Failed the CIC Exam? How to Pass on Your Next Try

A CCO Community member passed three outpatient credentials on the first try, then scored 59% on the CIC. That happens often, and it is not about intelligence. The inpatient exam tests different skills.

What the exam looks like

The CIC has 40 multiple-choice questions plus 7 inpatient cases with fill-in-the-blank code answers, in one four-hour sitting. You need 70% overall. You may bring an ICD-10-CM and an ICD-10-PCS code book (AAPC: Taking the CIC exam).

The fill-in cases are the big difference. There are no answer choices to narrow down, so you have to build every code yourself.

Why outpatient coders struggle

• ICD-10-PCS is a build-a-code system. You must identify the root operation, body part, approach, device, and qualifier from the operative report. Outpatient coders rarely use PCS.
• Inpatient diagnosis rules are different. Uncertain diagnoses documented at discharge (probable, suspected) are coded as if confirmed in the inpatient setting, which is the opposite of outpatient rules.
• Principal diagnosis selection follows Section II of the Official Guidelines, and secondary diagnoses follow Section III.

A study plan that works

1. Master the PCS root operations. Know the definitions cold, especially Excision vs. Resection, Drainage vs. Extirpation, and Replacement vs. Supplement.
2. Read the PCS guidelines at the front of the book, then code operative reports for practice every day.
3. Drill Sections II and III of the ICD-10-CM Official Guidelines.
4. Practice fill-in cases timed. Code full discharge summaries without looking at answer choices.
5. Learn MS-DRG basics: how the principal diagnosis, CCs, and MCCs drive the DRG.

Get support

CCO students can practice in the CCO Exam Center and ask questions in the CCO Academy community. Working through inpatient cases with an instructor who explains each code choice is often what moves a score from 59% to passing.

Refreshed from the CCO Community archive, November 2026.