Inpatient and Outpatient Hospital Coding Credentials

Future medical coders aspiring to work in a hospital setting can specialize in one of two areas: inpatient or outpatient. Although there are similarities between the two, there are important differences you should be aware of, including which code sets are used and earning potential. View our infographic below to help you determine your path.

CIC

The new inpatient medical coding certification standard, CIC (Certified Inpatient Coder), is the only certification dedicated exclusively to inpatient hospital/facility coding. The CIC validates expert level knowledge and experience in abstracting information from the medical record for ICD-10-CM and ICD-10-PCS coding, and specialized payment knowledge in MS-DRGs and Inpatient Prospective Payment Systems (IPPS). Invest in your future with the CIC^® certification—certified coders earn 40% more than non-credentialed coders

CICs have demonstrated:

• Expertise in medical record review to abstract information required to support accurate inpatient coding

• Expertise in assigning accurate ICD-10 medical codes for diagnoses and procedures performed in the inpatient setting

• Superior knowledge of current rules, regulations, and issues regarding medical coding, compliance, and reimbursement under MS-DRG and IPPS systems

• Strong ability to integrate coding and reimbursement rule changes in a timely manner to include updating the Charge Description Master (CDM), fee updates, and the Field Locators (FL) on the UB04

• Solid understanding of anatomy, physiology, and medical terminology required to correctly code facility services and diagnoses

• Understanding of outpatient reimbursement methodologies (OPPS)

COC

Outpatient ambulatory coder jobs are trending faster than ever before. As physicians move away from private practices and join hospital groups, career opportunities in outpatient facilities such as ambulatory surgical centers or hospital outpatient billing and coding departments are opening for coders. The COC^® (formerly CPC-H^® exam validates your specialized payment knowledge needed for these jobs in addition to your CPT^®, ICD-10, and HCPCS Level II coding skills. Invest in your future with the COC^® medical coding certification.

Certified COC's (formerly CPC-H) abilities in outpatient facility/hospital services include:

• Proficiency in assigning accurate medical codes for diagnoses, procedures and services performed in the outpatient setting (emergency department visits, outpatient clinic visits, same day surgeries, diagnostic testing (radiology and laboratory), and outpatient therapies (physical therapy, occupational therapy, speech therapy, and chemotherapy)

• Proficiency across a wide range of services, including evaluation and management, anesthesia, surgical services, radiology, pathology, and medicine

• Knowledge of coding rules and regulations along with proficiency on issues regarding medical coding, compliance, and reimbursement under outpatient grouping systems. COC's can better handle issues such as medical necessity, claims denials, bundling issues, and charge capture

• Ability to integrate coding and reimbursement rule changes in a timely manner to include updating the Charge Description Master (CDM), fee updates, and the Field Locators (FL) on the UB04

• Correctly completing a CMS 1500 for ASC services and UB04 for outpatient services, including the appropriate application of modifiers

• Knowledge of anatomy, physiology, and medical terminology commensurate with ability to correctly code provider services and diagnoses

• A working knowledge in the assignment of ICD-10-CM codes from Volumes 1 & 2