Becoming a Medical Coding Specialist
Medical coding specialists play an essential role in the business of healthcare. Using alphanumeric diagnosis and procedure codes, they communicate critical information about medical conditions and treatments. Coders translate medical terminology into a standardized format, allowing information to be transmitted accurately and efficiently between healthcare providers and insurance payors.
Correct coding ensures proper recording of a patient’s medical conditions, verification of the provider’s services, and appropriate reimbursement by payors for those services. Additionally, codes are used to monitor public health threats, such as diabetes or measles outbreaks, to track provider performance and to identify potential areas of financial or medical fraud or abuse within the healthcare industry. When coding is done properly, patients, providers, and payors all benefit.
Medical coding specialists rely on their knowledge of anatomy, medical terminology, health conditions, and medications to assign diagnostic and procedural codes for each patient encounter. They must review a patient’s medical record and will, at times, talk to the patient’s healthcare provider or research payor policies to uncover missing information.
Medical coding is a dynamic occupation, as evidenced by the health care community’s implementation of the ICD-10 code set as of October 1, 2015. ICD-10 is more advanced than the decades-old ICD-9 code set that it replaces, and the skills of medical coding specialists will be in greater demand than ever with this transition.
Medical coding specialists work in a variety of settings, both clinical and non-clinical. Clinical settings may include:
- Physician offices and group practices
- Surgery centers
- Skilled nursing and other long-term care facilities
- Dental offices
- Home health agencies
- Mental health facilities.
Some medical coders work outside of the clinical setting at insurance companies, independent billing and coding services, consulting firms, public health organizations, and government agencies.
Most medical coding specialists work full time in a business office environment, spending a majority of their time abstracting clinical data from patient charts. They use a variety of resources to code correctly for services, supplies, and diagnoses, including the International Classification of Diseases (ICD) and Current Procedural Terminology (CPT) codebooks; coding software; websites, such as InnerBody; and medical providers and colleagues.
While working hours for coders usually parallel business hours, some 24-hour facilities may schedule coders for evening or overnight shifts. In recent years, the number of at-home work opportunities, especially among non-clinical employers, has increased; however, these positions generally require several years of proven work experience.
Education and Training
While there are no mandatory educational requirements for employment, success as a medical coding specialist depends on a strong knowledge of biology, anatomy, physiology, and medical terminology. Most employers look for a minimum of a high school diploma or equivalent, and prefer candidates with a postsecondary certificate, or at least a year of study beyond high school. O*Net estimates that 21% of health information technicians (including medical coders) have attended some college without earning a degree, while 20% hold an associate’s degree. The annual salary survey conducted by AAPC for 2014 indicates that almost 80% of its members have at least some postsecondary education.
Programs in medical coding are available through community colleges, continuing education centers and four-year colleges, in both online and traditional formats. The core program takes about a year to complete, although additional supporting coursework in the sciences may be needed. Two professional organizations - the American Health Information Management Association (AHIMA) and the American Academy of Professional Coders (AAPC) - also offer online certificate programs.
A growing number of for-profit career schools offer certificate programs and associate degrees in medical coding; however, an investigation by the Government Accountability Office found that some of these programs engage in fraudulent or deceptive practices while charging very high tuition. To ensure a valid and appropriate education, research the program carefully, or consult the list of approved certificate programs on AHIMA’s website.
In some cases, medical coding specialists may be trained entirely on the job. This can be an option for people who already have a strong background in health care or experience in other areas of health information. Additionally, the US Department of Labor (DOL) includes medical coding in its list of registered apprenticeship programs. An apprenticeship provides paid on-the-job training and academic instruction. For more information, see the US DOL website, or contact a state apprenticeship office or local chapter of the AAPC.
Certification as a medical coding specialist is voluntary, but well worth pursuing. Candidates with AHIMA or AAPC credentials are strongly preferred by employers, and often earn more than non-certified peers. In fact, AAPC estimates that coders holding a Certified Professional Coder (CPC) credential earn 20% more.
In addition to its entry-level CPC credential, AAPC offers certifications that demonstrate coding and/or health care business expertise in various settings and medical specialties. To become fully certified, candidates must, at a minimum, hold a high school diploma or equivalent, pass the certification exam, and have practical coding experience. AAPC specialty credentials require additional knowledge, additional work experience, or both.
AHIMA offers two levels of certification: the entry-level Certified Coding Associate (CCA) and the mastery-level Certified Coding Specialist (CCS). A high school diploma or equivalent is needed for the CCA certificate. Certification as a CCS or CCS-P (CCS Physician-Based) requires one of the following:
- Completion of a coding training program
- At least two years of experience in the field
- CCA certificate and at least one year of experience in the field
- Coding certificate from another certifying body and at least one year of experience.
Necessary Skills and Qualities
Medical coding rules are complex, and sometimes ambiguous; therefore, the job requires strong analytical skills. Coding specialists must be able to recognize key details in a patient record in order to apply the appropriate codes, or to know when additional information is needed. Coders often act as liaisons between patients, providers, and payors, which requires the ability to communicate effectively, and they must be comfortable working and making decisions independently. Computer skills are essential, especially in light of the increasing use of health informatics software and electronic health records. Experience interpreting and applying federal health regulations is also valuable.
Opportunities for Advancement
Experienced medical coding specialists often supervise coding teams or serve as directors of coding at hospitals, health systems, or insurance companies. Due to the growing emphasis on accountability in health care, some organizations are even creating executive-level positions to direct coding strategy and operation. A bachelor’s or advanced degree in health information management or healthcare administration increases a coding specialist’s opportunities for advancement.
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The U.S. Bureau of Labor Statistics reports that the median annual salary for health information technicians (including medical coding specialists) was $35,900 as of May 2014. The lowest paid 10% earned less than $22,700 while the highest paid 10% earned more than $57,320.
Meanwhile, according to Salary.com, the median yearly income of medical coding specialists was $53,200 as of September 2014.
In 2013, AAPC estimated that coders who earned their Certified Professional Coder credential receive a median annual salary of $48,593, while those with higher credentials could expect higher earning potential (up to an average of $69,138). Experience, education and certification all increase a medical coding specialist’s earning potential.
Medical coding specialists are in demand. According to the U.S. Bureau of Labor Statistics, job growth for medical records and health information technicians is expected to increase by 22% between 2012 and 2022, which is considered much faster than average for all occupations. This increase is partly due to the aging of our population; Americans will be using more and more healthcare services in coming decades. New regulations that require more accountability from healthcare providers are also creating jobs for qualified medical coding specialists.
Opportunities are greatest for candidates with mastery-level credentials (CCS or equivalent), those with several years of work experience and those with expertise in certain medical fields such as interventional radiology.
Medical coding jobs are posted on the websites of hospitals, health systems and other healthcare providers. The AAPC and Health Information Careers websites also list medical coding jobs. Because of the strong employment projections for health information professionals, those with an interest in the business of health care may want to consider a career as a medical coding specialist.