If you're considering a career as a professional medical coder, one of your first goals is to figure out the qualifications or credentials that will help you break into the business.
One of the first things you'll learn is that professional certification is highly recommended.
There are two organizations that will stand out in your research: AAPC and AHIMA. They're each considered the gold standard for coding certification, but it can be hard to figure out the difference between them. Add in the acronyms for each organization's certification programs, and it quickly turns into a confusing alphabet soup.
Let's break down the similarities and differences so you can choose the training program and credential that will set you up for success.
What is AAPC Certification?
AAPC stands for the American Association of Professional Coders. They offer over a dozen different certifications for medical coding in different facilities and specialties. They also offer certifications for medical billing, auditing, documentation, compliance, and practice management.
The most popular AAPC credential is Certified Professional Coder (CPC).
What is AHIMA Certification?
AHIMA stands for the American Health Information Association. They offer roughly half a dozen certifications, mostly focused on coding and health information management.
The most popular AHIMA credential is Certified Coding Specialist (CCS).
What Do AHIMA and AAPC Have in Common?
Both organizations can provide well-respected certification of your professional knowledge and skills. They use the same medical coding systems, namely CPT and HCPCS codes for medical procedures and services and ICD codes for medical diagnoses.
Both organizations offer somewhat separate designations for relatively new coders and more experienced coders so that your resume can reflect your level of experience as well as competence. Both, at this point in their growth, offer certifications that cover inpatient and outpatient coding practices.
Both CPC and CCS exams test your ability to properly apply medical codes. They're both computer-based and similar in length and cost, though the CPC exam is slightly longer. You can find training programs and exam preparation resources for both, as well.
What is the Difference Between AHIMA and AAPC?
There are many small differences between the organizations, but the significant differences lie in what jobs they train you for.
Although both organizations offer inpatient and outpatient programs now, they used to specialize. AAPC coding has historically been associated with outpatient services, while AHIMA coding was associated with inpatient facilities.
In recent years, they've expanded their offerings. AAPC now has CPC certification for physician's offices, COC certification for outpatient hospitals and surgical centers, and CIC for inpatient hospitals. AHIMA now has CCS for hospitals and CCS-P for physician-based practices.
At this point, many people argue that the distinction is minimal when you're starting out. Some employers accept the right kind of certification from either organization equally.
However, many employers still base their hiring preferences on what's familiar. That means AAPC is still more popular in outpatient settings and AHIMA is still more popular for inpatient settings. It may be easier to get hired if you're credentialed with the "right" organization.
The bigger differences come later in your career.
If you want to advance your career into coding for a particular medical specialty, like cardiology, then you'll want a specialty certification from AAPC. No equivalent certifications are available through AHIMA.
If you want to advance into administration, then the setting will dictate your choice. AAPC has a number of relevant certifications for auditing and practice management in a physician's office. AHIMA's health information certifications are probably better suited to larger organizations like hospitals.
It's important to realize that most medical coders have certifications from both organizations. Choosing where to get your initial certification doesn't "lock you in" to that organization or even to a particular career path.
Should You Get AHIMA or AAPC Coding Certification?
If you're already committed to either an inpatient or outpatient setting, you should probably go with the organization more closely associated with that kind of work. In other words, get AAPC coding certification for outpatient work and AHIMA coding certification for inpatient work.
But maybe you haven't gotten that far yet. You know you're interested in medical coding, but you aren't sure where you fit. It's probably a good idea to figure that out first.
What's the Difference Between Outpatient and Inpatient Coding?
Well, first: what's the difference between outpatient and inpatient, period?
Outpatient means the patient isn't admitted to a hospital or facility for an extended stay. Most outpatient visits last less than 24 hours, though technically an overnight stay can still be outpatient. Think doctor's offices, urgent care facilities, emergency rooms, specialist clinics, and ambulatory surgical centers.
Inpatient means being admitted for an extended stay in a facility, including acute and long-term care hospitals, hospices, nursing facilities, mental institutions, and home health services. Visits typically last at least 2 days.
Why does this matter to the medical coder? They have different coding policies, essentially.
The procedure codes come from different places, for one thing. Additionally, inpatient facilities assign codes based on the entire stay, and reimbursement is based on the diagnosis group. Inpatient coding allows for diagnoses that are unclear, "probable," or "suspected." Outpatient facilities assign codes based on a single visit, reimbursement is based on the facility's rates, and uncertain diagnoses aren't allowed. When the diagnosis isn't definitive, outpatient facilities code the patient's symptoms, instead.
Should You Become an Outpatient Coder or an Inpatient Coder?
One of the biggest questions you should ask yourself is whether you want clear-cut coding work or whether you want something a little more challenging.
Due to the differences in coding policy, outpatient coding tends to be more straightforward. Outpatient coders handle definitive symptoms or diagnoses, plus a finite number of services that are provided during short visits.
Inpatient coding tends to be more challenging for the coder. Coders often describe it as a puzzle or a mystery to solve.
There are a few reasons inpatient coding is more complex. There's more information to code for each patient, due to the long stay and the complicated nature of care that may involve a lot of people and departments. Inpatient coding also requires a "present on admission" (POA) indicator to distinguish between a patient's symptoms when they were admitted and any symptoms or complications that appear during their stay. Finally, coding for uncertain diagnoses and irregular findings often requires professional judgment.
In other words, inpatient coding requires more critical thinking and interpretation of medical records before you can apply medical codes appropriately. Mistakes or misjudgments can have big consequences – for the bill, but also the patient's health. Your choices regarding uncertain diagnoses and irregular findings, for instance, can influence their diagnosis and treatment for future hospital visits.
Beyond the level of difficulty, you should also consider potential workplaces and incomes. Outpatient coders work in smaller medical practices, while inpatient coders are more likely to work in a hospital billing office. Both jobs provide the opportunity to do some medical coding work from home. Inpatient coding pays better, due to its complexity. Meanwhile, outpatient coding offers more opportunities to do coding and billing, for greater variety at work.
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