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What does a Certified Professional Coder™ do?

By Elva K.
Updated May 17, 2024
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To be a Certified Professional Coder™ means that one is a health information professional who enables hospitals, doctors' offices, outpatient centers, nursing homes, or group practices to be paid for health services. Specifically, Certified Professional Coders™ read health treatment information and assign codes to those procedures so the information can be submitted to insurance companies, Medicare, or Medicaid. The particular codes must be entered properly, because if errors are made in coding, that could reduce the amount that medical providers are paid for the health care services they provide.

Working as a Certified Professional Coder™ means working with procedural coding and diagnostic coding. For example, there are codes that a Certified Professional Coder™ uses to code treatments that doctors provide. There are health care common procedure coding system (HCPCS) codes that pertain to products or services that doctors might provide to patients. The diagnostic codes are codes that pertain to specific diagnoses that doctors might give a patient. For instance, if a patient comes in complaining of arm pain and if the doctor diagnoses the problem, there is a specific diagnostic code for arm pain.

Typically, to prepare for a career as a Certified Professional Coder™, one must complete high school and college. An associate's degree can be done, but individuals interested in becoming a Certified Professional Coder™ usually complete the bachelor's degree in medical coding at an accredited college medical coding program. After completion of the college degree, in order to get appropriate certification, one must pass the Certified Professional Coder™ (CPC) exam, which is the entry-level exam to become a Certified Professional Coder™.

Once they start working, coders often specialize. For example, a coder might choose to specialize in emergency medicine, oncology, or cardiology. At any given time, some specialties might be more in demand than other specialties. Thus, some coders may get paid more than others due to the particular coding specialty they have chosen.

Needless to say, because they work with numbers and codes, coders tend to be very detail-oriented. Also, they tend to be persistent because there are times when they may have to contact a medical provider to get more information about a treatment the provider gave so that the appropriate code can be given. They may also have to contact the insurance company pertaining to a particular claim.

Coders also tend to move into other careers after having several years of coding experience. For instance, coders may decide to become health information directors or coding supervisors. By contrast, a coder may decide to go back to school and become a nurse, which would enable the option of working as a nurse-coder and potentially receiving a higher rate of pay for coding services.

WiseGeek is dedicated to providing accurate and trustworthy information. We carefully select reputable sources and employ a rigorous fact-checking process to maintain the highest standards. To learn more about our commitment to accuracy, read our editorial process.
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