What's CPC-H? - Hospital Outpatient Coder Certification

An explanation of the CPC-H certification offered by the AAPC, including everything you need to know about what it qualifies you for and how to get it...

The CPC-H (Certified Professional Coder-Hospital Outpatient) is among the many medical coding certifications offered by the American Academy of Professional Coders (AAPC).

The CPC-H is a relatively new certification, and comes from a change in the modern health care industry.

Due to the rising cost of health care, many hospitals and patients are choosing to treat and be treated on an outpatient basis. What this also means is that there is a much larger need for certified professional coders who can correctly code outpatient visits.

See the medical billing glossary for help with terminology.

This is a very specialized certification. It indicates your ability to translate and code outpatient medical records, as well as your ability to review the services, diagnoses, and supplies reported on claims.

The credential also proves your ability to increase the productivity and financial viability of outpatient hospital settings.

What is a CPC-H qualified to do?

CPC-H certification

A Certified Professional Outpatient Hospital Coder is able to do all the things that a typical Certified Professional Coder (CPC) can do. This includes being proficient in assigning the correct codes for diagnoses, procedures, and other services on a medical claim.

Where the CPC-H differs from the CPC, however, is that their specialty lies in the outpatient setting.

The certificate holder doesn't only have knowledge of certain types of services and diagnoses, either. The certification includes a wide range of knowledge across the medical spectrum, such as:

  • evaluation and management services
  • anesthesia
  • surgery
  • radiology
  • and medicine.

This includes an adequate and accurate knowledge of medical terminology and anatomy, needed to translate doctor and procedure notes into the correct codes on claims.

Just like all other certifications offered by the AAPC, this certification comes with the requirement of continuing education units (CEUs).

These are education opportunities that the certified coder must take advantage of to keep their certification up to date. These CEUs consist of the most current information in your certification area, including any future changes.

Click here for more on medical coding CEUs.

This certification includes the ability to use medical coding guidelines and regulations to stay compliant with the outpatient setting. The certification also allows you to handle issues like medical necessity, denied claims, and charge capture.

More specifically to the CPC-H, as opposed to other certifications, you'll be able to:

  • Integrate changes in coding and reimbursement and update the Charge Description Master (CDM), updates fees, and Field Locators (FL) on the UB04 claim form
  • Use a working knowledge of AHA Coding Clinic guidelines when assigning ICD-9 diagnosis codes
  • Complete the UB04 claim form correctly, using all appropriate modifiers (see our UB-04 claim form tutorial)

So how do you get the certification?

You'll need to study hard to pass the CPC-H exam

Just like all the other AAPC certifications, you have to be a member of the AAPC to take any of their certification exams.

So to take your CPC-H exam, you must first become a member of the AAPC. This is as simple as paying the annual membership fee and staying within their standards of ethical practice.

Of course, it goes without saying that in order to take the CPC-H exam, you have to be confident in your ability to pass the test.

This means that you either have enough on-the-job experience in hospital and outpatient coding to be able to pass the test, or that you have acquired an adequate education in the field of hospital coding and using the UB04 form.

See our UB-04 claim form tutorial for help.

This is very important, because non-facility coding doesn't use the UB04 form.

All physician, laboratory, DME, clinical, or other non-facility settings use the CMS-1500 claim form. These two forms are extremely different from each other. Facility coding is also different from non-facility coding - you must understand the differences between them.

See our CMS 1500 claim form tutorial for more help.

After you have the right education or background in training and have paid the AAPC membership fee, you're ready to register for the exam. To take the test, you'll have to pay the specified fee and follow the directions on the AAPC website.

For more information on registering for the test, go to this page on the AAPC website.

How do you prepare for the test?

Prepare well for your exam and you'll pass with flying colors!

Whether or not you have an extensive education or background in hospital outpatient coding, you should use the AAPC study manuals to help you prepare for the test. These materials are specially produced by the AAPC - they have all the correct information you'll need to study for the exam.

Furthermore, the AAPC offers practice exams, in the exact same form as the exam itself, which will help you figure out how much time you can spend per question, as well as practice taking the test and answering the questions.

The AAPC's extensive materials to help you prepare for the CPC-H exam include:

You may also find that you live in an area where there's a local chapter of the AAPC. If this is the case you may want to check with them to see if they have any additional resources or study sessions for those taking the upcoming CPC-H exam.

You may also find our guide to preparing for your medical coding exam useful.

The CPC-H credential is a great way to break into the medical coding field. It's a highly specialized area, which is in great need of qualified, intelligent individuals. Good luck!

For more information on other certifications offered by the AAPC go to www.aapc.com/certification

Also see our advice on certificates and getting your certification.

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