July 23, 2007

Alphabet Soup
By Judy Sturgeon, CCS
For The Record
Vol. 19 No. 15 P. 8

Let’s say you’ve read the ads and salary reviews for coding jobs. We can suppose that a potential $3,000 sign-on bonus doesn’t offend you. The list of community colleges and universities including coding education in their curriculum is no longer abbreviated. Today, you can select from a range that starts at earning a coding certificate and escalates to obtaining a bachelor’s degree in HIM.

Before you direct your money and future to a career with that much scope, it would be wise to decide what part of the coding profession most interests you. Remember all those job ads? If you call the folks that placed them, chances are they will quickly inform you of a credentialing requirement that’s necessary if applicants are to earn the juicy salaries. While options for credentialing were once limited, there is now a veritable “alphabet soup” of initials that can be added behind one’s professional signature. Each designates not only a supporting association that bestows and validates the credential, it also explains the focus of the coder’s skills. Each carries a price tag for professional membership, a hefty examination fee, continuing education requirements, and required credential maintenance. Focusing your efforts and finances toward the one that best suits your opportunities and preferences will serve you best in the long run.

Perhaps the first thing you should consider is the difference between a coding certificate and a coding credential. A certificate is generally issued by an educational facility when a student successfully completes the planned course of study for basic coding. This is fine, a mark of achievement of its own merits. It is not, however, particularly marketable.

The credential usually expected from a medical employer is one issued by the American Academy of Professional Coders (AAPC) or the AHIMA. These agencies maintain standards of conduct and professional ethics, manage and administer updated testing and education, and ensure that coders who are awarded one of their credentials are of the highest skill and competency levels.

A highly regarded national association of professional coders, the AAPC has earned recognition and respect for its members and their formidable skills. It has raised the bar for ethical and technical standards and ensures that appropriate educational and networking opportunities are available to constituents. To meet initial qualification to sit for the exam, the candidate must be a current AAPC member and have two years of coding experience. If the job history is insufficient, the AAPC will issue an apprentice designation with the credential, which can be upgraded to full certification once the criterion for experience has been met. An apprentice status for a certified professional coder (CPC) credential would be designated as CPC-A until proof of job history is received.

The AAPC maintains credentialing opportunities in the following three distinct categories:

• CPC for the physician practice coder;

• CPC-H for the specialist in outpatient hospital or facility coding; and

• CPC-P for the coder who efficiently processes payer claims.

These credential examinations expect the candidate to have competency in medical terminology and anatomy, along with skills in CPT, ICD-9-CM, and HCPCS. It is from this point that they diverge into specialty knowledge and skills.

The CPC will also be tested on knowledge of CPT coding for anesthesia, medical, and surgical coding. The applicant will need to know evaluation and management codes and be able to appropriately use modifiers. A coder who intends to sit for the CPC-H exam will be expected to also know outpatient facility and Medicare guidelines and understand the intricacies of hospital claim forms. The CPC-P applicant should be prepared to demonstrate comprehension of insurance terminology and business processes, payment systems and standards such as covered services and authorizations, as well as basic coding skills. If you intend to acquire multiple credentials, be prepared to take multiple examinations and acquire multiple continuing education units because they do not overlap in fees or education requirements.

The AHIMA is another powerful national professional membership. While the AAPC has always been focused on the coding profession, the AHIMA initially nurtured and harvested health information managers at levels that included both associate’s degrees (RHIT) and bachelor’s degrees (RHIA). While the RHIT and RHIA designations include some coding education and skills, they are not generally considered coding credentials. The first credential that the AHIMA issued to recognize coding as a specialty was the certified coding specialist (CCS).

The rigorous CCS credential designates a mastery of ICD-9 and CPT coding skills. Holders of this credential usually work in a hospital setting and understand payment systems, Medicare and Medicaid rules and requirements, diagnosis-related group assignments, and data management issues. They must be knowledgeable not only in anatomy and medical terminology but also in the pathological process of disease, pharmacology, and even the basics of medical necessity and admission criteria. Also available is the CCS-P, a similar designation with focus on the physician-based expert as opposed to the facility-based designation.

While these options fill the need for expert designations, the AHIMA recognized the need for a validation of general coding competence and now offers the certified coding associate credential. This is a good starting point for applicants whose intent is to validate their focus, commitment, and competency in the coding profession, even at an entry level.

Whether you opt for the AHIMA or AAPC credentialing, be sure to research the education and employment opportunities available in your area. Can you get what job or schooling you seek locally? Will you have to relocate to attend the school of your dreams or get that perfect job? Perhaps moving is part of the dream—if you’re tired of the plains of the heartland, doctors and hospitals on both coasts and in Hawaii need coders, too. And if living with hurricanes and earthquakes doesn’t appeal to you, they love coders just as much in Kansas and Oklahoma as they do in California and Florida.

Either way, the right credential will certainly help you build a coding career no matter where you live.

— Judy Sturgeon, CCS, is the hospital coding senior manager at The University of Texas Medical Branch in Galveston and a contributing editor at For The Record. While her initial education was in medical technology, she has been in hospital coding and appeal management for the past 18 years.