Medical Coding Guidelines for CPC – Key Rules and Concepts for
AAPC CPC Exam Prep 2024–2025
This document outlines the official coding guidelines essential for success on the AAPC
Certified Professional Coder (CPC) exam for the 2024–2025 cycle. It covers current
instructions and rules for CPT, ICD-10-CM, and HCPCS Level II coding, including
sequencing, modifiers, medical necessity, and documentation requirements. A valuable
resource for mastering the guidelines that govern correct and compliant medical coding.
1. Conventions: genral rule to use of the classification independent of the guidilines
2. Placeholder character: X
3. 7th character: as required by the category
4. Abreviation - Alphabetic index and Tabular List: NEC = "Not elsewere
classifiable " -when a specific code is not available for a condition , the alphabetic
index directs the coder to the "other specified" code in the tab list
NOS = " Not otherwise specified" - equivalent of Unspecified
5. Punctuation: Brackets -used in Tabular list to enclose synonims but in
Alphabetic index to identify Manifestation codes.
Parentheses - used in Tab.list and Alph. Index to enclose supplemntary word that
may be presentnt in a statement of disease or a procedure.
7. Condition that are integral part of disease: Sings and simptoms that are
associated routinelly with a routine process, should not be assigned as
additional codes. - unless otherwise instructed by classification
, 8. Condition that are not and integral part of a disease: Should be coded
when present
9. Multiple coding for a singe condition:
10. Acute and Chronic: If the same condition is descried as both actue and
chronic and separate subentry exist in index at the same indentation
level.code both and sequence acute( subacute ) code first.
11. Combination Codes: A combination code is a singe code used to classify:
Two diagnoses, or A dx with and associated secondary process/manifestation,
a dx with an associated complication
12. Sequela ( late effect): A residual effect ( condition produced) after the acute
phase of an illness or injury has terminated.
13. Impending or Threatened conditions:
14. Reporting Same diagnosis more that Once: Not allowed
Codes may only be reported once per encounter
15. Laterality: Some ICD 10 codes indicate laterality, specifying whether the
condition occurs on the left, right or is bilateral.
*If not codes for bilateral is available assign lt and Rt side.
*If the side is not identified assign unspecified side.
16. Documentation for BMI, Depth of Non- pressure ulcer, Pressure Ulcer
Stages, Coma Scale, and NIH Stroke Scale: Code assignment must be based on
med.documentation of the clinicians that is not patients provider.
However - the associated dx ( such as overweigh, obesity, acute stroke, or pressure
ulcer) must be documented by the patients provider.
BMI, coa scale, and NIHSS codes should only be reported as secondary dx.
17. Syndromes: Follow the index guidance when coding syndromes. In absence
of index doc. assign codes for the documented manifestation of the syndrome.
18. Documentation of the complication of care: Code assignment is based on
the providers documentation of the relationship between the condition and the
care or procedure unless otherwise instructed by the classificaton
19. Borderline Dx: If documented as "borderline" at the time of discharge the dx
is coded as confirmed- unless the classification provides a specific entry ( e.g.
AAPC CPC Exam Prep 2024–2025
This document outlines the official coding guidelines essential for success on the AAPC
Certified Professional Coder (CPC) exam for the 2024–2025 cycle. It covers current
instructions and rules for CPT, ICD-10-CM, and HCPCS Level II coding, including
sequencing, modifiers, medical necessity, and documentation requirements. A valuable
resource for mastering the guidelines that govern correct and compliant medical coding.
1. Conventions: genral rule to use of the classification independent of the guidilines
2. Placeholder character: X
3. 7th character: as required by the category
4. Abreviation - Alphabetic index and Tabular List: NEC = "Not elsewere
classifiable " -when a specific code is not available for a condition , the alphabetic
index directs the coder to the "other specified" code in the tab list
NOS = " Not otherwise specified" - equivalent of Unspecified
5. Punctuation: Brackets -used in Tabular list to enclose synonims but in
Alphabetic index to identify Manifestation codes.
Parentheses - used in Tab.list and Alph. Index to enclose supplemntary word that
may be presentnt in a statement of disease or a procedure.
7. Condition that are integral part of disease: Sings and simptoms that are
associated routinelly with a routine process, should not be assigned as
additional codes. - unless otherwise instructed by classification
, 8. Condition that are not and integral part of a disease: Should be coded
when present
9. Multiple coding for a singe condition:
10. Acute and Chronic: If the same condition is descried as both actue and
chronic and separate subentry exist in index at the same indentation
level.code both and sequence acute( subacute ) code first.
11. Combination Codes: A combination code is a singe code used to classify:
Two diagnoses, or A dx with and associated secondary process/manifestation,
a dx with an associated complication
12. Sequela ( late effect): A residual effect ( condition produced) after the acute
phase of an illness or injury has terminated.
13. Impending or Threatened conditions:
14. Reporting Same diagnosis more that Once: Not allowed
Codes may only be reported once per encounter
15. Laterality: Some ICD 10 codes indicate laterality, specifying whether the
condition occurs on the left, right or is bilateral.
*If not codes for bilateral is available assign lt and Rt side.
*If the side is not identified assign unspecified side.
16. Documentation for BMI, Depth of Non- pressure ulcer, Pressure Ulcer
Stages, Coma Scale, and NIH Stroke Scale: Code assignment must be based on
med.documentation of the clinicians that is not patients provider.
However - the associated dx ( such as overweigh, obesity, acute stroke, or pressure
ulcer) must be documented by the patients provider.
BMI, coa scale, and NIHSS codes should only be reported as secondary dx.
17. Syndromes: Follow the index guidance when coding syndromes. In absence
of index doc. assign codes for the documented manifestation of the syndrome.
18. Documentation of the complication of care: Code assignment is based on
the providers documentation of the relationship between the condition and the
care or procedure unless otherwise instructed by the classificaton
19. Borderline Dx: If documented as "borderline" at the time of discharge the dx
is coded as confirmed- unless the classification provides a specific entry ( e.g.
