Guide to Medical Coding Certification

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 in order to keep effective medical records and ensure that bills and payments are accurate.

But what it lacks in drama, the career makes up for in stability and growth. According to the Bureau of Labor Statistics (BLS Oct. 2017), the number of positions for medical records and health information technicians—including medical coders—is expected to grow 13 percent from 2016 to 2026. 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 applicants chance at landing a job and can come along with a higher salary. In order 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 that 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 a number of 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 with 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

Certifying Organization

The CPC certification is offered by the American Academy of Professional Coders (AAPC), which is the largest organization of its kind with more than 170,000 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. In order 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 cost of membership is $80 for active students and $150 for non-students.

Certifying CPC Exam Details

The CPC exam consists of 150 questions, divided into 12 distinct sections, including:

  1. Surgical procedures (60 questions)
  2. Evaluation and management (10 questions)
  3. Anesthesia (8 questions)
  4. Radiology (10 questions)
  5. Pathology and Laboratory (10 questions)
  6. Medicine (10 questions)
  7. Medical terminology (8 questions)
  8. Anatomy (8 questions)
  9. ICD-10, volumes 1 and 2 (10 questions)
  10. HCPCS Level II Codes (5 questions)
  11. Coding guidelines (6 questions)
  12. Compliance and regulation (5 questions)

An overall score of 70 percent is required in order 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 in order 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.

Certifying Organization

The CCS is available through the American Health Information Management Association (AHIMA).

Prerequisites for CCS Certification

In order 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 in order to sit for the exam. Membership costs $175 for uncertified individuals and $10 for renewing members.

Certifying CCS Exam Details

The CCS exam covers eight main topics, including:

  1. Health information documentation
  2. Diagnosis and procedure coding
  3. Guidelines and reporting requirements for inpatient services
  4. Guidelines and reporting requirements for outpatient services
  5. Data and quality management
  6. Information technologies
  7. Privacy, confidentiality, legal, and ethical issues
  8. Compliance

Diagnosis and procedure coding comprises the largest portion of the exam at up to 68 percent of the questions. The CCS exam is thought to be significantly more difficult than the CPC exam, with just 56% of people earning a passing score on the first attempt.

Ongoing CCS Certification Requirements

Continuing education is required in order 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).

Certifying Organization

The CMC certification is offered by the Practice Management Institute (PMI).

Prerequisites for CMC Certification

Prior to 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 exam consists of approximately 133 questions. Examinees must earn a minimum of 70 percent in order to become certified.

Ongoing CMC Certification Requirements

In order 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 a 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)
  • Orthopaedic 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 prior to 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 may 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.

Cowley College

Located in Arkansas City, KS, Cowley College offers a medical coding program as part of their health & human services and allied health programs. Students are able to 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 subsequent to completing the program.

Davenport University

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 A.A.S. degree in health information technology or a bachelor of science degree in health information management. Students who choose to complete the B.S. can be prepared to take the Registered Health Information Administrator (RHIA) exam, offered by the AHIMA.

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.

California State University San Bernardino

Cal State San Bernardino is another accredited institution that offers a certificate (not certification) as a medical coder. The CSUSB professional medical coding & billing 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 640 hours.

Western Governors University

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. Graduates of the WGU program also earn the CompTIA Project+ certification for their project management experience. Notably, the WGU program is accredited by the Commission on Accreditation for Health Informatics and Information Management Education.