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CPC Exam Question Breakdown – Medical Coding Certification
Question Breakdown – This is a rough breakdown of what’s covered on the exam. They do have on the website the topics that are covered, but they don’t really let you know how many questions per. This is coming from going back to 2004, was the last time they published this on their website. I’ve been told that it’s pretty much the same today, students who have recently taken the exam said, “Yeah. That’s pretty much how it is.”
If you picture your CPT Manual because that’s really the star, that’s really where you mostly have to be proficient at, is understanding CPT procedure coding. The Surgery section starts with the 10000 series of codes to the 60,000. There are approximately 10 questions on each of those. As we go through it, you’ll see that the 10,000 is the Integumentary System; 20,000 is Musculoskeletal; 30,000 is Respiratory/Cardio, etc.
What I am doing in this review class is really saying, “Okay, if I have to write a board exam with 10 questions from the Integumentary System, and it’s based on guidelines, what kind of questions am I going to write?” And that’s what I teach. I teach the highlights where there are guideline issues that you should know. Straight up coding looking up something in the index confirming it in the main part of the book, if it’s that clear, that will not be in the board exam. They are testing you in coding guidelines. Keep that in mind.
After the Surgery, we’ve got 10 questions on Radiology approximately, 10 on Path and Lab, 10 on Medicine. Okay? That’s the CPT book.
Then, 10 on E/M, approximately 8 on Anesthesia, 8 on Medical Terminology, 10 on Anatomy. So, right there, 18 questions (maybe about 20) are on understanding medical terminology and anatomy. 
Those are the ones you normally can pick up some speed. Hopefully, you can get those done quickly. If you have not had a medical terminology course, and you don’t feel strong in it, then I highly recommend if you have time to at least get some flash cards and really drill yourself. There are some good sites out there, Studystack.com is one, where other students taking other medical terminology courses have made flash cards for themselves. So, whatever you’re studying, pop in Integumentary and test yourself, see how you do. Okay?
10 questions on ICD-9, but like I said before, you could have questions on the surgery codes or the radiology codes that throw in diagnostic codes. Don’t be afraid of this. Sometimes, you can use them to your advantage. It could be like a tie breaker if you’re struggling with the CPT portion. I personally don’t think that ICD code should be, if you’re testing an examinee on surgery questions, that I think it should just be having CPT surgery codes in it.
5 questions on HCPCS, like I said, don’t blink; very, very short portion of this. Practice Management is like this catch all kind of phrase, what’s on that? I did bring the CPC study guide from the AAPC that we’ll go over. I’ll show you some sections. In there is a chapter in the beginning that is where they’re pulling information from. I have a slide with some details on it that I actually just put together this morning.
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By Laureen Jandroep
CPC, CPC-I.,Sr. Instructor for CodingCertification.Org. Resides in southern New Jersey with her husband of over 20 years Anthony and four children. They are active foster parents and spend most of their time these days just being parents which they love.
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Coding Certification Review Blitz- Course Excerpt Part 1
Welcome to the Coding Certification Review Blitz. The reason I call it a “blitz” is because after two full days of this, you’re going to feel like you’re blitzed. Other people call them boot camps or whatever, but basically, it’s intensive. It’s two full days. In the past, have you talked to anybody who has attended this before? Okay, you’ve heard that sometimes you get out early on the second day. It’s not going to happen this time. I’ll tell you why.
The AAPC has really expanded the E/M questions on the board exam. There are only 10 questions out of 150, but it takes a long time to explain it so that you can handle those 10 questions. Before, they used to make it a little less where you had to work to get the answer. Now, you got to work a little bit more.
So, I need to teach you more in that areas, so that’s going to take up that time, but I think it’s time well spent. I hope you agree. We are going to probably go to the full time both days, okay?
So, this is Day One, and looking at the schedule we’re going to cover introductory stuff. Honestly, I say the very first part, the first morning of these two days, if that’s all you got and you had to leave, you would probably have enough to pass the board exam.
It’s the test taking tips, because I’m sure all of you have already studied. At least you should have, because this is a review class. It’s not to teach everything about coding to pass the board exams. It’s to take knowledge you’ve already taken in, and really review it, and make sure you understand the key points that you’re going to be tested on.
So, really pay attention this morning — that’s the key.
We’re going to cover HCPCS, it’s like 20 minutes tops. There’s only, I think five questions on HCPCS on the whole exam. Tomorrow, you do not need to bring your HCPCS Manual with you if you brought it today. If you don’t have it today, I won’t even panic about that because I think from the slides you’ll be able to see what you need to focus on for the exam. Then, we’re going to do ICD-9. They will not be testing on ICD-10 until 2014. We’ll go over that.
Again, there are only about ten questions on the board exam for ICD; however, ICD questions codes can show up in answers when they are testing you maybe on surgery coding principles. We’ll spend some time on that, but after today, you don’t need to bring your ICD Manual tomorrow. Okay?
We will go into modifiers after lunch, we’ll do E/M, and we’ll start getting into CPT Manual. Anesthesia, Radiology, Path and Lab, and we’ll try and get your Medicine. We might only get through halfway — we’ll see how it goes, okay?
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By Laureen Jandroep
CPC, CPC-I.,Sr. Instructor for CodingCertification.Org. Resides in southern New Jersey with her husband of over 20 years Anthony and four children. They are active foster parents and spend most of their time these days just being parents which they love.
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Every doctor can learn from a medical coder – KevinMD.com
Mrs. B was washing dishes in the kitchen when she heard a thump where her twelve-month-old son was asleep. She ran to him and found her son had fallen from a chair (code: e884.2). He was crying (code: 780.92) and visibly shaken, but did not have overt signs of bleeding, bruising, or trauma. She picked him up and immediately brought him to the emergency room.
There, he was triaged by the nurse (nursing report #1) and vitals were taken (nursing report #2). Shortly after the mother and son pair settled into the pediatric emergency room, he vomited once (code 787.03). The emergency medicine residents came by an hour later to conduct a focused interview, and performed a comprehensive physical exam (code: 89.03).
He took care to ask at least four elements of the history of present illness that included location, quality severity, duration, timing, context, or associated symptoms from the event. He performed a complete review of at least 10 organ systems and surveyed the patient’s social history (code: 99223). It was decided that the boy was to be observed in the ED for the next few hours for signs of brain injury or concussion.
No labs or imaging studies were ordered. The nurses were instructed to check for vital signs every hour (nursing reports #3,4,5,6). During the observation period, the boy was found to be active, interacting well with mom, hungry, without signs of lethargy or focal neurologic deficits. When the attending physician came by to evaluate and assess the patient, he agreed with the resident’s report and signed the discharge note. The mother was given discharge paperwork and instructions for returning to the hospital if she noticed any new, alarming symptoms.
***
This is what Kelly, an emergency department medical coder, gathers while reading an ED admission note. She turns to me and explains that the few lines of attending attestation are the only way the patient can get billed. Kelly types in “959.01” into her software because she memorized the diagnosis code for “head injury, unspecified.” She has been doing this for the last 18 years.
As I listened, she explained that a head injury in a twelve-month-old infant is automatically a level three, so long as the resident documents a review of ten systems, past medical history, and a physical exam. These levels indicate the complexity and severity of the patient’s disease/injury.
“It’s all about the documentation,” she says. “If just 9 organ systems instead of 10 are documented, even a critically ill patient could be down-coded to a level 4.”
In this case, the resident did not order any additional labs or imaging studies, keeping him at a level three. Kelly then counts the number of nursing reports that were filed for this patient and enters the number. There are no specific codes for procedures performed by the nursing staff. So, the only indication of level of nursing care is the number of nursing reports written.
During my morning with Kelly, I learned about how patient charts are medically coded and about which services contributed most to the costs of care. How are medical supplies accounted for? How do hospitals bill for the amount of time spent on each visit? As a medical student and prior to my morning with Kelly, these concepts were foreign to me. There is little in the medical education curriculum that prepares students in a way that my visit with Kelly did.
I learned that first of all, coding and billing are two separate procedures, done by two different people, trained individually, working miles apart. The coders see only what is documented on paper while billers see only a column of numbers of which to assign monetary value. I learned that there are two parts to coding: hospital services and physician services. The bill that results from these codes can contribute to the large bill that the patient or insurance company receives. These charges are the basis for what is negotiated with insurance companies, who use an algorithm to determine actual reimbursement rates for each patient based on risk factors. As you can see, this is a complicated business that involves many different stakeholders.
Everything documented in a physician’s note contributes to determining the level of care of the patient and in turn determines what charges get submitted to the insurance company and to the patient. It is crucial that physicians not only understand the importance of clear documentation but the effect these procedures and tests in the documentation have on the increased costs passed on to the patient and payer.
After my experience with Kelly learning about medical coding, I am now much more aware of the information conveyed in my progress notes. The medical chart is a physician’s way of communicating the severity of the patient’s health and the amount of effort invested in the patient’s care. It is also a potential channel for documenting exams that were not performed. This process has shown me, in real time, how a plethora of unnecessary tests and imaging could increase a bill exponentially. Most importantly, there is no medical code for good or bad outcomes and there is no reward for physicians who are conscious of medical resources to cut costs of care.
On the contrary, physicians are incentivized to order more tests and provide critical care measures that may be unnecessary. I believe all medical students and residents should take a class that outlines the lessons I learned with Kelly that morning- that billing, coding, and every decision can contribute directly to the exponentially rising health costs in America.
Jessica Jou is a medical student.
This post originally appeared on the Costs of Care Blog. Costs of Care is a 501c3 nonprofit that is transforming American healthcare delivery by empowering patients and their caregivers to deflate medical bills. Follow us on Twitter @costsofcare.
Correct Coding Elevated Troponin – Video – Medical Coding …
I’m not sure how everybody says this Medicare or this…
Laureen: Troponin.
Alicia: Yeah, I wouldn’t have said troponin. I was going to say… Well, I’ll say troponin now because you said it. Now, I can’t remember how I said it.
Q: What is the correct code for elevated troponin without mention of any definite diagnosis? Okay, very good.
A: So, what we’ve got here is what actually is troponin? It’s creatine kinase. That’s probably not how you say it either but that’s how I say kinase and sometimes they call that CKs.
The ICD-9, they want to know what the ICD-9 code for that. Well, see, it’s a common problem because this is also known as CPK and it’s phospo-creatine kinase and sometimes wrongfully as creatinine kinase. It’s an enzyme present primarily in the heart and the skeletal muscles and also in the brain.
Now, what happens when you have these enzymes going on? If these levels aren’t just at the proper level for everything, then it will give people a heart attack. It will make you have horrible muscle spasms or you can have seizures. Everybody, usually, doesn’t think about the chemical balance of your body but you really are made up of a whole batch of chemicals, and if they are just not right, you can have some nasty repercussions.
Any injury to any of these structures will lead to a measurable increase in CK levels. That means, let’s say a person is walking down the street and they get hit on the head with a baseball because they’re walking by a game or something. So, you think okay, they’re walking around. They’re fine and everything, and then all of a sudden they have the seizure and they are taken to the hospital and they’re really, really sick. Because trauma to the brain make these levels go wacky.
Let’s say a person is… Oh, gosh! Think about those women who get anorexia. They’re not eating. Their body is literally eating off of itself but your enzyme levels and some like that all get screwed up and they’ll have seizures. They can have a heart attack but that’s usually what kills these people that suffer from that. It’s the chemical imbalance and stuff in the body, not necessarily just the body.
That being said, 790.5 Other Nonspecific Abnormal Serum Enzyme Levels.
Extra Note from Alicia: 790.5 is used for nonspecific serum enzyme levels and CK is specific. So 790.5 would not be the correct code in this case.
Here is a website for more information: http://circ.ahajournals.org/content/45/2/471.full.pdf
Serum enzymes tests ares used to check for MI damage.
The troponin is a complex of three regulatory proteins that is integral to muscle contraction in skeletal and cardiac muscle. Elevated troponin levels indicate myocardial injury but may occur in critically ill patients.
As we scroll down, ICD-9 code for Elevated Troponin. Again, what is the best code? There is no ICD-9 code specifically for this particular enzyme or what’s going on. Now, there may be on ICD-10 but there is not for ICD-9. What’s the best code to use – 790.99 Other Abnormal Findings On Examination Of Blood. So, with this definition, we would need to use 790.99 for the elevated troponin.
Now, as a coder, wanting to know how to be educated on this stuff, that’s where you really have to go and do the research; and if you’re dealing with stuff like this, you’re going to have to go in and understand what some of these are.
This is not a common thing that happens, guys. This is very rare, but it does happen. I don’t want to scare you and make you think that you’ve got to know what all of these enzymes and stuff are. If you come across something like this, you can usually query the doctor and say, “Okay, I’m not really sure I understand what this is. What’s troponin? What do I need to know so I can code to the highest specificity?” and then get that information.
So, it’s not something that you would just know. I would say you would have to investigate to get this, okay, unless you really deal with blood and enzymes all the time.
Laureen: Great! And I wanted to share. This is the site I use on how to pronounce things.
Alicia: Oh, good.
Laureen:It’s called howjsay.com but I put in “kinase.” I don’t think you could hear it when I did it, did you?
Alicia: No. I can’t hear it.
Laureen: Kay-nase or Kee-nase is what he said.
Alicia: Kee-nase?
Laureen: Yeah. So, now I’m going to try troponin.
Alicia: Troponin. I still think Laureen talks funny guys so I always giggle to myself, but then I have this thing about accent so…
Laureen: Tropop-neen. Wait a minute, one more time.
Alicia: No E.
Laureen: Tropo-neen.
Alicia: Tropo-neen. That’s how I said it without the “een.” That’s how I was saying it to myself earlier today. Tropop-onin.
Laureen: Sure, sure.
Alicia: Yeah, yeah.
Laureen: Very good.
Alicia: So you don’t have to be perfect to be a coder guys.
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By Laureen Jandroep
CPC, CPC-I.,Sr. Instructor for CodingCertification.Org. Resides in southern New Jersey with her husband of over 20 years Anthony and four children. They are active foster parents and spend most of their time these days just being parents which they love.
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established patient with no exam – AAPC Medical Coding & Billing …
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(CPC®) Medical Coding Study Guide – AAPC
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Physician Based Coding Course – Video – Medical Coding Certification
And just a real quick overview of what we offer, and you’ll hear us kind of mention it throughout. And Ruth and Boyd, and Alicia and I will be kind of answering some of your questions in the chats, but it normally comes down to one of these products so probably answer a need that you have or a pain point that you’re going to in preparing for getting these certifications or maintaining them because you need to get continuing education units once you get the credentials.
We have a full Medical Terminology & Anatomy Course that’s very popular. We’re getting a lot of good feedback on it. We use a textbook that is made for coders by coders and it relates to the new ICD-10 coding system that’s coming out next year. It’s a very good text. By the way, all of our products are listed at http://go.codingcertification.org/medical-coding-training-certification-products so you can see a full listing of everything all in one page.
We’ve got our Physician Based Coding Course, that’s an 80-hour type course. If I was teaching it face-to-face, it would take 20 weeks. We have that in an online format where you can go at your own pace. You get a coach, like Alicia, that helps you through the course and the lectures are of me teaching the particular topic. We try to make it like a classroom-type course in that you have a reading assignment and you have textbook exercises that you can do at the kitchen table or whatever. So it’s not completely online, we don’t have to be tethered to a computer.
Bundled into that course or you can purchase it separately are our Review Blitz Video packages. We’ve got online only and we’ve got the DVD version, same exact videos, just different formats. We made the online-only available for those that were more on a budget.
We have got the 150 Question Downloadable Practice Exam. We actually haven’t put a link up here yet, but we have a deluxe one which is basically two 150-question practice exam, plus a bunch of other goodies. So you can check those out. If you’ve purchased our first one and you need even more practice, we now have an additional set of practice exams.
You can combine the Medical Terminology with the Physician-Based Coding Course for a discount.
It includes everything above this line.
We’ve got our new Facility-Based Medical Coding Course that’s for those aiming for the CPC-H and it will also help for a portion of the CCS.
We’ve got our CEU Webinars and we’ve got an ICD-10-CM Mini Course. So, lots of good stuff and lots of CEUs.
Another CEU announcement we have to make, we don’t have a slide for is, we have taken the Physician-Based Coding Course Chapters, and we’re going to break them up into their own CEU classes and get them approved. So stay tune for that. So, if you’re really looking for CEUs and you want to get a lot of them through CCO, you can pick anything you’re interested without having to take the whole course. So that’s coming soon.
Physician Based Coding Course
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By Laureen Jandroep
CPC, CPC-I.,Sr. Instructor for CodingCertification.Org. Resides in southern New Jersey with her husband of over 20 years Anthony and four children. They are active foster parents and spend most of their time these days just being parents which they love.
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Recommended Steps to Prepare for the CPC® Exam – AAPC
Prepare for the CPC® exam with medical coding courses, study guides, workbooks, and practice exams.
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