Medical Coding Credentials

Are All Medical Coding Credentials the Same? Understanding Different Certifications in the Field

Medical coding credentials are crucial for professionals in healthcare information management, ensuring they possess the necessary knowledge and skills to accurately assign medical codes for diagnoses, procedures, and services. However, not all credentials in medical coding are the same. Here’s an overview of the different certifications available and what sets them apart:

Medical Coding Credentials

AAPC:

Certified Professional Coder (CPC)

Offered by the American Academy of Professional Coders (AAPC), the CPC credential demonstrates proficiency in outpatient coding. CPC holders are skilled in assigning CPT (Current Procedural Terminology) codes, ICD-10-CM diagnosis codes, and HCPCS Level II codes for procedures and services performed in outpatient settings.

Competencies proven with CPC credential include:

• Expertise in medical record review to abstract information required to support accurate coding.
• Ability to identify documentation deficiencies and properly query providers for proper code capture. Ӏ Expertise in assigning accurate CPT^®, HCPCS Level II, and ICD-10-CM medical codes for diagnoses and procedures.
• Solid understanding of anatomy, physiology, and medical terminology required to correctly code professional provider services and diagnoses.
• Proficiency across a wide range of services, including evaluation and management, anesthesia, surgery, radiology, pathology, and medicine.
• A sound knowledge of medical coding guidelines and regulations including compliance and reimbursement – allowing a CPC to better handle issues such as medical necessity, claims denials, bundling issues, and charge capture.
• Understanding of how to integrate medical coding and payment policy changes into a practice’s reimbursement processes.

Certified Inpatient Coder (CIC)

The CIC credential is specifically for professionals specializing in inpatient hospital coding. CIC holders are proficient in assigning ICD-10-CM diagnosis codes and ICD-10-PCS procedure codes for inpatient hospital stays. The Certified Inpatient Coder (CIC) credential is the only certification exclusively specialized in hospital and facility inpatient coding. This certification validates mastery in abstracting information from the medical record for ICD-10-CM and ICD-10-PCS coding. It also represents expert knowledge of Medicare Severity Diagnosis Related Groups (MS-DRGs) and the Inpatient Prospective Payment System (IPPS). Inpatient coding differs from physician-based coding in that it focuses on services provided by the facility, rather than on services provided by the physician.

CIC-certified professionals typically work in hospitals (acute care facilities), skilled nursing facilities (SNFs), critical access hospitals (CAHs), teaching hospitals, inpatient rehab facilities (IRF), and long-term care hospitals (LTCHs).

Certified Professional Outpatient Coder (COC)

The COC focuses on outpatient coding.

Coders who earn their COC credential go on to report outpatient services in a variety of settings, such as:

• • Hospital emergency departments
  • Outpatient hospital clinics
  • Outpatient therapy departments
  • Outpatient cancer centers
  • Dialysis services
  • Outpatient radiology departments
  • Ambulatory surgery centers

Certified Professional Risk-Adjustment Coder (CRC)

Healthcare professionals earning their CRC credential possess demonstrated expertise in the complexity of diseases associated with chronic conditions and comorbidities, as well as mastery of ICD-10-CM guidelines and risk adjustment guidelines. As CRCs, they are equipped both to ensure clinical documentation accurately portrays the patient’s health status and to ensure all clinically documented diagnoses are properly reported.

Certified Professional Medical Auditor (CPMA)

With tighter regulation on reporting medical services, there is a growing demand for CPMAs. They have a clear understanding of when and where an organization is at risk for non-compliance. CPMAs help providers avert liability and secure proper reimbursement for their patient care.

Certified CPMAs demonstrate expertise in:

• Medical documentation, fraud, abuse, and penalties for documentation and coding violations based on governmental guidelines
• Coding concepts
• Scope and statistical sampling methodologies
• Medical record auditing and abstraction
• Quality assurance and coding risk analysis
• Communication of results and findings
• The medical record

Certified Professional Practice Manager (CPPM)

This credential is a logical next step for individuals with a lot of experience in many areas of healthcare and who are ready to advance their careers into a physician practice management position.

Certified Professional Compliance Officer (CPCO)

Passing the CPCO exam, employers recognize you possess an understanding of the key requirements necessary to effectively develop, implement, and monitor a healthcare compliance program for your practice based on governmental regulatory guidelines — including internal compliance reviews, audits, risk assessments, and staff education and training.

Certified Documentation Expert Outpatient (CDEO)

This credential validates expertise in reviewing outpatient documentation for accuracy to support coding, quality measures, and clinical requirements. CDEO professionals give feedback to providers to improve clinical documentation and facilitate ongoing documentation improvement to meet all requirements of the medical record.

Certified Documentation Expert Inpatient (CDEI)

This credential validates expertise in reviewing inpatient documentation for accuracy to support coding and clinical requirements. CDEI professionals provide feedback to providers to improve clinical documentation and facilitate ongoing documentation improvement to meet all requirements of the medical record. To become a CDEI, documentation professionals must demonstrate knowledge of pathophysiology, inpatient coding and billing guidelines, and healthcare payment models.

Certified Evaluation Management Coder (CEMC)

Experienced evaluation and management (E/M) coders are encouraged to sit for the CEMC exam. CEMC certification demonstrates proficiency applying correct ICD-10-CM, CPT^®, HCPCS Level II, and modifier assignment when reporting evaluation and management services. The CEMC certification validates command of E/M medical decision making (MDM) and time guidelines, which pertain to multiple specialties.

The CEMC certification exam will test:

• Understanding of E/M guidelines for new and established office and outpatient services, as well as other E/M services such as consultations and hospital services
• Ability to determine E/M level of service based on MDM and time
• Knowledge of rules and regulations for Medicare billing — including incident to, teaching situations, shared visits, consultations, and global surgery
• Coding per National Correct Coding Initiative (NCCI), ICD-10-CM, CPT^®, and modifier rules
• Risk assessment, including (but not limited to) the ability to benchmark and identity problematic situations and missed billing opportunities
• Medical terminology
• Anatomy and physiology

Certified Ambulatory Surgery Center Coder (CASCC)

Experienced ambulatory surgery center coders are encouraged to sit for the CASCC exam. CASCC certification demonstrates proficiency navigating operative reports and applying ASC rules for reimbursement, such as multiple, device-intensive, and discontinued procedures.

The CASCC certification exam will test:

• Ability to read and dissect operative notes to apply correct ICD-10-CM, CPT^®, HCPCS Level II and modifier coding assignment
• Knowledge of types of surgery performed in the ASC healthcare setting
• Coding of ancillary procedure codes, as well as drugs and biologicals
• Rules for reimbursement of services provided at ASCs (multiple, device-intensive, and/or discontinued procedures)
• Regulatory rules established under federal and/or state standard committees
• Medical terminology
• Anatomy and physiology

Certified Anesthesia and Pain Management Coder  (CANPC)

CANPC certification demonstrates proficiency applying correct ICD-10-CM, CPT^®, HCPCS Level II, and modifier assignment when reporting anesthesia and pain management services and procedures, and validates a medical coder’s proficiency in surgical reporting and pain management. This proficiency includes knowledge of anesthesia coding, as well as elements of anesthesia claims, such as units of time and anesthesia modifiers.

The CANPC certification exam will test: 

• Selecting the appropriate CPT^® codes for surgical cases and cross walking to the appropriate anesthesia code
• Proper use of modifiers common for anesthesia cases
• Determining time units and total units for anesthesia cases
• Rules and regulations governing Medicare billing — including incident to, teaching situations, shared visits, consultations, and global surgery
• Coding per National Correct Coding Initiative (NCCI) policy, ICD-10-CM, CPT^®, and modifiers
• Understanding of evaluation and management (E/M) guidelines for new and established office and outpatient services, as well as other E/M services such as consultations and hospital services
• Medical terminology
• Anatomy and physiology

Certified Cardiology Coder (CCC)

Experienced cardiology coders are encouraged to sit for the CCC exam. CCC certification demonstrates proficiency applying correct ICD-10-CM, CPT^®, and HCPCS Level II codes, as well as modifiers, for cardiology services and procedures. This certification recognizes demonstrated skill reporting surgical procedures performed by cardiologists, such as heart catheterization, coronary interventions, pacemaker insertions, peripheral vascular procedures, etc

The CCC certification exam will test:

• Ability to read and abstract physician office notes and operative notes to apply correct ICD-10-CM codes, CPT^® codes, HCPCS Level II codes, and modifiers
• Understanding of evaluation and management (E/M) guidelines for new and established office and outpatient services, as well as other E/M services such as consultations and hospital services
• Knowledge of rules and regulations for Medicare billing — including incident to, teaching situations, and shared visits
• Coding of ancillary and surgical procedures performed by cardiologists such as heart catheterization, coronary interventions, pacemakers, peripheral vascular procedures, etc.
• Medical terminology
• Anatomy and physiology

Certified Cardiovascular and Thoracic Surgery Coder (CCVTC)

Experienced cardiovascular and thoracic surgery coders are encouraged to sit for the CCVTC exam. CCVTC certification demonstrates proficiency applying correct ICD-10-CM, CPT^®, HCPCS Level II, and represents excellence in reporting surgical procedures performed by cardiovascular and thoracic surgeons, such as cardiopulmonary bypass, PTCA, lung tumor ablation, etc.

The CCVTC certification exam will test:

• Ability to read and abstract physician office notes and operative notes to apply correct ICD-10-CM codes, CPT^® codes, HCPCS Level II codes, and modifiers
• Understanding of evaluation and management (E/M) guidelines for new and established office and outpatient services, as well as other E/M services such as consultations and hospital services
• Knowledge of rules and regulations for Medicare billing — including incident to, teaching situations, shared visits, consultations, and global surgery
• Coding of surgical procedures performed by cardiovascular and thoracic surgeons such as cardiopulmonary bypass, PTCA, lung tumor ablation, etc.
• Medical terminology
• Anatomy and physiology

Certified Emergency Department Coder (CEDC)

Experienced emergency department (ED) coders are encouraged to sit for the CEDC exam. CEDC certification demonstrates proficiency applying correct ICD-10-CM, CPT^®, HCPCS Level II, and modifier assignment when reporting ED services and procedures. The CEDC certification endorses excellence in coding the myriad procedures performed by ED physicians, such as thoracentesis, laceration repair, moderate sedation, fracture care, foreign body removal, etc.

The CEDC certification exam will test:

• Ability to read and abstract physician office notes and operative notes to apply correct ICD-10-CM codes, CPT^® codes, HCPCS Level II codes, and modifiers
• Understanding of evaluation and management (E/M) guidelines for ED services
• Knowledge of rules and regulations for Medicare billing — including incident to, teaching situations, shared visits, consultations, and global surgery
• Coding of ancillary procedures performed in an ED
• Coding of surgical procedures performed by ED physicians such as thoracentesis, laceration repair, fracture care, foreign body removal, etc.
• Coding of moderate sedation
• Time-based coding
• Medical terminology
• Anatomy and physiology

Certified  Family practice Coder (CFPC)

Experienced family practice coders are encouraged to sit for the CFPC exam. CFPC certification demonstrates proficiency applying correct ICD-10-CM, CPT^®, HCPCS Level II, and modifier assignment when reporting family practice services and procedures. The CFPC certification recognizes expertise in coding general medicine/family practice services and procedures, such as venipunctures, injections, EKGs, lesion excisions, foreign body removals, fracture care, etc.

The CFPC certification exam will test:

• Ability to read and abstract physician office notes and operative notes to apply correct ICD-10-CM codes, CPT^® codes, HCPCS Level II codes, and modifiers
• Understanding of evaluation and management (E/M) guidelines for new and established office and outpatient services, as well as other E/M services such as consultations and hospital services
• Knowledge of rules and regulations for Medicare billing — including incident to, teaching situations, shared visits, consultations, and global surgery
• Coding of ancillary procedures performed in a family medicine practice such as venipuncture, injections, EKG, etc.
• Coding of minor surgical procedures performed in a family medicine practice such as lesion excision, foreign body removal, fracture care, etc. The examinee must know proper sequencing using relative value unit (RVU) when multiple procedures are performed.
• Time-based coding
• Medical terminology
• Anatomy and physiology

Certified Gastroenterology Coder (CGIC)

Experienced gastroenterology coders are encouraged to sit for the CGIC exam. CGIC certification demonstrates proficiency applying correct ICD-10-CM, CPT^®, HCPCS Level II, and modifier assignment when reporting gastroenterology services and procedures. The CGIC certification shows expert aptitude for coding procedures performed by gastroenterologists, such as colonoscopies, esophageal dilations, endoscopic retrograde cholangiopancreatography (ERCP), etc

The CGIC certification exam will test:

• Ability to read and abstract physician office notes and operative notes to apply correct ICD-10-CM codes, CPT^® codes, HCPCS Level II codes, and modifiers
• Understanding of evaluation and management (E/M) guidelines for new and established office and outpatient services, as well as other E/M services such as consultations and hospital services
• Knowledge of rules and regulations for Medicare billing — including incident to, teaching situations, shared visits, consultations, and global surgery
• Coding of surgical procedures performed by gastroenterologists such as gastric or duodenal intubation, enteroscopy, mediastinotomy, hernia repair, etc.
• Medical terminology
• Anatomy and physiology

Certified General Surgery Coder (CGSC)

Experienced general surgery coders are encouraged to sit for the CGSC exam. CGSC certification represents expert ability to read and dissect operative notes and apply correct ICD-10-CM, CPT^®, HCPCS Level II, and modifier coding assignment when reporting general surgery procedures, such as hernia repairs, breast procedures, transplants, etc.

The CGSC certification exam will test:

• Ability to read and abstract physician office notes and operative notes to apply correct ICD-10-CM codes, CPT^® codes, HCPCS Level II codes, and modifiers
• Understanding of evaluation and management (E/M) guidelines for new and established office and outpatient services, as well as other E/M services such as consultations and hospital services
• Knowledge of rules and regulations for Medicare billing — including incident to, teaching situations, shared visits, consultations, and global surgery
• Coding of surgical procedures performed by general surgeons such as gastric bypass, breast biopsy, ambulatory phlebectomy, skin graft, cholecystectomy, pancreatic resection, etc.
• Medical terminology
• Anatomy and physiology

Certified  Hematology and Oncology Coder (CHONC)

Experienced hematology and oncology coders are encouraged to sit for the CHONC exam. CHONC certification demonstrates proficiency applying correct ICD-10-CM, CPT^®, HCPCS Level II, and modifier assignment when reporting hematology and oncology services and procedures. CHONC certification validates expertise in coding of surgical procedures performed by hematologists and oncologists and auxiliary staff, including chemotherapy administration, hydration services, therapeutic, prophylactic and diagnostic administration, bone marrow aspiration, bone marrow biopsies, venipuncture, vaccinations, therapeutic phlebotomy, etc.

The CHONC certification exam will test:

• Ability to read and abstract physician office notes and operative notes to apply correct ICD-10-CM codes, CPT^® codes, HCPCS Level II codes, and modifiers
• Understanding of evaluation and management (E/M) guidelines for new and established office and outpatient services, as well as other E/M services such as consultations and hospital services
• Knowledge of rules and regulations for Medicare billing — including incident to, teaching situations, shared visits, consultations, and global surgery
• Coding of surgical procedures performed by hematologists and oncologists and auxiliary staff such as chemotherapy administration, hydration services, therapeutic, prophylactic and diagnostic administration, bone marrow aspiration, bone marrow biopsies, venipuncture, vaccinations, therapeutic phlebotomy, etc.
• Medical terminology
• Anatomy and physiology

Certified  Interventional Radiology Cardiovascular Coder (CIRCC)

Experienced interventional radiology cardiovascular coders are encouraged to sit for the CIRCC exam. CIRCC certification demonstrates proficiency applying correct CPT^® and HCPCS Level II codes, as well as modifiers, for interventional radiology cardiovascular services and procedures. Interventional radiology coding and charging error rates are known to be high for this radiology subspecialty. This certification validates an additional level of education, knowledge, and expertise required by the individuals who work in this complex and specialized area.

The CIRCC certification exam will test:

• Diagnostic angiography
• Nonvascular interventions (biliary procedures, biopsies, ablations, spine interventions, etc.)
• Percutaneous vascular interventions
• Diagnostic cardiac catheterization
• Basic coronary arterial interventions
• Basic coding
• Medical terminology
• Anatomy and physiology

Certified Obstetrics Gynecology Coder  (COBGC)

Experienced obstetrics-gynecology (ob-gyn) coders are encouraged to sit for the COBGC exam. COBGC certification demonstrates proficiency applying correct ICD-10-CM, CPT^®, HCPCS Level II, and modifier assignment when reporting ob-gyn services and procedures. COBGC certification validates coding proficiency for the spectrum of obstetric services — from antepartum care and delivery to postpartum care — and gynecological procedures that include hysterectomies, biopsies, colpopexies, etc.

The COBGC certification exam will test:

• Ability to read and abstract physician office notes and operative notes to apply correct ICD-10-CM codes, CPT^® codes, HCPCS Level II codes, and modifiers
• Understanding of evaluation and management (E/M) guidelines for new and established office and outpatient services, as well as other E/M services such as consultations and hospital services
• Knowledge of rules and regulations for Medicare billing — including incident to, teaching situations, shared visits, consultations, and global surgery
• Coding of obstetric services including antepartum care, deliveries, and postpartum care
• Coding of surgical procedures performed by ob-gyn physicians, such as hysterectomy, biopsies, colpopexy, etc.
• Medical terminology
• Anatomy and physiology

Certified Ophthalmology Coder (COPC)

Experienced ophthalmology coders are encouraged to sit for the COPC exam. COPC certification demonstrates proficiency applying correct ICD-10-CM, CPT^®, HCPCS Level II, and modifier assignment when reporting ophthalmology services and procedures. COPC certification recognizes demonstrated skill reporting procedures performed by ophthalmologists, such as cataract surgery, glaucoma surgery, refractive surgery, cancer treatment, reconstructive surgery to repair trauma or birth conditions, etc.

The COPC certification exam will test:

• Ability to read and abstract physician office notes and operative notes to apply correct ICD-10-CM codes, CPT^® codes, HCPCS Level II codes, and modifiers
• Understanding of evaluation and management (E/M) guidelines for new and established office and outpatient services, as well as other E/M services such as consultations and hospital services
• Knowledge of rules and regulations for Medicare billing — including incident to, teaching situations, shared visits, consultations, and global surgery
• COPC certification represents expertise in coding office and surgical procedures performed by ophthalmologists, such as retinal detachment repair, vitrectomy, and corneal transplants.
• Medical terminology
• Anatomy and physiology

Certified Professional Biller (CPB)

The CPB focuses on the billing aspects of medical coding. CPBs are skilled in medical billing processes, including claims submission, reimbursement, and compliance with billing regulations.

AHIMA:

Certified Coding Associate (CCA)

The CCA credential is an entry-level certification demonstrating competency in basic coding skills. CCAs are knowledgeable in ICD-10-CM and CPT coding systems. This certification is not often asked for by employers as it is considered an apprentice credential you can’t remove the A from.

Certified Coding Specialist (CCS)

The American Health Information Management Association (AHIMA) offers the CCS credential, which focuses on inpatient hospital coding. CCS holders are proficient in assigning ICD-10-CM diagnosis codes and ICD-10-PCS procedure codes for inpatient hospital settings.

Certified Coding Specialist  Physician Based (CCS-P)

The CCS-P certification exam assesses mastery-level proficiency in coding of health services delivery beyond the hospital setting.

Key Differences Among Credentials

• Focus of Practice: Each credential is tailored to a specific area of medical coding or billing. For example, CPC and CIC focus on outpatient and inpatient hospital coding, respectively, while CPB emphasizes medical billing processes.
• Exam Content: The certification exams differ in content and complexity. CPC and CIC exams include questions on CPT, ICD-10-CM, and HCPCS Level II coding, whereas CCS exam includes ICD-10-CM and ICD-10-PCS coding for hospital settings.
• Employer Requirements: Depending on the healthcare setting (e.g., outpatient clinic vs. hospital), employers may prefer candidates with specific credentials. Inpatient coding roles typically require CCS or CIC certification, while outpatient roles may favor CPC or CCA credentials.
• Career Advancement: Some credentials, such as CCS or CPC, may open doors to higher-level positions or specialties within medical coding and health information management.

Choosing the Right Credential

When deciding on a medical coding credential, consider your career goals, preferred healthcare setting, and the scope of practice you wish to pursue. Research the requirements and exam content of each credential to determine which best aligns with your professional aspirations.

While all medical coding credentials demonstrate competency in healthcare coding and billing, they are not interchangeable. Each credential serves a specific purpose, reflecting different scopes of practice and areas of specialization within medical coding. By understanding these distinctions, healthcare professionals can make informed decisions regarding certification and career advancement in the field of medical coding.

https://www.aapc.com/certifications

https://www.ahima.org/certification-careers/certification-exams/

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