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 specified codes to different medical procedures to keep effective medical records and ensure that bills and payments are accurate.
But what it lacks in drama, the career makes up for stability and growth. According to the Bureau of Labor Statistics (BLS 2021), the number of positions for medical records and health information specialists—including medical coders—is expected to grow 9 percent nationally from 2020 to 2030. Medical coders are required in virtually every private practice, hospital, and clinic. After gaining some experience, many coders are even able to work from home, which adds to the appeal of this profession for many.
However, for someone with little to no experience, medical coding certification is a critical step to take. Certification can improve an applicant’s chance at 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 code sets that are currently in use: 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. The right certification for any coder ultimately depends on a candidate’s experience and intended specialization.
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 not earned a certification. Certification demonstrates an important foundational knowledge of the three aforementioned key code sets, meaning that certified medical coders can be more efficient and by extension, offer more value to their employer.
There are several different certifications that prospective medical coders can choose to pursue, although 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 the healthcare setting a coder chooses, so it is important that students seeking certification choose the one that matches their ultimate goals.
How to Become a Certified Professional Coder (CPC)
The Certified Professional Coder (CPC) certification may be an ideal path 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 the field of medical coding.
The CPC certification is offered by the American Academy of Professional Coders (AAPC), which is the largest organization of its kind with more than 200,000 members.
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 existing experience in the field of medical coding.
It is important to note that successful completion of the CPC exam is not enough to qualify the examinee as a Certified Professional Coder. Those that choose to take the exam without first 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. Sitting for the CPC exam costs $399 ($325 AAPC Students).
Certifying CPC Exam Details
The CPC exam consists of 150 questions, divided into 12 distinct sections, including:
- Surgical procedures (60 questions)
- Evaluation and management (10 questions)
- Anesthesia (8 questions)
- Radiology (10 questions)
- Pathology and Laboratory (10 questions)
- Medicine (10 questions)
- Medical terminology (8 questions)
- Anatomy (8 questions)
- ICD-10, volumes 1 and 2 (10 questions)
- HCPCS Level II Codes (5 questions)
- Coding guidelines (6 questions)
- Compliance and regulation (5 questions)
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.
Ongoing CPC Certification Requirements
Continuing education is required to remain certified. CPCs must complete at least 36 hours of approved Continuing Education Units (CEUs) every two years. CEUs may be earned 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 most comparable to the CPC.
The CCS is available through the American Health Information Management Association (AHIMA).
Prerequisites for CCS Certification
To sit for the CCS exam, a coder must 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 plus one year of medical coding experience
As with the CPC, examinees must be members of the AHIMA to sit for the exam. Member price is $299, while non-members pay $399.
Certifying CCS Exam Details
The CCS exam covers four main domains, including:
- Coding Knowledge and Skills
- Coding Documentation
- Provider Queries
- Regulatory Compliance
The Coding Knowledge and Skills domain comprises the largest portion of the exam at up to 51.9 percent of the questions. The pass rate for first-time testers in 2020 was 83 percent. The passing score for the CCS exam is 300.
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 year. 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 either the CPC or CCS certifications, but it’s increasingly recognized as a comparable certification. In fact, the CMC has an exam format that is thought to be more difficult than the other two exams (which are multiple-choice).
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 offers 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 exam and the CPC or CCS exam is that it is not offered in a multiple-choice format. Rather, examinees must assess coding scenarios and be able to fill in the blanks accurately. The CMC exam is also only offered in a live, proctored setting.
The CMC online preparatory course comprises 21 hours of high-level coding instruction and practice exercises led by a PMI-approved Instructor. Examinees must earn a minimum of 70 percent to become 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 act as important entry-level certifications for medical coders who are newer to the profession.
However, in order to open more doors for career advancement and higher salaries, many medical coders choose to specialize even further. The AAPC and AHIMA offer more specialized certification exams for experienced coders.
Certified Outpatient Coder (COC)
The COC certification (formerly known as the CPC-H) 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)
The CIC certification, as the name suggests, is targeted to those working or wishing to work in inpatient settings. According to AAPC, the CIC “validates expert-level knowledge and experience in abstracting information from the medical record for ICD-10-CM and ICD-10-PCS coding, and specialized payment knowledge in MS-DRGs and Inpatient Prospective Payment Systems (IPPS).”
Certified Professional Coder-Payer (CPC-P)
While medical coders have typically worked in healthcare provider settings, increasingly health insurance companies and other healthcare payers are 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 those coders working 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
There are several specialized coding certifications available through the American Health Information Management Association (AHIMA) as well.
Certified Coding Associate (CCA)
The CCA certification is appropriate for entry-level coders in both hospital and physician office settings. A high school diploma, as well as six months of professional coding experience, are recommended before taking the CCA exam.
Certified Coding Specialist – Physician-based (CCS-P)
The CCS-P 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, which are separate from the certification outlined above. Bachelor’- or master’s-level degrees in medical coding are not available, as such, but many schools offer relevant degrees such as health information technology (HIT) or health information management (HIM) which do include foundational courses in medical coding and billing. Following are a few of the top medical coding programs that can provide a strong academic basis for medical coding professionals.
Located in Arkansas City, KS, Cowley College offers a medical coding program as part of their health & human services and allied health programs. Students can earn a medical coding certificate or an associate of applied science (A.A.S.) degree. It is important to note that the certificate offered by the college is not equivalent to a CPC or other certification, which would still need to be earned after completing the program.
The AAS degree program is made up of 65 credits, while the vocational certificate comprises 36 credits. The curriculum includes courses such as health care finance; pharmacology; pathophysiology; medical terminology; legal and ethical issues in healthcare; bioethics; and introduction to health information.
All courses in the program are taught by experienced instructors who have worked in the healthcare field for more than three decades bringing necessary experience from the industry. Upon successful completion, graduates will be ready to seek work as medical coders.
- Location: Arkansas City, KS
- Accreditation: Higher Learning Commission
- Expected Time to Completion: Certificate (with 12 months); AAS (24 months)
- Estimated Tuition: Cowley County residents ($114 per credit); other Kansas residents ($125 per credit); Oklahoma residents ($135 per credit); other state residents ($173 per credit)
The campus for Davenport University is located in Grand Rapids, MI but the school’s health information programs are available online. Students can select from an AAS degree in health information technology or a bachelor of science degree in health information management. Students who choose to complete the BS can be prepared to take the Registered Health Information Administrator (RHIA) exam, offered by the AHIMA.
The AAS degree is consists of 69 credits, while the BS requires completion of 120 credits. The curriculum includes courses such as anatomy and physiology with human disease; medical terminology; introduction to health information management; health information technology; health care management; and presentation techniques.
Students in the bachelor’s degree program will also have the option to choose from three available specialties: cancer tumor registry, revenue management, or global project management. Graduates of both these programs will gain the skills needed to become medical coders through courses like ICD coding and CPT/HCPCS coding.
- Location: Grand Rapids, MI
- Accreditation: Higher Learning Commission; Commission on Accreditation for Health Informatics and Information Management Education (CAHIIM)
- Expected Time to Completion: AAS (5 semesters); BS (eight semesters)
- Estimated Tuition: Michigan residents ($836 per credit); non-Michigan residents ($565 per credit)
Minnesota West Community & Technical College
Minnesota West Community & Technical College offers an online medical coding specialist diploma. Earning the diploma takes just one year. Students completing this diploma can go on to earn their associate of applied science as a medical secretary at the same institution.
It is recommended that students have prior knowledge of the basic elements of spreadsheets, word processing, document integration, and databases, along with the basic concepts of telecommunications and graphics.
Made up of 34 credits, the curriculum includes courses such as body structure & function; medical terminology in healthcare; introduction to medical coding, billing & insurance; CPT/HCPCS coding; diagnosis coding; introduction to health records; and pharmacology among others.
- Location: Worthington, MN
- Accreditation: Higher Learning Commission
- Expected Time to Completion: 12 months
- Estimated Tuition: $200.85 per credit
California State University San Bernardino
Cal State San Bernardino is another accredited institution that offers an online certificate (not certification) as a medical coder. Offered in partnership with CareerStep, the CSUSB professional medical coding & billing with PCS program is part of the professional & continuing education sector of the school and takes place completely online. The total time necessary to complete this training is 390 hours.
As part of the program, students will delve into topics such as health information management; reimbursement methodologies; medical terminology; ICD-10 coding; CPT/HCPCS coding; healthcare delivery systems; and advanced ICD-10 coding.
The additional PCS training included in this program puts students a step ahead in the job market because not many entry-level coding certificates include this ICD-10-PCS training. With this course, students will be prepared to work in both hospitals and physician practices, making them more marketable as they consider job options, as well as advancement opportunities.
- Location: San Bernardino, CA
- Accreditation: Western Association of Schools and Colleges
- Expected Time to Completion: 390 clock hours
- Estimated Tuition: $3,699
Western Governors University (WGU) offers a bachelor of science degree in health information management. Completion of this four-year online program can make students eligible for the Registered Health Information Administrators (RHIA) credential. Students in this program will learn about the technology and business side of healthcare and how health information management impacts providers, payers, and patients.
To get accepted into the program, applicants must possess a high school diploma or its equivalent and be able to demonstrate healthcare, IT, or business experience through either an associate degree in an allied health field, or current active HIM or revenue cycle industry certifications, or one year of administrative healthcare-related work experience.
The curriculum consists of 36 courses. Sample some of the courses in the curriculum: introduction to medical coding; foundations in healthcare information management; pathophysiology; healthcare ecosystems; anatomy and physiology; healthcare financial resource management; and organizational leadership in healthcare.
- Location: Millcreek, UT
- Accreditation: Northwest Commission on Colleges and Universities (NWCCU); Commission on Accreditation for Health Informatics and Information Management Education (CAHIIM)
- Expected Time to Completion: 24 to 36 months
- Estimated Tuition: $15,180