The Guide to Medical Coding and Billing Certifications

A certification in billing and coding is an excellent approach to gain a competitive advantage in the healthcare industry employment market. This certificate confirms that you have the abilities and expertise to execute a job successfully. That can give you a career boost whether you are looking for your first job or your tenth.

Not only does getting the proper certification improve your chances of landing a job, but it could also mean a better salary when you do. Employers see certification as a sign that you can do the job and that you are serious about it.

The downside to considering certification is the sheer magnitude of certification options out there. Consider some of the top certifications that can give you a leg up on the competition.

What Is a Medical Coder?

Medical coding is one of the most perplexing parts of healthcare to the general population. They don’t write TV shows about these healthcare specialists. People don’t see them as heroes like other career professionals. If anything, they may cast a negative light on them because they have a hand in the billing, and nobody likes to pay bills.

However, the work medical coders do is a critical part of the healthcare system. They translate reports from healthcare providers into universal codes for more accurate medical records and billing.

In order to process a bill after a medical professional evaluates or treats a patient, the insurance company or government provider must understand what was done. Coding uses an alpha-numeric system that provides more precise information than just writing it out. Words are subject to interpretation; codes are not. Enrolling in a certification program can enhance your career in this important field.

What Is a Medical Coding Certification?

A medical coding certificate program tests and confirms your knowledge in this field. There are several medical coding certificates available. Each one tests your knowledge and soft skills on a variety of code sets, which can include:

• Current Procedural Terminology (CPT) – The CPT code set for treatments and services.
• International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) – ICD-10-CM is a medical coding system to identify symptoms, diagnoses, and operations that occur in the hospital system in the United States.
• Healthcare Common Procedure Coding System (HCPCS) – HCPCS is a series of health care procedure codes based on the CPT system.

Learning these coding systems is like learning a new language. Testing ensures you understand the codes. You can earn a credential in general code sets or a specialty medical coding to demonstrate your degree of skill in your specific subject.

Types of Medical Code Certifications

There are a variety of coding certifications you can take once you complete your studies. Once you pass a test and get a certificate, you add the acronym to your name, such as Jane Smith CPC.

There are two primary certifying organizations to consider: AAPC and AHIMA.

Certification Exams from the AAPC

Certified Professional Coder (CPC)

The CPC certification exam is a general test that covers a variety of codes, including:

• CPT procedure codes
• HCPCS Level II supply codes
• ICD-10-CM diagnosis codes

During the exam, you will refer to authorized coding books, including the American Medical Association’s CPT® Professional Edition and your choice of ICD-10-CM and HCPCS Level II code guides. To succeed, you must finish the CPC test in 4 hours and correctly answer 70% of the questions.

To pass the exam, you must have a thorough knowledge of services provided in the office by doctors and other authorized healthcare practitioners and professional-fee coding for institutional settings, such as a hospital.

The CPC certificate program has fewer prerequisites than other certifications and is geared for the coder just starting their career.

Certified Outpatient Coding (COC)

The COC exam focuses on outpatient hospital coding. It requires knowledge of general coding plus Ambulatory Payment Classifications (APCs), payment status indicators, and MS-DRGs. Coders with this certification tend to work in ER departments, outpatient clinics and centers, and ambulatory surgery units. This test does not cover ICD-10-PCS and DRG code assignment because they focus on inpatient care.

This exam tests everything from medical terminology to codes and compliance regulations. It will also require you to code ten cases accurately.

Certified Inpatient Coder (CIC)

A coding professional with a CIC certification specializes in inpatient care such as hospitals or long-term care facilities. The CIC verifies knowledge of ICD-10-CM and ICD-10-PCS coding. It also demonstrates expertise in the understanding of Medicare Severity Diagnosis Related Groups (MS-DRGs) and the Inpatient Prospective Payment System (IPPS).

Along with inpatient coding, you must know the IPPS, medical terminology, and human anatomy. These are necessary to assign codes accurately.

Certified Coding Specialist (CCS)

The CCS exam is similar to the CPC but for the more experienced coder. The CPC is the definitive test for someone just out of school and looking for their first job. The CCS has more prerequisites, such as two years of coding experience, additional education in anatomy, pathophysiology, medical terminology, medical services, pharmacology, and procedural coding. Individuals with this certification tend to work in hospitals.

There are also a number of specialty certifications available. These exams allow you to specialize in a medical discipline such as dermatology or cardiology and take a certification exam specific to that study.

Certification Exams from the AHIMA

Certified Coding Associate (CCA)

This exam is for entry-level coders who want to work in either a physician’s office or a hospital. This test assesses competence in supporting the coding and billing process, assigning codes for diagnosis and treatments, preventing fraud through billing audits, and submitting claims for payment.

Certified Coding Specialist (CCS)

This certification validates advanced abilities in categorizing medical data from patient records, which is often done in a hospital context.

Certified Coding Specialist – Physician-Based (CCS-P)

CCS-P Certification is similar to the CCS certification but with a focus on coding necessary for physician’s offices and other types of private practice such as healthcare groups, multi-specialty clinics, and specialty centers.

It is not unusual for a professional medical coding and billing specialist to have certifications for both organizations. The more proof you have of your proficiency in this field, the better the opportunities.

Start Your Journey Today

Of course, a medical coding and billing career doesn’t start with certification. You must first get the proper education. Bryant & Stratton College’s medical reimbursement and coding associate degree program prepares students for entry-level careers in medical billing and coding and other sectors of the healthcare profession.

Find out more by going online to read more about the program or contacting us for more information.