Medical Billing and Coding Experience for Coding Certification

by Mel Bry
(Jkn, MS USA)

Hi Gina! Love your website and personal experience you relate throughout it. I’m interested in getting certified as a coder, compared to 90% of my experience of 10 yrs has been billing–related. Yet, I know both can go hand in hand depending on your job.

But, I’ve been looking at the requirements to sit on the coding exam and a couple of the requirements has to do with having experience with a minimum of six months – two years of related coding experience directly applying codes. What does that mean? It’s hard to think that this would not apply to a medical biller.

Does “applying codes” have to do with entering them in the system and sending them off to the payer electronically? What are your thoughts on the description or at least your advice on this matter? I took a billing and coding course years ago, but now I’m trying to find out whether i need to actually take up a strictly coding course to be eligible to take the coding exam. Thanks for your help.

Hi Mel – thanks for your question.

I understand your confusion on certification. A lot of people assume being certified just requires passing the coding exam. But that’s just one of the criteria. I assume you are referring to the AAPC coding certification like the popular CPC certification.

I’m sure you probably already know this but I’ll explain for our visitors: To be CPC certified by the AAPC (American Academy of Professional Coders) requires membership in AAPC, passing the CPC exam, and two years of professional experience. Without the 2 years of experience, you receive a CPC-A certification. The “A” indicating Apprentice. (It’s also sometimes referred to as the Scarlet A). Similar requirements apply for other types of AAPC certification – I just mentioned the CPC since it’s one of the most common.

Per AAPC the 2 years of experience must be documented by two letters of recommendation verifying at least two years of on-the-job experience using the CPT treatment, ICD diagnosis, or HCPCS Level II codes. One letter must be on letterhead from your employer or previous employer. The other can be from a co-worker. AAPC has a template and specific requirements on their site

Verification of the experience requirements per the AAPC site above says “you must obtain and submit two letters of recommendation verifying at least two years of on-the-job experience (externships accepted) using the CPT®, ICD-9-CM/ICD-10-CM, or HCPCS Level II code sets. One letter must be on letterhead from your employer, the other may be from a co-worker.

Experience includes time coding for a previous employer and prior to certification. Both letters are required to be signed and will need to outline your coding experience and amount of time in that capacity.”

If you look at the template provided for documenting the experience it says ” ….has shown an extensive knowledge in utilizing and maneuvering through the ICD-10-CM, CPT, and HCPCS coding books….which are required on a daily basis.”

So in my view if your experience meets this criteria and your employer or co-worker will verify (sign), then it would qualify. I know a lot of the work I’ve done as a medical biller meets this criteria of extensively using and applying coding books on a daily basis.

Hope this helps and invite visitors to share their comments below.

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