Six Steps to Becoming a Certified Medical Coder

If you've always wanted to be involved in the health care industry but you would rather explore the more clerical aspects instead of the more clinical (administering shots or taking part in the operating room), a career in medical coding and billing might be just what you're after.

Medical coding and billing are the lifeblood of the health care industry. Without these dedicated professionals to navigate the bureaucracy and financial needs of the medical provider, doctors and nurses simply wouldn't be able to perform their duties in an efficient manner.

Medical coding is the process of assigning codes that describe both diagnoses (the condition or medical problem a patient has) and procedures or services rendered to the patient (office visit, consultation, urine test, biopsy, major surgery).

Medical Billing is the process of submitting these specific codes to insurance companies and then following them through to obtain payment.

Assuming that you are starting from square one, here's a step-by-step path to becoming a medical coder:

1. Education

Education is the first step on the road to a career as a medical coder. Start by looking for classes in your area. You can either look into a coding certificate program or obtaining an associate degree in the field. Your options will vary depending on what's available where you live. You should be able to find a technical school or a trade school where you can learn the necessary skills. Many of these schools even offer classes online, so you may well be able to attain certification without so much as leaving home. Given that the job consists of clerical work, there's not much that you can learn in the classroom that you can't learn from the comfort of your home office.

Review the types of medical coding certificates that are available to determine if you want to certify as a hospital coder or physician-based coder. For the purposes of this article, we will assume you are looking to certify as a physician-based medical coder (working in an outpatient/in-office setting).

A good medical coding study program will include at least the basics, which are as follows:

a.  HIPAA (Health Insurance Portability Accountability Act) related to patient confidentiality.
b.  Medical Terminology
c.  Anatomy and Physiology
d.  Pharmacology
e.  ICD-9-CM and ICD-10-CM (Diagnostic Coding)
f.  CPT (Procedural Coding)
g.  Practical Application of Learned Skills or a Skills Assessment Practicum
h.  Computer Software Programs Typically Used by Medical Coders (Encoders, EMR, etc.)
e.  Healthcare Reimbursement Methodologies

2. On-The-Job Experience

Although the ultimate goal is to become a fully credentialed medical coding professional by applying for and taking the national certifying examination, attaining on-the-job experience is important and usually required.

Verify through the certifying body you intend to test with how much on-the-job experience you are required to attain before sitting for the examination. Some of the better schools offer some great programs for finding internships and entry level positions in medical coding. If your school isn't one of these, then you'll have to browse the classifieds yourself to find medical coding work.

Successfully passing a national certification coding examination indicates that you have acquired an understanding of medical coding throughout all general medical and specialty fields of medicine.  You don't have to know everything, but you do have to know the basics.  Continuing to review your educational materials while gaining practical, on-the-job, experience are key factors in being prepared for national certification testing.

3. Selecting a National Certifying Body for Testing

Selecting the right national certifying body is important and we suggest you go to each website and review the details of what is required to sit for the exam with each of them.  There is an application process, fees to be paid, deadlines, timelines and instructions for taking the exams.  You can locate, and we suggest you do, study guides to review and practice tests to take to see how you fare and if you are ready for the actual exam.

There to two major national certifying bodies: American Academy of Procedural Coders (AAPC) located in Salt Lake City and the American Health Information Management Association (AHIMA) located in Chicago.

Both have criteria that must be met in order to sit for the national certification exam.

AAPC prefers you have experience of up to two (2) years or that you sit for the apprentice exam (CPC-A) and then attain work experience. If you opt for the CPC-A, you will then apply any on-the-job experience to meet the requirement to have your CPC-A convert to a fully credentialed CPC. The alternative is to attain on-the-job experience and then test to attain the CPC credential and skip the status of apprentice altogether.

AHIMA requires experience or the equivalent of experience through a medical coding training program that provides a specific number of hours practicing what is being learned. The credential you will attain is that of CCS-P when you pass the examination.

If you have worked hard, studied hard, and continued to review the information you learned throughout your education, you should be ready to take the exam.

4. Registering for the Exam

Once you have determined if you will test with AHIMA or AAPC, and you can test with both if you like, it is time to apply for the examination.

If you choose to test with the American Academy of Procedural Coders (AAPC), you can go to their website at http://www.aapc.com and select from the menu 'certification.'  There you can read all about the testing process and find instructions on how to apply for it.  You can determine which test to sit for, fees associated with testing and the where testing will take place.

If you choose to test with the American Health Information Management Association (AHIMA), you can go to their website at http://ahima.org and select 'certification' from the menu.  There you can read about the various certifications they offer, examination requirements, cost, and more.

Whichever certifying body you choose, when you pass certification, your credentials will be well respected in the coding industry.

5. Taking the Exam

All that's left is taking the exam.  Make sure to show up on time and well prepared with the coding books and reference materials you are allowed to bring. Be sure to read the instructions carefully as you will only be allowed to bring into the examination the specified materials and nothing more.

The physician-based medical coder exam through AAPC is called the CPC exam. AAPC allows up to six hours for exam completion, which consists of 150 multiple choice questions.

The physician-based medical coder exam through AHIMA is called the CCS-P exam. AHIMA allows up to four hours (no breaks) for exam completion, which consists of approximately 109 questions including multiple choice coding, billing, reimbursement and medical record cases.

Once the examination is completed it will be graded and your pass or fail status reported to you via your contact information.  Upon passing you will receive an official certificate, which you can proudly display in your office or home and provide to your employer for proof of credentials and your official title will then be added to the end of your name on resumes, coding information, applications, etc.

6. Continuing Education

Each certifying body and certificate carries with it a requirement for continuing education (CE). Continuing education units (CEUs) are assigned to each CE opportunity. Each website lists the annual or bi-annual CEU requirements needed to maintain your coding credential along with a list of approved activities and how many CEUs they are worth.

At the end of each re-credentialing period you will turn in your CEUs to the certifying body along with renewal fee and they will validate your credentials for another period.

For Your Information

The system in place for assigning codes to medical diagnoses and conditions has been ICD-9-CM (International Classification of Diseases, Ninth Revision, Clinical Modifications), implemented with annual updates since 1979. It is antiquated and in serious need of an overhaul. As a result, the World Health Organization (WHO), who is responsible for these codes, created ICD-10 and implemented it, internationally, in 1992. The United States has finally made and accepted changes, specific to the needs of the United States healthcare system and has set a date for implementation for 2014.

The change from ICD-9-CM to ICD-10-CM is enormous and will have significant impact on all areas of healthcare. Therefore, any program you undertake to learn medical coding should also include instructions on the use of ICD-10-CM.

Although it may sound imposing, the WHO makes it relatively easy to study the ICD-10 with a number of resources like on-line training support and study guides. Remember implementation of ICD-10-CM is not until 2014 so there is still plenty of time to study and prepare for this great change. Medical coders are not required to memorize the codes contained in these code sets but rather understand the process of locating the proper codes within them using the guides and indexes available.

What you learn as a coder is how to search and determine if the result of your search is an accurate, applicable, and reportable code describing the services rendered for the determined diagnosis in the most accurate way.

As medical coders will be in high demand for years to come, you have plenty of time to determine if this is the right career path for you.

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Aimee Wilcox, MA, CST, CCS-P is a Certified Coding Guru (CCG) for Find-A-Code. For more information about ICD-10-CM, ICD-10-PCS, and medical coding and billing please visit FindACode.com where you will find the ICD-10 code sets and the current ICD-9-CM, CPT, and HCPCS code sets plus a wealth of additional information related to medical billing and coding.

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