Clinical coding specialist qualifications, training, and certification requirements

Clinical Coding Specialist is a Health Information Management professional who specializes in the coding and billing of clinical information, for both medical records keeping and for the purpose of billing in a standardized coding system that is dependant upon national clinical coding standards. (Johns, 2007, pg. 13) Diagnostic and procedural coding is one of the most essential aspects of both records keeping and billing in any health care setting, as the fundamental aspects of diagnostic coding determines the reimbursement to facilities and care providers as well as creating an easily understood medical record system, where all health professionals can rapidly access diagnostic and procedural information and then seek out more specific medical and diagnostic information, as it is needed for future treatment. The diagnostic codes given patient condition can also determine protocol in existing medical situations.

Qualifications for designation as a clinical coding specialist include mostly on-the-job training with specific coding software, as well as a full knowledge of reference materials that determine the diagnostic codes and standards and the ability to translate medical records to coded data. The CCS must have intimate knowledge of medical terminology as well as the ability to designate relatively minor differences in documentation that can make significant differences in treatment as well as billing outcomes. CCS professionals may seek greater than on-the-job training and the position may also require a certification, which requires 21 semester hours of specific coding education.

The clinical coding specialist possesses the technical knowledge and skills necessary to evaluate medical records, code symptoms, diseases and operations according to various classification systems and report health data for insurance reimbursement.

Education

On-the-job experiences as well as coding education from seminars or college classes are required. The Certificate Program in Clinical Coding requires 21 semester hours.

Registration/Certification/Licensure

The American Health Information Management Association gives a certification examination. Two years of coding experience are recommended before taking the certification exam. There is a Certified Coding Specialist (CCS) and a Certified Coding Specialist - Physician based (CCS-P).

Salary

Western Kentucky University Website "Clinical Coding Specialist," 2003, NP)

According to an interview I conducted with a CCS, the traditional route to becoming a CCS has been to learn the systems on the job, especially with regard to institution specific computer coding systems, with minimal additional facility sponsored continuing education credit hours per year, yet as the job becomes increasingly important, with regard to accountancy and cost containment in medical care more and more institutions are requiring certification and therefore prior education with regard to clinical coding. The professional noted that when she began her job 15 years prior it was not unusual to hire people with minimal business and some medical experience in a clinical setting yet now more and more institutions including her own are seeking candidates with prior coding experience and certification through education. This change in the system is supported by Tinsley, an expert in the field of medical accountancy. (Tinsley, 1993, pg. 34) the CCS I interviewed, also stressed that the job is very high paced and requires serious attention to detail, which increases with the size of the facility one works at. (Personal Communication September 1, 2008) This new change in the coding specialist entrance role will likely be a big part of my future educational goals, as seeking certification will likely occur prior to completion of my Bachelors degree and will assist me in a better understanding of what my future roles in health care administration may be.