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-9-CM Volume 1-3 coding, 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-9-CM) codes for a wide variety of clinical cases and services for risk adjustment models (e.g., HCC, CDPS, and HHS Risk Adjustment).
- Certified Professional Coder-Payer (CPC-P)—awarded to individuals who have demonstrated competence in the application of ICD-9-CM diagnosis coding and HCPCS/CPT as it pertains to the adjudication of provider claims.
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 coding34% respectively reported making more than $30 an hour.
ICD-10 and the future of the coding profession
The ICD-9 system has been in use in the United States since 1979. The original intent was to update it every 10 years. However, these updates never occurred and a major revision is long overdue. ICD-9-CM is based on the World Health Organization’s ICD-9 system. In the United States, the National Center for Health Statistics and the Centers for Medicare & Medicaid Services maintain the ICD-9-CM codes.
Effective October 1, 2015, ICD-10 will replace ICD-9 in the United States. ICD-10-CM will replace ICD-9-CM diagnosis codes (Volumes 1 and 2) in inpatient, outpatient, and professional services settings. ICD-10-PCS will replace ICD-9-CM procedure codes (Volume 3) used primarily for inpatient facility services. HCPCS, including CPT and HCPCS Level II, will remain in use for procedure coding in outpatient and physician settings.
Codes use codes to indicate how, why, and where a patient was seen for healthcare. The current ICD-9-CM system allows limited capture of this information, but more specificity is imperative to capture specificity in relation to diagnoses and also to measure outcomes for procedures used to treat such conditions. ICD-10-CM and ICD-10-PCS will allow increased specificity and room for expansion. ICD-9-CM does not allow for such growth, which limits its ability to remain a viable system. The United States also needs to be able to exchange clinical data with other nations. Most, including Canada, already use ICD-10.
Anticipated benefits of ICD-10-CM and ICD-10-PCS include:
- More accurate payments for new procedures
- A better understanding of new procedures
- A better understanding of the value of new procedures
- Improved disease management
- Standardization of disease monitoring and reporting internationally
- Fewer miscoded, rejected, and improper reimbursement claims
- A better understanding of health outcomes
The transition to ICD-10 will mean existing and new coders will need to learn the new coding system. Training for most will likely begin in earnest at the end of 2011 and throughout 2012 but industry experts suggest that coders start gaining a stronger knowledge of anatomy and physiology now. Inpatient coders will need in-depth knowledge of medical terminology to understand the different approaches and root operations that are fundamental to ICD-10-PCS.
Certified coders will also need to show their proficiency in the new coding system. For holders of an AAPC credential, all certified coders will need to take an ICD-10 proficiency exam that the organization will start offering in October 2012. Coders will need to complete the online, timed, open book test by September 30, 2014. The AAPC will require its certified coders to pass this test to retain their certification.
Those who hold a credential from AHIMA must participate in a predetermined number of mandatory baseline educational experiences specific to ICD-10-CM/PSC to maintain their certification. The number of required CEUs depends on the type of AHIMA credential. The total number of ICD-10-CM/PCS CEUs required, per AHIMA credential, includes:
- RHIT–6 CEUs
- RHIA–6 CEUs
- CCS-P–12 CEUs
- CCS–18 CEUs
- CCA–18 CEUs
These CEUs will count as part of the total required CEUs, by credential, per CEU cycle. Individuals who hold more than one AHIMA credential are required to report only the highest number of CEUs from among all credentials held. For example, if a coder holds both an RHIA and CCS, he or she would normally report 50 CEUs per recertification cycle, and 18 of those CEUs will be required to cover ICD-10-CM/PCS. AHIMA certified professionals may begin earning ICD-10-specific CEUs after January 1, 2011.