What Does a Certified Coding Specialist (Physician-Based) Do?
Behind the scenes of every successful healthcare facility, there’s a skilled professional who plays a crucial role in deciphering complex medical documentation and ensuring accurate reimbursement processes.
Enter the Certified Coding Specialist-Physician-based (CCS-P), a professional equipped with the knowledge and expertise to read medical charts and assign the correct diagnosis (ICD-10) and procedure codes (CPT and HCPCS) for a range of clinical cases and services.
With a coveted CCS-P certification, these specialists are qualified to excel in revenue cycle and reimbursement duties tailored to doctor’s offices, clinics, ambulatory facilities, and other healthcare settings.
Who Needs a CCS Certification?
A CCS certification is a valuable asset for those looking to advance their careers in medical coding.
Aspiring medical coders can benefit from CCS certification by gaining the necessary knowledge and skills to enter entry-level positions in medical coding, ensuring accurate assignment of diagnosis and procedure codes for proper reimbursement.
Current medical coders can use CCS certification to enhance their expertise, open doors to higher job opportunities, increase earning potential, and pursue specialized roles within the field.
What Is a CCS Exam?
The CCS-P exam is a rigorous and comprehensive assessment designed for professionals who wish to become certified coding specialists in physician-based settings.
Administered by the American Health Information Management Association (AHIMA), the CCS-P exam evaluates the candidate’s proficiency in accurately assigning diagnosis (ICD-10) and procedure codes (CPT and HCPCS) for a wide range of clinical cases and services commonly encountered in physician-based practices.
Passing the CCS-P exam demonstrates the candidate’s ability to navigate complex medical documentation and apply coding guidelines accurately, ensuring compliance and proper reimbursement. The exam covers topics like:
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Coding guidelines
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Documentation requirements
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Regulatory standards necessary
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Knowledge of anatomy, physiology, and medical terminology
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Coding principles specific to physician-based settings
Successful completion of the CCS-P exam grants a CCS-P certification, validating your expertise and opening doors to rewarding career opportunities in medical coding within physician-based healthcare settings.
About the Certified Coding Specialist Exam (Physician-Based)
Prerequisite Requirements
There are technically no prerequisite requirements to pursue the CCS-P (Certified Coding Specialist-Physician-based) certification. However, one of the following options is strongly recommended by the AHIMA:
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Successful completion of courses covering anatomy & physiology, pathophysiology, pharmacology, medical terminology, reimbursement methodology, intermediate/advanced ICD diagnostic coding, and procedural coding and medical services (CPT/HCPCS) AND one year of coding experience directly applying codes.
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Two years of related coding experience directly applying codes.
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Hold the CCA® credential plus one year of coding experience directly applying codes.
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Hold a coding credential from another certifying organization AND have one year of coding experience directly applying codes.
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Hold a CCS®, RHIT®, or RHIA® credential.
CCS-P Exam Cost
When you’re part of a MedCerts certified coding specialist physician-based CCSP exam preparation course, there’s no exam fee (your tuition covers it!) However, for everyone else, the CCSP exam price is as follows:
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$299 AHIMA exam cost for members
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$399 for non-members
CCS Certification Exam (Physician-Based) Overview
The CCS-P exam is a four-hour computer-based exam that has a time limit. The number of questions on the exam falls anywhere between 97 and 121.
The exam has two parts: a Multiple-Choice Section and a Medical Scenario Section (which includes multiple-choice and multiple-response questions) related to evaluation and management, surgery, and medicine.
Here’s a quick overview of the domains and some example tasks you’ll have to perform for each one. Additionally, you can find a complete overview of the AHIMA CCS exam (physician-based) here.
Domain 1 – Diagnosis Coding (16.5%)
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Review medical record documentation and accurately assign ICD-10-CM codes
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Apply ICD-10-CM conventions to accurately code to the highest level of specificity
Domain 2 – Procedure Coding (32.9%)
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Review medical record documentation and accurately assign CPT®/HCPCS
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Interpret Evaluation & Management (E&M) coding guidelines
Domain 3 – Research (7.6%)
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Differentiate and apply physician-based coding rules based on federal, state, and third-party guidelines
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Determine appropriate primary authoritative source to determine correct coding
Domain 4 – Compliance (31.6%)
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Determine if a query is appropriate based on existing documentation and apply a non-leading, ethical query
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Evaluate medical records to determine documentation that is permissible to support code assignment
Domain 5 – Revenue Cycle (11.4%)
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Apply knowledge of claims development and filing processes
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Demonstrate an understanding of Resource Based Relative Value Scale (RBRVS)
Certified Coding Specialist Salary & Jobs
When it comes to career paths in the healthcare industry, obtaining a Certified Coding Specialist-Physician-based (CCS-P) certification opens the doors to a variety of rewarding job opportunities. Here are some of the best roles within the CCS-P career pathways and estimated certified coding specialist salaries.
Professional Medical Coder
As a professional medical coder, you’ll work in clinics and physicians’ offices, playing a vital role in ensuring accurate reimbursement for healthcare claims. Your responsibilities will include utilizing specialized medical classification software or coding manuals to assign procedure and diagnosis codes to providers’ services for insurance billing. The estimated salary for this position ranges from $28,000 to $56,000 per year.
Professional Fee Coder
Like the professional medical coder, the professional fee coder also works in clinics and physicians’ offices, focusing on obtaining accurate reimbursement for healthcare claims. You’ll utilize medical classification software and coding manuals to assign procedure and diagnosis codes to providers’ services, enabling proper insurance billing. The estimated salary for this role falls within the range of $28,000 to $56,000 per year.
Coding Specialist
As a coding specialist, you’ll contribute to the accurate reimbursement of healthcare claims in clinics and physicians’ offices. Your expertise in specialized medical classification software and coding manuals will enable you to assign precise procedure and diagnosis codes to providers’ services for insurance billing. The estimated salary for a coding specialist varies between $30,000 and $64,000 per year.
Online Certified Coding Specialist Certification Course
MedCerts offers a specialized course for aspiring certified coding specialists. This program is specifically designed for anyone pursuing a career in medical coding for physician’s offices. It serves as a vital preparation tool for both the CCS-P exam and the CPC certification exam.
MedCerts instructors equip you with all the necessary skills and knowledge to excel in physician-based settings such as physician offices, group practices, multi-specialty clinics, or specialty centers.
Throughout the course, you’ll learn the following:
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Everything you need to know to ace the CCS-P certification exam
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How to review patient records
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How to assign accurate numeric or alphanumeric codes for each diagnosis and procedure
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An in-depth understanding of the CPT coding system
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Familiarity with the ICD-10-CM and HCPCS Level II coding systems
The best part? MedCerts works with students to ensure tuition payment options are affordable for all, and all materials (including exam fees!) are included in your tuition. All classes are available on-demand 24/7, and lessons are tailored to help you succeed on the CCS-P exam as well as in your role as a certified coding specialist.
Start Your Career As a Certified Coding Specialist Now
If you’re looking to attain your CCS-P certification and advance your career in the field of medical coding, our 22-week online program is the ideal starting point. With its comprehensive curriculum and focused preparation, this program equips you with the knowledge and skills necessary to excel in the CCS-P exam.
Don’t wait—take the first step towards achieving your professional goals by starting the enrollment process for MedCerts’ Online Certified Coding Specialist Certification Course today.
CCS-P Certification Frequently Asked Questions
CCS vs CPC Exams—What’s the difference?
The CCS (Certified Coding Specialist) exam and CPC (Certified Professional Coder) exam are two distinct certifications in medical coding.
CPC certification, administered by AAPC, is typically considered an ideal choice for beginners starting their coding journey, as it provides a solid foundation for entry-level positions. They often work in outpatient facilities, like private medical practices, and primarily focus on reimbursement-related coding.
In contrast, the CCS-P certification, administered by AHIMA, is more suitable for coders who are ready to specialize and advance their careers. They primarily specialize in diagnostic coding and commonly work in hospitals or other inpatient healthcare facilities.
How hard is the CCS-P exam?
The CCS-P (Certified Coding Specialist-Physician-based) exam is known to be challenging, with a pass rate of just 35% in 2022. It requires comprehensive knowledge of physician-based coding practices.
Although difficult, you can overcome the difficulty of the CCS-P exam with dedication and adequate preparation through an online certified coding specialist physician-based course with MedCerts.
