Which Core Medical Coding Credential is Right for You?

Coders play a valuable role in the healthcare industry by accurately selecting codes for proper reimbursement. The coder helps maintain compliance for providers and facilities by adhering to government regulations and coding guidelines.

When selecting a coding credential, consider the types of services you want to code and the type of setting where you want to work.

CPC
COC
CIC
CRC
Services
Professional services performed by physicians and non-physician practitioners
Outpatient hospital/facility services
Professional services performed by physicians and non-physician practitioners
Professional risk adjustment- documentation review and determining coditions that qualify for coding
About
The Certified Professional Coder (CPC) is the gold standard for medical coding in a physician office setting.

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The Certified Professional Coder (CPC) is the gold standard for medical coding in a physician office setting. The CPC certification exam tests the competencies required to perform the job of a professional coder who specializes in coding for services performed by physicians and non-physician providers (eg, nurse practitioners and physician assistants). Individuals who earning the CPC credential have proven expertise in physician/non-physician provider documentation review, abstract professional provider encounters, coding proficiency with CPT®, HCPCS Level II and ICD-9-CM Volume 1-2, ICD-10 CM, and compliance and regulatory requirements for physician services.

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The Certified Outpatient Coder (COC) is the only standalone outpatient coding credential in the healthcare industry.

read more

The Certified Outpatient Coder (COC) is the only standalone outpatient coding credential in the healthcare industry. The COC certification exam tests the competencies required to perform the job of an outpatient facility coder. Individuals earning the credential have proven expertise in outpatient documentation review, abstract outpatient care encounters (eg, emergency department, outpatient hospitals, and ASCs), coding proficiency with CPT®, HCPCS Level II and ICD-9-CM Volume 1-2, ICD-10 CM and outpatient payment methodologies.

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The Certified Inpatient Coder (CIC) is the only standalone inpatient coding certification in the healthcare industry.

read more

The Certified Inpatient Coder (CIC) is the only standalone inpatient coding certification in the healthcare industry. The certification exam tests the competencies required to perform the job of an inpatient coder. Individuals earning the CIC credential have proven expertise in inpatient documentation review, abstract inpatient acute care encounters, coding proficiency with ICD-9-CM Volume 1-3, ICD-10 CM, ICD-10 PCS and inpatient payment methodologies.

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The Certified Risk Adjustment Coder (CRC) is the only certification testing competencies for coders under all risk adjustment models.

read more

The Certified Risk Adjustment Coder (CRC) is the only certification testing competencies for coders under all risk adjustment models. As risk adjustment payment models gain more momentum, it is important for coders to demonstrate expertise in diagnosis coding for proper risk adjustment determinations. Professionals with the CRC certification demonstrate proficiency with documentation review, determining conditions that qualify for coding, assigning the proper ICD-9-CM & ICD-10 CM diagnosis codes and understanding the impact of reimbursement under various risk adjustment models.

hide

Skills
  • Expertise in medical record review to abstract information required to support accurate coding.

read more

  • 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.

hide

  • Expertise in medical record review to abstract information required to support accurate outpatient coding.

read more

  • 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.

hide

  • Expertise in medical record review to abstract information required to support accurate inpatient coding.

read more

  • 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.

hide

  • Expertise in reviewing and assigning accurate medical codes for diagnoses performed by physicians and other qualified...

read more

  • 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.

hide

Code Books
CPT®, HCPCS Level II and ICD-10-CM
CPT®, HCPCS Level II and ICD-10-CM
ICD-10-CM and ICD-10-PCS
ICD-10-CM
Location
Work in a physician office
Work in a hospital/facility or ambulatory surgical center
Work in a hospital/facility
Work in a hospital/facility, ambulatory surgical center, or physician office
Certification

Certified Professional Coder

Services

Professional services performed by physicians and non-pysician practitioners

About

The Certified Professional Coder (CPC) is the gold standard for medical coding in a physician office setting.
read more

The Certified Professional Coder (CPC) is the gold standard for medical coding in a physician office setting. The CPC certification exam tests the competencies required to perform the job of a professional coder who specializes in coding for services performed by physicians and non-physician providers (eg, nurse practitioners and physician assistants). Individuals who earning the CPC credential have proven expertise in physician/non-physician provider documentation review, abstract professional provider encounters, coding proficiency with CPT®, HCPCS Level II and ICD-9-CM Volume 1-2, and compliance and regulatory requirements for physician services.
hide

Skills
  • Expertise in medical record review to abstract information required to support accurate coding.
read more
  • 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.

hide

Code Sets

CPT®, HCPCS Level II, ICD-9-CM Vol 1-2, and ICD-10-CM

Location

Work in a physician office

Schedule your exam

Certification

Certified Outpatient Coder

Services

Outpatient hospital/facility services

About

The Certified Outpatient Coder (COC) is the only standalone outpatient coding credential in the healthcare industry.
read more

The Certified Outpatient Coder (COC) is the only standalone outpatient coding credential in the healthcare industry. The COC certification exam tests the competencies required to perform the job of an outpatient facility coder. Individuals earning the credential have proven expertise in outpatient documentation review, abstract outpatient care encounters (eg, emergency department, outpatient hospitals, and ASCs), coding proficiency with CPT®, HCPCS Level II and ICD-9-CM Volume 1-2, and outpatient payment methodologies.
hide

Skills
  • Expertise in medical record review to abstract information required to support accurate outpatient coding.
read more
  • 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.
hide
Code Sets

CPT®, HCPCS Level II, ICD-9-CM Vol 1-2, and ICD-10-CM

Location

Work in a hospital/facility or ambulatory surgical center

Schedule your exam

Certification

Certified Inpatient Coder

Services

Professional services performed by physicians and non-pysician practitioners

About

The Certified Inpatient Coder (CIC) is the only standalone inpatient coding certification in the healthcare industry.
read more

The Certified Inpatient Coder (CIC) is the only standalone inpatient coding certification in the healthcare industry. The certification exam tests the competencies required to perform the job of an inpatient coder. Individuals earning the CIC credential have proven expertise in inpatient documentation review, abstract inpatient acute care encounters, coding proficiency with ICD-9-CM Volume 1-3 and inpatient payment methodologies.
hide

Skills
  • Expertise in medical record review to abstract information required to support accurate inpatient coding.
read more
  • 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.
hide
Code Sets

ICD-9-CM Vol 1-3, ICD-10-CM, and ICD-10-PCS

Location

Work in a hospital/facility

Schedule your exam

Certification

Certified Risk Adjustment Coder

Services

Professional risk adjustment- documentation review and determining coditions that qualify for coding

About

The Certified Risk Adjustment Coder (CRC) is the only certification testing competencies for coders under all risk adjustment models.
read more

The Certified Risk Adjustment Coder (CRC) is the only certification testing competencies for coders under all risk adjustment models. As risk adjustment payment models gain more momentum, it is important for coders to demonstrate expertise in diagnosis coding for proper risk adjustment determinations. Professionals with the CRC certification demonstrate proficiency with documentation review, determining conditions that qualify for coding, assigning the proper ICD-9-CM diagnosis codes and understanding the impact of reimbursement under various risk adjustment models.
hide

Skills
  • Expertise in reviewing and assigning accurate medical codes for diagnoses performed by physicians and other qualified...
read more
  • 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.
hide
Code Sets

ICD-9-CM Vol 1-3, ICD-10-CM, and ICD-10-PCS

Location

Work in a hospital/facility, ambulatory surgical center, or physician office

Schedule your exam

Have a Question? Call 877-290-0440 or have a career counselor call you.

Which certification is right for you?

Call 877-290-0440 or have a career counselor call you.

Questions about what books to order?

Call 877-524-5027 to speak with a specialist.