Understanding Different Medical Coding Certifications

Medical coding credentials are crucial for professionals in healthcare information management, ensuring they possess the necessary knowledge and skills to accurately assign medical codes for diagnoses, procedures, and services. However, not all credentials in medical coding are the same. Understanding the different certifications available and what sets them apart is essential for career advancement in this field.

AAPC Medical Coding Credentials

Offered by the American Academy of Professional Coders (AAPC), several specialized certifications exist to validate expertise in various healthcare settings.

Certified Professional Coder (CPC)

The CPC credential demonstrates proficiency in outpatient coding. CPC holders are skilled in assigning CPT (Current Procedural Terminology) codes, ICD-10-CM diagnosis codes, and HCPCS Level II codes for procedures and services performed in outpatient settings. Competencies proven with this credential include:

• Expertise in medical record review to abstract information required to support accurate coding.
• Ability to identify documentation deficiencies and properly query providers for proper code capture.
• Expertise in assigning accurate CPT, HCPCS Level II, and ICD-10-CM medical codes for diagnoses and procedures.
• Solid understanding of anatomy, physiology, and medical terminology required to correctly code professional provider services and diagnoses.
• Proficiency across a wide range of services, including evaluation and management, anesthesia, surgery, radiology, pathology, and medicine.
• A sound knowledge of medical coding guidelines and regulations including compliance and reimbursement.
• Understanding of how to integrate medical coding and payment policy changes into a practice’s reimbursement processes.

Certified Inpatient Coder (CIC)

The CIC credential is specifically for professionals specializing in inpatient hospital coding. It is the only certification exclusively specialized in hospital and facility inpatient coding. This certification validates mastery in abstracting information from the medical record for ICD-10-CM and ICD-10-PCS coding. Furthermore, it represents expert knowledge of Medicare Severity Diagnosis Related Groups (MS-DRGs) and the Inpatient Prospective Payment System (IPPS).

Inpatient coding differs from physician-based coding in that it focuses on services provided by the facility, rather than on services provided by the physician. CIC-certified professionals typically work in hospitals, skilled nursing facilities (SNFs), critical access hospitals (CAHs), and long-term care hospitals (LTCHs).

Certified Professional Outpatient Coder (COC)

The COC focuses on outpatient coding. Coders who earn their COC credential go on to report outpatient services in a variety of settings, such as hospital emergency departments, outpatient hospital clinics, therapy departments, and ambulatory surgery centers.

Certified Professional Risk-Adjustment Coder (CRC)

Healthcare professionals earning their CRC credential possess demonstrated expertise in the complexity of diseases associated with chronic conditions and comorbidities, as well as mastery of ICD-10-CM guidelines and risk adjustment guidelines. They are equipped to ensure clinical documentation accurately portrays the patient’s health status.

Certified Professional Medical Auditor (CPMA)

With tighter regulation on reporting medical services, there is a growing demand for CPMAs. They have a clear understanding of when and where an organization is at risk for non-compliance. CPMAs help providers avert liability and secure proper reimbursement for their patient care by demonstrating expertise in medical documentation, fraud, abuse, and coding risk analysis.

American Allied Health (AAH) Certification

The Medical Coding and Billing Specialist (MCBS) certification sets you apart in one of the fastest growing health science career fields. AAH offers online national certifications via a secure, virtual computer-based testing (CBT) portal. This allows you to satisfy employer and state regulations and get immediate proof of certification.

Eligibility and Requirements

To demonstrate your eligibility, you must upload at least one of the following forms of documentation:

• Completion of related course or training program.
• One year's work experience in the field.
• Relevant military training.
• Previous certification by another agency.

Comparison of Coding Credentials