Medical Billing and Coding Certification

As the healthcare and insurance industries require accuracy and compliance with complex regulations, medical billers and coders are held to these same standards. Certification is a way of showing your dedication and expertise. While you may not necessarily need a medical coding certification to get an entry-level job, you will find that your opportunities for career advancement multiply once you’ve achieved such a distinction. You’ll be more likely to demand a higher salary, earn a position of leadership, and perform different kinds of work.

Certifications are available for various professionals that work in the medical records and health information field. They’re also offered by a number of different organizations. As you plan your career goals, do your research to get the basic facts about certification and opportunities for specialization. Then consider a timeline for gathering the education, training, and experience that will help you pass the certification exam that’s right for you.

Explore Certification and Continuing Education

Important information about the types of certification available for medical billers and coders is explained in the following section.

AAPC certification

The most well-known agency that administers and oversees certifications for medical billers is The American Association of Professional Coders (AAPC). It also tracks required continuing education units through a system that records the knowledge you’ve gained from classes, conferences, seminars, and other educational opportunities on a variety of topics. The AAPC offers general certifications, as well as 21 specialty certifications.

General certifications: The main certifications are the Certified Professional Coder (CPC), Certified Professional Coder – Hospital Outpatient (CPC-H), and Certified Professional Coder – Payer (CPC-P).

Specialty-specific coding certifications: You can choose to focus on a particular area in the healthcare industry and pursue certification to demonstrate expertise in that area. These specialty certifications emphasize coding problems related to those fields, as well as professional requirements to work in these areas. You don’t necessarily need to acquire a general coding certification to obtain one of these specialty certifications (see the AAPC website for accurate and up-to-date information about specific requirements), but you will find that a variety of certifications make you more versatile and marketable to employers.

Use the following list to discover the wide variety of medical billing and coding jobs that are available across all sectors of the healthcare industry.

• Ambulatory Surgical Center (CASCC™): Also known as outpatient surgery, ambulatory surgical centers (or same-day surgery) perform medical procedures that do not require overnight stay. This specialization requires knowledge of surgical procedures. You’ll interpret notes provided by medical professionals and convert them into medical codes that accurately represent highly specific information. There are no prerequisites for this certification exam (other than AAPC membership,) which is designed to simulate the transcription of case notes.
• Anesthesia and Pain Management (CANPC™): Anesthesiologists administer drugs to patients for their symptoms or as part of their surgical procedures. You’ll be expected to know how to choose the right CPT codes for different procedures, as well as how to use modifiers for anesthesia cases. You’ll also be tested on determining time units and total units for cases that require anesthesia.
• Cardiology (CCC™): Heart health is a growing sector of the healthcare industry. Passing the examination for this certification demonstrates that you have a knowledge of cardiological surgical practices and equipment, such as stents and pacemakers. Because heart health is often related to other vascular procedures and has associated insurance regulations, this coding specialization presents unique challenges. You’ll be expected to know how to code for surgical procedures such as catheterization, placement of pacemakers, and peripheral vascular procedures.
• Cardiovascular and Thoracic Surgery (CCVTC™): This certification demonstrates that you possess knowledge of the treatment, equipment, and testing procedures associated with cardiovascular and thoracic surgery (surgeries performed on the heart, lungs, and greater vessels in the chest). You’ll need to possess both technical knowledge of Medicare billing rules and medical knowledge of the heart and circulatory system.
• Chiropractic (CCPC™): Chiropractic services involve manually adjusting a patient’s spinal system, which is considered complementary or alternative medicine. Medical billers and coders working alongside chiropractic professionals need to be able to navigate the specific ways that insurance companies reimburse these practitioners. You’ll also need to be aware of its diagnostic procedures in this field.
• Dermatology (CPCD™): Dermatologists diagnose and treat diseases related to the skin. Billers and coders working with dermatologists need to have knowledge of these skin conditions and related treatments. This means you’ll have to familiarize yourself with the anatomy of human skin and the classification of its disorders. You should also be knowledgeable of procedures such as debridement, lesion excisions, and flaps.
• Emergency Department (CEDC™): Billers and coders who have this specialized certification have obtained proof of their expertise in accident and trauma codes, as well as some knowledge of pain management and sedative treatments. Because this dynamic subfield requires you to work quickly on your feet, you’ll need to be very familiar with associated codes.
• Evaluation and Management (CEMC™): The healthcare industry relies upon a system of classifying codes not only to bill insurance companies, but also to track health information for planning purposes. Coding professionals in this specialization work to manage the costs incurred by medical offices and hospitals and help ensure quality treatment. As you’ll be tested on both billing regulations and your coding proficiency, you’ll do best after earning broad professional experience in the field.
• Family Practice (CFPC™): There’s a variety of health information that billers and coders must manage in family practice settings. You’ll need to understand general insurance reimbursement regulations and know how to accurately sequence codes when several procedures are performed together (as in an annual checkup.) You should also have general knowledge of pediatric medicine.
• Gastroenterology (CGIC™): Gastroenterology is the field that treats gastric disorders. You’ll need to be knowledgeable about each abdominal organ in order to code very specific conditions and procedures. You can expect to learn codes used for procedures such as ERCPs, colonoscopies, and esophageal dilations.
• General Surgery (CGSC™): This certification demonstrates your expertise in the field of billing and coding surgical procedures. With a variety of surgeries performed each day, you’ll be tasked with quickly and accurately transcribing operating room notes into codes. You’ll need to also understand the set of rules regarding private and public insurance reimbursement. The AAPC recommends that you complete this certification after having plenty of work experience as this exam is based on simulated coding scenarios.
• Hematology and Oncology (CHONC™): This certification signifies that you have an expertise in coding issues related to the treatment of cancers and blood disorders. These can include bone marrow treatments, chemotherapy and hydration, and blood tests. These procedures are particularly complex, requiring that billers sequence on-going care that requires a number of treatments. Insurance providers also have stipulations about compensation for surgeries and drug-based forms of disease treatment and management.
• Internal Medicine (CIMC™): Internal medicine is the treatment and prevention of adult diseases. You’ll have to be comfortable using codes to classify vaccinations, blood draws, and other minor procedures and surgeries. This specialty requires high attention to detail and accuracy, and your best preparation for the exam is real-world experience.
• Obstetrics Gynecology (COBGC™): This medical coding specialty requires training and experience working in women’s health. To manage the health records and information in an OB/GYN office, you’ll need to be familiar with the procedures used in prepartum, postpartum, and childbirth care. You’ll have to stay up-to-date on gynecological concerns and complex sets of regulations maintained by insurance providers.
• Orthopaedic Surgery (COSC™): Coding orthopaedic surgeries requires a basic familiarity of the anatomy of the human skeletal system and its functions, as well as its related surgeries. These include fracture repairs, spinal surgeries, and other types of procedures for a variety of disorders. You’ll also need to demonstrate knowledge of insurance and billing regulations, including Medicare rules regarding shared visits, teaching situations, and consultations.
• Otolaryngology (CENTC™): Billters who work in the ENT specialty (ear, nose, and throat) have to learn the diagnostic procedures and treatments used by ENT specialists, including nasopharyngoscopies, laryngoscopies, and sinus surgeries, The AAPC recommends having work experience in this field because it requires a familiarity with insurance regulations, Medicare, and billing procedures for common surgeries and procedures.
• Pediatrics (CPEDC™): Achieving this professional certification demonstrates that you have training and experience managing the health information of children. You will need to possess general knowledge of pediatric medicine, as well as common procedures (like immunizations.) Pediatric care also requires knowledge of a wide range of treatments, many including multiple procedures or visits. The examination for this certification is based on sample doctor’s notes, so it’s a great advantage to have professional experience.
• Plastics and Reconstructive Surgery (CPRC™): Coding procedures for this field of medicine can be complex because of the highly specific kinds of procedures and surgeries performed. Because this field is also the site of elective and cosmetic procedures, you’ll need to organize data accurately for patients who are undergoing restorative surgeries so their insurers can cover their expenses. Medical coders who have experience working with plastic surgeons are more likely to succeed on this certification examination.
• Rheumatology (CRHC™): Rheumatology is the study of the treatment of joint disorders, such as arthritis. Medical billers and coders who earn this certification demonstrate general knowledge of the procedures, treatments, and medical devices and equipment used in patient care. You will also need to have an understanding of Medicare and other forms of public and private insurance billing procedures. Rheumatologists work with patients over multiple visits, and treatment can be extensive, which requires rheumatology coders to keep track of repeat treatments.
• Surgical Foot and Ankle (CSFAC™): To earn this certification, you’ll have to develop knowledge of common foot and ankle problems, as well as their associated medical treatment options and equipment. You’ll have to turn doctor’s notes into codes that accurately convey the forms of treatment provided, and know the ins and outs of Medicare and insurance billing. The AAPC recommends that you have significant clinical experience as a coder in this subfield before taking the certification examination.
• Urology (CUC™): Medical coders working with urologists must develop an understanding of urinary tract issues for patients of both genders, as well as knowledge of male reproductive health issues. If you choose to specialize in this subfield of medicine, you’ll need to accurately code ancillary procedures performed in a urologists’ offices, such as injections and urinalysis. You’ll also have to be familiar with codes for procedures performed in hospitals, such as biopsies, cystoscopies, and prostatectomies.