Exam at a glance
- 100 multiple-choice questions (including ~10 case studies)
- 4 hours, one session → roughly 2 min 24 sec per question
- Open book — your printed CPT, ICD-10-CM & HCPCS manuals
- Pass mark: 70% · open book ≠ easy — speed of lookup is the real skill
The three code sets
| Set | Covers |
|---|
| ICD-10-CM | Diagnoses — the "why." 3–7 characters. |
| CPT | Procedures/services — the "what." 5 digits, maintained by the AMA. |
| HCPCS Level II | Supplies, drugs, DME & services not in CPT. Letter + 4 digits. |
CPT sections & ranges
| Section | Range |
|---|
| E/M | 99202–99499 |
| Anesthesia | 00100–01999 |
| Surgery | 10021–69990 |
| Radiology | 70010–79999 |
| Path & Lab | 80047–89398 |
| Medicine | 90281–99607 |
Symbols: ● new · ▲ revised · + add-on (never reported alone) · ⊘ modifier-51 exempt.
Must-know modifiers
| Modifier | Meaning |
|---|
| 25 | Significant, separately identifiable E/M the same day as a procedure |
| 59 | Distinct procedural service (unbundling, when appropriate) |
| 26 / TC | Professional / Technical component |
| 50 | Bilateral procedure |
| 51 | Multiple procedures, same session |
| 76 / 77 | Repeat procedure by the same / a different provider |
| 24 | Unrelated E/M during a postoperative period |
| 57 | E/M that led to the decision for surgery |
| RT / LT | Right / Left side |
ICD-10-CM guideline reminders
- Always start in the Alphabetic Index, then verify the full code in the Tabular List — never code from the Index alone.
- 7th character: A = initial encounter · D = subsequent encounter · S = sequela.
- "Code first" means sequencing the underlying/etiology code before this one.
- Combination codes capture two conditions in a single code (for example, diabetes with a manifestation).
- Use laterality (right/left) and the most specific code the documentation supports.
- Use "unspecified" only when the documentation genuinely won't support more detail.
HCPCS Level II letters
| Letter | Covers |
|---|
| A | Transport, supplies, miscellaneous |
| E | Durable medical equipment (DME) |
| G | Procedures / professional services (temporary) |
| J | Drugs (injectables), chemotherapy |
| L | Orthotics & prosthetics |
| P | Pathology & laboratory |
| V | Vision & hearing |
E/M quick guide (2021+ rules)
- Office visits are leveled by Medical Decision-Making (MDM) or total time — whichever is higher.
- MDM = problems addressed + data reviewed + risk.
- New patient: 99202–99205 · Established patient: 99211–99215.
- History and exam no longer drive the level — they just need to be medically appropriate.
Medical terminology — high yield
| Term part | Meaning |
|---|
| -ectomy | Surgical removal |
| -otomy | Incision into |
| -ostomy | Creation of a new opening |
| -itis | Inflammation |
| -plasty | Surgical repair |
| -scopy | Visual examination |
| hepat/o | Liver |
| nephr/o · ren/o | Kidney |
| cardi/o | Heart |
| arthr/o | Joint |
| dys- / tachy- | Difficult / fast |
Compliance & forms
| Term | What it means |
|---|
| CMS-1500 | Professional / physician (outpatient) claims |
| UB-04 | Institutional / hospital facility claims |
| HIPAA | Protects patient PHI (minimum necessary standard) |
| NCCI edits | Prevent improper unbundling / invalid code pairs |
| Upcoding | Billing a higher level than documented — fraud |
| Medical necessity | The diagnosis (ICD-10-CM) must justify the procedure (CPT) |
Open-book & exam-day strategy
- Tab your manuals by section — highlighting is fine, long handwritten notes are not.
- Use a 3-pass method: easy questions first, flagged lookups next, case studies last.
- Never spend more than about 4 minutes on one question — flag it and move on.
- Eliminate two wrong answers, then verify the remaining code in the book.
- Read E/M and operative-note case studies twice — the detail usually decides the code.
- Leave no blanks — there's no penalty for guessing.
Note: this is a study aid, not a substitute for the official AAPC materials or your current-year code manuals. Code sets, ranges, and exam rules update annually — always confirm against your current CPT, ICD-10-CM, and HCPCS books and aapc.com.