You’ve decided to become a medical coder. You’re in it for the flexible schedule, the good salary, and the ability to work from home. Your first step towards your new career is understanding what it takes to become certified.
Here is your comprehensive guide to medical coding certification.
Why Should You Get Certified?
While certification is not technically required to be a medical coder, it is crucial to remaining competitive. A recent American Academy of Professional Coders (AAPC) survey of 18,000 coders found that certified coders have lower unemployment rates than uncertified coders.
Coders without certifications earn $7,000 less annually than those with certifications. Plus, the more credentials you have, the more you can expect to earn. The same AAPC survey found that on average, nationwide, salary increases dramatically with additional certifications.
- Coders with any single certification earned $46,899 per year.
- Coders with any two certifications earned 25% more on average than those with single certifications.
- Coders with any three or more certifications earned 12% more on average than those with two certifications.
In addition to improving your job prospects and earning potential, getting certified as a medical coder has other advantages.
- Ensures you have a strong foundation in current standards and protocols.
- Improves your ability to catch and correct coding errors.
- Connects you, through your certifying organization, to a network of other healthcare professionals.
- Improves your ability to advance in your career.
What Certification Should You Get?
There are a variety of coding certifications out there.
This guide focuses primarily on the two most popular certifications: the Certified Professional Coder (CPC) and the Certified Coding Specialist (CCS). They are the two gold-standard certifications that will open up opportunities for you as a medical coder. There are also a variety of other specialized certifications.
How do you know which one is right for you?
Though CPCs generally code in a physician’s office and CCSs tend to be more in demand in hospitals, either certification is acceptable for a wide variety of positions.
The CPC is the most popular certification option for coders who are interested in working in an outpatient setting. It will prepare you to process and improve the profitability of outpatient data in a doctor’s office or a private medical clinic.
CPCs take on many tasks:
- Accurately code physician and medical clinic data.
- Ensure compliance and quality in all coded data.
- Identify and report medical records errors.
- Reconcile patient charges and minimize data-based insurance rejections.
- Master ICD-10, Current Procedural Terminology (CPT), and Healthcare Common Procedures Coding System (HCPCS) Level II coding systems.
The CPC exam covers 12 primary areas of knowledge:
- Surgical procedures performed on all body systems
- Evaluation and management
- Medical terminology
- ICD-10 Volumes 1 & 2
- HCPCS Level II Codes
- Coding guidelines
- Compliance and regulation
The CCS is the certificate to go for if you are more focused on inpatient coding. This will prepare you to classify and process data from hospital medical records.
- Help hospitals maintain rigorous standards for accuracy and consistency in data.
- Monitor compliance and quality measures.
- Identify and prevent coding errors.
- Improve hospital profitability.
- Master ICD-10-CM and CPT coding systems.
The CCS certification exam is extensive and much more difficult than the CPC exam. It contains more complex, situation questions and covers topics in eight domains:
- Health information documentation
- Diagnosis and procedure coding (64%-68% of the test)
- Guidelines and reporting requirements for inpatient services
- Guidelines and reporting requirements for outpatient services
- Data and quality management
- Information technologies
- Privacy, confidentiality, legal, and ethical issues
Certified Professional Coder vs. Certified Coding Specialist
Here’s a comparison of the two certifications.
|Certified Professional Coder (CPC)||Certified Coding Specialist (CCS)|
|Typical career settings||
|Education or experience requirements||Two years professional experience or enrollment in an apprentice program.||
|National average salary range, once certified||$27,419 – $51,753||$29,883 – $64,090|
|Certifying body||American Academy of Professional Coders (AAPC)||American Health Information Management Association (AHIMA)|
|Annual membership dues||$80 for students pursuing a certificate or degree; $150 for individuals who are not.||$175 for individuals without an AHIMA certification; annual re-certification costs an additional $10.|
|Exam difficulty||Medium: According to an AAPC representative, first-time test takers that use AAPC prep materials pass 80% of the time, on average.||Difficult: Only 56% of first-time test takers pass the CCS exam on the first attempt.|
|Recertification requirements||36 continuing education units (CEUs) every two years; AAPC applies a broader definition of what counts towards CEUs than AHIMA.||20 continuing education units (CEUs) annually and two coding self-reviews; AHIMA has stricter regulations on CEUs and stresses an annual recertification process.|
You may choose to branch out from the most popular certifications. The credentials in this section are common secondary certifications, achieved after gaining a CPC or CCS.
The Certified Coding Associate credential offered by AHIMA will give novice coders a foot in the door. You only need six months coding experience to sit for the CCA exam. It provides entry-level competency in coding across all medical settings.
A relatively new certification, Certified Inpatient Coding (CIC) is the AAPC’s answer to the CCS. This certification helps you gain proficiency in inpatient coding for hospitals. CIC isn’t as recognized as the CCS, but it’s gaining traction.
A physician-based Certified Coding Specialist is AHIMA’s mastery-level certification for those coding in physicians’ offices and other outpatient settings. It offers more in-depth training in physician coding than the AAPC’s CPC.
A Certified Risk Adjustment Coder demonstrates expertise in auditing and coding for different risk adjustment models, such as Hierarchical Conditions Categories (HCC). Building off of foundational medical coding knowledge, this AAPC certification prepares you for more in-depth analysis of the interrelationship between diagnoses and revenue.
Certified Outpatient Coding (COC), offered by the AAPC, prepares you for specialized medical coding demands in outpatient settings, such as ambulatory surgery facilities, physical therapy centers, and other clinics in which physicians are connected to a hospital group. It is generally pursued by those who already have CPC certifications.
A Certified Professional Coder with a specialty in payers is a unique AAPC certification. While other credentials prepare you to work in a medical environment, the CPC-P credential allows you to work for insurance companies and other health plans. As a CPC-P, you’ll learn the intricacies of coding from the payer’s perspective.
The AAPC also offers 22 specialty coding certifications. These certifications give you in-depth knowledge of and proven expertise in specific medical areas:
Which path is the best for you?
The best credentialing route for you to take depends on your interests and location.
- Decide what area of medical coding interests you.
- Outpatient medical coding generally takes place in a physician’s office or medical clinic outside of a hospital. If you are interested in this kind of coding, the most common route for you is to become a Certified Professional Coder (CPC) through the AAPC. Some coders opt to become a physician-based Certified Coding Specialist (CCS-P) through AHIMA.
- Inpatient medical coding generally takes place in a hospital. If this is the kind of coding that interests you, you’ll most likely become a Certified Coding Specialist (CCS) through AHIMA. The AAPC recently introduced its certification in inpatient coding as well, Certified Inpatient Coding (CIC). It is still gaining traction.
- Most certifications will provide opportunities for you to code from home if you choose.
The most sought-after certifications vary region to region. Look beyond national averages. Research which certifications have the most job openings and highest pay in your area.
Educational Paths Towards Certification
You have a variety of options for where to get certified.
A diploma program is the quickest path to a medical coding certificate. Medical coders and billers typically enter the profession with a postsecondary nondegree award. This means many go directly from their high school diploma to a medical coder diploma program.
- Educational requirement: High school diploma
- Location: Community and junior colleges, technical colleges, medical facilities, traditional 4-year colleges, and online
- Program length: 6 months to 1 year
- Cost: Between $1,000 and $3,000
An Associate degree will give you a more in-depth medical coding education. Often, you will study medical billing, too, and take courses such as medical terminology, anatomy and physiology, and other academic building blocks.
- Educational requirement: High school diploma
- Location: Junior and community colleges, adjunct programs at 4-year universities, and online
- Program length: 2 years
- Cost: $3,435 at a public institution
Bachelor’s degree and beyond
For an even more in-depth and broad base of knowledge, you can go for a Bachelor’s degree in health information management. These are four-year programs at accredited universities. Annual tuition for four-year programs run from $9,410 on average to over $32,000. There are also Master’s degrees and PhDs in health information management.
Keep in mind that earning potential for medical coders steadily increases with education. Those in the profession with Bachelor’s degrees earn more than those with Associate degrees, who in turn earn more than those with no degree. Though initial costs are steeper, your higher salary will make it worth the investment!
How to Prepare for Your Certification Exams
So, you’ve picked your certification and your program, and you’re ready to start studying for the big exam. Here’s how to tackle the challenges of passing the certification exam.
Study, study, study, and then study some more.
There are extensive online resources to help you prepare for your certification exam.
AHIMA and AAPC sell many resources:
AAPC’s CPC Exam Resources
AHIMA’s CCS Exam Resources
But studying doesn’t always need to be expensive. Be sure to take advantage of a variety of free resources as well.
Quizzes, Clinical Scenarios, and Study Materials
- Just Coding provides inpatient and outpatient practice coding quizzes.
- Optimum 360 Coding offers weekly clinical scenarios that you can try your hand at.
- The Codebusters blog has an extensive collection of medical coding questions and answers.
- Quizlet and StudyBlue offer medical coding flash card decks, quizzes, and notes created by other students on sites.
- PocketPrep’s CPC ICD-10 Exam Prep app lets you study for your CPC on the go.
- Visual Anatomy Free is a great app to help you bone up on your anatomy lessons.
- Learn Medical Terminology (Android) or Medical Terminology and Abbreviations (Apple) are great for fleshing out your medical terminology skills.
- YouTube has great introductory videos on medical coding.
- Medical Billing and Coding Certification offers introductory videos on each section of the CPC exam.
Practice makes perfect.
Take multiple practice exams. Don’t take your test unless you are scoring well on your practice exams. They’ll give you a good indicator of what you’ve mastered and where you have room for improvement.
- AHIMA’s Certified Coding Specialist (CCS) Exam Preparation is chock full of practice exams.
- The AAPC offers online practice exams for all its certifications.
Don’t attempt to frantically stuff your head full of medical coding guidelines and scenarios a week or two before the tests. Chances are, if you cram, you will fail.
- Study at a calm pace, with spaced repetitions of materials, for about 8 to 13 weeks before your test date.
- Study for about 20-50 minutes at a time, taking short breaks in between, for ideal retention.
Multitasking kills your brain. If you are logging onto Facebook or watching TV while you’re studying, chances are you aren’t making the most of your study time. It makes you less efficient and impairs your ability to retain knowledge.
Tell yourself a story.
Having trouble remembering a set of coding guidelines or medical terminology suffixes? Tell yourself a vivid, interesting story with the information.
For example, a popular way to remember the 12 cranial nerves in order is with a story, such as “On Old Olympus’ Towering Top, A Fine Victorian Gentleman Viewed A Hawk.”
Find a study buddy.
Find a partner who can check your progress and motivate you. You can also share study resources. One of the best ways to know you’ve learned something is to be able to teach it to someone else. Talk out those codes and standards.
Before the exam
- Be sure to arrive early to your testing location.
- Come with the proper identification
- Bring the most recent acceptable coding books.
- Both the CCS and CPC exams are very long, with limited breaks, so be sure to get plenty to eat beforehand.
During the exam
Here are some tips for doing your best during the exam.
Do it backwards.
Many medical coding hopefuls suggest starting at the back of the test and working towards the front. The more difficult questions tend to be at the front and this will prevent you from being bogged down.
Remember that the devil’s in the details.
Read all the instructions very closely. Go over directions twice to make sure you are proceeding correctly.
Mind the clock.
When taking the test, be constantly mindful of time.
- Move through the multiple choice questions at a pace of about one question per minute.
- For the more substantive case study questions, it’s appropriate to spend 15-18 minutes.
- Don’t allow yourself to get stuck on any one question.
- If you move through quickly, you’ll be able to go back and puzzle over any questions you weren’t able to immediately answer.
Make educated guesses.
If you’re stuck on a multiple-choice question, eliminate answers that you are sure are incorrect. Pick the best choice from the remaining questions.
How to Maintain Your Medical Coding Certifications
Congratulations! You’ve passed your exam! You’re now a certified medical coder.
Each year, you’ll want to keep up on what’s what in the medical coding world. The AAPC and AHIMA both require you to take regular continuing education credits (CEU) to make sure your knowledge is fresh and on-point.
- The AAPC requires you to take 36 CEUs every two years for a single medical coding certification.
- AHIMA requires you to take 20 CEUs every year to maintain a single medical coding certification. For CCSs, this requirement includes two coding self-reviews, which are 25-question self-guided exams.
- For both the AAPC and AHIMA, if you have more certifications, you need more CEUs each recertification cycle.
Each organization has a recertification schedule based on when you obtained your certification. Be mindful of these dates and conscientious of obtaining your required CEUs in time.
Here are some example CEUs for medical coders:
- Webinars, online courses, and on-demand workshops
- In-person conferences, talks, and seminars
- Local meetings and events
You are now ready to enjoy your career as a medical coder. Looking for an exciting new position? Check out our medical coding job listings today.