How to Become a Certified Medical Biller & Coder: Specialties & Certifications
Get the facts about getting certified in your medical billing and coding career.
Boost Your Career
Because many employers prefer to hire candidates with certification, earning your medical billing and coding certification gives you a competitive edge in the job market. Certification assures your prospective employers that you have the right skills and professional qualifications to do the job.
Once you’ve gained some experience in the field, pursuing medical billing and coding certification in a particular specialty—beyond just basic certification—can help boost your career. For many professional medical coders, the path to advancement is through management positions or jobs that require specialty expertise.
American Academy of Professional Coders
The American Academy of Professional Coders (AAPC) offers several types of medical billing and coding certification:
- Certified Professional Coder (CPC): A Certified Professional Coder (CPC) examination consists of questions regarding the correct application of CPT®, HCPCS procedure and supply codes and ICD-10-CM diagnosis codes used for billing professional medical services to insurance companies. A CPC must have at least two years coding experience and maintain yearly renewal and CEU requirements.
- Certified Professional Coder-Hospital (CPC-H): A Certified Professional Coder-Hospital (CPC-H) examination consists of questions regarding the correct application of CPT®, ICD-10-CM diagnoses and procedure codes used for billing facility services to insurance companies. A CPC-H must have at least two years coding experience and maintain yearly renewal and CEU requirements.
- Certified Professional Coder-Payer (CPC-P): The Certified Professional Coder-Payer (CPC-P) credential certifies that the successful candidate has knowledge and skills to adjudicate provider claims effectively. The CPC-P demonstrates the payer coder’s aptitude, proficiency and knowledge within the payer environment. Their coding is viewed by claims reviewers, utilization management staff, benefits staff, provider relations and customer service staff. A CPC-P must have at least 2 years coding work experience that includes working with CPT®, ICD-10-CM, or HCPCS code sets and must maintain the required amount of yearly CEUs.
Specialty credentials are also offered through the AAPC in the following areas:
|Evaluation & Management||Internal Medicine|
|Obstetrics & Gynecology||Gastroenterology|
|Orthopedics||Plastic & Reconstructive|
|Ambulatory Surgical Center||Rheumatology|
|Cardiovascular & Thoracic||Urology|
American Health Information Management Association
The American Health Information Management Association (AHIMA) offers the following credentials:
- Certified Coding Associate (CCA): New coders who earn the CCA will immediately demonstrate their competency in the field. CCA holders will distinguish themselves from non-credentialed coders and those who hold credentials from other organizations that do not require the higher level of expertise necessary to earn AHIMA certification.
- Certified Coding Specialist (CCS): Certified Coding Specialists are professionals skilled in classifying medical data from patient records, generally in the hospital setting. These coding practitioners assign numeric codes for each diagnosis and procedure. To perform this task, they must possess expertise in the ICD-10-CM coding system and the surgery section within the CPT coding system. In addition, the CCS is knowledgeable of medical terminology, disease processes and pharmacology.
- Certified Coding Specialist-Physician-based (CCS-P): The CCS-P is a coding practitioner with expertise in physician-based settings such as physician offices, group practices, multi-specialty clinics or specialty centers. This coding practitioner reviews patients’ records and assigns numeric codes for each diagnosis and procedure. To perform this task, the individual must possess in-depth knowledge of the CPT coding system and familiarity with the ICD-10-CM and HCPCS Level II coding systems. The CCS-P is also expert in health information documentation, data integrity and quality.
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