Going the Distance

Code With an Edge that Only Specialty Credentials Can Provide

By Maryann M. Cox, RN, BSN, CPC, CHC

Just as patients turn to specialists to address specific health care concerns, providers seek specialty-specific credentials when hiring coding professionals to meet their practice needs.

Certified Hematology and Oncology Coder CHONC

Having recently learned that a loved one suffered a heart attack, my family’s first reaction was to locate a reputable cardiologist to guide the care and recovery of our family member. The same logic is, with increasing frequency, being applied in the arena of medical coding, as, physician specialists enlist the assistance of coding professionals with specific expertise related to their particular area of focus.

Although general certifications such as CPC® and CPC-H® provide practitioners with assurance that a coding professional has earned proficiency in general multi-specialty coding conventions, the specialty credential speaks to a level of mastery in a given specialty arena. This mastery serves a dual purpose — ensuring that the coding professional is recognized and compensated for his or her expertise, and providing powerful assurance to the specialist physician that his or her hard-earned revenue is captured proficiently.

As the coding profession continues to escalate in stature, we have moved from the value of possessing a general credential to the added value of the specialty certification which implies expertise in the given arena. This allows the coder to parlay his or her experience and knowledge base to better educate practitioners and maintain succinct compliance with particular coding guidelines. Further, the advent of specialty credentials provides employers and entities with yet another metric for determining the level of expertise expected from a potential employee.

Ensure Success When Obtaining Your Specialty Credential

Successfully completing the specialty credential examination will hinge upon several factors:

  1. Experience or extensive study of the specialty; however, there is no prerequisite requirement for experience or core knowledge related to the given specialty.
  2. Sound command of terminology, acronyms and procedural methodology specifically related to the specialty.
  3. The ability to research and retain knowledge related to specialty-specific coding conventions, including adjunct references. For example, a candidate sitting for the orthopedic specialty credential would be well served by familiarity and utilization of an additional reference text, such as the Orthopedic Coding Companion two-volume set, during the exam.
  4. Current AAPC credentials such as CPC®, CPC-H®, CPC-P®. Because the specialty examination is difficult and designed to show advanced proficiency in that arena, the exam is not available to apprentice level coders.

Educate Potential Employers as to the Value of Your Specialty Credential

As coding requirements have become more rigorous, specialty physician practices work diligently to balance capture of all earned revenue and remain in compliance with federal and state mandates. Often, educating “upward” is necessary to assure that practice administrators understand the benefit of hiring a specialty credentialed coding professional versus a generalist coder to help meet practice compliance and revenue capture needs.

Many practices already realize the value of a specialty credential. “Helping with internal coding and clarifying subtleties of coding are helpful toward getting the claim generated,” says Mona Reimers, director of revenue services at Orthopaedics NorthEast. “But we are finding that it is the coders’ expertise that is helping us win reviews of claims when payers deny or try to bundle what should not be bundled. Coding expertise on the back end of claims management (after the first EOB reaches the office) is adding considerable depth to our practice. When you are deep into an argument with a payer about what a code does and does not cover, the additional certification would certainly add credibility.”

In addition, AAPC’s recent salary survey showed that 8 percent of coders with specialty credentials earned over $85,000, whereas only two percent of coders with core certifications earned that much. Just 1 percent of non-certified coders took home over $85,000.

Prove Your Worth

Prowess during the interview process will likely enhance your ability to receive recognition of your specialty credential achievement and the natural adjunct of salary enhancement. Utilizing the following tips during the interview process will showcase your value, while serving to accelerate the administrator’s understanding of the need for high-level proficiency in their practice specialty.

  1. Come to your interview prepared to discuss a few specific coding scenarios that are often miscoded or denied based on inappropriate coding, and illustrate how first-time correct coding can affect the practice revenue and guard against billing non-compliance.
  2. Be prepared to demonstrate your knowledge of commonly missed or inappropriately coded procedures related to your specialty area.
  3. If the opportunity presents itself, discuss the differences between general and specialty-specific coding credentials.

As coding professionals continue to rise to the forefront as candidates expected to lead revenue cycle improvement and compliance, specialty credentials become progressively essential to qualify for employment in specialty practices. Coding professionals, scrutinizing the development of our profession, logically take the next step toward enhancing our professional capabilities. A natural progression for professional development is to seek out and master the specialty credential examination of your choice. Your career and specialty practice employers will thank you for taking the step!

AAPC offers specialty examination study guides for Cardiology, Evaluation and Management, Orthopedics, Obstetrics/Gynecology and General Surgery, Cardiovascular and Thoracic Surgery, Ambulatory Surgery Centers, Family Practice Medicine, Pediatrics, Gastroenterology, Internal Medicine, Otolaryngology and Plastic and Reconstructive Surgery. Visit the AAPC website to learn more about obtaining a specialty credential.

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