What are the two main coding professional organizations?

The two primary credentialing organizations for medical coding and billing professionals are the AAPC (formerly the American Academy of Professional Coders) and the American Health Information Management Association (AHIMA). AHIMA certification covers coding in hospitals, and AAPC certification covers everybody else.

The AAPC was founded in 1988 with two goals: providing education and professional certification to medical coders working in physicians’ offices and setting a higher standard of coding by adhering to accepted standards.

AHIMA’s certifications are primarily directed at coders working in hospitals. Founded in 1928, AHIMA’s original goal was to improve the quality of medical records; today it continues to strive for excellence in medical record integrity with the evolution of electronic medical records.

Both the AAPC and AHIMA offer educational resources and programs including certifications.

Prior to applying for membership in either organization and registering to take a certification exam, research each one to see which best fits your need and your budget. You also may want to find out when and where the local chapter meets and attend a meeting or two just to get the feel of the organization’s culture.

And feel free to press some flesh and talk people up: Both organizations offer network and mentoring opportunities.

The AAPC

The AAPC is widely recognized for credentialing both physician- and hospital-based coders and is expanding to offer physician training services to practices as well as a credential for healthcare attorneys and IT staff. Its training programs are offered throughout the United States.

The organization also offers access to continuing education opportunities and a job database. In addition to regional conferences, the AAPC has a national convention every year, where you can find both educational and networking opportunities. (The regional conferences offer the same opportunities and are usually more economical.)

The American Health Information Management Association (AHIMA)

AHIMA is highly respected in the area of hospital and physician coders. The organization offers a variety of training programs, has an annual convention, and conducts workshops lasting several days in a variety of locales. If you choose to be credentialed by the AHIMA, you’ll have access to training and networking opportunities throughout your career.

Although it offers entry-level credentials, AHIMA doesn’t offer apprentice-level certifications as AAPC does. AHIMA certifications are intended for those already intimately familiar with coding.

The benefits of membership in a medical coding credentialing organization

In today’s world of privacy and compliance concerns, certification is the industry standard. Because certification shows that you are proficient in your area and are committed to quality healthcare by disseminating quality information, it’s one of the first qualifications that employers look for when they review you as a potential candidate, and it’s an asset when you’re negotiating a salary.

In addition, the majority of billing companies have contracts with their clients that obligate them to hire only certified coders.

As a member of one of the two main credentialing organizations —AHIMA or AAPC — you’re privy to different professional goodies. Both organizations provide numerous networking opportunities.

In addition, AAPC members receive discounts on certification tests, preparation materials, workshop fees, and numerous other products. They also are automatically subscribed to the association’s monthly publication, The Coding Edge, which keeps members up to date on changes and offers continuing education units.

Similarly, AHIMA members enjoy membership perks such as access to professional publications, discounts on books, and other training opportunities open to members only.

A clinical coder—also known as clinical coding officer, diagnostic coder, medical coder, or nosologist—is a health information professional whose main duties are to analyse clinical statements and assign standard codes using a classification system. The Health data produced are an integral part of health information management, and are used by local and national governments, private healthcare organizations and international agencies for various purposes, including medical and health services research, epidemiological studies, health resource allocation, case mix management, public health programming, medical billing, and public education.

For example, a clinical coder may use a set of published codes on medical diagnoses and procedures, such as the International Classification of Diseases (ICD), the Healthcare Common procedural Coding System (HCPCS), and Current Procedural Terminology (CPT) for reporting to the health insurance provider of the recipient of the care. The use of standard codes allows insurance providers to map equivalencies across different service providers who may use different terminologies or abbreviations in their written claims forms, and be used to justify reimbursement of fees and expenses. The codes may cover topics related to diagnoses, procedures, pharmaceuticals or topography. The medical notes may also be divided into specialities for example cardiology, gastroenterology, nephrology, neurology , pulmonology or orthopedic care. There are also specialist manuals for oncology known as ICD-O (International Classification of Diseases for Oncology) known as "O Codes" which are also used by tumor registrars (who work with cancer registries) as well as dental codes for dentistry procedures known as "D codes" for further specifications.

A clinical coder therefore requires a good knowledge of medical terminology, anatomy and physiology, a basic knowledge of clinical procedures and diseases and injuries and other conditions, medical illustrations, clinical documentation (such as medical or surgical reports and patient charts), legal and ethical aspects of health information, health data standards, classification conventions, and computer- or paper-based data management, usually as obtained through formal education and/or on-the-job training.

In practice[edit]

The basic task of a clinical coder is to classify medical and health care concepts using a standardised classification. Inpatient, mortality events, outpatient episodes, general practitioner visits and population health studies can all be coded.

Clinical coding has three key phases: a) Abstraction; b) Assignment; and c) Review.

Abstraction[edit]

The abstraction phase involves reading the entire record of the health encounter and analysing the information to determine what condition(s) the patient had, what caused it and how it was treated. The information comes from a variety of sources within the medical record, such as clinical notes, laboratory and radiology results, and operation notes.

Assignment[edit]

The assignment phase has two parts: finding the appropriate code(s) from the classification for the abstraction; and entering the code into the system being used to collect the coded data.

Reviewing the code set produced from the assignment phase is very important. Clinical coder must ask themselves, "does this code set fairly represent what happened to this patient in this health encounter at this facility?" By doing this, clinical coders are checking that they have covered everything that they must, but not used extraneous codes. For health encounters that are funded through a case mix mechanism, the clinical coder will also review the diagnosis-related group (DRG) to ensure that it does fairly represent the health encounter.

Competency levels[edit]

Clinical coders may have different competency levels depending on the specific tasks and employment setting.

Entry-level / trainee coder[edit]

An entry level coder has completed (or nearly completed) an introductory training program in using clinical classifications. Depending on the country; this program may be in the form of a certificate, or even a degree; which has to be earned before the trainee is allowed to start coding. All trainee coders will have some form of continuous, on-the-job training; often being overseen by a more senior coder.

An intermediate level coder has acquired the skills necessary to code many cases independently. Coders at this level are also able to code cases with incomplete information. They have a good understanding of anatomy and physiology along with disease processes. Intermediate level coders have their work audited periodically by an Advanced coder.

Advanced level / senior coder[edit]

Advanced level and senior coders are authorized to code all cases including the most complex. Advanced coders will usually be credentialed and will have several years of experience. An advanced coder is also able to train entry-level coders.

Nosologist[edit]

A nosologist understands how the classification is underpinned. Nosologists consult nationally and internationally to resolve issues in the classification and are viewed as experts who can not only code, but design and deliver education, assist in the development of the classification and the rules for using it.

Nosologists are usually expert in more than one classification, including morbidity, mortality and casemix. In some countries the term "nosologist" is used as a catch-all term for all levels.

Clinical coders may use many different classifications, which fall into two main groupings: statistical classifications and nomenclatures.

A statistical classification, such as ICD-10 or DSM-5, will bring together similar clinical concepts, and group them into one category. This allows the number of categories to be limited so that the classification does not become too big, but still allows statistical analysis. An example of this is in ICD-10 at code I47.1. The code title (or rubric) is Supraventricular tachycardia. However, there are several other clinical concepts that are also classified here. Amongst them are paroxysmal atrial tachycardia, paroxysmal junctional tachycardia, auricular tachycardia and nodal tachycardia.

Nomenclature[edit]

With a nomenclature, for example SNOMED CT, there is a separate listing and code for every clinical concept. So, in the tachycardia example above, each type and clinical term for tachycardia would have its own code listed. This makes nomenclatures unwieldy for compiling health statistics.

Education and professional qualification[edit]

In some countries, clinical coders may seek voluntary certification or accreditation through assessments conducted by professional associations, health authorities or, in some instances, universities. The options available to the coder will depend on the country, and, occasionally, even between states within a country.[citation needed]

Australia[edit]

United Kingdom[edit]

Clinical coders start as trainees, and there are no conversion courses for coders immigrating to the United Kingdom.

The National Clinical Coding Qualification (NCCQ) is an exam for experienced coders, and is recognised by the four health agencies of the UK.

England[edit]

In England, a novice coder will complete the national standards course written by NHS Digital within 6 months of being in post. They will then start working towards the NCCQ.

Three years after passing the NCCQ, two further professional qualifications are made available to the coder in the form of NHS Digital's clinical coding auditor and trainer programmes.

Scotland[edit]

In 2015, National Services Scotland, in collaboration with Health Boards, launched the Certificate of Technical Competence (CTC) in Clinical Coding (Scotland). Awarded by the Institute of Health Records & Information Management (IHRIM); the aims of the certificate include supporting staff new to clinical coding, and providing a standardised framework of clinical coding training across NHS Scotland.

The NCCQ is a recognized coding qualification in Scotland.

Wales[edit]

The NCCQ is a recognized coding qualification by NHS Wales.

Northern Ireland[edit]

Health and Social Care in Northern Ireland recognizes the NCCQ as a coding qualification.

United States[edit]

As of 2016; the typical qualification for an entry-level medical coder in the United States is completion of a diploma or certificate, or, where they are offered, an associate degree. The diploma, certificate, or degree will usually always include an Internet-based and/or in-person internship at some form of a medical office or facility. Some form of on-the-job training is also usually provided in the first months on the job, until the coder can earn an intermediate or advanced level of certification and accumulate time on the job. For further academic training, a baccalaureate or master's degree in medical information technology, or a related field, can be earned by those who wish to advance to a supervisory or academic role. A nosologist (medical coding expert) in the U.S. will usually be certified by either AHIMA or the AAPC (often both) at their highest level of certification and speciality inpatient and/or outpatient certification (pediatrics, obstetrics/gynecology, gerontology, oncology are among those offered by AHIMA and/or the AAPC), have at least 3-5 years of intermediate experience beyond entry-level certification and employment, and often holds an associate, bachelor's, or graduate degree.

The AAPC offers the following entry-level certifications in the U.S.: Certified Professional Coder (CPC); which tests on most areas of medical coding, and also the Certified Inpatient Coder (CIC) and Certified Outpatient Coder (COC). Both the CPC and COC have apprentice designations (CPC-A and COC-A, respectively) for those who pass the certification exams but do not have two years of on the job experience. There is no apprentice designation available for the CIC. After completing two years of on the job experience the apprentice credential holder can request to have the apprentice designation removed from their credential. There are also further specialist coding certifications; for example, the CHONC credential for those who specialize in hematology and oncology coding and the CASCC credential for those who specialize in ambulatory surgery center coding.

The other main organization is American Health Information Management Association (AHIMA) which offers the Certified Coding Specialist (CCS), Certified Coding Specialist-Physician-based (CCS-P), and the entry-level Certified Coding Associate (CCA).

Some U.S. states now mandate or at least strongly encourage certification from either AAPC or AHIMA or a degree from a college to be employed.[citation needed] Some states have registries of medical coders, though these can be voluntary listings. This trend was accelerated in part by the passage of HIPAA and the Affordable Care Act and similar changes in other Western countries, many of which use the ICD-10 for diagnostic medical coding. The change to more regulation and training has also been driven by the need to create accurate, detailed, and secure medical records (especially patient charts, bills, and claim form submissions) that can be recorded efficiently in an electronic era of medical records where they need to be carefully shared between different providers or institutions of care. This was encouraged and later required by legislation and institutional policy.

Professional associations[edit]

In many countries clinical coders are accommodated for by both professional bodies specific to coding, and organisations who represent the health information management profession as a whole.

Australia[edit]

• Clinical Coders' Society of Australia (CCSA)
• Health Information Management Association of Australia (HIMAA)

• Canadian Health Information Management Association (CHIMA)

Saudi Arabia[edit]

• Saudi Health Information Management Association (SHIMA)

United Kingdom[edit]

• Institute of Health Records and Information Management (IHRIM)
• Professional Association of Clinical Coders UK (PACC-UK)

IHRIM is the awarding body for the National Clinical Coding Qualification (NCCQ).

United States[edit]

There are several associations that medical coders in the United States may join, including:

The accredited programs from AHIMA, ABHCP, and AAPC will generally train medical coders at a sufficient level to work in their respective states. Some medical coders elect to be certified by more than one society.

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