Earning Your ICD-10 Certification

Find, Prepare for and Pass an ICD-10 Assessment

Medical coders keep patient records accurate for both healthcare providers and insurance companies. To do so, they rely on the World Health Organization’s International Classification for Diseases (ICD), a system that classifies and codes all diagnoses, symptoms and procedures. The previous industry standard – the ICD-9 code sets – has recently been updated with a more detailed version, the ICD-10. While the complexities of the new system may seem daunting, medical coders should see their efforts to understand how to use it pay off with increased efficiency and better health outcomes.

Decoding the ICD-10

Codes in the ICD-CM code set can have three to seven characters. In most cases, the first three characters are used to establish major code categories, such as diseases or injuries. The code can then be expanded with the remaining characters, which correspond to more specific details about a diagnosis. The ICD-10-CM uses the following code structure:

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Category of diagnosis (1st to 3rd characters)

Each category is three characters. The 1st character is always alpha (excluding U) and the 2nd character is always numeric. The 3rd character may be either alpha or numeric. There is always a decimal after the 3rd character. These categories separate major, different diagnoses, such as fractured bones or disorders of the nervous system.

Etiology, Anatomical Site, Severity (4th to 6th characters)

This three-character section provides greater detail about the diagnosis. It can include the cause, anatomic site, severity, or other clinical details vital to the diagnosis. For example, these codes may be used to indicate the activity that was happening at the time of an injury.

Extension (7th character)

The 7th character extension is unique to the ICD-10, and does not appear in every code. It is usually found in cases concerning pregnancy and childbirth, where it is used to provide information about a fetus; and those of injuries, poisoning and other events, where it may refer to the sequence of care visits, such as an initial consultation or a follow-up.

Note: If a code contains fewer than six characters and a 7th character applies, a dummy placeholder of “X” is used to fill any empty spaces.

The new ICD-10 codes are designed to streamline the process in two major ways:

More detail 

The number of codes has been dramatically increased to encompass more nuanced diagnoses and treatments. In addition, the three- to five-digit coding system has been expanded to a three- to seven-character system. The first three characters identify common traits, while the final four characters identify specific traits.

Better organization 

The structure of the ICD-10 has two parts: one for diseases themselves, and the other for the procedures used to treat them. The ICD-10 CM is for diagnosis coding, and the ICD-10-PCS is for procedure coding (for hospital procedures). Even though they are two separate code sets, the term “ICD-10” often refers to both.

Top 7 Facts to Know About the ICD-10

  1. The ICD-10 is a detailed diagnostic coding system, with 69,000 codes determined by the World Health Organization (WHO). It is used in more than 100 countries worldwide.
  2. Greater detail in coding is expected to improve care management, analytics, reporting and tracking public health issues, and identifying and assessing risk factors.
  3. Almost every clinical and administrative process in a healthcare setting will depend on ICD-10 codes.
  4. Although the ICD-10 has been in place since the early 1990s, the final compliance date in the United States did not happen until October, 2015.
  5. All professionals certified by the American Association of Professional Coders (AAPC) must pass the ICD-10-CM Proficiency Assessment, an online, open-book exam available for purchase from the AAPC. Another certifying agency for medical coders, the American Health Information Management Association (AHIMA), does not require its members to pass an assessment exam. However, those with AHIMA certification must prove knowledge of the ICD-10 through continuing education.
  6. The ICD-10 Proficiency Assessment measures understanding of ICD-10-CM format and structure, groupings and categories of codes, guidelines, and coding concepts. It does not cover the ICD-PCS.
  7. Professionals who receive training in the ICD-10 can earn continuing education units (CEUs) for AAPC and AHIMA recertification.

Path to an ICD-10 Certification

A passing score on the ICD-10-CM Proficiency Assessment is required to maintain AAPC certification. While AHIMA does not require the assessment for certification, those with AHIMA certification need to prove knowledge of the ICD-10 through continuing education. The number of CEUs varies depending on the credential. CEUs can be earned through independent or employer-sponsored training programs, college coursework, or other instruction. Medical coders ready to begin the process should take the following steps:

1.Find the right course 

Training for the ICD-10 Proficiency Assessment is available online and in-person from a variety of outlets, including AAPC and AHIMA.

Training by the AAPC covers all ICD-10 guidelines and provides students with practice coding exercises. Training is offered in a variety of formats and venues:

  • Online Assessment Course This 16-hour course allows students to work at their own pace as they learn the ICD-10-CM or ICD-10-PCS.
  • On-Site Training Participating local AAPC chapters offer members a two-day comprehensive course for code set training.
  • On-site ICD-10-CM and ICD-10-PCS Code Set Training Certified trainers teach organizations with groups of 10 or more in this two-day program.
  • ICD-10 Anatomy and Pathophysiology Training Training in 14 modules provides a strong understanding of anatomy and physiology.
  • Specialty ICD-10 Code Set Training Provides more detailed training in particular specialties, but is not required to pass the assessment.

Students can also look to AHIMA for online training for the ICD-10 (acute care). The four stages are:

Stage 1
Awareness, Readiness Assessments, and Foundation Training Courses.

Stage 2
ICD-10-CM Coding Course Collection. A comprehensive overview followed by 22 one-hour courses focused on each specific chapter of ICD-CM. Coders in the acute care setting must take all 22 chapter-focused courses to be proficient.

Stage 3
ICD-10-PCS Coding Course Collection. A comprehensive overview followed by 10 courses focused on specific root operation groupings and other procedures, as well as an overview of the PCS Ancillary Section. Coders in acute care must show mastery of all 100 of the root operations and procedures, with coursework usually taking about 27 hours.

Stage 4
ICD-10-CM and –PCS Practice Exercises. Various four-hour modules offer practical coding experience using in-depth case scenarios for outpatient and inpatient coders.

AHIMA also offers an online training option for those who work in specialty settings such as home health, long-term care and physician practices.

2.Sign up for the ICD-10 Proficiency Assessment 

The ICD-10 Proficiency Assessment measures an understanding of the ICD-10-CM format and structure; the groupings and categories of codes; official guidelines; and coding concepts. Students may opt to take a self-paced or timed exam.

  • Self-paced This 150-question test has no time limit and includes unlimited attempts. It also includes comprehensive training. This option is worth 16+ CEUs.
  • Timed This 75-question multiple-choice test has a 3.5-hour time limit, and requires 80 percent accuracy to pass. It is open-book, online, and not proctored. No CEUs are awarded because it does not include training.

Medical coders can purchase the self-paced assessment or register for the timed assessment online.

A passing score allows those with AAPC certification to retain their credentials. Those who do not pass the assessment must repeat it until they earn a passing score.

3.Get Advanced Training 

There are advanced ICD-10 trainings available for those who want to further develop their knowledge of code sets and earn additional CEUs. The AAPC offers a variety of courses including:

  • Advanced A&P for ICD-10 Covers anatomy and physiology as they relate to chronic conditions to assist in finding the correct table to build an ICD-10-PCS code. (14 CEUs)
  • ICD-10-CM for HCC An interactive online course exploring the reasons for changes to quantity-based payments, and how chronic conditions can increase healthcare costs. (8 CEUs)
  • Advanced Code Set Training Investigates the clinical concepts of commonly-treated conditions to help assign the correct codes. (8 CEUs)

Top 5 Tips to Passing the ICD-10

While the self-assessment exam offers an unlimited number of attempts, the timed assessment can only be taken twice per registration. Here are five tips to achieving the passing score of 80 percent on the first attempt: 

  1. Check your connection
    Don’t take the timed assessment unless you have a good Internet connection. If you accidentally time out, you must start over.
  2. Watch the clock
    You must complete the timed assessment in one session and have up to 3.5 hours if you need it. Pace yourself to get through the entire test.
  3. Read the assessment carefully
    Don’t waste time by doing unnecessary work. Read all the instructions for each question to prevent mistakes.
  4. Obey the rules
    Even though the test is open-book, it is still an official assessment. Supplying or receiving answers from others is considered cheating. Such incidents may be reported to the ethics board and disqualify you from the exam.
  5. Consider the self-paced option
    If you don’t like the idea of a timed exam, switch strategies by working at your own pace with AAPC’s online training option.

ICD-10 Resources & Study Guides

Mastering the intricacies of ICD-10 coding is an involved process, and last-minute cramming won’t do the trick. To best prepare themselves for the exam, students will not only need to invest the necessary time, but find the resources that will best help them engage with the material. Depending on your study style and preferences, the following resources and study guides may be of use:

Study Links

Daily ICD-10-CM Quiz
HealthFusion MediTouch offers a daily quiz with coding questions about the ICD-10-CM.

ICD Conversion and Mapping
Tutorial from the AAPC explaining ICD-9 to ICD-10 conversion and mapping.

ICD-10 Coding Basics
This video from the Centers for Medicare and Medicaid Services (CMS) provides an in-depth explanation of the ICD-10 code set.

ICD-10 Competency Assessment for Coders
A sample of 100 questions from the ICD-10 Competency Assessment for Coders: ICD-CM & ICD-10-PCS published by HCMarketplace.

ICD-10 Interactive Self Learning Tool
The World Health Organization offers this free ICD-10 training tool for self-learning and classroom use.

ICD-10 Quiz
Sample questions about the ICD-10.

ICD-10-CM Basic Coding Training Workbook
Coding workbook and answers from the North Carolina Department of Health and Human Services.

ICD-10-CM Test Your Knowledge

Practice quiz based on the ICD-10-CM.ICD-10-CM Primer

AHIMA explains the changes made to the ICD-9 with the release of the ICD-10.Just Coding ICD-10 Resources

Members of this site can access free review quizzes to prepare for the ICD-10 proficiency assessment.Putting ICD-10 into Practice

This comprehensive guide includes coding exercises and scenarios from AmeriHealth.

Understanding the ICD-10 Code Structure
An explanation of the ICD-10 code structure designed to help students memorize the codes.

Other Resources

8 Things You Need to Know About the ICD-10
This article explores the reasons behind the change from the ICD-9 to the ICD-10.

AHIMA Recertification
A look at the CEU guidelines for AHIMA recertification.

AHIMA Top Ten ICD-10-CM/PCS Questions
Answers to the top questions about the ICD-10-CM and ICD-10-PCS.

Choose Your Path to ICD-10
Helpful ICD-10 resources from AHIMA.

Clinical Concepts for Family Practice
Explores implementing ICD-10 coding for physician practices.

CMS Partnership Webinar Recordings
Find CMS webinars about the ICD-10.

Commonly Used ICD-10 Codes
ICD-10 coding information from the American College of Physicians.

Diagnostic Coding and ICD-10-CM
The American Psychiatric Association examines the ICD-10 and how it affects healthcare.

ICD-10 Clinical Scenarios for OB-GYN
This in-depth guide to clinical concepts for obstetrics and gynecology includes common ICD-10 codes, clinical documentation tips, and scenarios.

ICD-10 Codes
AAPC provides a comprehensive list of coding resources, including specialty reference guides, naming conventions, and an e-newsletter.

ICD-10 Documentation and Coding Concepts
The Centers for Medicare and Medicaid Services offers a series of webcasts about how the ICD-10 relates to individual specialties such as general surgery and orthopedics.

ICD-10 Frequently Asked Questions
The American Osteopathic Association provides answers to questions about the ICD-10.

ICD-10 HubBlog
A blog that focuses on issues associated with ICD-10 implementation.

ICD-10 Implementation
This section of the Healthcare Information and Management Systems Society (HIMSS) website provides information and links about ICD-10 testing, software tools, and coding and business analytics.

ICD-10 Organizational and Structural Changes
An overview of the ICD-10 and its applications from the National Association of Rural Health Clinics.

ICD-10 in Practice
The ModernMedicine network offers case studies in using ICD-10 codes.

Interactive Case Studies
CMS provides a variety of scenarios to illustrate the coding and documentation requirements for the ICD-10.

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Whether you’re looking to earn your online degree or you’re a parent looking for answers, you can find all of your questions covered here. Explore these resources to help you make informed decisions and prepare for whatever is thrown your way.


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