Steps, Requirements & Certifications to Become a Medical Coder
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Medical coders perform some of the most critical behind-the-scenes work of medical facilities. They ensure that patient data is accurately logged in electronic health records (EHRs). Medical coding requires a detail-oriented approach and a specialized technical skillset. It is an ideal profession for those who want to work in non-patient-facing positions within the healthcare industry.
A rapid increase in the adoption of electronic health records (EHRs) means that medical coding is a career that’s projected to grow faster than the average occupation, according to the U.S. Bureau of Labor Statistics (BLS 2020). Between 2019 and 2029, there is expected to be an 8 percent rise in openings nationally, which is much faster than the average for all occupations during the same timeframe (4 percent).
Even though medical coders can get started in their careers with as little as one year of postsecondary education, it is not a job that everyone can do. Medical coders need to be fluent in coding systems like the International Classification of Diseases (ICD), the Current Procedural Terminology (CPT), and the associated Healthcare Common Procedure Coding System (HCPCS).
Even after their preliminary education is complete, medical coders are presented with a series of professional credential opportunities that can distinguish a coder from the pack and kickstart their career. The numerous continuing education requirements for recertification of those credentials means that the journey is a winding one, and never complete.
Beyond certification credentials, medical coders must possess a full range of professional skills to do their jobs well. Not only do medical coders need to be analytical and detail-oriented, but they must also be able to discuss patient medical data accurately with physicians and hospital administration teams. And while state licensure is not typically required, specialized medical coders working in oncology may be required to earn a Certified Tumor Registrar (CTR) credential to work in the cancer registry field.
Read on to learn the step-by-step process of becoming a medical coder.
Step-by-Step Guide to Becoming a Medical Coder
Step One: Postsecondary Education (One to Four Years)
After graduating from high school, aspiring medical coders have three main options for their undergraduate education: a certificate program, an associate’s degree, or a bachelor’s degree.
A certificate program is the quickest route to working in the field, as most take less than a year to complete. These are focused programs of study that cover the basics of disease processes, treatment procedures, terminology, body systems, and basic coding in ICD-10. Students will also gain proficiency in medical office software, billing procedures, and regulatory compliance. The curriculum of these programs is designed to prepare students for immediate employment and to take official credentialing exams.
An associate’s degree in an area like healthcare administration or health information management provides a reliable and adaptable option for aspiring medical coders. In addition to the medical coding basics covered in a certificate program, students receive a well-rounded liberal arts education that improves their writing, speaking, and critical thinking skills.
While an associate’s degree takes longer than a certificate to complete (about two years), employers may be keener to hire applicants with official degrees on their resume. An associate’s degree can also easily be transferred towards a bachelor’s degree program, should graduates decide to pursue further education in the field of healthcare.
A bachelor’s degree in healthcare administration or health information management is a longer but more complete path to working in medical coding. In addition to the foundational understanding of medical coding found in certificate programs and on top of the soft skills learned in the associate’s degree, the bachelor’s degree offers exposure to the broader and more nuanced concepts in healthcare management. Graduates learn about human resources, health policy, legislative compliance, data analytics, and project management. Although most bachelor’s degrees take four years to complete, medical coders who choose this route are not only at the top of the hiring list for employers; they are also more likely to take on leadership roles and earn higher salaries.
No matter which pathway one takes to gain their prerequisite education in medical coding, it is essential that the educational institution is accredited. Program-specific accreditation is available through the American Health Informatics Management Association (AHIMA), the Commission on Accreditation for Health Informatics and Information Management Education (CAHIIM), and the American Association of Professional Coders (AAPC).
Step Two: Earn Preliminary Credentialing (Six Months)
Almost all education programs for medical coders prepare graduates for basic credentialing exams, two of which students can take right away. Both are offered through AHIMA.
The first option is to obtain a Certified Coding Associate (CCA) credential, which is a nationally-recognized standard of achievement in health information management. AHIMA recommends six months of work experience before taking this exam but does not require applicants to have any if they have completed an AHIMA-approved or otherwise comprehensive medical coding education program.
The credentialing exam consists of 90 to 115 multiple choice questions that test for fundamental competency, commitment, and capability across both hospital and physician-based practices. The application fee is $199 for AHIMA members and $299 for non-members. The CCA credential can distinguish a medical coder and help them secure better job prospects and the higher salaries that go with them.
The second option is to earn the Registered Health Information Technician (RHIT) credential. While this certification also does not require work experience, it does call for at least an associate-level education in health information management from a CAHIIM-accredited program.
The 3.5-hour credentialing exam consists of 130-160 multiple choice questions that measure competency in ensuring the quality of medical records, using computer applications to assemble and analyze patient data, and specializing in coding diagnoses and procedures in patient records for reimbursement and research. It costs $229 for AHIMA members and $299 for non-members. Like the CCA, achieving the RHIT credential can improve job placement and salary earnings.
Step Three: Get Work Experience (One to Two Years)
Once new medical coders have earned their certificate or degree, it is time to step into the office and get to work. Professionals should utilize the resources available to them at their school and within their peer network to find employment. Joining a professional association such as AHIMA or the AAPC can unlock employment opportunities and career preparation materials.
Furthermore, gaining work experience helps young professionals determine their work setting preferences—in a hospital or a physician practice environment—which will, in turn, help them select possible further professional credentials.
Step Four: Earn Additional Credentials (One to Two Years)
After a medical coder has gained some work experience, further professional credentials from AHIMA become available such as the Certified Coding Specialist (CCS) or the Certified Coding Specialist Physician-Based (CCS-P) certifications.
The CCS credential is for coders who are skilled in classifying patients’ medical data, primarily in a hospital setting. It not only tests for knowledge in terminology, disease processes, and pharmacology, but also for expertise in ICD-10-CM and CPT/HCPCS coding systems.
The CCS-P credential denotes a medical coder as specializing in physician-based settings. The CCS-P exam tests for competency in ICD-10-CM, HCPCS Level II, and CPT coding systems – testing for mastery-level understanding rather than entry-level skills.
For both credentials, the corresponding exam consists of 115-140 multiple choice questions, as well as eight medical scenarios that require candidates to pick from a range of medical codes. Both exams require either two years of work experience or one year of work experience plus a secondary credential. However, work experience requirement exceptions exist for candidates who already hold an RHIT credential. Each exam has an application fee of $299 for AHIMA members and $399 for non-members.
Step Five: Pursue Continuing Education (Ongoing)
The credentials earned in steps two and four are not eternally valid. To maintain a standard of excellence, AHIMA requires medical coders to recertify every two years. Those holding a CCA, CCS, or CCS-P have to complete 20 continuing education units (CEUs) and two annual coding self-reviews (which count as five CEUs each) over the course of each recertification cycle.
Medical coders with an RHIT credential only have to take 20 CEUs. And those with two AHIMA credentials must complete 30 CEUs every two years. Continuing education activities can come in the form of AHIMA meetings, formal educational programs, teleseminars, delivered presentations, published academic work, independent study, and more. A full list is available in AHIMA’s recertification guide.
Helpful Resources for Aspiring Medical Coders
Founded in 1928, the American Health Information Management Association (AHIMA) is the leading source of knowledge-sharing for health information management, and it acts as a one-stop-shop for aspiring, professional, and veteran medical coders. The organization has 52 affiliated state associations and more than 100,000 members. It offers education and events through textbooks, credentials, meetings, continuing education, academic journals, and more. The following offerings may be of particular interest to aspiring medical coders:
- Online Courses
- Resources (Practice Briefs, Toolkits, AHIMA Query Template Library)
State Licensure for Medical Coders
As mentioned above, state licensure is not often required for medical coders (BLS 2020). Having certification through AHIMA or AACP is recommended to demonstrate a commitment to the profession and stand out on job applications. As well, some employers may require medical coders to hold a valid certification in order to meet minimum qualifications. However, some states and facilities require medical coders working in oncology or cancer treatment centers to hold a Certified Tumor Registrary (CTR) credential given by the National Cancer Registrars Association (NCRA). There are three routes of eligibility for CTR certification:
- Route A1: Complete an NCRA-accredited associate degree program and complete a 160-hour clinical practicum under the supervision of a CTR.
- Route A2: Complete a 60-credit associate’s degree program, an NCRA-accredited certification program, and a 160-hour clinical practicum supervised by a CTR.
- Route B: Complete an associate’s degree of 60 or more credits including two semesters or six credit hours in human anatomy and physiology with a grade of C or better, and complete 1,950 hours (one year of full-time work) in the cancer registry field.
For complete details on what to expect during test day and how to study for the exam, the NCRA provides a CTR Exam Candidate Handbook. Registration for the CTR exam is $415 for non-members and $315 for NCRA members.