PCA CPP study guide
PCA CPP · Work through your exam, one topic at a time.
The PCA Certified Professional Coder (CPP) credential is designed for medical coders who assign ICD-10-CM, CPT, and HCPCS Level II codes in physician and outpatient settings. It signals that a coder can translate clinical documentation into compliant claims across evaluation and management, surgery, radiology, pathology/laboratory, and medicine sections, while applying reimbursement and regulatory rules. The PCA CPP study guide has 8 sections and about 2,215 words.
01Coding Guidelines and Regulatory Compliance
Compliance items ask whether a claim is supported, not merely whether a code exists. Expect HIPAA privacy, the False Claims Act, Anti-Kickback Statute and Stark, NCCI edits, LCD/NCD coverage, ABNs, audit response, and query practice.
298 words, about 1 min02ICD-10-CM Diagnosis Coding
This domain tests the Alphabetic Index and Tabular List, conventions, combination codes, laterality, 7th characters, external causes, Z codes, and outpatient versus inpatient reporting rules. Look up the term in the Index, verify the code in the Tabular List, and follow all notes at the category and code level.
289 words, about 1 min03CPT Evaluation and Management Coding
Office and outpatient E/M items test the 2021 guidelines: level by medical decision making (MDM) or total time on the encounter date, not a combination. New patients use 99202–99205; established patients use 99211–99215.
283 words, about 1 min04CPT Surgery and Procedural Coding
Surgical items cover the global surgical package, global periods, modifiers, multiple procedures, bilateral and assistant surgery, and add-on codes. The package includes the preoperative evaluation, intraoperative services, typical postoperative care, and supplies.
294 words, about 1 min05CPT Radiology, Pathology/Laboratory, and Medicine Coding
This section covers radiology professional and technical components, laboratory panels and CLIA, pathology specimens and stains, and medicine services such as immunizations, injections, and time-based therapies. Radiology codes have a global service; modifier 26 is the professional component and TC the technical component.
260 words, about 1 min06HCPCS Level II Coding
HCPCS Level II items cover drugs and biologicals, supplies, DME, prosthetics, ambulance, and their modifiers, units, and coverage rules. Level II codes begin with a letter followed by four digits, such as J, A, E, K, L, Q, and V codes.
283 words, about 1 min07Medical Terminology and Anatomy/Physiology
Terminology items test word roots, prefixes, suffixes, directional terms, planes, cavities, organ systems, and the link between anatomy and code selection. A combining form is a root plus a vowel, such as chol/e (bile) or cyst/o (bladder).
248 words, about 1 min08Reimbursement, Claims, and Revenue Cycle
Revenue cycle items cover charge capture, coding, claim submission, payer adjudication, patient responsibility, denials, and coordination of benefits. The CMS-1500 or electronic 837P carries provider, patient, diagnosis, service, and charge data.
260 words, about 1 min