Earning Your ICD-10 Certification

Find, Prepare for and Pass an ICD-10 Assessment
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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:

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


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.


Greater detail in coding is expected to improve care management, analytics, reporting and tracking public health issues, and identifying and assessing risk factors.


Almost every clinical and administrative process in a healthcare setting will depend on ICD-10 codes.


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.


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.


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.


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:


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.


Watch the clockYou 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.


Read the assessment carefully Don’t waste time by doing unnecessary work. Read all the instructions for each question to prevent mistakes.


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.


Consider the self-paced optionIf 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:

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