Which Core Medical Coding Credential is Right for You?

• 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. Expertise in assigning accurate CPT®, HCPCS Level II, and ICD-9-CM Volume 1-2 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.

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• Expertise in medical record review to abstract information required to support accurate outpatient coding.
• Ability to identify documentation deficiencies and properly query providers for proper code capture.
• Proficiency in assigning accurate medical codes for diagnoses, procedures and services performed in the outpatient setting (emergency department visits, outpatient clinic visits, same day surgeries, diagnostic testing (radiology and laboratory), and outpatient therapies (physical therapy, occupational therapy, speech therapy, and chemotherapy).
• Proficiency across a wide range of services, including evaluation and management, surgical services, radiology, pathology, and medicine.
• Knowledge of coding rules and regulations along with proficiency on issues regarding medical coding, compliance, and reimbursement under outpatient grouping systems. COC’s can better handle issues such as medical necessity, claims denials, bundling issues, and charge capture.
• Ability to integrate coding and reimbursement rule changes in a timely manner to include updating the > Charge Description Master (CDM), fee updates, and the Field Locators (FL) on the UB04.
• Correctly completing a CMS 1500 for ASC services and UB04 for outpatient services, including the appropriate application of modifiers.
• Knowledge of anatomy, physiology, and medical terminology commensurate with ability to correctly code provider services and diagnoses.
• Superior knowledge of current rules, regulations, and issues regarding medical coding, compliance, and reimbursement under OPPS.
• Strong ability to integrate coding and reimbursement rule changes in a timely manner to include updating the Charge Description Master (CDM), code updates, and the Field Locators (FL) on the UB04 for proper reimbursement.
• Solid understanding of anatomy, physiology, and medical terminology required to correctly code facility services and diagnoses.
• Understanding of outpatient reimbursement methodologies (OPPS) and how it differs from IPPS.

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• Expertise in medical record review to abstract information required to support accurate inpatient coding.
• Understand reporting requirements under UHDDS.
• Ability to identify documentation deficiencies and properly query providers for proper code capture.
• Expertise in assigning accurate ICD-9-CM Volume 1-3 medical codes for diagnoses and procedures performed in the inpatient setting. The CIC exam includes ten acute care inpatient cases in fill-in-the-blank format. Examinees must demonstrate coding ability without multiple choice options.
• Identify condition POA and use of indicators.
• Superior knowledge of current rules, regulations, and issues regarding medical coding, compliance and reimbursement under MS-DRG and IPPS systems.
• Understand different types of DRGs (eg, APR-DRG).
• Determine proper MS-DRG assignment.
• Understand impact of readmissions within a 30 day period.
• Understand the 72 hour rule and how services occurring prior to admission are reported.
• Strong ability to integrate coding and reimbursement rule changes in a timely manner to include updating the Charge Description Master (CDM), code updates and the Field Locators (FL) on the UB04 for proper reimbursement.
• Understanding of anatomy, physiology and medical terminology required to correctly code facility services and diagnoses.
• Knowledge of pharmacology to include common medications; their uses and side effects.
• Understanding of outpatient reimbursement methodologies (OPPS) and how it differs from IPPS.

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• Expertise in reviewing and assigning accurate medical codes for diagnoses performed by physicians and other qualified healthcare providers in the office or facility setting (e.g., inpatient hospital).
• A sound knowledge of medical coding guidelines and regulations allowing a CRC to understand the impact of diagnosis coding on risk adjustment payment models.
• Apply proper diagnosis code assignment under various risk adjustment models including HCC, CDPS, ACA-HHS and private payer models.
• Demonstrate the ability to apply trumping in the risk adjustment hierarchy.
• Understand the use of data mining from data captured through risk adjustment coding.
• Understand the use of predictive modeling from data captured through risk adjustment coding.
• Identify common coding errors identified in RADV audits and how to prevent audit findings.
• Ability to identify and communicate documentation deficiencies to providers to improve documentation for accurate risk adjustment coding. Knowledge of anatomy, pathophysiology, and medical terminology necessary to correctly code diagnoses.

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