Why a Certified Coder is Important for Your Practice

Written by Jerri Ivey, MHA, MBA, CCS-P, CPCD, Director of Revenue Cycle Management at VitalSkin Dermatology

If your practice has a billing and coding team in-house, you may already understand the importance of having certified professional coders. If not or if you are considering adding a coding team, you may be wondering if bringing in a certified coder is needed over hiring a non-certified individual.

I have been in healthcare for 35+ years and there have been many discussions and debates on whether a certified coder is really necessary. Through my own experience, I would like to share with you my thoughts and findings. 

Let’s start with the basics, a certification in coding requires proficiency in coding across all specialties, a knowledge of medical coding guidelines and regulations, a master of anatomy, physiology and medical terminology, and an understanding of how to integrate payer reimbursement policies (How to get CPC certified? – AAPC). This entails rigorous formal training and ongoing education. An individual must have two years or more coding experience to obtain their certification. When a coder sits for their examination, they have four hours to complete it. Now imagine if a coder obtains a specialty certification that adds to their knowledge CPT and ICD10 specifics to that specialty. That is another round of training, studying and examination. 

When hiring a certified coder, you’re adding a verifiable skill set to your team. These individuals participate in local and state chapters of their certified organization, which provides a built-in network. Each certifying body requires continuing education credits. These credits are similar in nature to those of providers, where webinars and conferences must be attended to achieve the CEU.    

I used to think that a certification was not necessary and that experience was really all that was needed. I have had non-certified coders and certified coders on my teams in the past. But once I had a team with certified coders, I began to rethink their importance. I, myself, went most of my career without my certification. However, when my own abilities were questioned, I studied and sat for the exam. My perspective has now shifted, as I truly see the value of the certification. I have since obtained my specialty certification. 

I have found that there are many advantages to having a certified coder. The certification process sets a gold standard for medical coding and coders are experts in their field. With the varying fines and penalties an organization or practice can encounter if coding is not done accurately, a certified coder significantly reduces the risk. When coding is done right, a coder can find missing revenue opportunities and can make an impact on the reduction of denials. 

Along with those benefits, I have seen where clinical documentation is improved with the partnership of the coder and provider. I have also witnessed where providers will reach out directly to their coders to obtain coding advice, thereby becoming a valued resource. 

So if you’re on the fence about adding a certified coder to your team or if you’re questioning the value he or she would bring, I can tell you that the knowledge and expertise that certified coders possess can impact your practice for the better – both for efficiently and accurately handling your coding and creating an added layer of protection against possible coding penalties. In addition, as part of ongoing continuing education requirements, certified coders stay up-to-date on coding and other regulatory changes that directly affect your practice.