Step into the Shoes of a Medical Coder
These FAQs will walk your through the process.
If you are thinking about a career in medical coding, here are the answers to some frequently asked questions (FAQs) to help you decide.
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What does a medical coder do?
A medical coder reviews medical records and translates the documented medical procedures, diagnosis, products, supplies, and services into codes. The codes are submitted on claim forms. A medical biller confirms the correct demographic, insurance, and other information on the claim, and submits it to the insurance carrier or government payer agency. Coders and billers work together to ensure providers and facilities receive proper payment for their patient care, while observing compliance with coding and billing rules and regulations.
When claims denials occur, the coder may assist in resolving potential coding problems, so that the claim may be re-submitted for payment. Coders also may meet with physicians to explain how they can improve their documentation to better support complete, compliant coding and payment.
What kind of person makes a good medical coder?
To do the job, a coder must:
- know medical terminology and anatomy;
- review medical records and understand clinical notes;
- abstract information from the medical record; and,
determine the appropriate codes.
Successful coders can come from anywhere, but typically share a few traits, in common. A medical coder must be analytical, detail-oriented, well organized, determined, and knowledgeable in their area of practice (for example, a coder may work within a particular medical specialty, such as radiology or family medicine; or, a coder may work in an inpatient facility vs. an outpatient office). An effective coder is a lifelong learner with the ability to apply new information, rapidly.
What is a typical day for a medical coder?
Coders work at a desk, usually with a computer, and spend most of their time reviewing provider documentation, reviewing guidelines, and assigning codes. Coders typically work in a “back office,” so their dress code is usually more relaxed. A clean, neat appearance and business casual attire usually are sufficient.
Because healthcare policy changes rapidly, coders must constantly update their knowledge. CPT®, ICD-10, and HCPCS Level II code sets change yearly. To stay current, you must continuously research payer policies, government regulations, and coding updates. The Centers for Medicare & Medicaid Services (CMS) and Medicare administrative contractors (MACs) offer daily or weekly list-serve and e-mail alerts with the most up-to-date information. These are resources you will work with to ensure you are choosing the correct and most current codes to report provider services and procedures, patients’ diagnoses, medical supplies, and more.
Do I need a degree?
Although some schools offer a two or four-year degree in medical coding, it isn’t necessary to devote extensive time or expense to become a certified professional coder (CPC®). For example, AAPC’s training courses may be completed at your own pace, in is little as a few months.
How do I get started?
For those seeking a career in medical coding, a Certified Professional Coder (CPC®) credential from AAPC is the gold standard, nationally recognized by employers, physician societies, and government organizations. A CPC® certification validates proficiency in the correct application of CPT®, HCPCS Level II procedure and supply codes, and ICD-10-CM diagnosis codes used for coding and billing of medical claims. As an initial step to earning a CPC® credential, you must take and pass the CPC® examination.
To decipher providers’ documentation and assign codes from the medical record, you have to know the lingo. AAPC offers online medical terminology and anatomy courses that are ideal for students who have never studied these topics, or for those who want to refresh or improve their knowledge. The courses introduce you to medical terminology and human anatomy used in coding and reimbursement. The classes include module tests and a final exam, so you can measure and verify your comprehension.
If you have previous clinical experience, or have taken medical terminology and anatomy, AAPC offers an 80-hour online course that covers CPT®, HCPCS Level II, and ICD-10-CM coding, and assures you have a broad knowledge in reviewing and assigning the correct procedure and diagnosis codes for professional services.
Experienced coders may take the CPC® exam review which is an 8-hour online review, focusing on the competencies tested on the CPC® exam, most missed coding concepts, and test strategies. The review is divided by domains covered on the exam. Each session focuses on a single area of the exam, and reviews key concepts, test taking tips and strategies, and most commonly missed questions. This is an excellent review regardless of where you received your education.
The CPC® study guide reviews each section of the CPC® exam in detail and provides practical examples, sample questions, and test taking techniques. Included are over 200 sample questions with answers and rationales. Twenty chapters guide you through a review of anatomy and terminology, ICD-10, HCPCS Level II, and CPT® coding for each body system, E/M coding, anesthesia, radiology, pathology/laboratory, and appropriate use of modifiers. The study guide also provides you with testing tips for taking AAPC’s CPC® exam.
Finally, AAPC’s online practice exams were developed by the same people who created the CPC® exam, and simulate the format and effort of the actual exam. Practice exams are 5 hours and 40 minutes and will help you to gauge your readiness for the certification exam.
What happens after I’m Certified?
After you’ve passed the CPC® exam, there are a few additional steps to earn your full CPC® credential:
- Become an AAPC member. New AAPC members must submit membership payment with examination application. Renewing AAPC members must have a current membership at the time of submission and when exam results are released. Membership must be renewed annually.
- Verify your work experience. Regardless of your level of preparation, coding is a skill best learned and honed from hands-on application of coding principles and practical experience. To receive CPC® designation, you must have at least two years’ medical coding experience. If you do not initially meet this qualification, you’ll receive a CPC-A® (apprentice) designation, until you’ve achieved the required experience.
- Maintain your certification through AAPC-approved continuing education units (CEUs). Healthcare technology and regulation changes rapidly. To demonstrate continued knowledge and expertise, a CPC® must submit 36 CEUs every two years for verification. CEU-earning opportunities are available through AAPC, many of which are low or no cost , and through approved vendors
How do I find a job?
Experienced, proficient medical coders are in demand. According to the U.S. Bureau of Labor Statistics Occupational Outlook Handbook, employment of healthcare occupations is projected to grow 18 percent from 2016 to 2026, much faster than the average for all occupations. Becoming a CPC® helps you to prepare for a career in a growing, dynamic healthcare industry, and improves your chances of getting hired in a competitive job market.
AAPC has resources to help with your career search through their online Job Search tool to help you find a job in medical coding.
It’s a good idea to attend AAPC local chapter meetings, payer meetings, conferences, and webinars to stay educated and as current as possible to help you address coding issues with clinical staff and to better understand the nuances of coding. For job seekers, these are great networking opportunities, as are the AAPC Forums, and AAPC’s official Facebook page .
Can I work from home?
Usually you need to have some experience in the field to land a remote position. Coding-at-home positions are usually staffed with experienced coders. When starting out, working closely with other coders and under direct supervision will help with your success. Most entry-level coders work better onsite, until they become proficient in coding processes and are confident at working independently. Regardless of where you work, you must strictly adhere to the HIPAA Privacy and Security Rules, which protect individuals’ medical records