9 Jul 2018

Tips to pass CPC Exam

Tips to clear CPC exam in the first attempt:

Everyone would like to clear the CPC exam in the first attempt itself and it’s easy to do so. We have given below a few useful tips based on our experience to help those who are planning to take the CPC exam. We hope it will help to some extent during your CPC exam. 

A clear understanding of Anatomy, Medical terminology, Modifiers, CPT section-wise guidelines and ICD 10 CM chapter-specific guidelines is very important to pass the CPC exam in the very first attempt. 

It’s an open book exam 150 questions for the duration of 5 hours and 40 minutes be on time try to be one hour early to the exam place and try to complete the exam within 5 hours and 30 minutes. 70% and above is considered a pass.


Make a practice of rule out among the four choices to find the correct answer, the presence of a modifier, ICD codes are the best clue to rule out. Read the complete description of the given CPT and ICD codes from the book and compare with the questions. Make sure to watch all the instructions (Included/Don’t code/Use in conjunction with etc) given below the CPT’s or guidelines given in paragraphs at the beginning of the respective code range.

Time management is very important during CPC exams. Few questions may take a few secs to find the answer but few tough scenarios may eat our time. Don’t waste time in reading the huge paragraph or complicated scenarios, let’s try to skip the difficult questions and clear it later. After completing all the known questions later you may have plenty of time to read the whole scenario to understand.

Normally we divide the 5 hours and 40 minutes into 3 hours for 60 questions from surgery section alone and the remaining time for the rest of the 90 questions from other sections. It may vary from person to person.  

Don’t leave any questions unattended. In short of time try to read it like eagle view (Search for appropriate words instead of reading the entire question) and mark the answers.     

Answer sheet: Make sure that you are 100% confident with the answers until otherwise don’t shade completely in the answer sheet it may utilize your time in case of rework. Just a dot or tick mark is enough later on you can shade it completely.  

E&M – 10 Questions

        1.   Selecting the E&M level based on three key components (Or) “Time” is very important. For Time based E&M (Total face to face time, greater than 50% time spent on counselling and content of counselling should be documented)

        2.   Check for a new patient or established patient if the service is performed in-office or outpatient settings, Domiciliary, Rest home, Custodial care services, Home services, and Preventive care services.

        3.   Inpatient or observation care services are based on whether it’s is an initial visit or subsequent visit or discharge care services. In CPT book same day admit and discharge care codes are given separately. 

        4.   Office or Inpatient Consultation codes should be selected based on “RRR” (Request, Rendered, and Report) and place of service. Medicare won’t pay for consultation codes instead select an appropriate office or inpatient E&M codes.     

            Regular follow up visits with the consultation provided physician should be coded as Established E&M office/outpatient visits (or) subsequent visits in hospitals.

        5.   Preventive service or annual wellness visit should be selected based on age as well as a new or established patient.  Can be billed with other office visit codes with modifier 25.

        6.   To differentiate Critical care services from Emergency department service are by Critical care time should be 30 min or more. Certain services are included in the CC services which are listed in the CPT book just make a note of that before selecting your answers.  

        7.   Prolonged services (Face-to-face or Non-face-to-face) If the E&M code selection is based on key components (History/PE/MDM) then we can add Prolonged services CPT with any level of E&M [additional 30 min or more from the typical time of the E&M level].  If the E&M is based on “Time”. Then the prolonged service CPT would be added only to the highest level of the E&M.

        8.   Telephone service – Patient should initiate the call and it should be the time spent with the physician. No pre or post visits related the call (7 days before the call and within 24 hrs after the call)

        9.   Interprofessional Telephone/Internet consultations services are billed for a consultant who providing treatment advice to the treating physician. This service is not eligible to bill if the call is to arrange a transfer of care. This service should not be reported more than once within a seven-day interval.   

        10.  Newborn care services codes are for normal newborn until 28 days. Whether the initial day or a subsequent day or discharge day management.

        11.  TCM care can be billed once in 30 days by the single physician.

        12.  Modifier 24 (Postoperative unrelated service), 25 (Minor surgery / Medicine section codes) and 57 (Major surgery) are used with E&M codes based on different scenarios.  “AI” modifier with admitting physician service if two admit codes are about to bill on the same day.

        13.  E&M with radiology and/or pathology services doesn’t require any modifiers. E&M with medicine section codes on same day append modifier 25 with E&M codes.

ANESTHESIA – 7 Questions

1.     Watch for Base unit, time unit, Anesthesia modifiers, Physical status modifier and qualifying circumstances.


2.     Watch for who has provided the anesthesia care and the anesthesia start and end time.


3.     Under anesthesia section guidelines, Included and excluded services are listed out.


4.      If multiple surgical procedures are performed during a single anesthesia administration, then only the highest base unit value CPT code should be reported, but the total time spent for all procedures would be considered for Anesthesia Time unit.


5.     Time of anesthesia is calculated in units (Each 15 min = 1 unit), For certain insurance there may be round up or round down concepts applicable, anything below 7.5 minutes round down and above 8 min roundup. 


6.     There may be some interruptions in anesthesia care during a procedure; if the provider is no longer personally attending the patient should be recorded correctly about the interrupted timings.


7.     Modifier 23, 47, (For Anesthesiologist- AA, QY, QK, and AD) (For Non-physician anesthesiologist - QX, QZ) (For MAC - QS, G8, and G9) and (Physical status - P1 to P6) are the best clue to narrow down the answer.


8.     MAC service is Local anesthesia along with sedation.  


9.     Conscious sedation codes are based on a single physician involved or two physicians and based on time.


SURGERY - totally 60 questions

        1.   Surgery can be performed either by open/percutaneous / Endoscopic/laparoscopy, watch the question carefully about the approach and anatomic location.  

        2.   Most of the percutaneous procedures are performed using guidance;

            A. Ultrasound 76837 (Vascular) and 76842 (Non-vascular)

            B. Fluoroscopy 77001 (Vascular) 77002 (Non vascular) 77003 (Spine)

            C. Computer tomography 77012

            D. Magnetic resonance imaging 77021

        3.   When there is S&I codes along with surgery don’t code guidance codes separately.

        4.   Few surgery codes include the guidance, S&I etc. then “7” series codes should not be coded separately along with surgery codes.

        5.   Modifier 51 should not be used along with add-on code.

        6.   Modifier 58 is preplanned postoperative service, Modifier 78 and 79 or unplanned postoperative services.

        7.   If there is a more specific anatomical modifier like (FA, F1-F9 / TA, T1-T9) are given in the choice go with more specific site modifiers.

        8.   Modifier 59 (XE, XS, XP, XU) should be for distinct services / NCCI edits

        9.   Watch for the procedures performed at that particular operative session and code all the services if there are no NCCI edits. If there is an edit between the services then use an appropriate modifier (59). Some scenarios, we can’t bill all the services performed at the same session, few procedures may be considered as part of the procedures. For included and excluded services read the instruction given below the CPT’s in parenthesis ( ) and also the coding guidelines carefully before selecting the answers.

        10.  Usage of modifier 52/53 will differ based on CPT book guidelines.

A.  Integumentary – 10 Questions 
B.  Musculoskeletal – 10 Questions
C.  Respiratory / Cardiovascular – 10 Questions             
D. Digestive system – 10 Questions
E.  Urinary system – 10 Questions
F.  Nervous system – 10 Questions

RADIOLOGY – 10 Questions: 

        1.   X-rays codes are based on the number of views (AP, Lateral, Oblique – 3 views), not by the number of images or films.

        2.   Few combination codes are available in this section like Ribs with chest, Abdomen with chest, Hips with pelvis, Abdomen and pelvis etc. Read the complete description of the CPT codes and match with your questions before finalizing the answers. 

        3.   CT, MRI codes are based on contrast used or not. (Via oral/anal contrast is not considered as contrast study, only the Intra-venous, Intra-articular, Intra-arterial and Intra-thecal administration are contrast study)

a.    Contrast-Enhanced means contrast study.

b.   Contrast Unenhanced means non-contrast study.  

c.    CT or MRI performed following procedures like arthrogram / Myelogram / Discogram should be considered as with contrast CT / MRI study. 

        4.   3D codes shouldn’t be coded along with CTA / MRA codes. 

        5.   Ultrasound codes are based on elements (all required elements are documented code it as a complete otherwise limited study).

        6.   Mammogram coders are based on screening (No abnormalities) or diagnostic (Some abnormalities present) study and Uni (One) side or B/L (both sides).

        7.   Nuclear medicine sections are based on type of study (Limited / multiple / whole body / three-phase / SPECT).  

        8.   Modifiers like RT, LT, 26, TC, 76, 77, 50, 52 & 59 are major clues in radiology section, A clear understanding of the above-mentioned modifiers is very important in selecting the appropriate answers.  

        9.   Watch the questions carefully regarding which portion of the services [Profession service (26) or Technician service (TC) or global service (no modifier)] should be reported.

PATHOLOGY – 10 Questions

MEDICINE – 10 Questions

ICD 10 CM – 10 Questions

        1.   Read the ICD 10 CM General guidelines and Chapter specific guidelines completely most of the questions would be asked about these. How to sequence the codes based on the scenario is very important. Definitive diagnosis related to the RFV should be the primary Dx in most of the cases.

        2.   When there is a definitive diagnosis / Disease, don’t assign related sign and symptoms as additional codes.  

        3.   In a Maternal record for any complications, ‘O’ series codes should be the primary Dx. Other chapter codes can be sequenced next.  

        4.   Some of the default codings in case of lack of information is,

-      For Diabetes it should be coded as Type II DM.

-      For Traumatic fracture, it should be coded as a closed fracture and displaced fracture. 

-      For Hemiplegia, Right should be dominant and left should be non-dominant

-      Hypertension and kidney disease should be coded as hypertensive kidney disease.

-      Repeated heart attack within 4 weeks following AMI should be coded as subsequent MI.

        5.   External cause codes shouldn’t be coded as primary codes.

        6.   The health status codes ‘Z’ series with PDx symbol should be coded in the first place.

HCPCS II – 5 Questions

        1.   Will get 5 questions from HCPCS II, All the injection codes are listed out in this book in Appendix “A” codes are in ‘J’ series. Based on the route of administration and dosage of the drug select the appropriate codes with units. Administration codes are based on the route of administration.

        2.   Guidelines are given at the beginning of the book. All the HCPCS level II modifiers are given in the appendix “B” please refer this section for modifier information.

        3.   Few codes are not covered by the Medicare please check the symbols in front of the codes for more information look at the bottom of the book to find the symbol with description details given at all the pages.   

ANATOMY – 10 Questions

        1.  The medical coder should have a basic knowledge about Human Anatomy (11 organ system). We can refer to the CPT and ICD-10-CM book for all the anatomical illustrations (All the organ system with labels) are given.


        1.   Knowing medical terminology will help you lot in saving your time. Easily we can complete 8 questions in a few minutes. If you find difficulties then the alternate ways are either we can search those words in CPT or ICD books. In CPT book index as usual like code search will guide you to the section and subsection, so that you will get the answer.

    Eg: Blepharoplasty search in the index to find the CPT codes 15820-15823. (Procedure performed in eyelids). –plasty (suffix) are listed next to the Introduction section of the CPT book.

    Similarly, we can search for the conditions in the ICD-10-CM book to get the answers.  


        1.   CPT Guidelines are given at the beginning of each section and the beginning of the set of codes. Read the guidelines carefully before selecting the answers.

        2.   Standard instructions about the modifiers and their usage are given in Appendix “A” in the CPT manual apart from that under a few chapters they specifically mentioned about the modifier usage based on scenarios. Even below the codes, there are some scenarios with modifiers. Watch carefully before selecting the answers.


    Everything would be found in the CPT and ICD books itself. Take your time in searching, reading the descriptions and understand it properly before selecting the answers.  Answering 150 questions within the given time is very important.

    Among the four choices look for the same CPT code or nearby CPT codes first. Try to rule out among given choices and find the answer. Always watch the given four choices first then read the question. Don't go by intended codes alone, always read the stand-alone code description to find the difference. 

    Keep practice with few mock (150 questions) exam papers before taking up the CPC Exam that would help you lot.

    5 questions would be asked about billing.

    Our team wishes you “All the Best”.