Job Outlook and Passing the Coding Certification Test

Medical coders work in all kinds of healthcare settings, from clinics, to hospitals, to nursing homes. They are experts at interpreting doctors’ notes and identifying the correct medical codes for different healthcare services, medical diagnoses, and medical supplies and equipment used in the treatment of patients. These codes ensure that the healthcare provider or facility is properly reimbursed by the insurance company or other payer.

Coding requires not only an understanding of the medical codes themselves, but also of medical terminology, and human anatomy and physiology.

For example, suppose a patient goes to the doctor for a physical exam. The patient tells her doctor that she recently took a fall and that her shoulder has been aching ever since. The doctor performs the physical exam and orders an x-ray, which reveals that the patient has a stress fracture. Based on the doctor’s notes, the medical coder will identify and indicate the appropriate medical codes for each of the services and diagnoses the doctor made during the patient’s visit. These codes will be indicated on the bill that goes to the insurance provider for proper reimbursement.

Medical coders receive specialized training to understand the thousands of different medical billing codes. This may include any or all of the following: CPT, ICD-9-CM, and HCPCS Level II codes.

CPT stands for Current Procedural Terminology; these codes were developed by the American Medical Association (AMA) and identify different healthcare services. There are nearly 10,000 CPT codes.
ICD-10-CM stands for International Classification of Diseases, Tenth Revision, Clinical Modification; these codes identify different medical diagnoses (such as Type II diabetes, arthritis, etc.) There are over 70,000 ICD-10-CM codes. The ICD-9 was replaced by the ICD-10 in late 2015.
HCPCS-Level II stands for Healthcare Common Procedure Coding System, Level II; these codes were developed by the Centers for Medicare & Medicaid Services (CMS) to identify different medical services, supplies, and durable medical equipment. They are used to bill Medicare/Medicaid and other healthcare payers, such as HMO plans, veteran’s health care plans, etc.

In Medical Coding, Accuracy Is Key

Medical coding is complex and requires carefully reviewing physician notes to determine what services the patient received. Medical coders must comply with government regulations for medical billing, as well as private payer policies, adding to the complexity of their job. There are thousands of medical codes, many of which cover the same condition but with slight variations. For example, code K45.1 in the ICD-10 describes a “Other specified abdominal hernia with gangrene” while code K45.0 describes “Other specified abdominal hernia with obstruction, without gangrene.”¹

Medical coders need to be familiar with complex medical terminology in order to choose the right codes. Reviewing medical information and translating it into codes is challenging, but many medical coders find their jobs rewarding and take pride in mastering the skills of the job.

Physicians and other healthcare professionals rely on the expertise of medical coders to receive proper reimbursement for services. Inaccurate coding can cost providers thousands of dollars a year in lost payments. It can also result in overpayment, which the doctor then must repay. In worst case scenarios a healthcare provider could face legal charges for overbilling. Overpayment to a doctor or hospital by Medicare or Medicaid because of inaccurate coding ultimately hurts taxpayers, whose tax dollars support these programs.

It is clear that medical coders have an important job, and accuracy is the key.

Job Outlook and Salary Range

The outlook for certified AAPC Professional Certified Coders is excellent, according to the U.S. Bureau of Labor Statistics (BLS). Employment of medical coders and health information technicians is projected to grow 22 percent from 2012 to 2022, much faster than average.² The median pay rate in 2012 was $34,160 per year, but coders with specialty credentials tend to earn more. According to AAPC, certified coders earn 21 percent more than non-certified coders. Additionally, the BLS notes that coders employed by pharmaceutical companies earn the most, averaging $66,000 a year.

Several factors are contributing to job growth in medical coding. First, healthcare providers are increasingly adopting electronic health records (EHR) systems, which add to the responsibilities of electronic data management. Additionally, as the population ages, the number of medical procedures and services increases.

Becoming a Certified Coder

While at one time coders learned on the job, today people can train to become a certified professional coder (CPC). This designation is very attractive to potential employers, as it indicates you have demonstrated a certain level of skill and accuracy in coding. Medical coding certification courses and programs may include any or all of the following:

AAPC (American Academy of Professional Coders) certification is the gold standard in the industry, and AAPC certified coders are preferred by physicians and payer organizations .Be sure when you take a course it is from an AAPC Licensed Instructor.

Online distance learning medical coding certification programs are a popular option for those who work full-time. Training generally takes between 6 and 18 months, and you must pass an exam administered by AAPC.

Since coding is largely based on the healthcare setting, certifications are becoming available for different medical specialties, including general surgery, and obstetrics and gynecology. Those with fewer than two years of experience are considered “apprentices” and receive a CPC-A designation. Those who work in outpatient hospital facilities are given the COC designation (formerly CPC-H), and payers are given the CPC-P designation. Continuing education is required to maintain certification. Codes change constantly, so medical coders must stay on top of new rules and interpretations.

Medical Coders Play an Important Role in Healthcare

The job outlook for medical coders is excellent, making this career path an ideal choice for those who want to make a real contribution to healthcare while securing a stable job. Medical coders play an important role in the healthcare administration process, helping medical professionals focus on what’s important—caring for patients.