Guide to Medical Coding Certification
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To the general public, medical coding is one of the more mysterious aspects of healthcare. There are no prime-time TV dramas about the love lives of the medical coders as they sit behind their desks, assigning specific codes to different medical procedures to keep accurate medical records and ensure that bills and payments are correct.
What lacks drama, the career makes for stability and growth. According to the Bureau of Labor Statistics, the number of positions for medical records and health information technicians is expected to grow 7 percent from 2021 to 2031. Medical coders are required in every private practice, hospital, and clinic; many can work from home.
However, for someone with little to no experience, medical coding certification is a critical step to take. Certification can improve an applicant’s chance of landing a job and can come along with a higher salary. To become certified, medical coding professionals must demonstrate a thorough knowledge of one or more of the three commonly-used code sets: Current Procedural Terminology (CPT), ICD-10-CM, and Healthcare Common Procedure Coding System (HCPCS) Level II.
Medical coding certification is available through a few different organizations. However, the proper certification for any coder ultimately depends on a candidate’s experience and intended specialization. Read on for details on how to earn medical coding certification.
What is Medical Coding Certification?
Although medical coding certification is not a legal requirement to find employment as a medical coder, professionals with certifications are more likely to be employed and earn a better salary than those who have yet to make a certification. In addition, certification demonstrates an essential foundational knowledge of the three aforementioned key code sets, meaning that certified medical coders can be more efficient and offer more value to their employers.
There are several different certifications that prospective medical coders can choose to pursue. However, three of the most common are the Certified Professional Coder (CPC), the Certified Coding Specialist (CCS), and the Certified Medical Coder (CMC), each of which is offered by a different organization. Coding work can vary greatly depending on a coder’s healthcare setting, so students seeking certification must select the one that matches their ultimate goals.
How to Become a Certified Professional Coder (CPC)
The Certified Professional Coder (CPC) certification may be ideal for those interested in working in an outpatient setting, such as a physician’s office or outpatient clinic. The CPC exam is the most popular medical coding certification exam in medical coding.
Certifying Organization
The American Academy of Professional Coders (AAPC) offers the CPC certification, the largest organization of its kind, with more than 220,000 members in 39 countries.
Prerequisites for CPC Certification
Although not strictly required, the AAPC recommends that anyone taking the CPC exam have at least an associate’s degree from an accredited institution. Most people who choose to take the CPC exam also have experience in medical coding.
It is important to note that more than completing the CPC exam is needed to qualify the examinee as a Certified Professional Coder. Those who choose to take the exam without gaining professional experience in the field will earn a CPC-A certification, which stands for Certified Professional Coder-Apprentice. To become a full CPC, the coder must complete at least two years of professional experience and submit two letters of recommendation to the AAPC.
To qualify for the exam, applicants must be current members of the AAPC and pay an exam fee. The exam costs $399 for one attempt and $499 for two for US-based applicants.
Certifying CPC Exam Details
The CPC exam consists of 100 multiple-choice questions that cover the following areas:
- Anatomy and Physiology
- Anesthesia
- Coding Guidelines
- Digestive System Surgical Coding
- Endocrine System Surgical Coding
- Evaluation and Management
- Eye & Ocular Adnexa Surgical Coding
- HCPCS Level II
- Hemic & Lymphatic Surgical Coding
- ICD-10-CM
- Integumentary Surgical Coding
- Laboratory
- Male/Female Genital Surgical Coding
- Maternity & Delivery
- Mediastinum & Diaphragm Surgical Coding
- Medical Terminology
- Medicine
- Musculoskeletal System Surgical Coding
- Nervous System Surgical Coding
- Pathology
- Practice Management
- Radiology
- Respiratory Surgical Coding
- Urinary System Surgical Coding
Candidates have four hours to complete the open-book CPC exam. An overall score of 70 percent is required to become certified—more than 80 percent of people who take the CPC exam pass on their first attempt.
The AAPC offers a test prep course that increases an applicant’s chances of passing threefold and provides a guide for how to study for the CPC exam.
Ongoing CPC Certification Requirements
Continuing education is required to remain certified. In addition, CPCs must complete at least 36 hours of approved Continuing Education Units (CEUs) every two years. Certificate holders may earn CEUs by attending conferences, online courses, or other approved events.
How to Become a Certified Coding Specialist (CCS)
For those who want to jump-start or grow their career in medical coding at inpatient facilities, the Certified Coding Specialist (CCS) certification program is the most popular choice and is comparable to the CPC.
Certifying Organization
The CCS is available through the American Health Information Management Association (AHIMA).
Prerequisites for CCS Certification
To sit for the CCS exam, it is recommended that coders have at least one of the following:
- A diploma or degree from a medical coding training program
- Two years of medical coding experience
- An existing medical coding certification (e.g., CCA, CCS-P, RHIT, or RHIA, plus one year of medical coding experience)
The CCS exam is computer-based and must be completed in four hours. The exam has two parts: multiple-choice and medical scenarios, and includes a range of 115 to 140 questions. Applicants must earn a score of 300 or higher to pass the CCS certification exam.
AHIMA members pay $299 to sit for the exam, and the price for non-AHIMA members is $399.
Certifying CCS Exam Details
The CCS exam covers four domains, including:
- Coding Knowledge and Skills (51.9 percent)
- Coding Documentation (10.1 percent)
- Provider Queries (8.9 percent)
- Regulatory Compliance (29.1 percent)
The CCS exam is considered significantly more complex than the CPC exam, with just 55 percent of people earning a passing score on the first attempt.
Ongoing CCS Certification Requirements
Continuing education is required to remain certified. CCSs must complete at least 20 hours of approved Continuing Education Units (CEUs) every two years. In addition, CCSs must complete an annual coding self-assessment.
How to Become a Certified Medical Coder (CMC)
The Certified Medical Coder (CMC) certification is less common than the CPC or CCS, but it’s increasingly recognized as a comparable certification. In fact, the CMC has an exam format that is thought to be more complicated than the other two exams (which are multiple choice).
Certifying Organization
The CMC certification is offered by the Practice Management Institute (PMI).
Prerequisites for CMC Certification
Before completing the CPC exam, applicants should have at least one year of professional experience in medical coding. PMI offers an introductory course called Principles of Coding for inexperienced coders. Although PMI provides preparatory courses for the CMC exam, those courses are not a prerequisite for taking the CMC exam.
Certifying Exam Details – CMC
The most significant difference between the CMC and the CPC or CCS exams is that they are not offered in a multiple-choice format. Instead, examinees must assess coding scenarios and be able to fill in the blanks accurately. The CMC exam is only offered in a live, proctored setting and is graded by hand and twice-verified. The CMC exam must be completed in six hours. Examinees must earn a minimum of 70 percent to become CMC-certified.
Ongoing CMC Certification Requirements
To maintain certification, CMCs must earn 12 CEUs annually and submit proof of completion to PMI.
Specialized Medical Coding Certifications – AAPC
The CPC, CCS, and CMC are among the most common certifications and can be necessary entry-level certifications for newer medical coders. However, many medical coders specialize even further to open more doors for career advancement and higher salaries. The AAPC and AHIMA offer more specialized certification exams for experienced coders.
Certified Outpatient Coder (COC)
The COC certification is specifically for coders working in hospital settings. The COC exam and certification indicate a high level of competency in coding specific to hospital groups, ambulatory surgical centers, and hospital billing and coding departments.
Certified Inpatient Coder (CIC)
As the name suggests, the CIC certification targets those working or wishing to work in inpatient settings. According to AAPC, the CIC “validates mastery in abstracting information from the medical record for ICD-10-CM and ICD-10-PCS coding. It also represents expert knowledge of Medicare Severity Diagnosis Related Groups (MS-DRGs) and the Inpatient Prospective Payment System (IPPS).”
Certified Professional Coder-Payer (CPC-P)
While medical coders have typically worked in healthcare provider settings, health insurance companies, and other healthcare payers are increasingly employing their own coders. The CPC-P certification is designed for those wanting to work on the payer side of the coding practice, demonstrating “proficiency and knowledge of coding guidelines and reimbursement methodologies for all types of services from the payer’s perspective.”
Certified Risk Adjustment Coder (CRC)
The CRC certification is specific to coders in the risk adjustment sector. CRC certification is awarded to those who pass an exam indicating knowledge of ICD-10-CM specific to risk adjustment models such as HCC, CDPS, and HHS Risk Adjustment.
Other AAPC Specialty Medical Coding Certifications
The AAPC also offers coding certifications in the following specialties:
- Ambulatory Surgical Center (CASCC)
- Anesthesia and Pain Management (CANPC)
- Cardiology (CCC)
- Cardiovascular and Thoracic Surgery (CCVTC)
- Chiropractic (CCPC)
- Dermatology (CPCD)
- Emergency Department (CEDC)
- Evaluation and Management (CEMC)
- Family Practice (CFPC)
- Gastroenterology (CGIC)
- General Surgery (CGSC)
- Hematology and Oncology (CHONC)
- Internal Medicine (CIMC)
- Interventional Radiology and Cardiovascular (CIRCC)
- Obstetrics Gynecology (COBGC)
- Ophthalmology (COPC)
- Orthopedic Surgery (COSC)
- Otolaryngology (CENTC)
- Pediatrics (CPEDC)
- Plastics and Reconstructive Surgery (CPRC)
- Rheumatology (CRHC)
- Surgical Foot & Ankle (CSFAC)
- Urology (CUC)
Specialized Medical Coding Certifications – AHIMA
Several specialized coding certifications are available through the American Health Information Management Association (AHIMA).
Certified Coding Associate (CCA)
The CCA certification is appropriate for entry-level coders in hospitals and physician offices. Before taking the CCA exam, a high school diploma and six months of professional coding experience are recommended.
Certified Coding Specialist – Physician-based (CCS-P)
The CCS-P certification has similar requirements to the CCS but is specific to those working in physician offices, group practices, or clinics rather than hospitals.
Medical Coding Certification Programs
Although most medical coding certifications do not require that applicants have a specific academic degree, those prospective medical coders who want to increase their value—particularly at the entry level—may want to consider an accredited college program.
Many colleges and universities offer professional certificates in medical coding, separate from the certification outlined above. In addition, not every school offers bachelor’s or master’s degrees in medical coding. Still, schools may provide relevant degrees such as health information technology (HIT) or health information management (HIM), including foundational medical coding and billing courses.
The following are a few top medical coding programs that can provide a solid academic basis for medical coding professionals.
California State University San Bernardino
Cal State San Bernardino offers an online medical coder certificate, including a voucher to take the CPC certification exam twice (if needed). The CSUSB professional medical coding & billing program is part of the extended learning education sector of the school and is offered online as a self-paced program. A one-year AAPC membership is included in the tuition, and students can begin the course anytime.
- Location: San Marcos, CA
- Duration: One year
- Accreditation: Western Association of Schools and Colleges (WASC)
- Tuition: $2,928-$4,326 total
Located in Arkansas City, Kansas, Cowley College offers a medical coding program as part of its health & human services and allied health programs. Students can earn a medical coding certificate or an associate of applied science (AAS) degree. It is important to note that the certificate offered by the college is different from a CPC or other certification, which would still need to be earned after completing the program.
- Location: Arkansas City, KS
- Duration: 18 months
- Accreditation: Higher Learning Commission (HLC)
- Tuition: $145-$255 per credit (depending on residency status)
With multiple campuses in Michigan, Davenport University also offers a health information program online. Students can select from a medical coding and billing certificate, an associate of applied science degree in health information technology, a bachelor of science degree in health information management, or a master of science in health informatics and information management.
In addition, students who choose to complete the BS can be prepared to take the Registered Health Information Administrator (RHIA) exam offered by the AHIMA.
- Location: Multiple campuses in Michigan
- Duration: 1-4 years (depending on the degree program)
- Accreditation: Commission on Accreditation for Health Informatics and Information Management Education (CAHIIM)
- Tuition: $928 per credit hour (residents); $627 per credit hour (non-residents after a tuition grant)
Minnesota West Community & Technical College
Located in Worthington, Minnesota, Minnesota West Community & Technical College offers an online medical coding specialist diploma that takes just one year. In addition, students can earn their associate of applied science as a medical secretary at the same institution. Courses include medical office procedures, medical terminology, clinical procedures, and medical assistant practicum.
- Location: Worthington, MN
- Duration: One year
- Accreditation: Higher Learning Commission (HLC)
- Tuition: $207.44 per credit
Western Governors University (WGU) offers a bachelor of science degree in health information management (HIM). Completing this four-year online program can make students eligible for the Registered Health Information Administrator (RHIA) credential. Students can transfer up to 33 credits and complete a bachelor’s degree in four years or less. Most students finish their HIM degree in 36 months and can choose to take courses part- or full-time.
- Location: Campuses in eight states in the USA
- Duration: Four years
- Accreditation: Commission on Accreditation for Health Informatics and Information Management Education (CAHIIM)
- Tuition: $3,998 per six-month term
