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% · results in roughly 7–10 business days
- Taken online (live remote proctor) or in person
- Voucher often includes one free retake
- Open book ≠ easy — speed of lookup is the real skill
Exam content areas: CPT — Surgery (by body system), E/M, Anesthesia, Radiology, Path/Lab, Medicine; ICD-10-CM diagnosis coding; HCPCS Level II; medical terminology & anatomy; coding guidelines & modifiers; compliance & regulatory (HIPAA, NCCI, fraud/abuse); practice management. CPT and E/M together make up roughly half the exam.
The three code sets
| Set | Covers |
|---|
| ICD-10-CM | Diagnoses — the "why." 3–7 characters. 21 chapters. |
| 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 · ∅ modifier-51 exempt
CPT Surgery — by body system
| Body system | Range |
|---|
| Integumentary | 10021–19499 |
| Musculoskeletal | 20100–29999 |
| Respiratory | 30000–32999 |
| Cardiovascular | 33016–37799 |
| Digestive | 40490–49999 |
| Urinary / Genital | 50010–58999 |
| Nervous | 61000–64999 |
| Eye / Auditory | 65091–69990 |
Must-know modifiers
| Modifier | Meaning |
|---|
| 25 | Significant, separate E/M same day as a procedure |
| 59 / X{EPSU} | Distinct procedural service |
| 26 / TC | Professional / Technical component |
| 50 | Bilateral procedure |
| 51 | Multiple procedures, same session |
| 52 / 53 | Reduced / Discontinued service |
| 76 / 77 | Repeat by same / different provider |
| 62 / 80 | Two surgeons / Assistant surgeon |
| 24 | Unrelated E/M during postop period |
| 57 | E/M that led to the decision for surgery |
| 91 | Repeat clinical lab test |
| RT / LT | Right / Left side |
Key CPT guidelines
- Global surgical package: pre-op, intra-op & routine post-op are bundled (0/10/90-day periods)
- "Separate procedure": bundled with a related larger procedure; billable when done alone
- Add-on (+) codes: report with a primary code, never alone; modifier-51 exempt
- Unlisted code: use when no specific code exists; attach documentation
- Don't unbundle — watch NCCI edits
Anesthesia & radiology
Anesthesia: (Base + Time + Modifying Units) × Conversion Factor. Time unit ≈ 15 min. Physical status modifiers P1–P6 describe the patient's health for anesthesia.
Radiology components: 26 = professional (read) · TC = technical (equipment) · no modifier = global.
ICD-10-CM guideline reminders
- Always: Alphabetic Index → verify in Tabular List (never code from the Index alone)
- 7th character: A = initial · D = subsequent · S = sequela; use "X" as a placeholder for empty positions
- "Code first / use additional code" = etiology before manifestation
- Combination codes capture two conditions in one
- Code to the highest specificity & use laterality
- Unspecified only when documentation won't support more
- Signs/symptoms not coded if a definitive diagnosis is documented
Chapter order (21): Infectious → Neoplasms → Blood/immune → Endocrine → Mental → Nervous → Eye → Ear → Circulatory → Respiratory → Digestive → Skin → Musculoskeletal → Genitourinary → Pregnancy → Perinatal → Congenital → Symptoms (R) → Injury (S/T) → External causes (V–Y) → Factors/Z codes. Z codes = reasons for a visit other than illness (screening, status).
HCPCS Level II letters
| Letter | Covers |
|---|
| A | Transport, supplies, misc. |
| B | Enteral / parenteral therapy |
| E | Durable medical equipment (DME) |
| G | Procedures/professional (temp) |
| J | Drugs (injectables), chemo |
| L | Orthotics & prosthetics |
| P | Pathology & laboratory |
| Q | Temporary codes |
| V | Vision & hearing |
E/M quick guide (2021+)
- Office visits leveled by Medical Decision-Making (MDM) or total time
- MDM = number of problems + data reviewed + risk
- New patient 99202–99205 · Established 99211–99215
- New = not seen by the practice/specialty in 3 years
- History & exam must be medically appropriate but no longer set the level
Terminology — suffixes
| Suffix | Meaning |
|---|
| -ectomy | Surgical removal |
| -otomy | Incision into |
| -ostomy | New opening |
| -plasty | Surgical repair |
| -scopy | Visual exam |
| -centesis | Surgical puncture |
| -itis | Inflammation |
| -oma | Tumor |
| -algia | Pain |
| -megaly | Enlargement |
| -emia | Blood condition |
| -pathy | Disease |
Terminology — roots & prefixes
| Root / prefix | Meaning |
|---|
| cardi/o | Heart |
| hepat/o | Liver |
| nephr/o · ren/o | Kidney |
| gastr/o | Stomach |
| oste/o | Bone |
| arthr/o | Joint |
| neur/o | Nerve |
| derm/o | Skin |
| hyper- / hypo- | Above / below |
| brady- / tachy- | Slow / fast |
| a- / an- | Without |
| dys- | Difficult / painful |
Common chart abbreviations
| Abbreviation | Meaning |
|---|
| Hx / Dx / Tx | History / Diagnosis / Treatment |
| Bx / Fx | Biopsy / Fracture |
| HPI / ROS | History of present illness / Review of systems |
| PMH / PFSH | Past medical / Past-family-social history |
| c/o · w/o | Complains of · without |
Payers & insurance
| Payer | Covers |
|---|
| Medicare A | Inpatient / hospital |
| Medicare B | Outpatient / physician |
| Medicare C | Medicare Advantage (managed) |
| Medicare D | Prescription drugs |
| Medicaid | Low-income (state + federal) |
| Others | Commercial, TRICARE, Workers' Comp, self-pay |
Revenue cycle steps
Registration → insurance verification → encounter & documentation → coding → charge entry → claim submission → payer adjudication → payment posting → denials/appeals → patient billing.
Compliance & forms
| Term | Meaning |
|---|
| CMS-1500 | Professional / physician (outpatient) claims |
| UB-04 | Institutional / hospital facility claims |
| HIPAA | Protects patient PHI (minimum necessary) |
| NCCI edits | Prevent improper unbundling |
| Upcoding | Billing higher than documented = fraud |
| Fraud vs. abuse | Intentional deception vs. improper (not intentional) |
| Reject vs. deny | Never processed (fix & resend) vs. processed & unpaid (appeal) |
| Clean claim | No errors; processes without extra info |
| EOB | Payer's explanation of benefits to patient |
| Medical necessity | Dx (ICD-10) must justify the procedure (CPT) |
Open-book & exam-day strategy
- Tab your manuals by section — highlighting OK, long handwritten notes are not
- 3-pass method: easy first → flagged lookups → case studies last
- Never spend more than ~4 min on one question — flag & move on
- Eliminate two wrong answers, then verify the code in the book
- Read E/M & op-note cases twice — the detail picks the code
- Watch qualifiers: "except," "not," "most/least"
- No blanks — no penalty for guessing
Smart study plan
- Weeks 1–2: terminology + anatomy; start tabbing books
- Weeks 3–4: ICD-10-CM guidelines & drills
- Weeks 5–7: CPT by section (heavy on Surgery & E/M)
- Week 8: HCPCS + modifiers
- Weeks 9–10: full timed practice exams; review every miss
- Official AAPC practice exams mirror the real test best
Study aid only — a quick reference, not a substitute for official AAPC materials or 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.