Understanding Pre-Employment Exams for Medical Coders
Victoria Vo 
Medical coding pre-employment exam tips
You applied for a coding job, the recruiter liked your resume, and now they want you to take a coding test before the interview. Don't panic. Pre-employment coding exams are a normal part of hiring in medical coding, and with a little preparation you can walk in confident.
What is a pre-employment coding exam?
A pre-employment exam is a skills test an employer gives you before (or right after) an interview. It shows them how you actually code, not just what credential is on your resume. Some employers give the same test to every candidate; others tailor it to the specialty you'd be working in.
Common test formats
- Multiple choice: Similar to a certification exam. You read a scenario and pick the correct code set.
- Code from scratch: You read an office note, operative report or chart and assign the codes yourself, with no answer choices. This is the most common format and the closest to real work.
- Abstracting: You pull specific information from a record, like diagnoses, procedures, modifiers or dates of service.
- Guideline and terminology questions: Short questions on coding guidelines, anatomy or medical terminology.
Tests can be timed or untimed, open book or closed book, and online or in person. Some let you use an encoder; others want you to use your code books.
What they're testing for
Most employers care about three things:
- Accuracy: Are your codes correct and supported by the documentation? Many employers set a minimum passing score.
- Guideline knowledge: Do you sequence codes correctly and apply modifiers and official guidelines the right way?
- Judgment: Do you code only what's documented, and do you recognize when a note is unclear and would need a provider query?
How to prepare
1. Ask questions before the test
It's completely fine to ask the recruiter what to expect. Good questions include: How long is the test? Is it timed? Can I use my books or an encoder? What specialty or setting will the charts be from? What score do you need to pass?
2. Practice with real-world charts
Multiple-choice practice is helpful, but coding from scratch is a different skill. Practice reading full notes and assigning codes without answer choices. If you can, time yourself so you get used to working at a steady pace.
3. Review the areas employers love to test
- Evaluation and management (E/M) leveling and medical decision making
- ICD-10-CM guidelines and sequencing
- Modifiers, especially 25, 59, XE, XP, XS and XU
- Common procedures in the specialty you're applying for
- Anatomy and medical terminology
4. Get your books ready
If the test is open book, tab and highlight your books the way you would for a certification exam. Knowing where things are saves a lot of time.
Tips for test day
- Read the whole note first. Important details are often in the assessment, plan or findings, not just the chief complaint.
- Code from the documentation, not assumptions. If it isn't documented, don't code it.
- Follow the guidelines. Check instructional notes, excludes notes and sequencing rules.
- Watch the clock. If you get stuck, make your best choice, flag it and move on. You can come back if time allows.
- Make notes if they're allowed. If you'd query the provider in real life, say so. That shows good judgment.
If you don't pass
It happens to a lot of good coders, especially early on. Ask whether you can get feedback and whether you can retake the test later. Then use it as a guide for what to study next. Every test you take makes the next one easier.
The bottom line
A pre-employment exam is your chance to show an employer what you can really do. Ask what to expect, practice coding real charts, brush up on your guidelines, and take your time with each note. You've got this.
