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Become a Medical Coder in California: Training, Experience and Certification can provide you with the best opportunity

Medical billers and coders play an important role in California's healthcare industry. Payment through Medi-Cal, Medicare, and private health plans is dependent on the ability to apply complex coding systems. Sometimes health research is as well. Organizations like the Kaiser Family Foundation often cite statistical information from the ICD.

The new ICD-10, used to code medical diagnoses, has nearly 70,000 diagnosis codes -- a big step up from the ID-9. But this represents only a portion of what coding specialists need to apply. Coding professionals often must be fluent with other common systems such as the Current Procedural Terminology (CPT) that is used to code for outpatient services. And, since some healthcare systems are now using alternatives to traditional fee-for-service, some coding specialists must have expertise in systems like Hierarchical Condition Category Coding (HCC). Payment depends on assessment of diagnoses and risk factors.

In large urban centers, medical billers and coders may take on specialized roles. Some coding specialists focus on particular types of medical service, for example, pediatrics or general surgical coding.

What does all this mean to future medical billers and coders? They will need to develop their expertise – and demonstrate it. Skill is often validated through examination by third party certification agencies. Prospective billing and coding specialists can look to these organizations as standard setters.

Select a California Medical Billing and Coding Topic:

Medical Billing and Coding Education in California

The American Health Information Management System (AHIMA) has identified courses that are especially valuable for success as a coder.

AHIMA will accept either education or experience as a prerequisite qualification for Certified Coding Specialist (CCS) credentialing. Candidates qualifying by education will need coursework in medical sciences (including medical terminology, anatomy and physiology, pharmacology, and pathophysiology) as well as coursework in ICD-10 and CPT coding. Coders can achieve the lower designation of Certified Coding Associate (CCA) without educational prerequisites. However. AHIMA recommends some of the same courses that will later be required for CCS at this level; coding may be at a basic level as opposed to intermediate/ advanced.

Formal education is not a requirement for certification through the AAPC (formerly the American Academy of Professional Coders). The only formal prerequisite is experience. However, individuals who have completed at least 80 contact hours of qualifying education can reduce their experience requirements by a full year. California has multiple 80-hour certificate programs; students may complete these within just a few months.

Students have many options, online and traditional. They may have practical experience as well as didactic coursework. Some programs articulate to health information programs. (The initial program may result in a certificate of achievement.

Billing is a slightly different, though overlapping, profession. The AAPC recommends, but does not require, that billers who plan on pursuing AAPC certification have education at the associate’s level.

Students who are unemployed may be eligible for funding for some medical billing and coding programs if they go through their local Workforce Initiative Board (http://www.careeronestop.org/LocalHelp/service-locator.aspx).

Employer Expectations

Employers, of course, have their own expectations. Some want candidates with academic degrees. Some administer their own coding examination. Experience is highly valued. Some employers like to see experience in the particular medical specialty (for example, surgical coding). However, this is typically not as fundamental as having been successful as a coder.

Many California employers value AAPC and AHIMA certifications. Some, but not all, certifications are available to those at the entry-level.

AAPC Coding and Billing Certifications

The AAPC grants several well-known and well-respected credentials: Certified Professional Coder (CPC), Certified Professional Coder-Payer (CPC-P), and Certified Outpatient Coder (COC) credentials. Examinations are, in a sense, open book. Candidates use approved manuals.

Candidates who seek CPC, CPC-P, or COC certification may take the examination well before they have met experience requirements for full certification at the professional level. (They will, however, have an “apprentice” designation until such time as requirements have been met.)

Coding specialists who want to display their expertise in particular branches of medical coding may select from AAPC specialty certifications such as the following:

  • Ambulatory Surgical Center (CASCC)
  • Evaluation and Management (CEMC)
  • General Surgery (CGSC)
  • Pediatrics (CPEDC)
  • Certified Professional Biller (CPB)

The above certifications are considered expert level.

AAPC examinations are scheduled on set dates. Prospective candidates can search by state (https://www.aapc.com/certification/locate-examination.aspx). Candidate resources can be downloaded from the AAPC website (https://www.aapc.com).

Coding specialists who hold one AAPC credential are responsible for completing 36 CEUs during their two-year certification cycle (https://www.aapc.com/medical-coding-education/help/). Those who hold multiple credentials have higher requirements.

The AAPC lists $57,021 as the average salary for a medical coder in the Pacific region (https://www.aapc.com/resources/research/medical-coding-salary-survey/).

AHIMA Coding Certifications

AHIMA offers Certified Coding Specialist (CCS) and Certified Coding Specialist- Physician-based (CCS-P) certifications. Entry-level professionals may opt for Certified Coding Associate (CCA). Again, candidates use approved code books. Applicants will find candidate guides and application materials on the AHIMA website (http://www.ahima.org/certification).

AHIMA tests are offered at Pearson VUE sites around California (and the nation). California sites include Fresno, Oakland, San Diego, San Jose, and Visalia, among others. There are multiple sites in the greater Los Angeles area. Candidates will need to confirm that the particular site offers the desired AHIMA examination. Approved candidates are granted four-month testing windows.

Candidates who hold a single AHIMA coding certification are responsible for earning 20 CEUs during the recertification cycle (http://www.ahima.org/certification/Recertification).

Additional Resources

The California Health Information Association (CHIA) is California’s AHIMA affiliate (http://www.californiahia.org/). California boasts seven regional ‘HIA’ associations.

There are AAPC chapters located in cities and towns throughout California (https://www.aapc.com/localchapters/find-local-chapter.aspx).