medical-coding-certifications

The ultimate guide to Medical Coding Certification

Medical coders play a significant role in the management of the revenue cycle. In a rapidly growing career such as medical coding, certification is an added benefit to coders by which they can achieve excellence through meticulous training and testing afterward. A certified medical coder will have extensive knowledge of the coding process and the certification will also give confidence to the coder and the employer concerning performance.

Certification will also increase the competency level and the skill set required to perform the task effectively. With improved efficiency and skills there are fewer chances of incorrect coding. An organization with a pool of highly efficient people can provide a high level quality for clients.

Becoming a certified coder requires familiarity with the basic components of medical coding, such as the International Classification of Diseases, 10th Clinical Modification, Current Procedural Terminology, and the coding of healthcare common procedure coding system.

There is an extensive array of coding certifications available in the industry. Certifications are based on the specialty they have chosen, such as inpatients, outpatients, and roles as a coder, auditor, etc. We will find out what different institutions and certifications are available.

Also Read: Get started with medical coding in India

Medical Coding Certifications

Organizations I would like to mention here include the American Health Information Management Association (AHIMA) and the American Academy of Professional Coders (AAPC). Both organizations offer certifications that provide immense knowledge and trust to medical coders to excel in their careers. In addition, knowledge about different certifications will help coders decide which one is appropriate for their ultimate purpose.

American Health Information Management Association (AHIMA) Certifications

AHIMA provides three certifications for medical coders as listed below,

  1. Certified Coding Specialist – CCS

CCS certification is more suitable for coders handling inpatient and outpatient records.

Eligibility requirements for CCS

While not required, one of the following is recommended to sit for the CCS examination:

  • Complete courses in all the following topics: anatomy & physiology, pathophysiology, pharmacology, medical terminology, reimbursement methodology, intermediate/advanced ICD diagnostic coding, and procedural coding and medical services (CPT/HCPCS) plus one (1) year of coding experience directly applying codes; OR
  • Minimum of two (2) years of related coding experience directly applying codes; OR
  • Hold the CCA® credential plus one (1) year of coding experience directly applying codes; OR
  • Hold a coding credential from another certifying organization plus one (1) year of coding experience directly applying codes; OR
  • Hold a CCS-P®, RHIT®, or RHIA® credential

Exam specifications

The CCS is a timed exam. Candidates have four hours to complete the exam. The total number of questions on the exam range between 115 and 140 total items. The exam consists of two sections, a Multiple-Choice Section and a Medical Scenario Section (inpatient, outpatient, and emergency department). The exam is given in a computer-based format with a passing score of 300. The exam is based on the 4 domains as Coding knowledge and skills, Coding Documentation, Provider Queries, and Regulatory Compliance.

  1. Certified Coding Specialist – Physician Based (CCS–P)

Coding specialist – physician-based professionals perform coding in physician offices, group practices, multi-specialty clinics, or specialty centers. While the eligibility requirements and exam specifications remain the same as CCS, there is a difference in the domains tested such as Diagnosis Coding, Procedure Coding, Research, Compliance, and Revenue cycle.

  1. Certified Coding Associate – CCA

Eligibility requirements

Candidates must have a high school diploma or equivalent to apply for the CCA examination.

While not required, at least one of the following is recommended:

  • 6 months of coding experience directly applying codes.
  • Completion of an AHIMA approved coding program (PCAP Program)
  • Completion of another coding training program to include anatomy & physiology, medical terminology, basic ICD diagnostic/procedural, and basic CPT® coding.

Exam specifications

CCA is a timed exam. Candidates have two hours to complete the exam. The total number of questions on the exam range between 90 and 115 total items. The exam is given in a computer-based format.  The passing score for CCA is 300. Competencies for CCA consist of six domains such as Clinical Classification System, Reimbursement methodologies, Health records and data content, Compliance, Information Technologies, and Confidentiality & Privacy.

American Academy of Professional Coders (AAPC) Certification details

AAPC is one of the training organizations which provides training and certification around all the areas of health care such as Medical Coding, Medical Billing, Medical Auditing, Practice Management, and Health care Compliance.

AAPC provides 4 major certifications such as a Certified Professional Coder (CPC), Certified Inpatient Coder (CIC), Certified Outpatient Coder (COC), and Certified Risk Adjustment Coder (CRC). Also, there are 18 other specialty certifications available with AAPC.

  1. Certified Professional Coder – CPC

A coder is validated on proficiency for correct application of CPT, HCPCS Level II procedures/supply codes, and ICD 10 CM used for coding in a physician’s office. This is a time-based exam wherein the coder must complete the exam in 4 hours and score 70% to pass.

  1. Certified Outpatient Coder – COC

A coder is validated on proficiency for correct application of CPT, HCPCS Level II procedures/supply codes, and ICD 10 CM used for coding in an outpatient hospital or facility such as Emergency Departments, Dialysis services, Outpatient hospital clinics, Outpatient Therapy departments, Outpatient Cancer Centers, Outpatient Radiology departments and Ambulatory Surgical Centers. This is a time-based exam wherein the coder must complete the exam in 4 hours and score 70% to pass.

  1. Certified Inpatient Coder – CIC

A coder is validated on proficiency for correct application of ICD 10 CM diagnosis codes used for coding medical claims in an inpatient hospital or facility. This is a time-based exam wherein the coder must complete the exam in 4 hours and should score 70% to pass. 40 multiple choice questions and 7 inpatient cases fill in the blank questions.

  1. Certified Risk Adjustment Coder – CRC

A coder is validated on proficiency for correct application of ICD 10 CM diagnosis codes used in risk adjustment payment models. This is a time-based exam wherein the coder must complete the exam in 4 hours and should score 70% to pass.

Specialty Credentials for Expert Coders

These specialty certifications enable coders to demonstrate superior levels of expertise in their respective specialty disciplines.

  1. Certified ASC Coder Credential – CASCC
  2. Certified Anesthesia and Pain Management Coder – CANPC
  3. Certified Cardiology Coder – CCC
  4. Certified Cardiovascular and Thoracic Surgery Coder – CCVTC
  5. Certified Professional Coder in Dermatology – CPCD
  6. Certified Emergency Department Coder – CEDC
  7. Certified Evaluation and Management Coder – CEMC
  8. Certified Family Practice Coder – CFPC
  9. Certified Gastroenterology Coder – CGIC
  10. Certified General Surgery Coder – CGSC
  11. Certified Hematology and Oncology Coder – CHONC
  12. Certified Interventional Radiology Cardiovascular Coder – CIRCC
  13. Certified Obstetrics Gynecology Coder – COBGC
  14. Certified Orthopaedic Surgery Coder – COSC
  15. Certified Pediatrics Coder – CPEDC
  16. Certified Rheumatology Coder – CRHC
  17. Certified Urology Coder – CUC
  18. Specialty Medical Coding Certification

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