AAPC CIC Exam Prep: Where the Points Are and How to Get Them
AAPC's Certified Inpatient Coder (CIC) exam is 40 multiple-choice questions plus 7 inpatient cases you code from scratch, in 4 hours, with your ICD-10-CM and ICD-10-PCS books open. You need 70% overall. (AAPC exam format)
Practice: 18 questions and 2 mini cases
Unofficial practice written by Castleport Test Prep, not AAPC questions.
Question 1 · Inpatient Coding
A patient is admitted to an acute-care hospital with fever and a productive cough. At discharge, the attending documents: "Probable community-acquired pneumonia, treated with IV antibiotics." Nothing else explains the symptoms. How is the pneumonia reported for this inpatient admission?
- A. Code only the fever and cough
- B. Code the pneumonia only if a culture identifies an organism
- C. Leave the pneumonia uncoded until imaging confirms it
- D. Code the pneumonia as if it were confirmed
Show answer and explanation for Question 1
Answer: D. For inpatient admissions to short-term acute, long-term care, and psychiatric hospitals, a diagnosis still qualified at discharge as probable, suspected, likely, or similar is coded as if it existed (Section II.H for the principal diagnosis, Section III.C for other diagnoses).
Why not A: Coding only the symptoms is the outpatient rule (Section IV), not the inpatient one.
Why not B: An unidentified organism changes which pneumonia code you pick, not whether you code pneumonia.
Why not C: Code assignment rests on the provider's diagnostic statement, not on a confirming test (Section I.A.19).
Question 2 · Inpatient Coding
A patient is admitted with sepsis due to pneumonia. Both were present when the inpatient order was written. No acute organ dysfunction is documented, and no organism is identified. What is the principal diagnosis?
- A. J18.9 Pneumonia, unspecified organism
- B. A41.9 Sepsis, unspecified organism
- C. R65.20 Severe sepsis without septic shock
- D. R50.9 Fever, unspecified
Show answer and explanation for Question 2
Answer: B. When the reason for admission is sepsis plus a localized infection such as pneumonia, the systemic infection is sequenced first and the localized infection is secondary (Section I.C.1.d.4). With no organism documented, sepsis is A41.9 (I.C.1.d.1.a).
Why not A: If a patient is admitted for pneumonia and sepsis develops later, pneumonia is sequenced first. That is not this record (I.C.1.d.4).
Why not C: R65.20 needs documented severe sepsis or acute organ dysfunction associated with sepsis, and an R65.2 code can never be principal (I.C.1.d.1.a and I.C.1.d.3).
Why not D: Fever is routinely part of sepsis and pneumonia, so it isn't coded separately (I.B.5).
Sources: ICD-10-CM Guidelines, I.C.1.d and I.B.5.
Question 3 · Inpatient Coding
After study, the provider documents that an admission was equally due to two unrelated conditions. Both were worked up and treated, and neither the Alphabetic Index, the Tabular List, nor any guideline gives sequencing direction. Which statement is correct?
- A. Either condition may be sequenced as the principal diagnosis
- B. The condition listed first in the discharge summary must be principal
- C. The condition diagnosed first in the emergency department must be principal
- D. Neither may be principal; code the presenting symptom first
Show answer and explanation for Question 3
Answer: A. Section II.C: when two or more diagnoses equally meet the definition of principal diagnosis and nothing in the classification or guidelines directs sequencing, any one of them may be sequenced first.
Why not B: Order of listing in a document isn't a sequencing rule.
Why not C: Where the diagnosis was first made doesn't decide principal diagnosis.
Why not D: Symptom codes aren't principal when a related definitive diagnosis has been established (Section II.A).
Sources: ICD-10-CM Guidelines, II.A and II.C.
Question 4 · Inpatient Coding
A laparoscopic cholecystectomy is started. After laparoscopic inspection of the gallbladder, the surgeon can't visualize the anatomy safely and converts to an open approach. The entire gallbladder is then cut out through the open incision. Which ICD-10-PCS codes are reported?
- A. 0FT44ZZ only
- B. 0FT40ZZ only
- C. 0FT40ZZ and 0FJ44ZZ
- D. 0FT44ZZ and 0FT40ZZ
Show answer and explanation for Question 4
Answer: C. When the intended root operation is attempted with one approach and converted to another, code both (ICD-10-PCS guideline B3.2d). The guideline's own example: a laparoscopic cholecystectomy converted to open is coded as percutaneous endoscopic Inspection (0FJ44ZZ) and open Resection (0FT40ZZ).
Why not A: The gallbladder wasn't removed laparoscopically.
Why not B: Dropping the laparoscopic portion misses the second code the guideline requires.
Why not D: The laparoscopic part didn't accomplish a resection, so it's reported as Inspection, not Resection.
Sources: ICD-10-PCS Guidelines, B3.2d; official PCS tables 0FT and 0FJ.
Question 5 · Inpatient Coding
A surgeon performs a hand-assisted laparoscopic sigmoid colon resection and removes the specimen through the hand port. Which approach value (5th character) is assigned?
- A. 4 Percutaneous Endoscopic
- B. 0 Open
- C. 3 Percutaneous
- D. 8 Via Natural or Artificial Opening Endoscopic
Show answer and explanation for Question 5
Answer: A. Guideline B5.2b: procedures done with a percutaneous endoscopic approach with hand-assistance, or with an incision or extended incision to remove a body part, are coded to Percutaneous Endoscopic.
Why not B: Open is for the reverse situation: an open procedure with laparoscopic assistance, such as a laparoscopic-assisted sigmoidectomy (B5.2a).
Why not C: The operation was completed using laparoscopic visualization, which fits Percutaneous Endoscopic.
Why not D: Nothing was done through a natural or artificial opening.
Sources: ICD-10-PCS Guidelines, B5.2a–b.
Question 6 · Medical Record and Healthcare Documentation Guidelines
On the same day, the attending documents "acute systolic heart failure" while the consulting cardiologist documents "chronic systolic heart failure, compensated." What should the coder do?
- A. Code the cardiologist's version because the specialist's note controls
- B. Code acute on chronic heart failure to capture both notes
- C. Query the provider to resolve the conflict
- D. Code whichever version groups to the higher-weighted MS-DRG
Show answer and explanation for Question 6
Answer: C. When medical record documentation conflicts, query the provider (Sections I.A.19 and I.B.14). A clarified diagnostic statement is what supports the code.
Why not A: No guideline gives a consultant's note automatic priority over conflicting documentation.
Why not B: Combining two conflicting statements creates a diagnosis nobody documented.
Why not D: Choosing a code for payment rather than documentation is a compliance problem.
Sources: ICD-10-CM Guidelines, I.A.19 and I.B.14.
Question 7 · Medical Record and Healthcare Documentation Guidelines
On hospital day 2, the serum potassium result is below the lab's reference range. No provider note mentions potassium, and no treatment or follow-up test is ordered. How is this handled?
- A. Code hypokalemia from the lab value
- B. Code it only if the value falls below a fixed threshold
- C. Code an abnormal-lab R code automatically
- D. Don't code it unless the provider documents its clinical significance
Show answer and explanation for Question 7
Answer: D. Section III.B: abnormal findings (lab, x-ray, pathology, other diagnostic results) aren't coded unless the provider indicates their clinical significance. If the provider orders further tests or treatment for an abnormal result, it's appropriate to ask whether a diagnosis should be added.
Why not A: A coder can't assign a diagnosis from a lab value alone; the provider establishes the diagnosis (I.A.19).
Why not B: No numeric threshold in the guidelines replaces provider documentation.
Why not C: The R-code route still requires the provider to indicate the finding is significant.
Sources: ICD-10-CM Guidelines, III.B.
Question 8 · Medical Terminology, Anatomy and Pathophysiology
The history and physical documents "hematemesis." What does that describe?
- A. Blood in the urine
- B. Vomiting blood
- C. Coughing up blood from the lungs
- D. Bright red blood in the stool
Show answer and explanation for Question 8
Answer: B. Hematemesis is vomiting blood: stomach contents containing blood. It points toward the upper GI tract (esophagus, stomach, duodenum).
Why not A: Blood in the urine is hematuria.
Why not C: Coughing up blood from the lungs is hemoptysis.
Why not D: Bright red blood in the stool is hematochezia.
Sources: MedlinePlus: Vomiting blood; NIDDK: Hematuria; MedlinePlus: Coughing up blood; MedlinePlus: Rectal bleeding.
Question 9 · Inpatient Coding
For an inpatient claim subject to POA reporting, a new acute condition develops while the patient is in the emergency department, before the inpatient admission order is written. It's reported as a secondary diagnosis using a code that is not exempt from POA reporting. Which POA indicator applies?
- A. Y
- B. N
- C. U
- D. W
Show answer and explanation for Question 9
Answer: A. Present on admission means present when the inpatient admission order occurs. Conditions that develop during an outpatient encounter, including the emergency department, observation, or outpatient surgery, are considered POA (ICD-10-CM Appendix I).
Why not B: N means not present at the time of the inpatient order; this condition was.
Why not C: U is for documentation too thin to decide; here the timing is clear.
Why not D: W is for when the provider can't clinically determine timing; here the timing is clear.
Sources: ICD-10-CM Guidelines, Appendix I.
Question 10 · Inpatient Payment Methodologies
For an otherwise payable IPPS admission subject to CMS's selected hospital-acquired condition (HAC) payment provision, a condition on the HAC list is coded as a secondary diagnosis. The provider documents that they can't clinically determine whether it was present at admission. Which POA indicator is assigned, and what happens to the CC/MCC payment?
- A. U; CMS won't pay the CC/MCC DRG for that HAC
- B. W; the selected HAC is not excluded from CC/MCC payment solely because of its POA status
- C. N; CMS will pay the CC/MCC DRG for that HAC
- D. 1; the code is exempt, so CMS pays
Show answer and explanation for Question 10
Answer: B. W means the provider can't clinically determine POA status. Under CMS's HAC payment provision, CMS pays the CC/MCC DRG for selected HACs coded Y or W, and doesn't for N or U. This concerns the selected HAC's effect on MS-DRG payment; W does not guarantee payment for the whole claim or every billed service.
Why not A: U means the documentation is insufficient; here the provider made a clinical statement, which is W.
Why not C: N means not POA, and CMS doesn't pay the CC/MCC DRG for a selected HAC coded N.
Why not D: The exempt indicator isn't applied to codes on the HAC list.
Sources: CMS HAC POA reporting table.
Question 11 · Inpatient Payment Methodologies
At an acute-care hospital paid under IPPS, a Medicare patient has an outpatient CT scan two calendar days before a covered Part A inpatient admission to the same hospital for a related condition. How is the hospital's charge for the CT reported?
- A. On a separate outpatient claim paid under OPPS
- B. On the inpatient claim only if done on the date of admission
- C. On the inpatient claim, because it falls within the 3-day payment window
- D. It isn't billed anywhere
Show answer and explanation for Question 11
Answer: C. Under Medicare's payment window policy, the hospital includes on the inpatient claim outpatient diagnostic services, and admission-related nondiagnostic services, furnished by the admitting hospital or an entity it wholly owns or operates on the admission date or during the 3 preceding calendar days. Diagnostic services need not be related to the admission.
Why not A: Diagnostic services inside the window are bundled into the inpatient stay, not billed separately.
Why not B: The window covers the date of admission and the 3 calendar days before it.
Why not D: The service is billed; it just goes on the inpatient claim.
Sources: CMS Three-Day Payment Window; CMS SE20024, pp.1–4.
Question 12 · Outpatient Payment Methodology
In Medicare's OPPS addenda, a procedure code carries status indicator "C." What does that tell you?
- A. It's paid under OPPS as a clinic or ED visit
- B. It's a pass-through drug or biological
- C. Its payment is packaged into another service's APC
- D. It's an inpatient-only procedure and isn't paid under OPPS
Show answer and explanation for Question 12
Answer: D. Status indicator C marks inpatient procedures, which aren't paid under the hospital outpatient prospective payment system. CMS lists these codes in OPPS Addendum E.
Why not A: V identifies clinic or emergency department visits in CY2026 Addendum D1.
Why not B: Pass-through drugs and biologicals carry G.
Why not C: N identifies items and services packaged into APC rates, with no separate APC payment.
Sources: CMS CY2026 OPPS Addendum D1, indicators C, G, N and V (ZIP).
Question 13 · Inpatient Payment Methodologies
Under Medicare's two-midnight benchmark, outside of inpatient-only procedures, when is an inpatient admission generally appropriate for Part A payment?
- A. Only when the patient actually stays two midnights
- B. When the admitting physician expects the patient to need medically necessary hospital care that crosses two midnights
- C. Whenever the patient arrives at the hospital before midnight
- D. Only when the stay is expected to exceed 72 hours
Show answer and explanation for Question 13
Answer: B. 42 CFR 412.3(d)(1) ties the benchmark to the admitting physician's expectation of medically necessary hospital care crossing two midnights. The expectation must be supported by the documented clinical circumstances. Unforeseen events such as death or transfer can shorten the stay without defeating it, inpatient-only procedures are generally appropriate regardless of expected length, and shorter expected stays can qualify case by case.
Why not A: The rule turns on the expectation at admission, not on what actually happened.
Why not C: Arrival time alone isn't the test.
Why not D: The benchmark is based on crossing two midnights, not a 72-hour duration. The separate preadmission payment window uses calendar days.
Sources: 42 CFR §412.3(d); CMS payment-window calendar-day explanation.
Question 14 · Regulatory and Payer Requirements
Under Original Medicare, which part covers a hospital inpatient stay?
- A. Part A
- B. Part B
- C. Part C
- D. Part D
Show answer and explanation for Question 14
Answer: A. Part A is hospital insurance: inpatient hospital care, skilled nursing facility care, hospice, and home health care. Medicare's own admission rule speaks of inpatient admissions paid under Part A (42 CFR 412.3).
Why not B: Part B covers outpatient care and provider services, including doctors' services during an inpatient stay.
Why not C: Part C is Medicare Advantage, an alternative to Original Medicare run by private plans.
Why not D: Part D is prescription drug coverage.
Sources: Medicare: Parts of Medicare; hospital payment examples.
Question 15 · Compliance
A coder reviewing a record finds a dietitian's nutrition assessment documenting concern for malnutrition. The patient's provider has not addressed whether malnutrition is present. What is the compliant next step?
- A. Assign the malnutrition code from the dietitian's assessment alone
- B. Ask a nurse to add malnutrition to the nursing notes
- C. Assign the code and add a note citing the dietitian's assessment
- D. Send the provider a compliant, non-leading query, then apply the provider's documented answer and the applicable reporting rules
Show answer and explanation for Question 15
Answer: D. Diagnosis codes rest on the provider's diagnostic statement (I.A.19), and for this kind of diagnosis the treating provider must document it (I.B.14). The dietitian's assessment can supply sourced clinical indicators for a non-leading query; it does not establish the provider's diagnosis. The query must leave the provider free to exercise independent clinical judgment, and any resulting code must meet the reporting rules.
Why not A: The dietitian's assessment alone doesn't establish this diagnosis for coding (I.A.19, I.B.14).
Why not B: Nursing documentation can't establish this diagnosis under the nonprovider-documentation exceptions in I.B.14.
Why not C: A note doesn't fix a missing provider diagnosis.
Sources: ICD-10-CM Guidelines, I.A.19, I.B.14 and III; ACDIS/AHIMA 2026 query guidance, pp.5,7–9.
Question 16 · Inpatient Coding
A surgeon cuts out the entire right lobe of the liver, with no replacement. The left lobe remains. ICD-10-PCS has a separate body-part value for "Liver, Right Lobe." Which root operation applies?
- A. Excision
- B. Extirpation
- C. Resection
- D. Detachment
Show answer and explanation for Question 16
Answer: C. When PCS gives an anatomical subdivision its own body-part value (lobes of the liver or lung, regions of the intestine), cutting out all of that subdivision is Resection of that body part, not Excision of the larger organ (guideline B3.8). The left lobe staying behind doesn't change that.
Why not A: Excision is cutting out a portion of a body part. The whole classified body part (Right Lobe) was removed.
Why not B: Extirpation takes solid matter, such as a stone or clot, out of a body part; it doesn't remove the body part itself.
Why not D: Detachment is cutting off all or part of an extremity (amputation), as described in guideline B3.19.
Sources: ICD-10-PCS Guidelines, B3.8 and B3.19; official PCS Definitions and table 0FT.
Question 17 · Inpatient Coding
During one operation, the surgeon performs a separate diagnostic excisional biopsy, waits for the frozen-section result, and then performs a more definitive resection at the same site. What is coded?
- A. Both the diagnostic biopsy and the resection
- B. Only the resection, because it includes the biopsy site
- C. Only the biopsy, because it established the diagnosis
- D. The resection with the Diagnostic qualifier
Show answer and explanation for Question 17
Answer: A. Guideline B3.4b: when a diagnostic Excision, Extraction, or Drainage (a biopsy) is followed by a more definitive procedure such as Destruction, Excision, or Resection at the same site, both are coded. Biopsies themselves use Excision, Extraction, or Drainage with the qualifier Diagnostic (B3.4a).
Why not B: The later treatment doesn't absorb a separately performed biopsy.
Why not C: The definitive resection was performed and must be coded.
Why not D: Here, the Diagnostic qualifier belongs on the applicable biopsy code, not on the therapeutic resection.
Sources: ICD-10-PCS Guidelines, B3.4a–b.
Question 18 · Inpatient Coding
The operative report clearly states the objective and the body part, but nowhere in the record does it say whether the procedure was open or laparoscopic. What should the coder do?
- A. Assign the approach most commonly used for this procedure
- B. Query the physician for the missing information
- C. Assign Open as the default approach
- D. Use Z in the approach character to show it's unknown
Show answer and explanation for Question 18
Answer: B. All seven characters are required for a valid PCS code, and when documentation is incomplete for coding purposes the physician should be queried (guideline A8). You don't need to query just because the surgeon didn't use PCS terms: if the description clearly maps to a PCS definition, you translate it yourself (A11).
Why not A: What's usual doesn't establish what happened in this record.
Why not C: PCS has no default approach.
Why not D: Z is a 'No Device' or 'No Qualifier' value; it doesn't mark a missing approach.
Sources: ICD-10-PCS Guidelines, A8 and A11.
How to code a CIC case
Use the same six steps on every case, in practice and on exam day.
- Read the whole record once before you code anything. The guidelines tell you to review the entire record to find the reason for the admission and the conditions treated. The answer to "why was this patient admitted?" is often clearest in the discharge summary.
- Pick the principal diagnosis with Section II. It's the condition established after study to be chiefly responsible for the admission. Check the special rules: symptoms vs. definitive diagnoses, two conditions that equally qualify, uncertain diagnoses (coded as if confirmed when still uncertain at discharge), and admissions from observation or outpatient surgery.
- List secondary diagnoses with Section III. Report other conditions that affected the stay: clinically evaluated, treated, needed diagnostic procedures, extended the length of stay, or increased nursing care or monitoring. Skip abnormal findings the provider never called significant.
- Look for combination codes and instructional notes. For ICD-10-CM diagnoses, use the Index first, then confirm every code in the Tabular List. "Code first" and "use additional code" notes direct sequencing and extra codes; Excludes1 and Excludes2 notes address whether code combinations are allowed.
- Build each ICD-10-PCS code character by character. Choose the root operation from its full definition, then body part, approach, device, and qualifier, using the applicable table and device rules. Don't code the steps needed to open and close, and watch the multiple-procedure rules, including a laparoscopic procedure converted to open.
- Check sequencing and POA last. Confirm the principal diagnosis is first, that "code first" pairs are in order, and that you can assign each nonexempt diagnosis a POA indicator and identify exempt codes. POA is a listed CIC competency even though AAPC doesn't say whether case blanks ask for it.
Worked example: building 0FT44ZZ one character at a time
Record: Total laparoscopic cholecystectomy. The whole gallbladder is removed through trocar incisions using a scope. No hand assistance and no conversion to open.
| Character | Value | Meaning | What in the record supports it |
|---|---|---|---|
| 1 Section | 0 | Medical and Surgical | An operative procedure |
| 2 Body system | F | Hepatobiliary System and Pancreas | Gallbladder |
| 3 Root operation | T | Resection | The entire gallbladder was cut out |
| 4 Body part | 4 | Gallbladder | Gallbladder |
| 5 Approach | 4 | Percutaneous Endoscopic | Trocar incisions with a scope |
| 6 Device | Z | No Device | Table 0FT supplies Z; routine sutures and ligatures are integral materials (B6.1b) |
| 7 Qualifier | Z | No Qualifier | Not hand-assisted |
Table 0FT offers a "Hand-Assisted" qualifier (G) for the same laparoscopic approach, so the record has to tell you which applies. And if this case had been converted to open, the answer would change to two codes: open Resection (0FT40ZZ) plus laparoscopic Inspection (0FJ44ZZ), per guideline B3.2d. Never code from the procedure name alone; confirm characters 4–7 come from the same row of the table (ICD-10-PCS Guidelines 2026, A6–A9, B3.1a, B6.1a–b; official table 0FT).
Mini cases: code them from scratch
These are short, fictional exercises in the CIC's fill-in-the-blank format. Write your codes before you open the answer key. Put the principal diagnosis first and follow the instructional notes that order additional codes. Give each nonexempt diagnosis a POA indicator; mark exempt codes Exempt.
Mini case 1: Gallbladder
Record: February 2026 discharge after an acute-care inpatient admission from the ED. 58-year-old with right upper quadrant pain. Ultrasound shows gallstones with gallbladder wall thickening. Final diagnosis: acute cholecystitis with cholelithiasis, no obstruction. Hospital day 2: total laparoscopic cholecystectomy removing the entire gallbladder, completed laparoscopically with no hand assistance, no conversion, and no complications. History: type 2 diabetes managed with metformin and essential hypertension on lisinopril; both medications were continued and blood glucose was monitored during the stay. The provider documents that the gallstones with acute cholecystitis, diabetes, and hypertension were present when the inpatient order was written.
Show answer key for Mini case 1: Gallbladder
Answer key
| Slot | Code | Description | POA |
|---|---|---|---|
| Principal diagnosis | K80.00 | Calculus of gallbladder with acute cholecystitis without obstruction | Y |
| Secondary diagnosis | E11.9 | Type 2 diabetes mellitus without complications | Y |
| Secondary diagnosis | Z79.84 | Long term (current) use of oral hypoglycemic drugs | Exempt |
| Secondary diagnosis | I10 | Essential (primary) hypertension | Y |
| Procedure | 0FT44ZZ | Resection of gallbladder, percutaneous endoscopic approach | — |
Why
- One combination code captures gallstones with acute cholecystitis; don't code them separately (I.B.9).
- No separate provider-documented clinically significant condition is supplied for the ultrasound finding (Section III.B).
- Diabetes and hypertension qualify as secondary diagnoses because they were treated and monitored (Section III).
- The E11 category's 'use additional code' note calls for Z79.84 for oral hypoglycemics; Z79.84 is POA-exempt. Sequence E11.9 before Z79.84.
- Whole gallbladder removed = Resection; laparoscopic = Percutaneous Endoscopic. Table 0FT supplies Z, No Device; routine closure materials such as sutures and ligatures are integral and are not separately coded as devices (B6.1b).
Sources: ICD-10-CM Guidelines, I.B.7, I.B.9 and III; Tabular E11 and K80.00; POA exemption list; PCS table 0FT and B6.1b.
Mini case 2: Sepsis
Record: February 2026 discharge after an acute-care inpatient admission from the ED. 72-year-old with fever, hypotension responsive to fluids, and rising creatinine. Blood cultures are negative. Discharge summary: "Severe sepsis due to community-acquired pneumonia, organism not identified, with acute kidney injury due to the sepsis, resolved with IV fluids and antibiotics. No septic shock." The provider documents that all conditions were present when the inpatient order was written. After a query addressing the negative culture results, the attending confirms the diagnoses in the discharge summary.
This is a diagnosis-only exercise; do not assign procedure codes.
Show answer key for Mini case 2: Sepsis
Answer key
| Slot | Code | Description | POA |
|---|---|---|---|
| Principal diagnosis | A41.9 | Sepsis, unspecified organism | Y |
| Secondary diagnosis | J18.9 | Pneumonia, unspecified organism | Y |
| Secondary diagnosis | R65.20 | Severe sepsis without septic shock | Y |
| Secondary diagnosis | N17.9 | Acute kidney failure, unspecified | Y |
Why
- Severe sepsis needs at least two codes: the systemic infection first, then R65.2-, plus codes for the associated organ dysfunction (I.C.1.d.1.b). The R65.2 use-additional-code note places N17.9 after R65.20.
- Sepsis and pneumonia both present on admission: sepsis is principal, pneumonia secondary (I.C.1.d.4).
- Negative blood cultures don't rule out a documented sepsis diagnosis (I.C.1.d.1.a.i). The guideline also calls for a provider query, which has been answered here.
- The provider documents severe sepsis and links the AKI to it; report R65.20 and N17.9. If the relationship is unclear, query (I.C.1.d.1.a.iv).
- No shock documented, so R65.20 rather than R65.21.
Sources: ICD-10-CM Guidelines, I.C.1.d; Tabular A41.9, R65.2, J18.9 and N17.9; POA guidance, Appendix I.
Your score on these items is feedback, not a prediction of your CIC result. This is a starter set, not a full mock exam; its small, uneven domain samples show specific topics to revisit, not a reliable readiness rating. Every full code used here was checked in the official FY2026 October and April releases and the FY2027 October release; the mini cases use February 2026 discharges.
Your CIC priority map
| Exam section | Questions | What it really tests | Your priority |
|---|---|---|---|
| Coding cases | 7 cases, 5–15 answers each | Reading an inpatient record and coding it with no answer choices: principal diagnosis, secondary diagnoses, ICD-10-PCS procedures | Highest. This is the core of the exam. |
| Inpatient payment methodologies | 9 MC | MS-DRGs, CC/MCC, POA and hospital-acquired conditions, the 3-day payment window, the two-midnight rule, readmissions, discharge disposition | High: the biggest multiple-choice block |
| Medical record and documentation | 7 MC | UHDDS, queries, copy/paste and template problems, timely documentation, addenda, Joint Commission, MDS | Medium |
| Inpatient coding (MC) | 7 MC | Coding Clinic use, DRG lookup, POA indicators, CAC and NLP, coder roles such as DRG validator | Medium; add review of CAC, NLP, DRG lookup, and coder roles |
| Regulatory and payer | 6 MC | LCD/NCD, Medicare Parts A–D, ABN and HINN, private payer policy, precertification | Medium |
| Compliance | 5 MC | Payer and internal audits, OIG Work Plan, CERT/MAC/RAC reviews, PEPPER, fraud and abuse, Medicare appeals | Medium |
| Medical terminology, anatomy, pathophysiology | 3 MC | Terms, anatomy, conditions and the drugs that treat them | Low on its own, but it powers every case |
| Outpatient payment methodology | 3 MC | OPPS, APCs, status indicators, pass-through payments, inpatient vs. outpatient payment | Low |
Priority labels are our starting recommendations, not AAPC weightings; adjust them to your own gaps.
Where the points are. AAPC says each case has 5 to 15 possible answers and that each answer is weighted the same. Seven cases therefore hold somewhere between 35 and 105 answer blanks, set against 40 multiple-choice questions. AAPC doesn't publish the exact total, but the cases can carry as many scorable answers as all the multiple-choice questions combined. If your prep time is mostly quiz apps, rebalance it toward coding whole records. The 35–105 range is derived from the published bounds, not an exact exam denominator or a fixed percentage of the score (AAPC breakdown).
No CPT. The CIC tests ICD-10-CM diagnosis codes and ICD-10-PCS procedure codes for inpatient facility claims. You won't need a CPT book.
The noncoding topics in plain English
Twenty-three of the 40 multiple-choice questions sit in payment, regulatory, outpatient, and compliance areas. These areas need practice alongside diagnosis and procedure coding. These are the core ideas the practice questions above test.
- How Medicare pays an inpatient stay (IPPS). The hospital is paid per discharge, not per day or per service. Each stay is grouped into an MS-DRG based on the diagnoses, procedures, complicating conditions (CCs and MCCs), age, sex, and discharge status. A base payment rate is multiplied by the MS-DRG's relative weight. As a made-up example: a $6,000 base rate × a relative weight of 1.40 = $8,400, before the other adjustments real payments include (CMS IPPS overview). That's why your secondary diagnoses and principal diagnosis matter so much, and why coding to raise the weight without documentation is a compliance problem.
- POA and hospital-acquired conditions. For claims subject to POA reporting, assign POA status to each reportable diagnosis unless its code is exempt. Under the selected HAC payment provision, Y or W does not exclude the condition from CC/MCC payment solely because of POA status; N or U prevents the additional payment attributable to that HAC (CMS HAC POA coding).
- The 3-day payment window. For a covered Part A stay, outpatient diagnostic services, and admission-related nondiagnostic services, given by the admitting hospital or an entity it wholly owns or operates on the admission date or in the 3 preceding calendar days go on the inpatient claim. Applicable non-IPPS hospitals use a 1-day window; the policy does not apply when the admitting hospital is a critical access hospital (CAH). The window uses calendar days, not a rolling 72 hours (CMS guidance, pp.1–4).
- Inpatient vs. observation. Inpatient status begins when the patient is formally admitted pursuant to an inpatient admission order. Observation is an outpatient service, even if the patient stays overnight in a regular bed. Under the two-midnight benchmark, admission is generally appropriate when the admitting physician expects medically necessary care to cross two midnights and the record supports that expectation (Medicare.gov; 42 CFR 412.3). Hospitals and CAHs must give the Medicare Outpatient Observation Notice (MOON) to Medicare beneficiaries, including Medicare Advantage enrollees, who receive observation services for more than 24 hours. It is due no later than 36 hours after observation begins, or sooner upon discharge, transfer, or inpatient admission (CMS manual, §§400.2 and 400.3.4).
- Outpatient payment (OPPS). Medicare generally pays hospital outpatient department services through OPPS, using Ambulatory Payment Classifications (APCs); some services and facilities use other payment methods. Each HCPCS code has a status indicator that tells you how, or whether, it's paid; "C" marks inpatient-only procedures (CMS CY2026 Addendum D1, ZIP).
- Coverage is not coding. A National Coverage Determination (NCD) is CMS's national decision on whether an item or service is covered. A Local Coverage Determination (LCD) is a Medicare contractor's decision for its region and can't conflict with national policy. An NCD does not assign a code or determine a payment amount. Services with no NCD or LCD are decided claim by claim (CMS coverage overview).
- Documentation and templates. CMS doesn't prohibit templates, but it discourages ones that leave too little room to record what actually happened, and reviewers look at what the template captured (Medicare Program Integrity Manual, ch. 3, §3.3.2.1.1). A filled-in template isn't proof the record supports a code.
Your six-week CIC study plan
Assumes: you already code (often a CPC or COC moving into inpatient) and can study 8–10 hours a week. If you're new to coding or rusty on anatomy and medical terminology, start with two weeks of foundations before Week 1 and extend that time until you can follow the terminology and navigate the code books. If your exam is closer, compress Weeks 3–4 but keep Weeks 5–6. This is an adjustable study framework, not a promise that 48–60 hours will be enough.
| Week | Focus | Do this | You're done when |
|---|---|---|---|
| 1 | Inpatient diagnosis rules | Read ICD-10-CM Guidelines Sections II and III and Appendix I (POA). Use Questions 1–3 and the two mini cases for principal-diagnosis practice, then work through the examples in Section II. Set up your books: tabs for navigation, brief notes on daily-coding points. | You can explain why a principal diagnosis is principal without looking it up. |
| 2 | ICD-10-PCS | Learn the 7-character structure and the Medical and Surgical root operations by definition. Read PCS Guidelines B3–B6. Work Questions 4–5 and 16–18, rebuild the worked 0FT44ZZ example, and use the guideline examples to practise selecting values in the official tables. Optional extension: build 30+ codes from legitimate operative-note practice you already have. | You can tell Excision from Resection, and Drainage from Extirpation, by objective. |
| 3 | Chapter-specific diagnosis rules | Work through the relevant Section I.C guidelines for sepsis and severe sepsis, diabetes, hypertension and CKD, heart failure, respiratory failure, neoplasms, OB, injuries, and complications of care. Recheck Question 2 and both mini cases against those instructions. | You can code a sepsis admission and its organ dysfunction in the right order on the first try. |
| 4 | Payment, regulatory, outpatient | MS-DRG logic and CC/MCC, HACs and POA, the 3-day window, the two-midnight rule, transfers and readmissions, Medicare Parts A–D, LCD/NCD, ABN and HINN, OPPS, APCs, and status indicators. Make a one-page summary. | You can answer the 18 practice questions above with explanations, not guesses. |
| 5 | Case method and pacing | Rework both mini cases without the key, explain every code and sequencing note, and practise locating the source for each decision. Then review documentation, query, and compliance topics. Optional extension: code at least 10 complete records from legitimate practice you already have, using about 23 minutes each as an adjustable rehearsal target. | Your misses are specific rules you can name, not "I ran out of time." |
| 6 | Review and rehearsal | Work through this page again, record time spent on lookup and reasoning, and review every miss against the guideline. Confirm exam logistics and book edition. Optional extension: if you already have a legitimate full practice exam, rehearse 40 MC plus 7 cases in 4 hours; this page does not supply that full mock. | You can explain the corrected rules and name the topics that still need work. A repeated-item score does not establish readiness. |
Daily case habit: from Week 2 on, revisit one case decision or official guideline example each day and explain it before checking the answer. If you already have additional legitimate records, code one full record a day. Cases require sustained practice without answer choices to lean on.
Adjusting the plan
- Only 30–45 minutes a day? Allow roughly 11–20 days for each planned 8–10-hour study week. The order matters more than the pace.
- Retaking after an unsuccessful attempt? Start with the domains AAPC reported at 65% or less, plus your own error log. Use repeated questions to practise the rule; a higher repeat score can reflect memory.
- New to ICD-10-PCS? Double Week 2. Use the extra time to practise root operations, approaches, and table navigation.
- Using other practice material? Check that it reflects the current format (40 multiple-choice questions + 7 cases in 4 hours) and the right code year. Never study from recalled live exam questions.
Free references for the plan: ICD-10-CM Guidelines, ICD-10-PCS Guidelines, official CM Tabular and Index, and official PCS Tables, Index and Definitions. The file packages are free reference downloads, not a full practice exam.
Keep an error log
Every miss gets one row. Review the log at the start of each week and pick that week's extra work from it.
| Item | My answer | Correct answer | Rule and section | What went wrong | When I'll recheck it |
|---|---|---|---|---|---|
| Question 9 (example) | N | Y | ICD-10-CM Appendix I: POA timing | Used ED arrival instead of the inpatient order | Next Monday |
| Blank row for your own entry |
Useful "what went wrong" labels: missed documentation, wrong setting (inpatient vs. outpatient rule), principal diagnosis choice, missed instructional note, wrong root operation or body part, unsupported assumption, payment or payer concept, slow book navigation.
Exam day: a 4-hour time budget
AAPC puts the seven cases at the end of the exam and suggests reading the answer choices before each question and saving harder questions for last. A workable split:
| Part | Time | Pace |
|---|---|---|
| 40 multiple-choice questions | About 60 minutes | About 1.5 minutes each; mark and skip anything slow |
| 7 coding cases | About 160 minutes | About 23 minutes per case |
| Review and buffer | About 20 minutes | Return to marked questions; check case sequencing |
This is our planning suggestion, not an AAPC rule. If cases are your strength, give them less time and move the rest to review.
Your code books: the rules that trip people up
- Allowed books: ICD-10-CM and ICD-10-PCS from any publisher. No other code books or references.
- Which year: AAPC exams use the current calendar year's code sets and switch every January. You may bring the current year's books, the preceding year's, or one of each, but only one copy of each book. Books older than one year aren't allowed, and next year's books aren't allowed.
- The October trap: ICD-10 codes change for real-world claims every October 1, and publishers label those books with the following year. If you test in November or December 2026, the exam still uses 2026 code sets and "2027" books count as next year's books. If you test during 2027, expect 2027 code sets.
- Notes and tabs: Brief handwritten notes and highlighting are allowed in printed books only if they relate to daily coding work. Tabs must be for navigation only. Nothing copied from study guides or practice exams, and no sticky notes, loose pages, or inserts. If you use eBooks for the exam, AAPC provides clean versions without your notes.
Check AAPC's book-year policy and allowed-notes rules again in the week before your exam; they're the final word.
CIC exam facts at a glance
| Item | Detail |
|---|---|
| Credential owner | AAPC |
| Format | 40 multiple-choice questions and 7 inpatient cases with fill-in-the-blank answers, proctored |
| Time | 4 hours, one sitting |
| To pass | 70% overall. If you don't pass, AAPC shows the domains where you scored 65% or less. |
| Where | Online at home with a live remote proctor, or at a testing center |
| Cancel or reschedule | Not available less than 48 hours before either format; see the remote policy and testing-center policy |
| Cost | Core exam pricing: $425 for 1 attempt or $499 for 2 attempts (student pricing: $400 or $475) |
| Membership | AAPC lists current membership as a basic exam requirement, and releases results only while your membership is active |
| Results | In your My AAPC account dashboard under My Exams |
For booking steps, see AAPC exam registration. For what happens after the exam, see AAPC exam results and the AAPC exam retake policy.
Common questions
Who should take the CIC? Coders who work, or want to work, in hospital inpatient settings: acute care, critical access, teaching hospitals, inpatient rehab, long-term care hospitals, and skilled nursing facilities. The CIC is a stand-alone credential: you don't need a CPC or COC first, and there's no minimum experience requirement. AAPC does recommend two years of experience in the field and warns that its exams aren't meant for people with little or no relevant experience.
Is the CIC hard? It's demanding in a specific way: the cases give you no answer choices, and the multiple-choice section includes payment and regulatory rules beyond diagnosis and procedure code selection. If you're coming from CPC preparation, give ICD-10-PCS and the case format dedicated practice.
What's the CIC pass rate? The official CIC pages reviewed do not report an overall candidate pass rate. The 70% figure above is the passing-score requirement, not the percentage of candidates who pass.
How long should I study? Plan on six weeks at 8–10 hours a week if you already code, longer if you're new to inpatient work or to coding. Use full records to practise accuracy and an adjustable time budget. About 23 minutes per case is the rehearsal target used here, not an AAPC readiness standard or a prediction of passing.
What if I fail? You'll see which domains came in at 65% or less, so start your retake prep there. If you bought the two-attempt voucher, your second attempt is already paid for. See the AAPC exam retake policy for timing and the January code-set switch.
CIC or COC or CPC? The CIC is inpatient facility coding (ICD-10-CM and ICD-10-PCS, MS-DRGs). The COC is outpatient facility coding, and the CPC is professional (provider) coding. For professional coding, see CPC exam prep; the overview of other billing and coding certification options compares additional routes.
How do I keep the credential after I pass? You'll need to keep your AAPC membership active and earn continuing education units. See AAPC certification renewal.
Sources
Last verified October 21, 2026: exam format, section counts, scoring, book rules, notes policy, pricing, membership, testing options, and every coding and payment rule used in the practice set.
- AAPC, Taking the CIC exam: format, time, 70% standard, domain question counts, case answers and weighting, test-taking tips
- AAPC, Certified Inpatient Coder (CIC) certification: credential scope and case format
- AAPC Help Center, Certified Inpatient Coder (CIC) certification: approved books, testing options, 4 hours, competencies
- AAPC Support, Exam registration prerequisites: membership, stand-alone credential, recommended experience
- AAPC Support, How much does the exam cost?
- AAPC Support, Which year's books should I use?
- AAPC Help Center, What notes are allowed in my exam books?
- AAPC Help Center, Membership requirements for taking and receiving results
- CMS/NCHS, ICD-10-CM Official Guidelines for Coding and Reporting, FY2026 and FY2027
- CMS, FY2026 CM Tabular and Index and FY2027; FY2026 POA exemption list and FY2027 (ZIP files)
- CMS, ICD-10-PCS Official Guidelines for Coding and Reporting 2026 and 2027; 2026 Tables, Index and Definitions and 2027 (ZIP files)
- CMS, April 2026 CM Tabular and Index, PCS Tables, and PCS Guidelines: the codes and rules used here were checked across the April update
- CMS, Hospital-Acquired Conditions (Present on Admission Indicator): Coding
- CMS, Three-Day Payment Window and MLN SE20024, especially pp.1–4 and 8–11
- 42 CFR 412.3, Admissions (two-midnight benchmark)
- CMS, IPPS overview for interested parties (last modified Sept. 30, 2026)
- CMS, Medicare coverage of items and services (last modified Sept. 30, 2026)
- CMS, Medicare Program Integrity Manual, chapter 3, §3.3.2.1.1
- Medicare.gov, Inpatient or outpatient hospital status
- CMS, CY2026 OPPS Addenda, Addendum D1, rows C/G/N/V; OPPS overview
- Medicare.gov, Parts of Medicare
- MedlinePlus, Vomiting blood (hematemesis)
- ACDIS/AHIMA, Guidelines for Achieving a Compliant Query Practice, 2026 Update, pp.5,7–9
- CMS, Medicare Claims Processing Manual, chapter 30, §§400.2 and 400.3.4
- AAPC, Remote cancellation and rescheduling and testing-center cancellation and rescheduling
- AAPC, Membership and continuing-education policy
Castleport Test Prep is an independent exam prep publisher. It is not affiliated with, endorsed by, or approved by AAPC. CIC and other credential names identify the exams they describe; trademarks belong to their respective owners. The practice items on this page are original and are not official exam questions.
Developed with AI assistance. The practice scenarios are fictional and original. See our methodology for how source checks differ from professional review.
By the Castleport Test Prep Editorial Team