintained by the American Medical Association. HCPCS codes include Level II codes for products, supplies, and services not covered by CPT codes, such as ambulance services and durable medical equipment.
- Question: How would you code a laparoscopic cholecystectomy using CPT codes?
Answer: The CPT code for a laparoscopic cholecystectomy (removal of the gallbladder) is 47562.
Modifiers and Coding Guidelines
- Question: What are modifiers, and why are they used in medical coding?
Answer: Modifiers are two-character codes added to CPT or HCPCS codes to provide additional information about the procedure or service performed. They indicate special circumstances, such as a bilateral procedure or a service performed by multiple providers.
- Question: Give an example of when you would use modifier -59.
Answer: Modifier -59 is used to indicate a distinct procedural service. For example, if a patient undergoes a separate, unrelated procedure during the same visit, such as an excision of a skin lesion and a biopsy of a different lesion, modifier -59 would be used to distinguish the two procedures.
Medical Billing and Documentation
- Question: How do you ensure compliance with medical billing regulations?
Answer: Compliance is ensured by staying updated with current coding guidelines and regulations, regularly participating in coding education and training, meticulously reviewing coding assignments for accuracy, and adhering to payer-specific billing requirements.
- Question: What steps do you take to verify the accuracy of a medical record before coding?
Answer: Steps include:
- Cross-referencing the medical record with the physician’s notes.
- Ensuring all procedures and diagnoses are documented.
- Verifying the dates of service.
- Checking for any missing information or inconsistencies.
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