By: Kathleen Gaines MSN, RN, CBC
Medical coders are essential members of the healthcare team, without proper medical coding, hospitals and physicians would not be properly reimbursed by insurance companies and patients could be saddled with large medical bills.
If you’re considering becoming a medical coder, one of the decisions you’ll have to make is deciding which coding certification is right for you. Keep reading to find out more information about medical coding and your certification options.
Part One What Is a Medical Coder?
Essentially, a medical coder is a translator, reviewing patients’ charts including all procedures, tests, surgeries, and diagnoses, and then coding them per the policy and procedure. This information is then sent to the healthcare system’s billing and the patient’s medical insurance.
The medical coder is a crucial part of the medical team because they review the patient’s file and translate everything from that file into universal codes required by insurance companies.
It is the responsibility of the medical coder to ensure that the right code is used every time and it’s the only way to ensure the insurance companies are billing properly.
Part Two What Are Medical Coding Certifications?
Medical coding certifications are considered the gold standard in the industry. While not required for all positions, certifications are nationally recognized by employers, government agencies, and medical groups.
Are Certifications Required?
A medical coding certification is not a requirement to earn a position as a medical coder, but certifications can help individuals get ahead in the profession and most employers do expect coders to become certified.
Certifications allow for advancement, increased job opportunities, and salary increases. Certification is also essential to top pay and longevity as a top medical coder.
What Are the Benefits to Getting Certified?
Despite certification not being a requirement, there are some significant benefits to becoming certified.
- Higher pay
- Greater employability
- Career advancement
- Personal growth
- Professional connections
- Increased job flexibility
- Increased educational opportunities
- Ability to work remotely from home
Part Three Types of Medical Coding Certifications
There are several medical coding certifications that test your knowledge on one of three code sets and one of three levels of code.
There are several medical coding certifications including:
- Certified Professional Coder (CPC)
- Certified Outpatient Coding (COC)
- Certified Inpatient Coder (CIC)
- Certified Coding Specialist (CCS)
- Certified Medical Coder (CMC)
To give you a better idea of the differences between the certification, let’s explore each of them individually.
Certified Professional Coder (CPC)
The Certified Professional Coder (CPC) is accredited by the American Academy of Professional Coders.
Who Is the CPC Right For?
The CPC is ideal for those medical coders interested in working in an outpatient setting such as a clinic or physician’s office. According to the AAPC, the CPC elevates the earning potential by more than $25,000 above other annual salaries. And it’s the most popular medical coder certification.
The CPC exam, previously only offered in person, is now offered online due to the ongoing COVID-19 pandemic. It costs between $299 to $399 depending on if you take it in-person or online.
Certified Outpatient Coding (COC)
The COC certification (formerly known as the CPC-H) is accredited by the American Academy of Professional Coders, indicates a high level of competency in coding specific to hospital groups, ambulatory surgical centers, and hospital billing and coding departments.
Who Is the COC Right For?
The COC certification is specifically for coders working in hospital settings.
The COC exam consists of 150 multiple-choice questions. You have 5 hours and 40 minutes to finish the exam. The exam costs $399 ($325 AAPC Students) and you get one free retake.
Certified Inpatient Coder (CIC)
The Certified Inpatient Coder (CIC) is the only credential dedicated exclusively to inpatient hospital/facility coding and is accredited by the American Academy of Professional Coders.
Who Is the CIC Right For?
As we mentioned, this certification is meant for those working in an inpatient hospital or facility and requires specific knowledge of inpatient coding, medical procedures, and inpatient procedures. It requires the correct application of ICD-10-PCS procedure codes and ICD-10-CM diagnosis codes used for coding and billing inpatient hospital services to insurance companies.
The CIC certification examination includes 60 multiple choice questions and 10 inpatient cases. You have 5 hours and 40 minutes to finish the exam. It costs $399 ($325 for AAPC Students) with one free retake.
Certified Coding Specialist (CCS)
Accredited by the American Health Information Management Association (AHIMA), the Certified Coding Specialist (CCS) certification codes medical data used by hospitals and medical providers to obtain reimbursement from insurance companies or government programs such as Medicare and Medicaid.
Who Is the CCS Right For?
The Certified Coding Specialist (CCS) certification is for medical coders experienced in coding both inpatient and outpatient records.
According to AHIMA, candidates must meet one of the following eligibility requirements in order to sit for the CCS examination:
- Complete courses in all the following topics: anatomy & physiology, pathophysiology, pharmacology, medical terminology, reimbursement methodology, intermediate/advanced ICD diagnostic coding, and procedural coding and medical services (CPT/HCPCS)
- Minimum of two years of related coding experience directly applying codes
- Hold the CCA credential plus one year of coding experience directly applying codes
- Hold a coding credential from another certifying organization plus one year of coding experience directly applying codes
- Hold a CCS-P, RHIT, or RHIA credential
The exam consists of a multiple-choice section and a medical scenario section. It’s a four-hour, timed exam. And you need a score of at least 300 in order to pass.
Certified Medical Coder (CMC)
Considered one of the most common and popular medical coding certifications, the Certified Medical Coder (CMC) certification is offered by the Practice Management Institute (PMI).
Who is the CMC Right For?
This specific certification, despite its appeal, is considered more difficult than other medical coding certification examinations because of the testing format. The CMC certification is solely for medical coders in the outpatient setting.
Because of the rigor of the exam, the PMI offers a review course to help prepare for the exam. While not mandatory, it is highly encouraged for success.
According to the PMI website, the are several benefits to earning a CMC including,
- A CMC protects the practice’s financial health by decreasing claim denials and improving billing accuracy and compliance with current guidelines
- A CMC does not rely on EHR presets, web searches or coding cheat sheets for coding assignments, which can cause repeat problems and trigger an audit
- A CMC communicates with confidence with physicians, third-party payers, patients, and business associates, which promotes advancement into chart auditing and supervisory roles.
The exam consists of 133 questions and you need a score of 70 percent or higher in order to pass.
Part Four How to Choose the Right Certification?
With several different medical coder certifications available, it can be confusing to know which is the best fit for you.
You'll want to become certified in the setting you desire to work in. For example, the CPC is for the outpatient setting while the COC is for the hospital inpatient setting.
Certification also demonstrates important foundational knowledge of medical coding. Medical coders can earn multiple certifications as long as they meet the eligibility criteria for each.
Part Five Resources for Medical Coders
Deciding to earn a medical coding certification can be scary and require a lot of prep work. However, the benefits can be substantial for your career and financial future. Check out these organizations for additional information regarding medical coding, medical coding careers, and certifications.
- American Association of Professional Coders
- Healthcare Billing and Management Association
- The Professional Association of Healthcare Coding Specialists
- American Association of Professional Coders
- American Health Information Management Association
- Medical Group Management Association
- How to Get Started in Medical Billing and Coding
- Medical Billing & Coding Careers & Growth Opportunities
- Medical Billing & Coding Explained: Codes & Fundamentals
- How to Get Your First Medical Billing & Coding Job