Medical Coders Are Dedicated Healthcare Professionals

By Rick Crosley

 

The decision to pursue a career in medical coding requires a commitment to personal and professional growth requiring the individual to push their intellectual capacities beyond what they imagined possible in any academic environment. 

 

Simply stated be prepared to sacrifice time, financial resources, and involving yourself in any activities that require little more than an idol mind. 

The philosophy that everyone deserves a trophy does not apply to this endeavor. 

 

The student earns the certification and becomes apprentice or they do not. 

Effort does not equal success. 

 

National associations such as the American Association of Professional Coders and the American Health Information Management Association offer certifications and award them to individuals based on test scores not how many evening or Saturday outings missed.

 

This is serious business and demands a rational and mature understanding of the journey and the goal. 

 

Researching a casual interest quickly dispels any misconceptions on how equally difficult and dedicated someone must be to ultimately call themselves a certified medical coder. 

Medical coders are forward thinkers simultaneously incorporating multiple disciplines to produce a work product rooted in a working knowledge of medical science, and information technology, all governed by state and federal bureaucratic institutions.   

 

The medical coding profession requires continuous education, a savvy approach to administrative complexities, and a working knowledge of medical language and conventions. 

 

According to the American Academy of Professional Coders (AAPC) medical coding is the translation or transformation of healthcare diagnosis, procedures, medical services, and equipment into medical numeric or alphanumeric codes.

 

The diagnoses and procedure codes are taken from medical record documentation, such as transcription of physician’s notes, laboratory, and radiology results and a patient’s health record. 

 

For every injury, diagnosis, and medical procedure, there is a specific and corresponding code. 

 

There are a number of sets and subsets of code that comprise thousands of codes for medical procedures, outpatient procedures and diagnoses. 

Medical coders review clinical statements and assign standard codes using CPT, ICD-10-CM, and HCPCS Level II classification systems.  

 

These codes are placed on a (UB-04) form for facility claim or a CMS 1500 for physician claims. 

 

A working knowledge of these two forms is needed to create accurate and CCI edit free claims in the productivity driven health information management department. 

 

The higher the accuracy and the faster the claim is sent electronically equates to increased cash collection and lowers the number of aged accounts sitting waiting to be corrected. 

  

Marilyn Fordney breaks down the genesis of the CMS-1500 claim form and UB-04 in her 14th Edition of The Insurance Handbook For The Medical Office explaining that the CMS 1500 was developed by the National Uniform Claim Committee (NUCC). 

 

The NUCC is a voluntary organization co-chaired by the American Medical Association and Centers for Medicare and Medicaid Services. 

 

The committee is made up of health care industry stakeholders representing providers, payers, designated standards maintenance organizations, public health organizations, and vendors.

 

The text further explains the Uniform Bill (UB-04) claim form is used by institutional facilities (for example, acute care facilities, dialysis centers, inpatient skilled nursing facilities, or rehabilitation centers) to report fees related to surgery only. In 1982, the (UB-82) claim form was developed for hospital claims and was printed in green ink. 

 

A revision was issued in 1992, which became known as the Uniform Bill (UB-92).  Because it was determined that an update of this form was necessary, a new form called the UB-04 claim form made its appearance in 2007.  The Uniform Bill (UB-04) paper or electronic is also known as the CMS-1450”.

Now that you have decided that spread sheets and conference rooms pique your interest and ignite your passions over emergency rooms and taking vitals you’re ready to plan your route to becoming a certified medical coder. 

The two organizations that lead the industry in creating and maintaining the highest ethical and competency standards in the healthcare industry are the American Academy of Professional Coders and the American Health Information Management Association.

 

AAPC was founded in 1988 is based in Salt Lake City Utah and has worked to elevate the standards of medical coding with certification, training, followed up by career and networking opportunities. 

 

AAPC has a primary focus on coding, billing, reimbursement, and practice management. 

 

The 2017 five main areas of study are certified outpatient coder (COC), and the risk adjustment coder (CRC) each are a five hour and forty minute 150 multiple choice exams. 

 

The COC exam is proctored.  The certified inpatient coder (CIC), is a sixtey question multiple choice with 10 inpatient cases fill in the blank and is also proctored. 

 

AAPC has two professional level certifications the first is certified professional coder (CPC) and the second is certified professional coder (CPC-P) with a focus on payers. 

 

Each exam is five hours and forty minutes and is proctored. The fifth category covers twenty-two specialty coding certifications. 

The second organization is AHIMA and was founded in 1928 to improve health record quality, and has taken the lead in advancing informatics, data analytics and information governance for healthcare while continuing to lead and support world class HIM practices and standards.

 

AHIMA has three dedicated certifications which are the CCA, the Certified Coding Associate, the CCS, the Certified Coding Specialist and the CCS-P the Certified Coding Specialist-Physician based. 

 

Currently these are the only coding certifications worldwide accredited by the National Commission for Certifying Agencies.

 

Knowing yourself and the type of work you find satisfying should be considered just as much as salary, current job market conditions, and the demand for certified coders. 

 

Selecting the appropriate organization to certify with is based on personal interests and long term goals. 

 

AAPC offers excellent education and training courses planned out starting with the required core classes to the advanced coding classes needed to take each exam.  These classes can also be taken at local community colleges or completely through AAPC.  AAPC offers independent study and in some cases does offer classroom training.  

 

AHIMA requirements for taking the exam are similar to AAPC each involve a combination of work experience and classroom or online education.  Some more advanced certifications that go beyond coding that require two and four year degrees based on the desired level of certification. The student should consider degrees and programs accredited by AHIMA to satisfy requirements for certification exams. 

 

I believe that joining each organization as a student has a benefit to shaping the beginning of your career and offers some welcome discounts on education materials, events, and webinars.

 

Attending a local chapter meeting of AAPC and AHIMA will give you the opportunity to learn about the principles and mission of each organization and most importantly the networking and relationship building that takes place at monthly events.  Getting to know people working in your local healthcare ecosystem will help plan your career and offer valuable insight into the local job market.  

 

If you’re interested in working in the healthcare field and don’t see yourself treating patients medical coding can be a great way to be a part of the challenging world of healthcare.

 

Medical coders are healthcare professionals who accept the responsibility of providing outstanding intellectual service guided by a compassionate heart with no distinction between healthy or sick.  Healthcare professionals serve patients.  A certified medical coder is fortunate to experience medicine through patient care and a challenging business environment.

 

Citations

www.ahima.org

www.aapc.com

Fordney, Marilyn T Insurance Handbook For The Medical Office 14e 2017