Familiarize yourself with medical terminology and the linguistic formation it follows. This includes the word root, prefix, suffix and combining form/vowel. Combining forms (generally 'i' or 'o') are situated in between the word parts and assist with pronunciation. Since the exam measures a physician practice coder's knowledge of the body's structures, make certain you're adept when it comes to the following systems: digestive, endocrine, hemic & lymphatic, integumentary, musculoskeletal, nervous, reproductive (male/female), respiratory and urinary. For Reimbursement Methodologies, go over the various kinds of insurance plans (HMO, PPO, POS and EPO), the Health Insurance Portability and Accountability Act (HIPAA), fundamental health insurance (coinsurance, co-payment, covered expense, deductable, premium) and reimbursement procedures.
Learn the different systems, when they are used, what they're used for and the specific criterion surrounding each. The American Medical Association (AMA) founded the CPT (Current Procedural Terminology) coding system; the most widely accepted medical nomenclature used to report medical procedures and services under public and private health insurance programs (ama-assn.org). There are three different CPT Category codes: Category I CPT codes are employed by physicians and outpatient providers to depict a procedure or service identified with a five-digit CPT code and descriptor nomenclature. Category I CPT codes are divided into the following categories: evaluation and management, anesthesiology, surgery, radiology, pathology, laboratory and medicine.
According to the AMA website, CPT Category II codes are supplemental tracking codes that can be used for performance measurement; using them is optional and they are not necessary for correct coding and can't be used as a substitute for Category I codes. As noted on ADVANCE for Health Information Professionals, Category II Codes are alphanumeric and consist of four digits followed by the alpha character 'F'; they're arranged according to the following categories: composite measures, patient management, patient history, physical examination, diagnostic/screening processes or results, and therapeutic, preventive or other interventions. Category III codes are for emerging technology and intended for data collection purposes in the FDA approval process or to substantiate widespread usage.
The "International Classification of Diseases, Ninth Revision, Clinical Modification," ("ICD-9-CM"), is used to code and classify morbidity data from the inpatient and outpatient records, physician offices, and most National Center for Health Statistics surveys (cdc.gov). The "ICD-9-CM" includes a list of the disease code numbers in tabular form; an alphabetical index to the disease entries; and a classification system for surgical, diagnostic, and therapeutic procedures.
HCPCS Level II (Healthcare Common Procedure Coding System) is a standardized coding system used to name supplemental medical equipment, products, and services that are not incorporated in the CPT codes. The Centers for Medicare & Medicaid Services, explains that Level II HCPCS codes were established so Medicare and other insurers could submit claims for items such as ambulance services, and durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) when used outside a physician's office.
Codes pertaining to diseases of the mediastinum and diaphragm, eye or ocular adnexa, maternity and delivery will also be present on the test. Furthermore, all codes are required to meet explicit federal and legal guidelines and act in accordance with the regulations set forth by insurance agencies and providers. It is critical to know these laws and standards, implemented by bodies such as the American Medical Association (AMA), Center for Medicare and Medicaid Services (CMS), Institute for Safe Medication Practices (ISMP) and the Joint Commission. A a comprehensive review of the information you need to know for the CPC exam, can be found in the "Coding Education Program Approval Manual," published by the American Health Information Management Association (AHIMA).