Posted by: Edelberg & Associates
The reality is that the coding credentials you should pursue should be based on your interests and area of specialization. There are different certifications for inpatient coding, outpatient coding, ambulatory coding and much more. These certifications each require a certain level of experience, plus satisfactory completion of an exam full of questions specifically related to that coding specialization.
However, there are a couple of broad certifications that provide a stepping stone to specialization, and medical coders would be wise to attain at least one of those as early as they can in their careers. We’ll explain some of these in detail below, but for now, suffice it to say the CPC or the CCS can open doors to all types of coding careers. All certifications are optional for coding professionals however, in this current coding landscape, it is becoming more and more mandatory for coders who would like to make this a career and make a good living.
Here is the definitive list of reputable medical coding certifications and what they mean, as researched and vetted by the Edelberg team.
American Association of Professional Coders (AAPC):
If you’re looking to begin your coding career, the AAPC is a great place to start. This highly reputable organization is the leader in coding certifications and offers a number of examinations to help you get certified and prove your coding expertise. Here are some of the most common coding credentials from the AAPC. You must obtain the first credential, CPC, before obtaining any of the specialty credentials.
Certified Professional Coder (CPC)
A CPC designation is a general coding certification that can also act as a gateway into all other types of physician coding expertise. This certification allows you to demonstrate a broad knowledge of coding concepts. Many people will start with this certification before they move into larger, more complex certifications. Those vying for this certification must pass the exam and have at least two years of work experience as a coder. Those who do not meet these qualifications must start with a CPC-A certification.
Certified Professional Coder Apprentice (CPC-A)
Those who do not have the required work experience to get their CPC certifications can apply to become Certified Professional Coder Apprentices. This means that the person has passed the CPC exam, but does not have the two years of work experience required to become a CPC. Once a person with this certification has two years of work experience, or 80 hours of a coding prep course (not CEU’s) and one-year on-the-job experience, they are eligible to become a full CPC.
Certified Outpatient Care (COC)
As more doctors are leaving private practice to work in hospital groups, they find themselves in ambulatory care positions. This is why it can be a good idea for coding professionals to get their COC designation. This certification emphasizes coding as it relates to accurate medical codes for diagnoses, procedures and services performed in the outpatient setting. Coding companies are constantly seeking people who have this certification, as people with these outpatient coding skill sets are in high demand. This certification was formerly known as CPC-H (Certified Professional Coder – Hospital Outpatient.)
Certified Inpatient Coder (CIC)
The CIC designation emphasizes inpatient hospital and facility coding. By attaining it, you have proven you have knowledge and experience abstracting information specifically as it relates to inpatient coding, making it an excellent certification for people interested in coding in an inpatient setting or remotely for inpatient groups. People who get this certification display superior knowledge of coding and compliance as it relates to inpatient systems.
Certified Emergency Department Coder (CEDC)
If you have sufficient knowledge and experience in ED coding, you are encouraged to get the CEDC designation. Having this designation means you have extensive experience coding surgical procedures performed by ED physicians, laceration repairs, fracture cares, moderate sedation and other things you may see in the ED. Typically, CEDC’s are one of the highest paid coding specialties.
Certified Risk Adjustment Coder (CRC)
Beyond basic medical coding, one of the most important roles in our field is that of the risk adjustment coding. With a CRC designation, you prove you understand the audit process for risk adjustment models, and you understand the impact of diagnosis coding on risk adjustment models. People who hold this certification often earn up to 40% more than non-credentialed coders.
Certified Professional Coder – Payer (CPC-P)
A CPC-P certification demonstrates a range of coding aptitude coding from a payer’s perspective. This is hugely important in the field, as it shows the coder can adjudicate provider claims effectively. The test covers coding accuracy and reimbursement methodologies, and people with this certification can earn up to 66% more than non-credentialed coders.
Certified Professional Biller (CPB)
Specifically for people interested in medical billing, this validation of expertise shows the person holding the credential understands various insurance plans, has a deep knowledge of coding guidelines and understands regulations surrounding medical billing.
Certified Professional Medical Auditor (CPMA)
CPMAs show they are prepared to conduct coding audits, proving they understand medical documentation, fraud, abuse and penalties as well as coding concepts and medical records. This is an excellent certification to hold, as companies depend on auditors to ensure compliance. As long as the field of medical coding exists, there will always be a need for people who are able to audit medical practitioners.
Certified Physician Practice Manager (CPPM)
People interested in managing a physician practice would be wise to go after their CPPM certification, which demonstrates a wide range of skills that go along with managing a physician’s practice. Some of these skills include human resources, compliance, revenue cycles, and general business processes. Those who hold this designation can increase their income potential as compared to those who do not and are employed in similar positions.
Certified Professional Compliance Officer (CPCO)
Specifically designed to manage scrutiny on Medicare/Medicaid fraud and abuse, holding this certification shows a mastery of the Office of Inspector General Compliance Guidance for Individual and Small Group Physician Practices, Clinical Laboratories and Third Party Billing Companies. It also shows the certification holder understands compliance program effectiveness, fraud and abuse laws and other regulations and risk areas.
American Health Information Management Association (AHIMA)
This organization seeks to advance the implementation of electronic health records and offers accreditation to those who aim to elevate the standards of clinical records. AHIMA’s certifications are outlined below.
Registered Health Information Administrator (RHIA)
A RHIA shows a person is an expert in managing patient health information and medical records. These professionals act as a critical link between providers, payers and patients. While this is not actually a coding certification, it can be useful for people who are interested in coding but would like to get a broader certification before they pursue specific coding certifications.
Registered Health Information Technician (RHIT)
Those who hold this certification show they can ensure the quality of medical records by verifying completeness, accuracy and proper entry into computer systems. Though not specifically a coding certification, the RHIT demonstrates a similar set of skills in being able to analyze patient care and costs, and may involve some specialized coding diagnoses and deep understanding of patent records for reimbursement and research.
Certified Coding Associate (CCA)
This certification showcases coding competency in any setting, which includes hospitals and physician facilities. It also displays commitment to the coding profession and is a great certification for those new to the coding field.
Certified Coding Specialist (CCS)
This distinction designates a professional coder within a facility setting, and is primarily for inpatient coding. As such, the coders are able to review patient records and assign codes for diagnoses and procedures, have a deep understanding of ICD-10-CM and CPT coding systems and understand medical terminology, disease processes and pharmacology. It is more specialized than the CCA.
Certified Coding Specialist – Physician-based (CCS-P)
The CCS-P designation means the certification holder has a distinct specialty in coding for physician-based settings such as physician offices or group practices. This certification is highly desirable as more physicians move beyond the hospital setting and need medical coders to assist them in these environments.
Certified Documentation Improvement Practitioner (CDIP)
People with a significant amount of experience can take the exam for this certification, which distinguishes those who are committed to improving and maintaining quality coding information. This certification can increase income potential for coders with experience.
Certified Health Data Analyst (CHDA)
Considered a prestigious distinction, coders can take the exam for this certification after reaching certain educational and experience thresholds. People who hold this certification prove they are able to combine the larger strategic vision with day-to-day coding details through dat analysis.
Certified in Healthcare Privacy and Security (CHPS)
Those reaching certain educational and experience requirements can apply for this certification, which denotes expertise in privacy and security programs in all types of healthcare organizations.
Certified Healthcare Technology Specialist (CHTS)
A person who holds this certification has proven he or she deeply understands health information technology (IT) workforce roles essential to the implementation and management of electronic health information. It is an ideal certification for those interested in the IT aspects of medical coding.
Association of Clinical Documentation Improvement Specialists
This association brings together people in the field of clinical documentation improvement.
Certified Clinical Documentation Specialist (CCDS)
Specially focused on documentation, those who hold this certification have proven a high level of skill and expertise across a wide range of specialized disciplines including physiology, pathophysiology and pharmacology. They also have extensive knowledge of coding guidelines and regulations and are able to analyze and interpret documentation accordingly.
National Academy of Ambulance Coding (NAAC)
This organization is committed to integrity and compliance in the ambulance industry. As such, it requires coders to hold a specific certification in order to designate professional distinction in the ambulatory coding field.
Certified Ambulance Coder (CAC)
This certification is for “front line” ambulance coding staff, such as those tasked with entering claims and the claims process. People who hold this certification demonstrate a mastery of a variety of ambulatory coding aspects, such as review of patient reports, selection of procedure codes, diagnosis and condition codes and modifiers, and more. Upper level management in ambulance transportation organization may also wish to hold this certification.
Coding Credentials are a Personal Choice
The type of coding credentials that is right for you are highly contingent upon your interests. The CPC and the CCS are generally good starting points, though you may not be able to apply for either of them until you have some experience under your belt and/ or an associates degree in coding.
From there, your specific interest should guide your direction. However, our experience shows CRC, CEDC, CPC-P and CCS-P are very in demand and require less experience than some of the other certifications.
If you are interested in learning more about opportunities as a medical coder with Edelberg, please see our careers page for information about openings.