How to Approach a Long Medical Coding Exam Scenario
Read the Case Carefully
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Skim the entire scenario once to understand the big picture (inpatient, outpatient, ED, surgical, etc.).
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Underline or highlight key clinical details:
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Primary diagnosis
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Secondary diagnoses/comorbidities
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Procedures performed
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Patient status (new vs. established, inpatient vs. outpatient)
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Provider specialty
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Tip: Watch for words like “complication,” “rule out,” “history of,” “secondary to,” as they guide coding choices.
Identify the Main Reason for the Encounter
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Ask yourself: Why is the patient being seen/admitted?
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Assign the principal diagnosis first (ICD-10-CM).
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For surgical cases, identify the main procedure and its purpose (CPT/PCS).
Example: If a patient is admitted for pneumonia with a history of COPD, pneumonia is the principal diagnosis; COPD is a secondary diagnosis.
Break Down the Scenario
Create a mini-outline:
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Diagnoses → List all conditions mentioned (active, chronic, or ruled out).
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Procedures → Circle/underline all tests, treatments, and surgeries.
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Medications/Treatments → Note if they support a diagnosis (e.g., insulin = diabetes).
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Complications/Findings → Capture sequelae, post-op conditions, or abnormal test results.
Apply Coding Guidelines
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ICD-10-CM
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Follow Official Guidelines (laterality, acute vs. chronic, sequencing rules).
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Remember “Code first,” “Use additional code,” and “Excludes1/Excludes2.”
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CPT / HCPCS
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Pay attention to modifiers (e.g., 25, 59, 76).
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Differentiate bundled vs. separately reportable procedures.
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PCS (if inpatient)
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Use root operations correctly (Excision vs. Resection, Insertion vs. Replacement).
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Capture approach, device, and anatomical site.
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2026 ICD-10 guildelines https://www.cms.gov/files/document/fy-2026-icd-10-cm-coding-guidelines.pdf
Sequence Correctly
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Start with principal diagnosis → then secondary diagnoses in order of significance.
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For procedures, report the primary surgery first, then add-on or secondary codes.
Sequencing in Medical Coding
Check for Exam “Traps”
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Rule-out diagnoses (do not code as confirmed unless exam guidelines allow).
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Multiple procedures (make sure to assign all, but avoid unbundling).
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Modifiers (ensure correct use for repeat, staged, and discontinued procedures).
Manage Your Time
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Don’t get stuck on one long case.
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Use the “30-second rule”: If you can’t locate the correct code quickly, mark it and return later.
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Answer easier questions first to build confidence.
Time Management for the AAPC CPC Exam https://codingclarified.com/time-management-for-the-aapc-cpc-exam/
Practice Strategy
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Work through full case studies regularly.
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Simulate timed exam conditions (5–7 minutes per long scenario).
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Use official coding guidelines as you practice—just like on exam day.
Official CPC® Certification Study Guide https://www.aapc.com/shop2/study-guides/cpc-study-guide.aspx
AAPC Practice Exams tps://www.aapc.com/shop2/practice-exams.aspx#cpc
Quick Case Example (Mini-Practice)
Case:
A 67-year-old male was admitted for chest pain. Workup revealed acute NSTEMI. Patient has type 2 diabetes and hypertension. A cardiac catheterization with stent placement was performed.
Steps:
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Principal Dx: NSTEMI (I21.4)
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Secondary Dx: Diabetes (E11.9), Hypertension (I10)
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Procedure: Cardiac cath with stent → CPT 92928
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Possible Modifier: If multiple vessels, add modifier or second CPT as appropriate
AAPC Exam breakdown https://www.aapc.com/certifications/cpc/taking-the-cpc-exam
Abstracting from the EHR https://codingclarified.com/ehr-abstracting/
Process of Elimination for the AAPC CPC Exam https://codingclarified.com/process-of-elimination-for-the-aapc-cpc-exam/
CPT Medical Modifiers https://codingclarified.com/cpt-medical-modifiers/
Medical Coding Anatomical Modifiers https://codingclarified.com/medical-coding-anatomical-modifiers/
Are You Prepared For The AAPC CPC Exam https://codingclarified.com/prepared-for-aapc-cpc-exam/
CPC Tips https://codingclarified.com/tips-to-pass-the-aapc-cpc-exam/
Prep your Medical Coding Manuals for AAPC CPC Exam
https://codingclarified.com/prep-your-medical-coding-manuals-for-aapc-cpc-exam/
AAPC Online Exam Review https://www.aapc.com/shop2/cpc-online-exam-review.aspx