Medical coding specialists are essential to the efficient functioning of the healthcare industry. They use alphanumeric diagnostic and procedure codes to convey critical information about illnesses and treatment. By translating medical terminology into standardized codes, information is transmitted with the efficiency that best serves patient and provider alike—so that patients' diagnoses are accurately communicated and providers' services paid.
Medical coding specialists rely on their knowledge of medical terminology, diseases and medications to assign a diagnostic or procedural code to each entry in a patient’s record. To choose the most appropriate codes, these specialists review the patient’s history and test results, and at times, talk to the patient’s doctor to uncover missing information.
By maintaining complete and accurate records of all care, these specialists contribute to efficient record processing on several fronts. Doctors and hospitals use code data to track their performance and prevent fraud and error that could harm patients. Insurance companies, Medicare and Medicaid all rely on coding to calculate their reimbursements to providers. This same data even helps government agencies track and combat public health threats like obesity, tobacco use and contagious diseases.
Medical coding continues to be a dynamic field, as illustrated by the healthcare community's mandatory adoption of ICD-10 by October 2015. ICD-10 is a much more advanced and expanded code set than the decades-old ICD-9 that it will replace, and the skills of medical coding specialists will be in greater demand than ever during this crucial transition.
Medical coding specialists perform an all-important function within the healthcare industry. Thanks to their knowledge and expertise, care is synchronized, bills are paid, and the gears of the healthcare industry remain turning.
Most medical coding specialists work in healthcare facilities, including:
Some medical coding specialists work outside the clinical setting at insurance companies, independent billing and coding services, consulting firms, public health organizations and government agencies.
Almost all medical coding specialists work in office buildings or in the back offices of hospitals and clinics. The idea that medical coding is a great work-at-home career is simply not true and is usually propagated by online scammers selling worthless classes or business opportunities. While off-site coding positions do exist, they’re relatively rare and usually require several years of successful work experience.
Medical coding specialists spend a majority of their time at their desks analyzing and coding patient charts. They also spend hours each day on their computers working with coding software, electronic health records and other applications. To resolve diagnostic questions, medical coders refer to comprehensive codebooks such as the International Classification of Diseases (ICD). Though most of their work is done alone, coding specialists sometimes consult doctors, colleagues or supervisors for clarification and additional information.
Most medical coding specialists work full time. In inpatient settings, they sometimes work evening or overnight shifts.
While there are no set educational requirements to enter the field, success as a medical coding specialist requires a strong knowledge of biology, anatomy, physiology and medical terminology. Most employers require a high school diploma or equivalent and prefer candidates with a postsecondary certificate or at least a year of study beyond high school.
Certificate programs in medical coding generally take about a year to complete and are available through community colleges, continuing education centers and four-year colleges. Two professional organizations, the American Health Information Management Association (AHIMA) and the American Academy of Professional Coders (AAPC) also offer online certificate programs. To become certified, students must pass one of several exams available through AHIMA and AAPC.
O*Net estimates that 21% of health information technicians (including medical coders) attended some college without earning a degree, while 20% hold an associate degree. A growing number of for-profit career schools offer certificate programs and associate degrees in medical coding. An investigation by the Government Accountability Office found that some of these programs engage in fraudulent and deceptive educational practices while charging very high tuition. To avoid educational scams, consult the list of approved certificate programs on AHIMA’s website.
Medical Billers and Coders can specialize in coding patients’ medical information for reimbursement purposes, or in the facility’s administrative billing process. Technicians, who specialize in coding, assign a code to each diagnosis and procedure by using classification systems software. The classification system determines the amount for which healthcare providers will be reimbursed if the patient is covered by Medicare, Medicaid, or other insurance programs using the system. There are several coding systems, such as those required for ambulatory settings, physician offices, or long-term care. Technicians, who specialize in the billing process, typically use an automated medical billing and administrative system that interfaces with the insurance programs used by the facility. In a smaller medical facility where the medical procedures performed are limited, a Technician’s duties may include both coding and billing.
In some cases, medical coding specialists are trained entirely on the job. This may be an option for people who already have a strong background in the sciences or experience in other areas of health information management.
The US Department of Labor classifies medical coding as an apprenticeable occupation. Registered apprenticeship programs provide paid on-the-job training and academic instruction. For more information, contact a state apprenticeship office or a local chapter of 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. In fact, AAPC estimates that coders who hold its Certified Professional Coder (CPC) credential earn 20 percent more than their non-certified counterparts.
In addition to its entry-level CPC credential, AAPC offers a variety of certifications that demonstrate expertise in certain settings and branches of medicine. To become certified, candidates must hold a high school diploma or equivalent and pass an exam. Some AAPC credentials require additional work experience.
AHIMA offers two levels of certification: the entry-level Certified Coding Associate (CCA) and the mastery-level Certified Coding Specialist. A high school (or equivalent) diploma is the requirement for the CCA (certified coding associate) license. To obtain the CCS or CCS-P (Certified Coding Specialist – Physician-based), a candidate must satisfy one of the following:
Because medical coding rules are complex and sometimes ambiguous, the job requires strong analytical skills. Coding specialists must pay attention to many details in order to translate records precisely and accurately. They must also be comfortable working and making decisions independently. Computer skills are essential in the coding field due to the growing use of health informatics software and electronic health records. Experience interpreting and applying federal regulations is also valuable.
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, some organizations are even creating executive-level positions to direct coding strategy and operations. 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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Medical coding specialists are in demand. According to the US Department of Labor, 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 demand more accountability from healthcare providers are also creating jobs for qualified medical coding specialists.
Demand is highest for candidates with mastery-level credentials (CCS/CPC 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.