Coding Certifications
Individuals just entering the medical coding profession--and even some "old-timers"--sometimes have questions about coding certifications. Although there are no laws or regulations mandating the use of certified coders--and no such requirements are even pending on the horizon--coding professionals may want to know more about professional and certifying organizations for the coding professional.
THE TWO MAIN CODING CERTIFICATION ORGANIZATIONS
The two professional organizations representing health care coders are the American Academy of Professional Coders (formerly, the American Academy of Procedural Coders) and the American Health Information Management Association. There is some friendly rivalry between these two organizations as the scope of these two organizations has begun to overlap. Interestingly however, although some friendly organizational rivalry has developed, members of one coding organization sometimes aren't even aware of the existence, much less the scope, of the other organization.
American Academy of Professional Coders (AAPC)
The American Academy of Professional Coders (AAPC) was founded in 1988 as the American Academy of Procedural Coders in an effort to raise the professional standards of physician practice procedural coders by providing education, recognition, and certification. As of February 2008, the AAPC has over 65,000 members in all 50 states and several foreign countries. Nearly 50,000 members are certified by the AAPC. Membership in the AAPC is open to all coding-related professionals. The members of this coding organization generally come from the ranks of physician practices. They are well-versed in HCPCS Level I (CPT-4), Level II, and Level III codes and ICD-9-CM (International Classification of Diseases, 9th Edition, Clinical Modification) diagnosis codes--the two coding systems used for physician billing. Lately, with the increase in the number of Ambulatory Surgical Centers, there has been a greater need in the Outpatient surgery facility setting for coders who have a greater proficiency with the CPT-4 coding system. Consequently, AAPC members have begun to make inroads into hospitals and are less relegated to physician practices.
The AAPC was founded a decade ago to fill a void left by the American Health Information Management Association. Because of their relatively short time on the scene, the AAPC tends to be thought of as the "young upstarts." And because physician procedural billing uses the CPT-4 procedural coding system rather than the ICD-9-CM procedural coding system, the AAPC's two Certifications focus more on CPT-4 than on ICD-9-CM. Although the ICD-9-CM coding system is touched upon, it is primarily the ICD-9-CM diagnosis coding system. However, the AAPC has now begun to broaden its focus from simply physician coding to include hospital coding as well and has introduced some aspects of ICD-9-CM procedure coding into its curricula and certification testing. As ASCs become more important in the healthcare market, as we continue to work through implementation of Ambulatory Payment Classifications (APCs), and as the Office of the Inspector General compels providers to take a greater interest in Medicare Part B Coverage and Compliance issues, the AAPC and its two Certifications have become more important and relevant to hospitals and to ASCs, not merely to physician practices. The AAPC has positioned itself well in case this trend continues.
The AAPC currently offers two coding certifications: Certified Professional Coder (CPC) and a Certified Professional Coder--Hospital (CPC-H) to reflect the AAPC's greater participation in hospital coding. Although it is no longer offered, an earlier certification, the Master Procedural Coder (MPC), was briefly offered by the AAPC. To take the tests, one must have:
1. A high school diploma or GED
2. Two years of coding employment history as "medical field experience" or one year of such medical field experience in addition to an 80-hour coding course or completion of an AAPC-approved course of study for CPT-4/ICD-9-CM coding
3. Completion of a medical terminology course
4. Two letters of professional recommendation
CPC Exam
The CPC Exam covers the entire CPT-4 book, with emphasis on the Surgery codes and the Evaluation and Management codes. It includes some very basic anatomy and medical terminology as well as some HCPCS and ICD-9-CM coding. The exam is 150 questions, all multiple choice, takes five hours, and is open book (current CPT-4 code book and current ICD-9-CM Volumes 1 and 2). The test is now broken into three sections, and a passing score must be obtained on each section; a passing score is 70% or higher.
CPC-H Exam
The CPC-H Exam focuses on the Surgery and Medicine CPT-4 codes as well as some HCPCS and ICD-9-CM diagnosis and procedure coding. It includes some medical terminology, basic anatomy, the format of the UB-92 claim form, Medicare guidelines, ASC facility questions, basic questions on reimbursement issues, and rules involving the use of modifiers. The exam is 150 questions, all multiple choice, takes five hours, and is open book (current CPT-4 code book and current ICD-9-CM book, Volumes 1, 2, and 3). The test is now broken into three sections, and a passing score must be obtained on each section; a passing score is 70% or higher.
CPC Apprentice and CPC-H Apprentice Designation
Those applicants who are successful in passing either the CPC exam or the CPC-H exam but have not met the the "medical field experience" requirement will be awarded the initial designation "CPC-Apprentice" or "CPC-H-Apprentice." The CPC-A and CPC-H-A are required to submit the annual 18 CEUs while completing their medical field experience requirement, and will receive a certificate from AAPC for CPC/CPC-H Apprentice. When the required medical field experience is met, they may submit documentation and receive their official, full AAPC CPC/CPC-H certification and diploma.
AAPC Membership
Membership in the AAPC is $85 for the first year and $85 for each annual renewal. There is also a special student rate of $50. Tests are $285 per member, $385 for non-members. The AAPC publishes a monthly medical coding newsletter and holds medical coding conferences. The AAPC also offers Independent Study Programs (ISPs) designed to teach CPT-4 procedural coding and ICD-9-CM diagnostic coding--all the way from Square One up to taking the coding exams. (Taking the ISP will enable one to meet the coding course option in Requirement # 2 above). The cost of the ISPs varies depending on member/non-member status and which of the two exams are being taken. Basically, they cost from $975 to $1225. For those who already have a coding background and a year's experience, simple medical coding Study Guides to prepare for the tests can be obtained from the AAPC: $45 for members, $60 for non-members. Tests are offered by Local AAPC Chapters two or three times a year--with a goal of offering the test four times a year. On just about any weekend, there's a test being offered somewhere in the country. One can even arrange (at an additional cost) for the AAPC to administer and proctor a coding exam at a place and time which is more convenient. The AAPC also offers exam practice tests to help you determine how prepared you are for the CPC exam. A candidate may be take a free "re-test" within a year if the candidate is unsuccessful at passing the test on the first attempt.
Certification can be maintained with 18 CEUs per year (24 CEUs if an individual has both certifications). CEUs are obtained by:
* Pre-approved Seminars, Workshops, and Web-based Training
* Pre-approved Publications and Subscriptions
* Pre-approved Subscriptions
* Coding scenarios from CPT, ICD-9 and HCPCS code books
* Attending Local or National Chapter Meetings
* Teaching/Presenting
* Pre-approved Videos
* Completing Specialty Proficiency Examinations
* Non-pre-approved Programs (you need to fill out some special forms)
Alternatively, an individual can retake the coding exam(s).
More information about the American Academy of Professional Coders and upcoming Certification exams can be obtained from:
American Academy of Professional Coders (AAPC)
309 West 700 South
Salt Lake City, Utah 84101
Phone: (800) 626-CODE
Fax: (801) 236-2258
Mailto:aapc@aapcnatl.org
Website: http://www.aapc.com
American Health Information Management Association (AHIMA)
The American Health Information Management Association (AHIMA) was founded in 1928. They administer credentials and continuing education credits for medical records and health information practitioners. As of November 2003, AHIMA has over 46,000 members, including Registered Health Information Technicians (RHITs) (formerly Accredited Record Technicians--ARTs) and Registered Health Information Administrators (RHIAs) (formerly Registered Record Administrators--RRAs). AHIMA also offers membership in six separate specialty groups. Among these specialty groups is the Society for Clinical Coding (SCC). AHIMA publishes a ten-times-per-year professional journal and holds an annual national convention.
Because AHIMA was founded 75 years ago, they tend to be thought of as an authority and leader in health information management. In fact, AHIMA is one of the four "Cooperating Parties" (along with the National Center for Health Statistics [NCHS], the Centers for Medicare and Medicaid Services [CMS], and the American Hospital Association [AHA]) that are responsible for oversight and maintenance of the ICD-9-CM code set.
Hospital coders became necessary chiefly to wade through a patient's medical chart, select appropriate ICD-9-CM diagnosis codes and ICD-9-CM procedure codes so that the patient could be placed into the proper DRG. As a result, AHIMA's focus has historically been on hospital health information and on ICD-9-CM diagnosis and ICD-9-CM procedural coding. As the line between hospitals and physicians has blurred, and as more and more health care information has become CPT-4 code-based, AHIMA's hospital focus on the ICD-9-CM system rather than the CPT-4 system left them a bit "out of the loop" regarding physician procedural coding--a void that was filled by the AAPC. AHIMA has now broadened their coding focus to include physician coding issues. Their new CCS-P exam is meant to cater to physician practice codes and bring them "into the fold." Rather than being thought of as an organization just for hospital medical records staff and hospital coders, the two Certifications offered by AHIMA may help broaden the organization' s focus and help to change their reputation; AHIMA may become thought of as an organization representing both hospital coders and physician practice coders.
In addition to offering RHIT and RHIA Certifications, AHIMA currently offers three coding Certifications: Certified Coding Specialist (CCS), Certified Coding Specialist--Physician-based (CCS-P), and Certified Coding Associate (CCA). To take the tests, one must have:
1. A high school diploma or GED
Experience in hospital inpatient (ICD-9-CM), ambulatory care (ICD-9-CM and CPT-4), or physician-based (ICD-9-CM, CPT-4, and HCPCS Level II) medical record coding is strongly recommended. Candidates with three or more years coding experience are more likely to pass the exams. (It is highly recommended that candidates for the CCA exam have at least six months experience in a healthcare organization applying ICD-9-CM and CPT coding conventions and guidelines, or have completed either an AHIMA-approved coding certificate program or other formal coding training.)
CCS Exam
The CCS Exam has two parts:
Part I consists of 60 multiple choice items testing all ICD-9-CM and ambulatory care (ICD-9-CM and CPT-4) coding competencies. Candidates have one hour for this portion.
Part II requires candidates to code 21 medical records (14 inpatients and 7 ambulatory surgery/emergency room patients). Candidates have five hours to complete this portion.
The multiple choice portion of the CCS Exam tests all sections of CPT-4. The medical record coding portion tests only the surgery section of the CPT-4. The passing score is based on a statistical equating process, which adjusts for the fluctuations in the difficulty across examinations.
CCS-P Exam
The CCS-P Exam has two parts:
Part I consists of 60 multiple choice items testing physician-based coding competencies (ICD-9-CM diagnostic coding, CPT-4, and HCPCS Level II procedural coding). Candidates have one hour for this portion.
Part II requires candidates to code 21 medical records (11 office patients, 3 inpatients, 4 operating room patients, two emergency room patients, and one skilled nursing facility patient). Candidates have five hours to complete this portion.
The medical record coding portion tests all sections of CPT-4 and HCPCS Level II. The passing score is based on a statistical equating process, which adjusts for the fluctuations in the difficulty across examinations.
CCA Exam
The content of the new CCA exam is based on HIM references and the status of regulations and legislation on or before December 31 of the previous year. The exam consists of 100 multiple-choice questions written at three different cognitive levels: recall, application, and analysis. The levels represent an organized way to identify the performance that entry-level practitioners will utilize on the job.
AHIMA Membership
Annual membership in AHIMA is $145 for an active membership and $130 for an associate membership. There is also a special Student Rate of $20. Tests are $275 per member, $320 for non-members. Tests are now offered twice a year at 51 test centers across the country. There is no "free re-test" if the candidate is unsuccessful the first time.
Certification must be maintained on an annual basis via a self-assessment. The self-assessment is comprised of multiple choice items and short medical record coding scenarios. The number of items will vary each year according to the nature of changes in the coding systems. For example, in a year in which only a few changes are made in either the ICD-9-CM or CPT-4 codes, the self-assessment may contain as few as 10 multiple choice items and two or three medical record scenarios. Alternatively, when significant changes take place, the self assessment may contain as many as 30 or more multiple choice questions and several medical record scenarios.
More information about the American Health Information Management Association (AHIMA) and the upcoming Certification exams can be obtained from:
American Health Information Management Association (AHIMA)
233 N. Michigan Avenue
Suite 2150
Chicago, IL 60601-5800
Main Number: (312) 233-1100
Main Fax: (312) 233-1090
Mailto:info@ahima.org
Website: http://www.ahima.org
For information specifically about AHIMA membership, you can visit the following web site:
http://www.ahima.org/membership
A NEWCOMER TO THE WORLD OF CODING CERTIFICATIONS
Radiology Business Management Association (RBMA)
The Radiology Business Management Association (RBMA) was founded in 1968. According to their motto, the RBMA "exists to provide resources to enable our members to more effectively manage, emphasizing those aspects unique to the business of radiology." In the year 2000, the RBMA created a smaller, daughter organization called the Radiology Coding Certification Board (RCCB). The RCCB was established "to improve professional development of radiology coders, identify a body of knowledge and skills necessary to the profession, and recognize those individuals who demonstrate a level of excellence through the certification exam." To this end, the RCCB has developed a radiology coding credentialing exam and to certify radiology coders. Candidates who successfully complete the exam are entitled to use the initials "RCC" ("Radiology Certified Coder") after their name. To take the test an applicant must have:
A high school diploma or equivalency and one year of full-time radiology coding experience within the past four years.
-or-
Two years of full-time radiology coding experience within the past four years.
-or-
An application to the RCCB demonstrating that one has had adequate or equivalent experience, such as teaching in the field. (Decision will be made by the RCCB.)
Applicants must also must not be excluded from participation in or sanctioned by the Medicare or Medicaid programs, and must not have been convicted of, or pled guilty or nolo contendre to, a criminal offense involving state or federal health care laws.
RCC Exam
The RCC Exam tests all aspects of radiology coding. The test content is broken down as follows:
International Classification of Diseases—9th Edition (ICD-9) . . . . . 10%
Specificity, Sequencing, Nonspecific Codes, Disease Codes and V Codes.
Current Procedural Terminology (CPT) . . . . . . . . . . . . . . . . . . . . . . . 60%
Modifiers, Supervision & Interpretation, Evaluation & Management, Component Coding,
Global Surgical Periods, Plain Radiography, Computerized Tomography,
Magnetic Resonance Imaging, Invasive/Interventional, Ultrasound, Nuclear Medicine and Radiation Oncology.
Anatomy and Terminology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20%
Radiological Terminology, Gastrointestinal, Metabolic, Cardiovascular, Respiratory,
Genitourinary, Musculoskeletal and Central Nervous Systems and Structures.
Ethics and Compliance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10%
Institutional/Practice Code of Ethics, Confidentiality, Accurate/Sufficient Documentation,
Billing Only for Items/Services Provided, Upcoding/Unbundling, Medically Unnecessary Services,
Institutional/Practice Compliance Plans, and Federal Register Regulations.
The first RCC examination was held in June, 2001. Tests are offered periodically throughout the year, often in conjunction with RBMA conventions and educational events. The cost to take the exam is $500 for non-RBMA members, and $450 for RBMA members. The RCC certification is valid for two years. RCCs must adhere to the RCCB standards, policies and procedures, and obtain 16 CEUs over two years to receive recertification. Alternatively, recertification can be obtained by retaking the exam. A new certificate will be provided upon receipt of the biannual renewal fee of $200 with documentation of the required CEUs. If recertification is obtained through retesting, the examination fee will be the same as for a new applicant.
More information about the RBMA's Radiology Coding Certification Board (RCCB) and the upcoming RCC exams can be obtained from:
Radiology Coding Certification Board (RCCB)
1550 S. Coast Highway #201
Laguna Beach, CA 92651
Main Number: (866) 227-7222
Mailto:info@rccbexam.org
Website: http://www.rccbexam.org