CIC (Certified Inpatient Coder) : AAPC (American Academy of Professional Coders) oversees this certification and it is also exclusively for inpatient hospital/facility coding.

Check marks for CIC Certification:

• 40 multiple choice questions and 7 inpatient cases fill-in-the-blank questions (proctored)
• 4 hours to finish the exam
• Two attempts to clear the certification (One Free Retake)
• Open code book (manuals)

The CIC examination consists of questions regarding the correct application of ICD-10-PCS procedure codes and ICD-10-CM diagnosis codes used for coding and billing inpatient facility/hospital services to insurance companies.

2. Medical Terminology, Anatomy and Pathophysiology

• 3 multiple choice questions
• Define and apply medical terminology and anatomy
• Identify pathophysiology to capture correct codes and identify documentation deficiencies
• Recognize medications and conditions/diagnoses they are used to treat

3. Inpatient Coding

• 7 multiple choice questions
• Identify benefits of Computer Assisted Coding (CAC)
• Explain what natural language processing is and which departments in the hospital use it
• Apply Coding Clinic guidance to inpatient coding
• Identify correct ICD-10-CM and ICD-10-PCS codes for cases done
• Identify proper procedure to look up DRG (eg, book, grouper)
• Explain emerging roles for inpatient coders (DRG validator, auditor)
• Identify conditions POA and use of indicators

4. Inpatient Payment Methodologies

• 9 multiple choice questions
• Recognize proper procedure for compliance with the 2 Midnight Rule and certification requirements
• Define different bill types
• Identify information found in a charge master
• List examples of auto population of services using a charge master
• Explain requirements to maintain and monitor the chargemaster
• Define the role each department plays in chargemaster maintenance
• Explain the 72-hour rule (24-hour for other types of inpatient services) and how services occurring prior to admit are reported
• Identify different types of disposition and the impact on coding
• Calculate base payments for DRGs
• Identify elements needed to determine DRG assignment
• Define what is supported in the DRG (eg, services performed at another facility)
• List and explain different types of DRGs (eg, APR-DRG)
• Identify Medicare Code Edits
• Define different inpatient types
• Explain and apply guidelines for selecting the principal diagnosis for different inpatient facilities
• Explain impact of readmissions in a 30-day period
• Explain when to rebill inpatient claim as an outpatient claim
• Identify data submitted on a UB-04

5. Outpatient Payment Methodology

• 3 multiple choice questions
• Identify differences between outpatient and inpatient payment methodologies
• Explain coding requirements under OPPS: Pass through payments
• Explain coding requirements under OPPS: APCs and Status Indicators

6. Regulatory and Payer Requirements

• 6 multiple choice questions
• Review LCD/NCD and apply the policy to inpatient coding
• Identify services covered by Medicare Parts A, B, C, D
• Explain proper execution of the ABN and HINN
• Review private payer policy and apply to inpatient payment
• Identify precertification requirements

7. Compliance

• 5 multiple choice questions
• Explain external payer audits process and responsibilities of hospital staff
• Explain internal audits and how they relate to compliance plans
• Know how to interact with auditors during an onsite audit
• Identify audit targets on the OIG work plan
• Explain the CERT audit process and requirements for response to a request for records
• Explain the PEPPER report and how it is utilized.
• Identify examples of fraud and abuse
• Explain the MAC audit process
• Identify services approved for audit by the RAC auditors
• Explain the Medicare appeal process and discuss requirements at each level
• Explain the RAC audit process and requirements for response to a request for records

8. Coding Cases

• 7 inpatient cases fill-in-the-blank
• Code the ICD-10-CM and ICD-10-PCS codes for 7 inpatient cases
• Each case will have anywhere from 5-15 possible answers. Each answer is weighted the same.