Medical Coding Certification- Where to begin?

Considering a career in medical coding? You could not pick a better time. Medical coders enjoy the ability to attend online classes, plenty of job opportunities, and a high rate of career growth. Medical coders are able to work in a wide variety of settings—from hospitals to their own homes.

Though it is not required by law that medical coders be certified, most employers will require a certification. Physician reimbursement for exams, procedures, and treatment relies heavily on proper medical coding and billing. Medical codes are an important part of preventing insure fraud and insurance proper payments are received. Physicians and medical facilities need professionals they can trust working in this department. In our research we have been unable to find any job openings for medical coders that did not require a certification- and there are a lot of job openings! This is why it is so important to find the right school and program for your new career.

Choosing the certification that works best for you doesn’t have to be confusing. Follow our guide to medical coding certifications. Once you have chosen the certification that works best for you look into schools near you. Many offer both online and on campus courses.

Medical Coding Certification- What is the difference?

Certified Professional Coder

A Certified Professional Coder has proven by rigorous examination and experience that they know how to read a medical chart and assign the correct diagnosis (ICD-9), procedure (CPT), and supply (HCPCS Level II) code for a wide variety of clinical cases and services.

The CPC’s abilities include:

• Expertise in reviewing and assigning accurate medical codes for diagnoses, procedures, and services performed by physicians and other qualified health care providers in the office or facility setting (inpatient hospital)
• Proficiency across a wide range of services, including evaluation and management, anesthesia, surgery, radiology, pathology and medicine
• A sound knowledge of medical coding guidelines and regulations including compliance and reimbursement – allowing a CPC to better handle issues such as medical necessity, claims denials, bundling issues and charge capture
• Understand how to integrate medical coding and payment policy changes into a practice’s reimbursement processes
• Knowledge of anatomy, physiology and medical terminology necessary to correctly code provider diagnosis and services

Certified Professional Coder-Hospital Outpatient (CPC-H)

Outpatient ambulatory coder jobs are trending faster than ever before. As physicians move away from private practice and join hospital groups, career opportunities in outpatient facilities such as ambulatory surgical centers or hospital outpatient billing and coding departments are opening for coders. The CPC-H certification validates your specialized payment knowledge needed for these jobs in addition to your CPT, ICD-9, and HCPCS Level II coding skills. Invest in your future with the CPC-H certification.

The CPC-H’s abilities in regard to outpatient facility/hospital services include:

• Proficiency in assigning accurate medical codes for diagnoses, procedures and services performed in the outpatient setting (emergency department visits, outpatient clinic visits, same day surgeries, diagnostic testing (radiology and laboratory) and outpatient therapies (physical therapy, occupational therapy, speech therapy and chemotherapy))
• Proficiency across a wide range of services, which include evaluation and management, anesthesia, surgical services, radiology, pathology and medicine
• Knowledge of coding rules and regulations along with keeping current on issues regarding medical coding, compliance and reimbursement under outpatient grouping systems. A trained coding professional can better handle issues such as medical necessity, claims denials, bundling issues and charge capture
• Ability to integrate coding and reimbursement rule changes in a timely manner to include updating the Charge Description Master (CDM), fee updates and the Field Locators (FL) on the UB04
• Correctly completing a CMS 1500 for ASC services and UB04 for outpatient services, including the appropriate application of modifiers
• Knowledge of anatomy, physiology and medical terminology commensurate with ability to correctly code provider services and diagnoses
• A working knowledge in the assignment of ICD-9-CM codes from Volumes 1 & 2

Certified Professional Coder-Payer (CPC-P)

More private and public payers (health plans) are recognizing the value of employing certified coders to process and analyze medical claims for payment. The CPC-P® credential meets the growing demand for certified coders in a payer environment.

The CPC-P® demonstrates a coder’s aptitude, proficiency and knowledge of coding guidelines and reimbursement methodologies for all types of services from the payer’s perspective. Contributing developers include Dr. Marc Lieb, M.D., J.D., Susan Goldsmith, CPC, as well as a number of other well-known CPC-Ps in the payer community. Claims reviewers, utilization management, auditors, benefits administrators, billing service, provider relations, contracting and customer service staff can each benefit their practice with the CPC-P® credential.

The CPC-P® certification exam certifies that the successful candidate has the knowledge and skills to adjudicate provider claims effectively. The exam will test the examinee’s basic knowledge of coding-related payer functions with emphasis on how those functions differ from provider coding. The relationship between coding and payment functions will be explored in depth.

Specialty Medical Coding Certification

Designed for experienced coders, the AAPC’s specialty credentials enable coders to demonstrate superior levels of expertise in their respective specialty disciplines. These specialty credentials are stand-alone certifications with no requirement to hold the CPC credential. They allow coders to validate their knowledge in a specialty with unique coding, reimbursement and compliance challenges.

Specialty exams aptly measure preparedness for “real-world” coding by being operative/patient-note based. In addition to questions regarding the correct application of ICD-9-CM, CPT, HCPCS Level II and modifier coding assignments, examinees will also be tested on specialty-specific coding and regulations.

Medical coder salary varies greatly depending upon education and certification level. Many medical coders start as Certified Professional Coders and continue their education while working in medical coding. This gives them invaluable experience, as well as means to pay for further schooling. See below for medical coding salaries by certification. You might also enjoy: How To Become A Medical Coder

•    Certified Professional Coder (CPC) – $48,593
•    Certified Professional Coder – Hospital Outpatient (CPC-H®) – $56,284
•    Certified Professional Coder – Payer (CPC-P) – $57,995
•    Certified Professional Practice Manager (CPPM) – $59,619
•    Certified Professional Medical Auditor (CPMA) – $61,115
•    Certified Professional Biller (CPB) – $61,667
•    Certified Professional Compliance Officer (CPCO) – $69,138

// ]]>