The Importance of Establishing a Compliant Coding Program

There are many misconceptions with regards to what is a “Certified Coder.” Is an individual with a certification from a coding school, who did not take the national coding exam offered by either the American Association for Professional Coders (AAPC) or the American Hospital Information Management Association (AHIMA), a certified coder? NO. Is an individual with a Registered Health Information Administrator (RHIA) or Registered Health Information Technician (RHIT) certificate a certified coder? NO (per AHIMA). There are many organizations that have independent credentials; fortunately or unfortunately, the Centers for Medicare & Medicaid Services (CMS) does not recognize these credentials as “Certified Coder.”

Currently, the AAPC has 21 variations of certifications, while AHIMA has 10 certifications with ONLY three certifications for coding: Certified Coding Specialist (CCS), Certified Coding Associate (CCA), and Certified Coding Specialist Physician-Based (CCS-P) (

AHIMA’s CCA certified coders haven been trained on coding competencies across all settings, including both hospitals and physician practices. Respectively, the CCS and the CCS-P have been trained on the basic coding concepts along with coding concepts for inpatient (CCS) and physician based (CCS-P). In order to obtain the CCS, the individual must already be a credentialed RHIA or RHIT or a CCS-P or have one to two coding experience or educational courses. The same holds true for the CCS-P: the individual must already be a credentialed RHIA or RHIT or a CCS or have one to two coding experience or educational courses prior to sitting for the exam.

AAPC’s Certified Professional Coder (CPC) credentials indicate the individual has mastered all the code sets (CPT, ICD, HCPCS LEVEL II), E/M, as well as surgical coding guidelines. CPC training has provided a foundation for both inpatient and outpatient coding professional coding.

The Certified Outpatient Coder (COC) (previously CPC-H) will demonstrate proficiency in coding visits from an outpatient setting, including emergency department, therapy visits, radiology, pathology, etc.

The Certified Inpatient Coder (CIC) will have expertise in abstracting information from inpatient charts, and the Certified Risk Adjustment (CRC) coder will demonstrate expertise in the risk adjustment arena.

Note that the COC, CIC, and the CRC are all standalone credentials. Coders with these credentials do not necessarily have the CPC credential. The curriculum surrounding these credentials is tailored to those specific areas of interest. These coders should only be coding in their respective specialty.

AAPC Certifications:

After reviewing hundreds of resumes, it is clear that not only are employers confused about credentials, so are the individuals applying for coding positions.

Three recommendations for resumes:

  1. If specific credentials have been obtained, place them by your name at the top of the resume.
  2. Indicate which professional organization provided the certification under the education section of the resume.
  3. If you are an “apprentice,” include the A in your credentials.

The national error rate for CMS risk adjustment audits is anywhere between 10% and 30%. Is this due to employers/providers hiring non-certified coders? Are the certified coders who are hired using their skills to code correctly, or are they just trying to meet the production rates? Do employers have a thorough quality assurance program? Are coders working full-time jobs then attempting to hold down part-time positions to make ends meet? Are they making errors at the second job? Are offshore coders being properly trained? Are offshore coders certified by national organizations? Are clinicians coding during patient visits? Is the conflicting information between CMS, Official Coding Guidelines, and Coding Clinics impacting the error rates?

The answer is: all of the above have an impact…now what? Contact to learn more about establishing a compliant coding program.




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Jessica Smith
Jessica Smith

Jessica Smith is Vice President of Healthcare Analytics & Risk Adjustment Solutions at Gorman Health Group (GHG). In this role, she is responsible for the execution and oversight of risk adjustment consulting services for managed care, provider practice, and commercial market clients, and leading and integrating cross-functional teams to ensure superior performance outcomes related to risk adjustment operations. Read more

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