Why Should Medical Coders Have the CCS Credential?

Posted on November 18, 2015 I Written By

Erin Head is the Director of Health Information Management (HIM) and Quality for an acute care hospital in Titusville, FL. She is a renowned speaker on a variety of healthcare and social media topics and currently serves as CCHIIM Commissioner for AHIMA. She is heavily involved in many HIM and HIT initiatives such as information governance, health data analytics, and ICD-10 advocacy. She is active on social media on Twitter @ErinHead_HIM and LinkedIn. Subscribe to Erin’s latest HIM Scene posts here.

In continuation of my posts on the value of HIM credentials, one very important credential is the Certified Coding Specialist (CCS). This tried-and-true credential shows current and potential employers that you are skilled in all of the domains of medical coding. The CCS exam is designed for experienced inpatient and outpatient coders to show competency in all of the potential functions a coder will be required to perform on the job. Disclaimer: this credential is not ideal for new graduates who have no prior experience in medical coding at some level although they may meet eligibility.

For those not familiar, medical coding involves reviewing clinical documentation in a medical record, assigning the appropriate ICD or CPT codes using established coding guidelines, and grouping the codes to determine a Diagnosis Related Group (DRG) for reimbursement. Some coders may be required to analyze DRG usage and report on documentation trends as part of their job roles. The codes and DRGs that are selected by the medical coders are used for a variety of data uses including tracking the prevalence of diseases, monitoring procedure and treatment outcomes, public reporting of quality measures, and the most critical function is to determine a healthcare organization’s reimbursement rate based on the treatment provided.

Coders must be educated on medical terminology and clinical documentation in order to effectively and accurately assign codes and DRGs. The CCS exam tests each applicant on his or her ability to understand the coding guidelines and assign codes properly. Candidates taking the CCS exam should have a working knowledge of both ICD coding guidelines and CPT guidelines. There are also questions on regulatory guidelines and information technology to make sure CCS credentialed professionals are well versed in healthcare operations.

The American Health Information Management Association (AHIMA) administers the CCS exam to those with the following qualifications:

Candidates must meet one of the following eligibility requirements:

  • By Credential: RHIA®, RHIT®, or CCS-P® OR
  • By Education: Completion of a coding training program that includes anatomy & physiology, pathophysiology, pharmacology, medical terminology, reimbursement methodology, intermediate/advanced ICD diagnostic/procedural and CPT coding; OR
  • By Experience: Minimum of two (2) years of related coding experience directly applying codes; OR
  • By Credential with Experience: CCA® plus one (1) year of coding experience directly applying codes; OR
  • Other Coding credential from other certifying organization plus one (1) year coding experience directly applying codes.

Source: AHIMA.org/certification/CCS

It is important to note that a majority of CCS credential holders also have either the RHIA or RHIT credentials (according to the 2012 AHIMA job analysis). This is because the RHIA and RHIT credentials cover all of the many different HIM job tasks and domains while the CCS is a specialty credential for coding. HIM management positions may be looking for RHIA or RHIT credentials while coding specific positions frequently require the CCS.

With the recent change to ICD-10 in the US, medical coders have become a hot commodity. As a side note, the CCS exam is also offered to some additional countries internationally yet the test covers US coding practices. Many organizations are experiencing a decrease in coder productivity therefore additional coders may need to be hired or contracted. While it is a great time to be a coder, we must also take into account that the role of a coder has changed over the years and will continue to change with new technologies and tools. Continuing education credits are required for all CCS credential holders to keep coding competencies up as well as educate coders on other hot topics and changes in healthcare.

For more information on HIM Credentials visit: RHIT, RHIA, CCS

If you’d like to receive future HIM posts by Erin in your inbox, you can subscribe to future HIM Scene posts here.