National Medical Insurance Coding Certification

Pellissippi State offers an institutional certificate in insurance coding which helps to open doors for employment in the field; but a credential that is recognized and acknowledged across state boundaries is national certification through one of the professional organizations such as the American Academy of Professional Coders (AAPC) or the American Health Information Management Association (AHIMA). “The national certification is designed to recognize and reward mastery in clinical coding as well as to provide a first line of defense against noncompliance issues” according the Marsha Diamond, CPC and Owner/Instructor of Coding Programs for the Medical Professional and MD Consultative Services.

To qualify for the national exam, both the AAPC and AHIMA recommend a coder have at least two (2) years of relevant coding experience. The AAPC has allowed the coursework for the insurance coding certificate offered at PSTCC to be substituted for one year of experience.

A career decision must be made prior to taking the exam because there are several certifications for insurance coding. If the goal is to seek certification as an outpatient hospital coder or a facility coder then the CPC-H exam is recommended. If the goal were to be an inpatient/outpatient hospital coder, the CCS exam would be the exam of choice. If being a certified physician or nonphysician-based coder is the goal, the CPC and CCS-P exams both test coding competencies in these areas.

The CPC-H exam contains questions specific to the ICD-9-CM Volumes 1-3, CPT and HCPCS Level II code sets. The CCS exam tests for competencies in both hospital inpatient and outpatient-ambulatory surgery (encompassing the same code sets as the CPC-H exam). The CPC and CCS-P exams test for physician-based coding competencies in ICD-9-CM (Volumes 1 & 2) CPT and HCPCS Level II across all specialties. AHIMA offers the CCS and CCS-P exams while AAPC offers the CPC-H and CPC exams.

Because each of these areas has unique regulations and coding guidelines, you should be knowledgeable in the area you intend to test. The PSTCC program focuses primarily on the physician-based coding competencies.

If you wish to know more about insurance coding, the PSTCC certificate in insurance coding, or national certification, please contact Katherine Harper. Katherine received her certification (physician-based coding) through the AAPC.