Responsibilities of a Certified Professional Coder

A certified professional coder (CPC) is an individual of high professional integrity who has cleared a coding certification examination.

Key responsibilities of a certified professional coder

A certified professional coder has knowledge and expertise in coding procedure and diagnosis used by physicians. As a CPC, you must know the correct application CPT and ICD-9 diagnosis – to translate diagnostic and procedural phrases into numerical codes used for billing and reimbursement purpose by insurance companies.

Responsibilities of a CPC are as follows:

• Code accurately: The most important task of a CPC is to determine accurate codes for physicians diagnosis and procedures.

• Being up-to-date: A CPC needs to be up-to-date with the latest medical compliance and reimbursement policies.

• Review medical records: Review medical record information to identify all appropriate coding, and see if it’s in tune with the latest reimbursement policies and CMS guidelines.

• Interface with physicians: To keep a check on compliance issues, a certified professional coder has to use her analytical skills to recommend new strategies to the physicians. Updating physicians with accurate coding information is also one of the responsibilities of a CPC.

• Implement new guidelines: A CPC must ensure that new coding guidelines are implemented in a timely manner.

• Update patient information: Patient information forms must also be updated from time to time as per requirement.

In a nutshell, a certified professional coder must demonstrate analytical and problem-solving skills regarding barriers to receiving reimbursement. Taking active part in process and quality improvement initiatives is always a plus.

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Question: Hi, I'm a stay at home mom wanting to get back into the work force.  I'm interested in getting certified as a coder.  But I have no background experience in this field at all.  My question is…what is the job prospect for a CPCs?  And since I have no experience in this field can anyone take the exam?  Thank you in advance for your assistance.

Answer:

Thanks for your question about the CPC Exam.  Anyone can take the CPC Exam but of course it is not recommended if you don't have any training or experience as you would likely fail the CPC Exam and waste your money.  A better plan is to take a CPC Certification Course followed by a CPC Exam Review just before sitting for your CPC Exam.  That way you will be best prepared. 

If you have no experience you would apply for the CPC-A credential – that is the apprentice level.  Once you have two years experience you could then submit some letters of proof and ask that you be made a full fledged CPC (without the -A).  The CPC exam is the same exam you take for the CPC-A credential.

So if you have been coding or took a course and just need a review before sitting for the exam check out the Blitz videos for COC exam preparation – otherwise consider a full fledged coding course first.

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I've been teaching medical coding and preparing students for coding certification since 1999. Many coding certification prospects that have come to my review class have said they took a medical coding course, attended a coding certification boot camp etc. and still did not pass the CPC exam. For those students it is no longer a matter of studying – it is about how they take the test.

For the CPC exam (Certified Professional Coder) sponsored by the American Academy of Professional Coders (AAPC) you will have to pass a 150 question exam in 5 hours 40 minutes.. The CPC exam is pass/fail – not about getting an A. Therefore you need to make sure you go through the CPC exam several times so you can answer the easier questions quickly and leave the more difficult ones for last.

Coding Certification (CPC Exam) Time Management Strategy

Coding Certification Exam Method 1: Multiple Passes

Answering an easy peasy medical terminology question carries as much weight as a time consuming surgical question. Your goal with this method is to go through the exam three times.  The first time you answer all of the easy questions first, the second time you focus on the medium difficulty ones and the third time you answer the difficult ones. 

Coding Certification Exam Method 2: One Dot – Two Dot Rating

As you go through your CPC exam booklet rate questions you've started to answer but decided to leave for later. In the margin of your exam grid put two dots if you feel it is a very hard, time consuming question, and one dot for a medium difficulty one. Don't over think it – just go by your gut feeling.  Now when it's time for your second pass you just focus on the one dots – you don't have to reassess the questions.  And on the third pass – you guessed it – you are going to focus on the two dot questions.

Coding Certification Exam Method 3: Final Pass

Don't leave any CPC exam questions unanswered. Use the last minutes to guess at an answer on any unanswered questions. You have a 25% chance of getting it right without even looking at the question. Of course if you've looked at the question and thrown out an answer or two indicate that on your answer grid so now you may have a 50/50 chance of getting the answer right.

Alternative Coding Certification Time Management Strategy:

One Hour Per Column Timing

When you open your CPC exam you'll find an answer grid with five columns containing 30 questions each. Allow yourself an hour for each column to keep yourself moving along.  That will leave some time left over to review.  You can ask the proctor to announce as each hour elapses. So when hour one is over and the announcement is made you finish the question you are on and move to the next column – so question 31. Yes you may have some unanswered questions in column one – that is ok – you will go back. The idea is to keep yourself moving.

If you mentally rehearse these CPC exam time management strategies, you will surely improve your chances of achieving coding certification.

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There are many benefits that come with a career in medical coding. It is a rewarding career with a median annual income of $30,000 to $45,000. Starting pay for medical coders without experience is around $11 per hour and is likely to increase after five years of experience. Most employed medical coders are also given health insurance, paid vacations, and a 401(k) package.

Medical coding is also one of the very few professions in health care that does not come into contact with patients. Most of the time, coders work in clean and comfortable offices of physicians, health care facilities, nursing facilities, hospital finance departments, insurance companies, or research institutions. In some cases, coders work in the comfort of their own homes if allowed by employers. A career in medical coding also offers many opportunities for advancement within the industry as medical coders have the option of specializing in certain fields that may suit their interests, such as cancer and neurology.

Obtaining a medical coding degree and passing the national coding certification exams will enhance job prospects as employers highly regard qualified and credentialed coders. Responsibilities of medical coders are starting to be wide-ranged as health care regulations and paperwork increases. Because of this, employers have more confidence in hiring coders who possess a coding certification with a strong background and formal training.

To be a certified medical coder, you must pass a written examination offered by the American Health Information Management Association (AHIMA). The CCA (Certified Coding Associate) is an entry level coding certification for recent graduates. CCA candidates must possess a U.S. high school diploma or its equivalent and preferably have six months of experience in the application of the ICD-9 and CPT coding or have completed a formal coding training program.

The CCS (Certified Coding Specialist) is a certification for skilled coders generally employed in inpatient or outpatient hospital settings. Eligibility requirements include a U.S. high school diploma or equivalent and completed coursework in anatomy, physiology, pharmacology, and pathophysiology. 3 years of job experience in hospital-based coding is also recommended for CCS examinees.

The CCS-P (Certified Coding Specialist-Physician Based) is a certification for coders who want to grow beyond coding for hospital settings such as a doctor's office, dental office, or clinic. Eligibility requirements for the CCS-P exam include a U.S. high school diploma or equivalent and completed coursework in anatomy, physiology, pharmacology, and pathophysiology. 3 years of job experience in physician coding services is also recommended for CCS-P examinees.

You can find more about getting medical coding certification and information on taking medical coding classes online by visiting MedicalCodingClassesOnline.net.

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Q: I want to be a CPC – where do I start?

A: The first thing you want to do is obtain a copy of the exam application packet from the American Academy of Professional Coders (AAPC) available at http://www.aapc.com or by calling 800-626-CODE. This four page form will explain exactly what is covered on the exam, how to apply and what you need to submit. Keep in mind the AAPC requires 6 weeks to process your application. Therefore an exam date of September 18th will require your exam application to be received no later than August 6th.

Q: What is the difference between the CPC and CPC-H credential?

A: Because there are distinct differences in CPT® coding for physician services vs. outpatient facility services, AAPC has two accreditation exams to meet this need. The CPC for physician coding and the CPC-H for facility coding (outpatient hospital).

Q: What is covered on the CPC exam?

A: The CPC exam covers medical terminology, anatomy, CPT Coding Guidelines, Use of Modifiers, ICD-9-CM (Vol. 1 & 2) Diagnostic Coding, E&M Coding, Anesthesia Coding, Surgical Coding and HCPCS Level II coding.

Q: What is the format of the CPC Exam?

A: There are 150 multiple choice or true/false questions as follows:

Evaluation & Management (12)
Anesthesia (6)
Radiology 70,000 series (9)
Pathology 80,000 series (10)
Medicine 90,000 series (10)
Medical Terminology (13)
Anatomy (9)
ICD-9-CM (11)
HCPCS (5)
Coding Concepts (5)
10,000 series (9)
20,000 series (10)
30,000 series (10)
40,000 series (10)
50,000 series (11)
60,000 series (10).

Q: How is the exam scored?

A: The exam used to be scored in three sections but that is no longer the case. You need to get a 70% or higher to pass.

Q: Is the exam open book?

A: Yes you will use your CPT, ICD-9-CM and HCPCS manuals for the current year or the year you applied for. You are not allowed to use a medical dictionary. You can use any version of ICD-9-CM or HCPCS but you can’t use the expert version of CPT. Review application instructions carefully.

Q: I heard that only people with experience can take the exam, is that true?

A: The CPC credential indicates you passed the exam AND have met the experience requirements. If you don’t meet the experience requirement you can apply for the apprentice credential (CPC-A). You will take the same exam but will be awarded the CPC-A credential. When the required medical coding field experience is met, you can submit documentation and receive your official AAPC CPC designation.

Q: How much experience is required?

A: Two years experience is required for the CPC designation. One year is waived if you have taken an 80 hour coding course and six months is waived if you have taken a 40 hour course. If you do not meet this experience apply for the “CPC Apprentice” designation.

Q: Where can I take the CPC exam?

A: The exam is offered annually at the national AAPC conference and quarterly at local chapters throughout the US. The best way to locate an exam in your area is to go to the AAPC web site (www.aapc.com) and use their “exam finder” feature. Once you find an exam date and location make a note of the exam index number and proctor information to put on your application. It is a good idea to contact the proctor to make sure there is room available.

Q: How do I apply for the exam?

At least eight weeks prior to your desired exam date mail in your completed exam application form, letters of reference (not needed if applying for apprentice designation) and exam application fee ($285). You should also be a member of the AAPC and it is a good idea to apply for membership before applying for the exam so you are established in their system.

Q: Do I have to take a course before taking the exam?

A: No, the AAPC does not require that you take a course in order to sit for the exam. However if your experience is limited to only one or two specialties it is recommend you take a course or at the very least attend a review class.

The AAPC has several educational products to help your prepare. They have an independent study program (ISP), the Professional Medical Coding Curriculum (PMCC) which is a classroom course offered by approved curriculum sites, and a study guide. Also many local chapters offer review classes.

Other education sources to consider are local colleges and vocational schools. Make sure they are advanced courses designed to prepare you for the board exam. Check their syllabus against what topics are covered on the board exam.

Q: Besides taking a course how can I prepare for the exam?

A: A lot of preparing depends on what you already know. Multispecialty surgery coders seem to have the broadest base of experience and do well on the exam because there are 60 out of 150 questions on surgery. Many are not so fortunate and spend time studying each surgery sub-section along with the medical terminology related to that sub-section.

Know your surgical suffixes like -otomy, -ectomy, -ostomy etc. like the back of your hand. This will help you read surgical scenarios accurately. If you’re weak in medical terminology purchase a medical terminology text book and consider making flash cards. You are not allowed to use a medical dictionary during the exam so it is very important you know your medical terminology.

I highly recommend using the professional version of CPT, study each of the guideline sections thoroughly and ask yourself what are 10 key things I could be tested on. When you’re in the guidelines you’ll see where they note additional guidelines that are found within the section instead of at the front. Go to those and make sure you understand the principles there.

Mark up your CPT books by highlighting key words especially in the guidelines area. You are allowed to make brief (one to three word) notes in the margin by your codes. Usually underlining a key word in a code is all that is needed to make it stand out compared to a neighboring code. Group families of codes together and underline or highlight the key word or phrase that makes that group different from the other groups in the same category.

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