What is medical coding?
Medical coding is the process of applying codes to represent clinical information. Providers can use codes to describe the following:
- Diagnostic information that is related to a patient’s condition
- Services and supplies
At this time, the United States uses these primary coding systems for billing purposes:
- International Classification of Diseases, 10th Revision, Clinical Modification/Procedure Coding System (ICD-10-CM/PCS)
- Healthcare Common Procedure Coding System (HCPCS), including Current Procedural Terminology® (CPT) and HCPCS Level II
In general, codes are used for billing purposes to describe
- Why the patient received the service (generally using codes from Volume 1 of ICD-10-CM)
- What services the patient received (generally using codes from CPT, HCPCS Level II, or ICD-10-PCS)
Medical coding as a profession
Although clinical knowledge can be extremely helpful to a coder, the medical coding profession does not involve the practice of medicine. Rather, it is the application of coding rules to a set of clinical facts.
Coding has become a recognized profession in its own right. Two national organizations certify individuals as having coding expertise:
Both organizations generally require some practical coding experience and successful completion of an examination before an individual can become certified. Credentialing is a necessity in the coding professional. Not only does the government recommend that only credentialed coders be permitted to provide coding for Medicare patients, credentialing validates the coders skills and knowledge to the world.
The AAPC offers a variety of coding certifications in addition to an apprentice credential (CPC-A) for an individual with limited coding experience and specialty coding certifications:
- Certified Professional Coder (CPC)—awarded to individuals who have demonstrated competence in diagnosis coding and HCPCS/CPT procedure coding.
- Certified Outpatient Coding (COC)—awarded to individuals who have demonstrated proficiency in assigning accurate medical codes for diagnoses, procedures and services performed in the outpatient setting.
- Certified Inpatient Coder (CIC)—validates expert level knowledge and experience in abstracting information from the medical record for ICD-10-CM and ICD-10-PCS, and specialized payment knowledge in MS-DRGs and Inpatient Prospective Payment Systems (IPPS).
- Certified Risk Adjustment Coder (CRC)—demonstrates the ability to read a medical chart and assign the correct diagnosis (ICD-10-CM) codes for a wide variety of clinical cases and services for risk adjustment models (e.g., HCC, CDPS, and HHS Risk Adjustment).
AHIMA offers two coding certifications in addition to a separate apprentice certification (CCA):
- Certified Coding Specialist-Physician-based (CCS-P)—awarded to individuals who have demonstrated competence in coding physician services
- Certified Coding Specialist (CCS)—awarded to individuals who have demonstrated competence in coding hospital inpatient and outpatient services
AHIMA also offers two credentials that require a degree from a program accredited by the Commission on Accreditation for Health Informatics and Information Management Education (CAHIIM):
- The Registered Health Information Administrator (RHIA) credential is awarded to an expert in managing patient health information and medical records, administering computer information systems, collecting and analyzing patient data, and using classifications systems and medical terminologies. RHIAs often manage people and operation units, participate in administrative committees, and prepare budgets.
- A Registered Health Information Technician (RHIT) is awarded to a health information technician who ensures the quality of medical records by verifying their completeness, accuracy, and proper entry into computer systems. An RHIT often specializes in coding diagnoses and procedures in patient records for reimbursement and research.
Earning potential for medical coders
Despite the economic downturn, salaries in the coding profession continued to rise, according to the 2013 JustCoding Coder Salary Survey. Out of 750 survey respondents, 68% reported that they earn more than $20 an hour ($41,600 annually); up from 60% of respondents who reported that they made this amount in 2009. And 42% earn more than $26 per hour ($54,080 annually), up from 29% in 2009.
An impressive 71% of survey respondents reported that they had received a raise in the past 12 months. More than half this group (68%) reported a 2%–3% salary increase.
Other factors, such as education, setting, and the type of coding performed, play a role in the overall increase in coder salaries:
Education: Higher education often leads to higher salaries. There is a clear distinction between coders whose highest education was “some college” compared to those who earned a master’s degree. Consider the educational achievements of those who earned more than $30 an hour:
- Some college: 23%
- Associate’s degree: 38%
- Bachelor’s degree: 21%
- Some graduate work: 4%
- Master’s degree: 8%
Inpatient vs. outpatient vs. combination: The type and breadth of records with which coders work also appears to affect salary. Of those respondents who code inpatient records, 34% make more than $30 per hour. The percentage decreases significantly for physician coders (15%) and outpatient coders (15%).
In addition, coders who code a variety of records are more apt to be at the higher end of the salary spectrum. For those who perform both inpatient and outpatient coding or some combination of inpatient, outpatient, and physician coding 34% respectively reported making more than $30 an hour.