Certified Coder Exam: Pass Your Test the First Time · 2019. 6. 5. · Certified Coder Exam: Pass...

Training Session Handouts

Certified Coder Exam:

Pass Your Test the

First Time

Presented by: Jeffrey Restuccio, CPC ,COC, MBA

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Certified Coder Exam: Pass Your Test the First Time

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Coding Certification Exam Prep – Study Tips and How to Triage Your Time.Jeffrey Restuccio, CPC, COC, MBAMemphis TN(901) 517‐[email protected]

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My Background• I first learned about coding in 1992. By 1996 the Restuccio Healthcare group was teaching coding exam prep courses locally and nationally.

• In 1999, our five‐day coding certification prep course was put online. Since then, the current company, Ritecode.com has helped over 1,000 coders become certified.

• I am a working consultant. I teach Webinars from home; in the last ten years alone, I’ve taught over 365 seminars to coders, billers, managers and providers. I sell my online coding certification course, my hardcopy coding certification prep manual, and dozens of sample exams organized by exam, specialty or type from a database of over 3,500 questions accumulated throughout a 25‐year career.

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Outline• The focus of this presentation is to help you with time management–both studying for the exam and taking the exam.

• Preparation• Study Aids• The Exam Ri

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Allowed Manuals !• Only AMA professional or standard Edition books are allowed. CPT, ICD‐10 and HCPCS. No other manuals.

• Optum CPT Expert is not allowed for test. It includes anatomical illustrations and additional information.

• It appears that the current Optum CPT manuals do not have the guidelines before every section (except E & M) like they did years ago.

• If you work for a clinic, you will need to purchase the AMA version of the manual for the exam. You want to tab and highlight it. According to AAPC “Long passages of information are not permitted on the blank pages of the print out.”

• If you fail you can retake the exam one more time (without paying extra).

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Non-Approved Manuals• Due to the advantages of additional information and/or ease of use, the following books cannot be used during the exam:

• Any Procedural Coding Expert• Any Procedural Professional• CPT® Plus! ‐ PMIC• CPT® Insider's View ‐ AMA• ICD‐10‐CM Easy Coder• Study Guides

• I repeat; The manuals above are NOT ALLOWED!• https://www.aapc.com/certification/cpc/#tab‐2

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AAPC Exam Tips• No cell phones !• Confirm location before the day of the exam.• Bring #2 pencils and manuals. Snacks and water are allowed.• Earplugs are allowed !• Learn how to quickly locate codes, guidelines, tables and instructions.

• Minimize and bathroom breaks.• Scan the test for Op Reports and particularly difficult questions.

• You may skip/guess 5‐10 questions so allow at least 20 minutes to come back to them.

• AAPC Tips: https://www.aapc.com/certification/exam‐tips.aspx

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Top 5 mistakes1. Run out of time by a wide margin. Not enough actual

practice taking tests. (work 150‐300 practice test questions) work at least 25 surgical op reports.

2. Do not know how to find codes, guidelines or topics quickly in the CPT manual.

3. Do not tab, bracket and highlight their manual.4. The exam assumes you have been working in a clinic and

coding every day.5. The basics: medical terminology, anatomy, concepts,

guidelines, overview of the manual.

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What should not be on the exam• There should not need to know the Medicare E & M Guidelines for the multi‐specialty exam or the specialties. Some call this counting bullets or elements.

• You should not have to calculate the anesthesia units and times.

• You won’t need to read E & M notes and calculate the level. The question should read: the History was EPF, the Exam was detailed and the MDM was moderate, the patient was new, what E & M level does this support?

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Other General Test Info• Historically AAPC and AHIMA have not provide any feedback which questions you get wrong–just the total count.

• That is a good reason to invest in one or more sample exams with both answers and explanations (rationale).

• You will know if you passed before you open the AAPC envelop because you will see the CPC or CPC‐A after your name on the address !

• No materials (other than tab dividers) may be inserted, taped, pasted, glued, or stapled in the manuals.

• Handwritten notes are acceptable in the coding books only if they pertain to daily coding activities.

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CPC Exam Section Percent• Add Hours

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CPC Exam Questions Study Hours10,000 Series 10 820,000 Series CPT® 10 830,000 Series CPT® 10 840,000 Series CPT® 10 850,000 Series CPT® 10 860,000 Series CPT® 10 8Evaluation and Management® 10 8Anesthesia 8 6.4Radiology 10 8Laboratory / Pathology 10 8Medicine 10 8Medical Terminology 8 6.4Anatomy 8 6.4ICD‐10‐CM/Diagnosis 10 8HCPCS Level II 5 4Coding Guidelines 6 4.8Compliance and Regulatory 5 4

TOTAL: 150 120



Work backwards (1 of 2)• Some sections are easier than others, some harder. • How much time do you have to prepare? Write down your number.

• Is it 50, 100 or 150 hours? Now divide that by month, week and even by day.

• I recommend a minimum of 4 hrs/week for 20 weeks.• Although E & M and Medicine both have 10 questions and 8 hours allocated, they are more difficult than other sections so spend another 50% on them. I would add cardiology to the list.

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Working Backwards (2 of 2)• Now allocate how much time you will study each section.• You must track your study efforts. Create a journal.• Set your expected test date 6 to 12 months ahead.• Try to study for no longer than two hours at a time.• Increase your study time as the deadline nears. I studied every night for at least four hours one week before my CPC‐H (now COC) exam. On the weekends the month before the exam, I would study for at least four hours each day in one or two‐hour increments.

• My scores were around 85 for both the CPC and CPC‐H.

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Create an Exam Planner• Exam name and association• Filing deadline and requirements (i.e., two references)• Test date, time and location.• Syllabus and outline of exam elements• Study outline times by week or month• Study outline by subject by week or month• Study resources:

• Anatomy book or CD• Medical terminology• CPT, ICD‐10/ICD‐10 and HCPCS manual• Prep Course• Sample exams

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Percent Wrong• 70% out of 150 is 105 correct and 45 wrong. But aim for 85%. That is 22 wrong.

• If the question is completely out of your league (like first and second‐order vascular families), guess quickly and move on. Another is interventional radiology. Both should be in your CPT index ; they are the only two specialties I don’t teach or consult on.

• I would not skip questions, but guess in in 30‐60 seconds and flag them to return if you have time. Add a notation for “hard” like a big “H”.

• During the exam, create a hashtag count of the questions likely be incorrect. That should be between 11‐22. You can guess on 22, get half right and still pass the exam.

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Quick Tips1. Add TABs to your ICD‐10 and CPT Book. Be sure to know

where each section is (medicine, Appendix A, Index etc…).2. Bring a Ruler or Straightedge. You will probably get one

question from the Neoplasm or Drug table. Use the straightedge to be sure you are reading across correctly.

3. Bring Sticky Notes and/or a few index cards to the testing let you flip back and forth between the Index and Tabular List.

6. Write in Injection Admin codes for vaccines and chemo, venipuncture and common HCPCS codes like a surgical tray in a NOTES section of your CPT book for quick reference.

1. Always read to the bottom of every CPT code group. Often there will be important coding notes. Make this a habit.

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Quantitative skills• This refers to the actual information.• You cannot pass the exam if you do not know the details.• This includes E & M, modifiers, as well as anesthesia surgical and OB guidelines.

• This includes: 1. Your lists.2. Practice exams3. Highlighting areas of the book.4. Memorization of key information

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Qualitative Skills• This refers to everything else• Being confident you will pass (positive attitude).• Being relaxed during the exam.• Having something eat and drink• Relaxation techniques• Avoiding test anxiety or running out of time.• Having enough sleep the night before.

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How do you learn best?• Visual learners: When you study diseases you should look some up to see what a basal cell melanoma looks like compared to squamous cell. You can look up images of an MRI versus a PET scan or CAT scan.

• Auditory: You learn by listening. There are audio seminars, webinars and live seminars.

• Kinesthetic: means you learn by doing. I recommend this highly. You should always be highlighting and annotating your study material and CPT manual. However, it is best to work with a clean sheet of paper and simply write over and over key terms. You know it when you can write 10‐12 elements without looking. You have officially overlearned it when you can remember them two weeks later. You know the material when you can pass a exam with 85% correct or more.

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Study Times• Work with your natural rhythms if possible.• Some study best early in the morning; others late at night.• Don’t focus on studying every day but set a weekly amount.• I always say a minimum of four hours per week for 20 weeks. That is 80 hours. Personally I probably invested more than double that amount. But at the time I was not coding on a daily basis. Ri

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Top Study Concepts• You should make your own list as you study.• The point is that not every section is equal. You will have to make decisions on which sections to focus.

• I recommend creating a list of at least 100 in a spreadsheet and then sort them by importance.

• Buy a deck (or two) of 100 index cards and create a deck of coding topics like: MRI, CABG, Strabismus, pain management, or myringotomy.

• Use the deck to study. If you focus on the top 85% of coding categories or subjects you have a greater probability of passing. It is okay to get about 22 wrong; that is 85%.

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Study AidsStudy Aids

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Studying Atmosphere• While some study with numerous distractions I will argue here for absolute silence and minimal distractions.

• Study the ten terms in the next slide and check and see if your retention is the same:

• With music playing (no words: classical, jazz or new age)• With music playing with words (contemporary)• With the television on.• With your family around and talking to you.• In a busy coffee shop• In absolute silence in a stark white room.• Remember, there will be no music or distractions when you actually take the test.

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Memorize ten elements• To test for you studying effectiveness, memorize the following:

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Critical Care1 Failure of: CNS2 Circulatory3 shock4 renal5 hepatic6 metabolic7 respiratory8 multiple days9 by time10 no video conferencing

Long-Term VS Short-Term Memory• If you attend a six‐hour seminar, you will most likely forget 80% of what you learned after two weeks. Most won’t pass a simple exam on the material at the end of the six hours.

• You must commit the information to long‐term memory.• This is called overlearning.• This is why repetition is so important.• All this practice will make you a much better coder.• I recommend studying the unique chapters like anesthesia or E & M thoroughly and then working other sections for a month or two.

• Then return and review anesthesia and E & M again after two months. This will aid in overlearning.

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The “Idiot Test”• This is named after my German teacher from High School.• No, he was not an idiot. He simply had us occasionally copy verbatim from the German book and reminded us that “any idiot” could do that so it did not take any special foreign language talent.

• Use this technique for anatomy. Draw all the main veins and arteries without looking. Try to draw 5‐10. Then read them. Try again.

• Copy this over and over and over again.• You need to know where the carotid and femoral arteries are. Those are the easy and common ones. Go down another level but know the basics and be able to draw them.

• Draw the bones of the skull (this was on one of my exams)

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Write over and over and over• Assume a one‐hour study session. Collect a list of facts or terms.

• Fold some 8 1/2 X11 paper in half, length‐wise and copy over the terms 3 – 5 times each.

• Goal is to make short, cryptic lists for every item.• Examples: MOD‐25 – E&M+10day Tx; MOD‐59– two Tx.• Use this technique for anatomy and medical terminology.• Copy some CPT code groups.• If you are doing this correctly, your arm should be slightly tired at the end of the hour.

• When you are done, throw the paper away.• Repeat the next day.

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Index Cards• Every modifier• Every E & M category• Anatomical planes• Carry them around with you everywhere you go.• Read them waiting in line at the bank.• Read them waiting in line at a fast‐food drive‐in.• Read them waiting on anything or anyone.

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Adding Notes to the CPT Manual• While I will recommend adding certain notes to your book, I did not have time to look at a single one during my CPC‐H™ exam. Not one!

• Therefore, like most of my advice, writing them down in the book, in an organized manner, is so you can remember them during the test. It’s a memorization technique.

• Some add many pages of notes to their manual. You will not have much time to review these. Instead, tab, highlight and bracket your manual. Circle key technique or approach terms.

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Every Study Session should be active• Repeat definitions 3 – 5 times.• Copy or write over definitions 3 times.• Make numerous lists and create a study book.• Use acronyms or mnemonics to memorize long lists.• Create your deck of index cards.• Have a hundred sheets of scrap paper handy.• Shorten terms to one word• HPI: location, duration, severity…etc…• Draw pictures next to concepts. For duration draw a clock, for severity draw an exclamation mark, for symptoms draw someone sneezing or coughing. Be creative. The more exaggerated the drawing the better you will remember it.

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Mnemonics: 12 Cranial Nerves • Cranial Nerves

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I‐Optic OnII‐Olfactory OldIII‐Oculomotor OlympusIV‐Trochlear ToweringV‐Trigeminal TopsVI‐Abducens AVII‐Facial FinnVIII‐Acoustic (Vestibulocochlear) AndIX‐Glossophrayngeal GermanX‐Vagus ViewedXI‐Spinal Accessory SomeXII‐Hypoglossal Hops



Mnemonics: Carpal Bones• The actual Mnemonics were more memorable:

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Scaphoid SomeLunate LadsTriquetrium TestPisiform PeopleTrapezium ThatTrapezoid TheyCapate Can'tHamatev Handle

Mind mapping• This is a non‐linear study technique popularized by Tony Buzan. There are numerous books available on the topic.

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Record It!• Use your computer, your phone or tablet and record yourself reciting:

• Medical terminology: 100 terms.• E & M types: all of them, short and sweet• Modifiers, keep it brief.• Guideline lists for anesthesia, OB, or Medicine sections.• Burn your list to a CD and listen to it before you go to bed every night or driving to work. That could be an additional 30 minutes of study once or twice per day!

• Most devices allow you to record hours. Most applications are free. Record a new lesson every couple of days. Keep it short‐15‐30 minutes. Even 10 minutes is potentially one or two correctly answered questions.

• Some applications will read simple text. It’s a little robotic but again worth a try.

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Test Anxiety• Use relaxation techniques.• At night relax your body and focus on your breathing. Count backwards from 100 and breathe out gently every number. Every time you exhale, focus on a body part to relax: your feet, your arms, your neck, you face.

• Repeat the word relax and you practice this technique.• Then, take a practice exam in the library under the exact same conditions as the real exam. Bring your ruler, you candy bar, your timer, all your books and go somewhere where you cannot see anyone or anything. If you need to, face the wall.

• Take the test and be sure to repeat the word relax every ten minutes, breathe out and relax your neck and shoulders when you do this. This works. However, you must practice it.

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Other Anxiety-reducing Strategies• Confront your fears• Be overly prepared• Excuse yourself from excuses; take responsibility.• Visualize Success• Block your escapes and take down your defenses.• Plan your work and work your plan.• If you can score 85% or better on a test exam you should feel confident that you will pass. 80% should be enough but anything near 70‐75% is too close and that means you need additional study.

• BTW: I was a psychology major in college.

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Specialties• In the real world most all specialties include surgical procedures plus diagnostic or test codes from the Medicine Section.

• Before studying for the exam choose a few specialties that might interest you. You will earn more working for a surgical group than family practice or pediatrics.

• Examples are oncology, orthopedics, ophthalmology, OB/GYN, and general surgeon (ASC).

• There is no oncology section, per se in CPT.• For ophthalmology, most office visit diagnostics are in the Medicine section. Surgical procedures are in the 60000 section plus a few from integumentary (eyelid repair).

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Content• Tips on coding• Specific areas to review.

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The Coding Guidelines (6)• Depending your CPT manual version/vendor, they may be in the beginning of every Section in CPT or intermixed with the codes.

• You must read these and highlight, circle and annotate.• All of them.• Additional study for:

• Anesthesia guidelines—what is included.• OB guidelines– both antepartum and postpartum care.• Surgical Package– what is included.• Beginning of surgery section.• Ortho, cardio etc…• Okay, maybe the best answer is all of them.

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Medical Terminology (8)• Prefixes• Suffixes• Planes – know these!• CPT terminology• ICD‐10 disease terminology.• I cannot stress this enough.• It will also be very important for learning the new ICD‐10 system.

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Anatomy (8) Body Systems1. Bones of the skeleton (arms/legs etc…) but specifically:2. 26 bones of the foot: phalanges and the metatarsals.3. 27 bones of the hand and fingers.4. Bones of the skull5. Know the 33 bones of the spine and region: cervical,

thoracic, lumbar, sacrum, and coccyx 6. Circulatory system (Arterial and Venous Systems)7. Respiratory8. Nervous system9. Lymph nodes10. Skin levels

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The CodingEdgePublication• If you are an AAPC member or know one, go online and work the Coding Edge Quizzes and take notes

• Read all the coding articles.• Focus on trick questions or tips that only someone who works in that field would know.

• Go to an AAPC meeting in your town and talk to several coders. They may have study guides or old copies they would lend you.

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Surgical Op Reports• Skip and work after all the M/C questions are done• You cannot work enough of these before the exam.• They will be very frustrating at first. You will spend a half‐hour or more on just one Op Report.

• They require specialty‐specific knowledge that most new coders won’t have.

• Use your knowledge of modifiers and look for exceptions in the description of the procedure.

• You need to work several in every category: integumentary, musculoskeletal, cardio, pulmonary, urinary, eyes, neurology, and ears. That is actually quite a few: probably 25 – 35.

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More on Op Reports• There should be one Op Report from the Cardiology section, most likely an arterial/venous graft (CABG) on the exam. Be sure you know how to do these (there is usually at least three codes)

• There will be an op report or question on hernia repair.• There will likely be one on shoulder, knee or foot repair.• There may be one on strabismus or tubes in the ear.• There may be one on a hysterectomy or similar urinary procedure.

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Tip: Create an exceptions list• Hernia repair codes that include mesh• Removal codes: cardio pacemaker, shunt in the eye• With magnetic/without magnetic• Performed in a hospital/not performed in a hospital• What exactly is a vascular proliferative lesion?• What exactly is uveal tissue?• Create a list of benign vs. malignant neoplasm names.I call these trick questions or Gotchas! Remember that the test assumes you are an active coder with real‐world experience. A prep course should fill in the gaps.

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The CPT Index Page• Is the page before the Index at the end of your CPT manual.• Know where this is and study it. Tab it.• I had a question on this page in my first exam and had never bothered to look for it. There really is no reason other than an academic interest.

• There are four primary classes of main entries:1. Procedure or service2. Organ or other anatomical site3. Condition4. Synonyms, eponyms, and Abbreviations

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Flip TestUsing a timer, check how long it takes you to find the following types of codes in the CPT manual:1. CABG – cardio2. Polysomnography3. Inguinal hernia repair4. Complex repair, skin5. Pharmacologic management6. Anticoagulant management7. Chiropractic codes8. Fundus exam (do you know what section this is in?)9. Doppler codes10. D & C

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Coding Guidelines (6)1. Separate procedure2. New versus established patient3. Preventive Medicine4. Surgical package5. OB antepartum care6. Modifier usage7. Add‐on codes8. MOD‐51 exempt9. Anesthesia special modifiers10. Resequenced Codes

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Compliance and Regulatory (5)1. Medicare Guidelines2. Coding Compliance3. Basic billing and insurance4. Compliance (OIG compliance Plan)5. Fraud and Abuse6. Stark Laws (self‐referral laws; general understanding) Ri

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ICD-10/ICD-10 Coding questions• You need to allocate your study time accordingly. I have attended two‐day ICD‐10 training courses. You can spend a week working questions. I have over 450 ICD‐10 questions.

• I would recommend at least 16 hours of study plus I would recommend working a 100 or 150 ICD‐10/ICD‐10 question exam if you are new to ICD‐10 coding.

• While many ICD‐10 manuals incorporate most of the 2019 AHA ICD‐10 coding and sequencing guidelines, they may not have all of them. The document is free to download and worth a quick (or long) read.

• On the next slides is a short list of ICD‐10 concepts you must know:

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ICD-10• No Hypertension table in ICD‐10‐CM;• There are no separate codes for benign or malignant hypertension

• No longer a need for the hypertension, unspecified code• In the I12 codes it is stated that these codes can be assigned when both hypertension and a condition classifiable to category N18, Chronic kidney disease ... Ri

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ICD-10/ICD-10 Concepts (1)1. Familiarize yourself with the layout of the ICD‐10 manual2. Translate a written diagnosis into the correct ICD‐10CM

codes.3. Learn the correlation between the alphabetic index and the

tabular list.4. Effectively use the Table of Drugs and Chemicals and the

Index to External Causes of Injury and Poisoning.5. Know what "main terms" and "sub‐terms" are.6. Know what Eponyms are.7. Understand the concept of sub‐categories.8. Be familiar with ICD‐10 Instructional Notes

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Taking the ExamSectionsCPT Sections

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Anesthesia1. Know the difference between general, region and local anesthesia. 2. Know what services are/are not included in an anesthesia services

(Guidelines). 3. Know how anesthesia values are determined. 4. Know what basic units, time units and modifying units are. 5. Anesthesia modifiers (P1 ‐ P6). 6. Know the four qualifying circumstances modifiers (99100; 99116;

99135 & 99140). 7. Know what constitutes an emergency condition for anesthesia. 8. Know when time is not a factor in coding anesthesia services. 9. Know the anesthesia billing formula [actual calculations will not

likely be on exam].

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Anesthesia section• Anesthesia coding is very different from other medial services. Anesthesia is billed by units and time as well as who performs the anesthesia (a physician or nurse anesthetist).

• Anesthesia Documentation Modifiers: AA, QK, AD, QY, QX, and QZ. These help explain who performed the service, concurrency issues and other factors related specifically to anesthesiology coding. Ri

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Obstetric Anesthesia CodesAnesthesia codes are reported differently for:• 01960: Vaginal delivery• 01961: Cesarean delivery (only) | 01968: following epidural

• 01965: Incomplete or missed abortion procedure• 01966: Induced abortion• 01968: cesarean delivery following epidural [Add‐On Code]

• 01969: cesarean hysterectomy following epidural [Add‐On Code]

E & M Section• If you plan on being a good coder, you need to learn E & M coding. Also, this is probably the most difficult section for new coders.

• There are multiple ways to study E & M codes.• First, is there are many types and locations. You need to know how to find these quickly in the CPT manual. Time yourself: how long does it take you to find the neonatal codes? The work exam codes (at the end). Create your index cards, shuffle them and time yourself looking up the codes.

• The second is the actual components of an E & M encounter such as the History, the exam and Medical Decision Making. This is conceptually very different. You need to copy over the MDM table of risk. Don’t just read it once. Have lots of scrap paper and copy the diagram several times. It will also make you a better coder and auditor.

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E & M level• Contributory "ancillary" components. • How Time, Coordination of care and Counseling impact the level of E & M Service.

• Know what systems are included in a Review of Systems. • Know what PFSH is. • Know the levels of Examination • Understand the levels and components of Medical Decision Making. • Understand the role of the three main components of MDM (possible diagnoses, amount of tests and in

• Understand how to document for an Encounter Dominated by Counseling or Coordination of Care.

• The levels of E & M Services • New versus Established patient. • Key components.

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E & M type• Introduction of E & M • Coding for E & M Services and surgical procedures. • Coding for preventive medicine services. • Coding for Emergency Room and Critical Care. • Coding for Inpatient services. • Coding for Special E & M Services.

Bottom Line: know them all and how to find them quickly !

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Integumentary1. Know the difference between the epidermis, dermis and

subcutaneous tissue. 2. Know the Incision and Drainage Codes. 3. Know the Debridement codes. 4. Know biopsy codes. 5. Coding for excision of lesions. 6. Coding for excisions and avulsions. 7. Know the difference & how to code simple, intermediate and complex

repairs. 8. Know the 7 steps of coding for repairs. 9. Understand tissue transfers, flaps and grafts. 10. Know the 4 categories of tissue transplantation. 11. Know what a decubitus ulcer is. 12. Coding for burns. 13. Coding for breast disorders. 14. Know the different types of mastectomies (radical, partial, simple). 15. Know the chest wall excision codes.

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Wound RepairWound repair of the skin may be classified as:1.Simple (Codes 12001‐ 12018)2.Intermediate (Codes 12031 ‐ 12057)3.Complex (Codes 13100 ‐ 13153)



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Simple Wound Repair• Performed for superficial wounds or lacerations involving primarily the epidermis, dermis, or subcutaneous tissues without significant involvement of deeper structures. This repair requires simple one layer closure/suturing and includes local anesthesia.

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Intermediate Wound Repair • For wounds that require closure of one or more of the deeper layers of subcutaneous tissue and superficial (non‐muscle) fascia, in addition to the skin itself.

• Single‐layer closure of heavily contaminated wounds that have required extensive cleaning or removal of particular matter also constitutes intermediate repair.



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Complex Wound Repair• (Codes 13100 ‐ 13153)• Repairs to complicated wounds requiring more than layered closures.

• Always sum up all the lengths of repairs for multiple injuries of the same anatomical site.

• See Lips or Eyelid section for full thickness repair of these anatomical sites.

Musculoskeletal (1 of 2)1. Arthritis and Arthropathies (ICD‐9 Review) 2. Understand the wound exploration codes. 3. Understand the three (3) types of fracture care

categories. 4. Understand the two (2) types of fixation. 5. Understand the types of manipulation and

stabilization. 6. Understand how to code for casts and strapping. 7. Coding for dislocations.

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Musculoskeletal (2 of 2)8. Understand arthroscopies and the difference between

diagnostic versus surgical. 9. Know the different purposes for surgery. 10. Shoulder Procedures11. Special procedures for knees. 12. Cruciate Ligament repair, augmentation & reconstruction. 13. Understand Arthrodesis, the proper questions and

approaches. 14. Understand the correct steps to code Bone Grafting.

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Grafts (or Implants)The example below is provided to explain the level of detail for documentation.

• Codes for obtaining autogenous bone, cartilage, tendon, fasci lata grafts, or other tissues through separate skin/fascial incisions should be reported separately unless the CPT© code descriptor references the harvesting of the graft or implant.



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Removal codes• Most CPT codes include the removal of devices, sutures, pins or staples.

• However, there are some removal codes in CPT©. For example: 24160 Implant removal; elbow joint.

• There is a HCPCS suture removal code: S0630 (non‐MCR)• Be sure to document accurately and ask questions concerning the procedures when in doubt.

• Note that pins, wires and screws are not considered “foreign bodies.”

CardiologyUnderstand that a cardiologist mostly conducts diagnostic and therapeutic services from the Medicine section. A cardiovascular surgeon performs the surgical procedures from the Surgery Section.I would study both sections together.1. Know the kinds of blood vessels. 2. Know the veins and arteries3. Know the chambers of the heart.

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CardiologyMedicine section 1. Understand the cardiac graphics Coding for Rhythm Strips. 2. Coding for patient event recorders. 3. Coding for exercise stress tests. 4. Coding for electrocardiography. 5. Coding for and understanding TEE. 6. Coding for PTCA. 7. Coding for and understanding Doppler Echocardiography.

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Cardiovascular Surgery1. Know what CABG is and how to code for it. 2. Understand valve procedures (know your valves!)3. Coding for Stent Placement. 4. Coding for cardiac catheterization. 5. Coding for pacemakers, their insertion and removal. 6. Know what an AICD is. 7. Know what VAD's are and do. 8. Know what a PICC line is. 9. Coding for implantable infusion pumps.

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Coronary Artery Bypass Grafts (CABG)• Because of the complexity of these procedures, it is highly recommended that the Physicians sit down and discuss these procedures with the coders.

• Document arterial and venous grafts.• There are individual vein/artery codes and combination codes for CABG procedures.

• Pay careful attention to Add‐On codes (33517 – 33530)

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Bypass Graft• The procurement of the saphenous vein graft is includedin the description of the work for 35501 – 35587 and should not be reported as a separate service or co‐surgery.

• Report harvesting of an upper extremity vein (35500+Tx)• Report harvesting of a femoropopliteal vein segment (35572+Tx)

• Report harvesting & construction of an autogenous composite graft of two segments from two distant locations (35682+Tx)



Respiratory1. Understand polyps and excision of polyps. 2. Understand the vocabulary for accessory sinuses. 3. Understand nasal endoscopy. 4. Larynx procedures. 5. Coding for bronchoscopies. 6. Terms associated with thoracotomy. 7. Coding for Laryngoscopy. 8. Coding for surgical thoracoscopy.

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Digestive System1. Coding for hernias (important!). 2. Review the medical terminology of the structures of the mouth

(above the esophagus). 3. Understand the difference between a gastronomy, gastrectomy and

gastrostomy. 4. Know how to code for EGD. 5. Understand and know how to code for ERCP.6. Coding and terminology for tonsillectomies. 7. Understand the variations of code 4312‐. 8. Understand the mechanics and coding for insertion of a stent. 9. Be familiar with the gastric bypass procedure. 10. Understand the difference between a proctosigmoidoscopy,

sigmoidoscopy and a colonoscopy. 11. Coding for hemorrhoid surgery. 12. Know how to code for a PEG tube. 13. Coding for laparoscopic cholecystectomy.

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Coding example - Hemorrhoids• 46083 – for excision of external thrombosed.• 46930 – for destruction by thermal energy• 46999 – destruction by cryosurgery (note this is an unlisted code)

• 46500 ‐ For injection• 46221, 46945, 46946 – for ligation• 46947 – for hemorrhoidopexy…by stapling

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Hernias and Mesh Repair• 49560: Repair initial incisional or ventral hernia; reducible• 49568: Implantation of mesh or other prosthesis for open incisional or ventral hernia repair or mesh for closure of debridement for necrotizing soft tissue infection. [Add‐On]

• [code first 11004‐1106; 49560‐49566]• C1781 Mesh (implantable) HCPCS code is reported for the mesh.

• Hernia Repair codes 49570‐49590 Includes Note: Includes Mesh !

• Be code to code the specific type of hernia.• Report the procedure with modifier 50 for a bilateral procedure.



Urinary - four sections• General• Understand what the lithotomy approach is.• Understand the difference between Endoscopy, Cystoscopy, Urethroscopy, and Cystourethroscopy.

• Know urological medical terms. • Know the difference between the Ureter and urethra (important!).

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Urinary - Male1. Coding for Vasectomy 2. Coding for the biopsy of the prostate 3. Coding for laparoscopy and related procedures. 4. Know coding for an inguinal hernia.

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Urinary - Female1. Know how to code for the insertion and removal of

contraceptive devices. 2. Know how to code for surgical sterilization procedures. 3. Know the difference between a surgical and a diagnostic

hysteroscopy. 4. Coding for a D & C. 5. Know how to code for laparoscopy/hysteroscopy

procedures.

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Urinary System Coding Examples• Vulvectomy codes are organized by: simple, radical, partial and complete procedures.

• Laparoscopy codes – include size of the uterus (impacts code selection).

• Always document the destruction method: laser, electrosurgery, cryosurgery, chemosurgery.

• 57505 Endocervical curettage (not done as part of a D & C – Dilation and curettage, (D&C) (57800)

• Spend an hour with the salpingo‐oophorectomy codes (about a dozen) and research these procedures if unfamiliar.



Urinary - OB1. Know how to code for maternity care and delivery 2. Know the difference between delivery, postpartum and

antepartum care. 3. Know the components of antepartum care. 4. Know how to code for multiple births.5. Know the delivery codes.

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Nervous System1. Know the anatomy and terminology of the nervous

system. 2. Familiarize yourself with the twelve (12) cranial nerves. 3. Know the difference between parasympathetic and

sympathetic nerves. 4. Understand and know how to code for pain

management. 5. Spinal surgeries

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Eyes1. Know how to code for the ocular adnexa 2. Know what is included in the code for extraction of a

lens. 3. Coding for insertion and removal of ocular implants. 4. Coding for strabismus surgery5. Coding for cataract surgery6. Coding for retinal detachments7. Coding for ocular injuries8. Note that Eyecare is the only specialty with two

interchangeable office visit codes: E & M codes and 92002, 92012, 92004, 92014.

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Eye and Ocular AdnexaMedical Terminology / Coding Example: • Evisceration. . . removal of the internal eye contents, but the sclera is left behind with the extraocular muscles still attached

• Enucleation. . . removal of the eye, leaving the eye muscles and remaining orbital contents intact

• Exenteration. . . removal of the contents of the eye socket (orbit) including the eyeball, fat, muscles and other adjacent structures of the eye.Each procedure is a different CPT© code but these

definitions are not in the CPT© manual. Stedmans Medical Dictionary lists evisceration,

enucleation and exenteration as synonyms.



Ears1. Be familiar with the 69100 ear excision codes. 2. Understand the difference between a tympanostomy

versus a myringotomy and how to code for it.3. Know which procedure code to use when the physician

inserts ventilating tubes in to the opening of 4. Understand the difference between a stapedectomy

and a stapedotomy. 5. Know what cochlear implant, aural rehabilitation,

speech processor mean. 6. Know what a basic audiologic assessment includes. 7. Know the components and factors involving coding for

hearing screening.

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Endocrine• Shortest section in the CPT manual.1. Know what organs are part of the endocrine system. 2. Be familiar with the options of the endocrine system

procedures (i.e., partial, complete, limited, etc...).

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Endocrine Section• Always read the notes carefully under each CPT© code. Example:

• 60100 – Biopsy thyroid, percutaneous core needle(If imaging guidance is performed, see 76942)(for fine needle aspiration, use 10021 or 10022)(For evaluation of fine needle aspirate, see 88172, 88173)

• For pituitary and pineal gland surgery, see Nervous System.

• A diagnostic laparoscopy is the same as a peritoneoscopy(CPT© code 49320)

Radiology1. Know the difference between the professional and technical component. 2. Understand the terms and coding for diagnostic radiology. 3. Always pay careful attention to the number of views for X‐rays. 4. Be familiar with CAT technology. 5. Understand the purpose and coding associated with contrast studies. 6. Be familiar with Computed Tomographic Angiography (CTA). 7. Understand MRI coding and techniques. 8. Understand diagnostic ultrasound techniques and coding. 9. Be familiar with the different types of ultrasound. 10. Understand the role and coding for radiation oncology. 11. Note the difference between simple, intermediate and complex planning

for the treatment of radiation.12. Be familiar with nuclear medicine.

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Pathology / Lab1. Review the sections of the Path/Lab section. 2. Know that mod‐51 is not used with Path/Lab codes. 3. Know the different types of lab test methods used. 4. Understand the guidelines for billing panels. 5. Lab panels have changed over the last few years. If you have been

coding for years, be sure to revi6. Familiarize yourself with the 11 panels. 7. Familiarize yourself with the drug screening tests. 8. Note that coding for qualitative screening tests is based on

procedure, not method or analyte. 9. Be familiar with the types of tests included under

Evocative/Suppression Testing. 10. Know the guidelines for coding blood transfusions. 11. Be familiar with anatomical and surgical pathology.

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Medicine (1 of 2)1. Be familiar with what type of information is found in the

medicine section. Scan the Sections by specialty.2. Be familiar with the Immunization Injection Codes. 3. Know how to use Prolonged Intravenous Infusion codes

90780 and 90781. 4. Know the difference between codes 90782 and 90788. 5. Be sure to read the Psychiatry Guidelines at the beginning of

the Psychiatry section of CPT. 6. Be familiar with coding for dialysis for ESRD. 7. Understand the "separate procedure" rule as it pertains to

codes 91000 and 91055. 8. Be sure to read the notes under the different vestibular and

audiologic function tests.

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Medicine (2 of 2)9. Know how to code for hand‐held Doppler devices. 10. Know how to code for ventilation assist and management. 11. Know how to code for code 95004. 12. Understand how to code for the Skin End Point Titration

Test. 13. Review the five levels of dermatological services. 14. Know the psychiatric codes15. Know that time is a major factor in coding physical therapy

and rehabilitation codes. 16. Familiarize yourself with Osteopathic, Chiropractic and

Special Services. Even though you may never

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CPT© Appendix – Modifiers (1)• We are not going to review every Modifier here. You should know every one. By memory. The top modifiers are:

• MOD‐22 – Increased Procedural Service• MOD‐24 – Service during Global Period• MOD‐25 – E & M and procedure – same DOS• MOD‐26 – Professional Component (Interpretation and Report)

• MOD‐50 – Bilateral Procedure (or –RT or –LT)• MOD‐51 – Multiple Procedures reported on same DOS



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CPT© Appendix – Modifiers (2)• MOD‐52 – Reduced procedure• MOD‐53 – Discontinued procedure• MOD‐59 – Unrelated Procedure performed on the same DOS• MOD‐76 Repeat Procedure by same physician• MOD‐77 Repeat Procedure by different physician

• Modifiers 58 (staged or related procedure) and 78 (return to the operating room) can be confusing. Be sure to compare and contrast these two codes. Same with modifiers 25 and 59.

Coding Certification Exam Prep IICPT SectionsJeffrey Restuccio, CPC, COC, MBAMemphis TN(901) 517‐[email protected]

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The ExamTest‐Taking Tips

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A Tip:• On one of my exams there was a question concerning the cricoid bone. I had no idea where that was. Instead of guessing, I backed into it using the CPT manual. There is a cricoid cartilage split (larynx…bingo!) code 31587.

• I gave myself about two‐minutes to find it using this technique; after that it goes into the “take a guess and come back to it” file. Ri

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How they rattle you• On both of my exams there were medical terminology/anatomy I had never hear of–and I’ve written medical terminology courses for the exam as well as medical terminology courses.

• Make the best guess you can using the CPT manual or the ICD‐10 manual to provide additional information.

• Don’t get anxious if you find a term you’ve never seen before. You can get 22 answers wrong and still earn an 85%. That is one of your 22. The majority of the questions are the most common questions and situations. However there are always a dozen that are challenging even for an experienced coder.

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Guessing (1 of 4)• Always eliminate wrong answers first using first modifiers and then key words

• Always circle the semicolon (;) when you find a group of codes with numerous indented options.

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Guessing (2 of 4)• Do not submit your exam with blank answers!• Worst case you should allocate 10 minutes and eyeball each question for thirty seconds and make an educated guess.

• Determine if two CPT codes are not be allowed on the same day of service. Close numbers, Add‐on, excluded.

• Always, always read the notes at the end of a CPT code group. Often they will include important information on what codes can or cannot e reported on the same day.

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Guessing (3 of 4)• Use your knowledge of suffixes: ‐ectomy, ‐otomy, ‐orrhaphy, ‐pexy to determine the best answer.

• Know your Latin terms. • Use your knowledge of anatomy to determine the best answer.

• Most often your first answer is correct. RiteCo

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Guessing (4 of 4)• Always go for the best answer.• Eliminate likely wrong answers before correct ones. The tips below are when you have no clue and are actually guessing blind.

• If you are guessing the correct answer is typically the longest.• Another option is the answer is the code that is out of sequence in a sequence of codes:

• 1101• 1102• 1103• 1100 – out of order; should have been first

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Multiple-Choice Questions• These contain:• Stem: the question.• Options: one correct answer and three incorrect.• Distractors: Sometimes there is extraneous information that an experienced coder would know to ignore. These will trip up a new coder or someone from a clinical background.

• Pay careful attention to the words on the exam; circle key words and phrases.

• Always work first to eliminate any obviously incorrect answers based on a modifier, definition or one incorrect code.

• Watch for these options: all of the above, none of the above, and (a) and (b) are correct.

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Multiple-Choice Questions• Read carefully absolutes: always, never, none or all.• If a question, has four or five codes in it and you cannot eliminate the wrong answers quickly, perhaps skip it and add it to your return list.

• If a question is difficult, concerning CABG or interventional radiology, you may consider skipping it and returning later.

• Work the easiest questions first.• If you skip 15 questions you must allocate at least 132 seconds each and probably more than that since the reason you skipped them is because they would take longer. You might need 45 minutes to work 15 skipped questions. Plan your time accordingly.

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Exam Time• Calculate the number of hours allowed and the amount of time per question.

• For a 5.5 hour exam with 150 questions you are allowed 132 seconds per question. That is no more than 2 minutes and 12 seconds; after that, make your best guess, move on and come back after you are done. Mark it as likely wrong. Keep track.

• Watch your question count and time every 30 minutes.• Have a scratch pad and list all the question numbers you skip.• Mark with a number next to them if you want to review them again after all the Op Reports are done.

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The Exam: Pacing Yourself• Estimate Time: 5.5 hours, 150 Questions

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Questions Done Time Hour14 3027 60 1 hr41 9054 120 2 hrs68 15082 180 3 hrs95 210109 240 4 hrs122 270136 300 5 hrs150 330 Done

Specific question construction• Another example with modifiers:1. Two CPT codes with no modifiers2. Two CPT codes with one modifier on one code3. Two CPT codes with two modifiers each4. One CPT code with either one modifier or no modifier5. You get the idea.• You should not have to look modifiers up and if you do check a specific code, it should be for less than a minute.

• Use the modifier combinations to eliminate the incorrect code. There will be as many as a dozen of these. Use them by memorizing all your modifiers.

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Specific question construction• I often create test questions with four permutations:1. Definition and CPT code correct2. Definition wrong, CPT code correct.3. Definition correct, CPT code incorrect.4. None of the answers is correct or• Add a modifier to confuse the situation.• Add an additional code where only one is correct. In other words this would be an NCCI edit violation.

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The Best Answer• Sometimes, particularly if you have been coding for awhile or have a clinical background, you won’t like any of the answers.

• You must choose the best answer. Sometimes it is best to work from the worst answer to the least worse answer.

• In my of my exams concerning what would be in a ChargeMaster, I knew the hospital had all the elements in their Chargemaster so I was not sure which one to omit. To me they were all the wrong answer. I guessed based on what would most likely be in the majority of Chargemasters.

• Also, if you are an experienced biller, what a coding exam considers a wrong answer may be what a specific insurance company requires of you daily. Carriers don’t have to follow strict AMA, AAPC, or AHIMA coding guidelines.

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Summary1. Don’t run out of time! Not enough actual practice taking

tests. (work 150‐300 practice test questions) work at least 25 surgical op reports.

2. Learn how to find codes, guidelines or topics quickly in the CPT manual.

3. Tab, bracket and highlight your manual.4. The exam assumes you have been working in a clinic and

coding every day. 5. Know the basics: medical terminology, anatomy, concepts,

guidelines, overview of the manual.6. It’s primarily an exercise in test‐taking–and your nerves. Be

sure to take at least one, complete 150‐question exam two weeks before the actual. At the library, no distractions, pencil down at 5.5. hours, with a timer. It will be exhausing.

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Coding Certification ExamQuestions?Jeffrey Restuccio, CPC, COC, MBAMemphis TN(901) 517‐[email protected]

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Certified Coder Exam: Pass Your Test the First Time · 2019. 6. 5. · Certified Coder Exam: Pass...

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