Certified Inpatient Coder (CIC)

The new inpatient medical coding certification standard, CIC (Certified Inpatient Coder), is the only certification dedicated exclusively to inpatient hospital/facility coding. The CIC validates expert level knowledge and experience in abstracting information from the medical record for ICD-10-CM and ICD-10-PCS coding, and specialized payment knowledge in MS-DRGs and Inpatient Prospective Payment Systems (IPPS). Invest in your future with the CIC certification—certified coders earn 40% more than non-credentialed coders.

CICs have demonstrated:

  • Expertise in medical record review to abstract information required to support accurate inpatient coding
  • Expertise in assigning accurate ICD-10 medical codes for diagnoses and procedures performed in the inpatient setting
  • Superior knowledge of current rules, regulations, and issues regarding medical coding, compliance, and reimbursement under MS-DRG and IPPS systems
  • Strong ability to integrate coding and reimbursement rule changes in a timely manner to include updating the Charge Description Master (CDM), fee updates, and the Field Locators (FL) on the UB04
  • Solid understanding of anatomy, physiology, and medical terminology required to correctly code facility services and diagnoses
  • Understanding of outpatient reimbursement methodologies (OPPS)

The CIC Exam

  • 60 multiple choice questions and 10 inpatient cases fill in the blank (proctored)
  • 5 hours and 40 minutes to finish the exam
  • $650 which includes one year membership
  • 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.

The CIC exam thoroughly covers:

Medical Record and Healthcare Documentation Guidelines

  • 10 multiple choice questions
  • Recognize the limitations of EHR and how downtime is handled
  • Identify documentation deficiencies caused by copy/paste and use of templates
  • Understand HIPAA security and privacy
  • Understand the reporting requirements under MDS
  • Demonstrate proper procedure for addendums and alterations to the medial record
  • Identify components of the medical record
  • Identify the length of time the provider has to document services
  • Understand the requirement for timely documentation
  • Recognize and properly code for procedures performed at the bedside
  • Understand the reporting requirements under UHDDS
  • Understand Joint Commission (JC) requirements for documentation

Medical Terminology, Anatomy and Pathophysiology

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

Inpatient Coding

  • 10 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)
  • Understand emerging roles for inpatient coders (DRG validator, auditor)
  • Identify conditions POA and use of indicators

Inpatient Payment Methodologies

  • 13 multiple choice questions
  • Recognize proper procedure for compliance with the 2 Midnight Rule and certification requirements
  • Understand 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
  • Understand the role each department plays in chargemaster maintenance
  • Understand 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
  • Understand what is supported in the DRG (eg, services performed at another facility)
  • Understand different types of DRGs (eg, APR-DRG)
  • Understand Medicare Code Edits
  • Understand different inpatient types
  • Understand guidelines for selecting the principle 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

Outpatient Payment Methodology

  • 5 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

Regulatory and Payer Requirements

  • 9 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


  • 8 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
  • Understand 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

Coding Cases

  • 10 inpatient cases fill in the blank
  • Code the ICD-10-CM and ICD-10-PCS codes for 10 inpatient cases