How to Become an RN Coder
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Registered nurses (RN)s are vital to the healthcare system. They can lend their experience and knowledge to the billing process to help keep accurate records and prevent insurance fraud.
Discover how this job opportunity may fit your lifestyle.
How Long to Become:
ADN or BSN
Certified Professional Coder (CPC) or Certified Coding Associate (CCA)
What is an RN Coder?
An RN coder applies medical coding and reimbursement policies in the claims process. Nurse coders review patient charts and provide diagnosis codes based on International Classification of Diseases (ICD) or Current Procedural Terminology guidelines.
They also help create and carry out cost strategies that ensure healthcare providers' success. Nurse coders may work in hospitals, offices, clinics, or insurance companies. Some RN coders work remotely at home.
A nurse coder works closely with medical billing specialists to identify errors and achieve team goals. For example, RN coders may audit the work of other coders for accuracy. (This differs from a clinical documentation specialist, who reviews a patient chart for potential errors before being discharged.)
RNs' familiarity with medical terminology, anatomy, and physiology, and their clinical experience can aid the transition to nurse coding.
Nurse coders must review patient charts, procedure notes, medication reconciliations, and labs to assign the correct ICD and CP codes. Many of these codes have dual meanings and slight differentiations that may be easier to distinguish with clinical experience.
Nurses can add coding to their knowledge and skills in a matter of weeks by attending a medical coding bootcamp or webinar. Earning coder certification can lead to more job opportunities and higher salaries.
Steps to Becoming an RN Coder
The path to a billing and medical coder career does not always begin with a nursing degree. However, those who have a nursing degree are in high demand. They have the education and skills to read medical records and choose the right diagnostic codes for billing. Additional education and requirements can vary among states and employers.
Earn an ADN or BSN Degree From an Accredited Program
Students seeking a nursing degree have two entry-level options. Nurses who complete an associate degree in nursing (ADN) may begin working as a nurse in as little as two years. Nurses may also complete nursing prerequisites through a four-year bachelor of science in nursing (BSN) program. A BSN degree increases career and salary potential.
Pass the NCLEX Exam to Receive RN Licensure
Gain Experience in Clinical Nursing
RN coders with clinical experience are highly valued and sometimes better paid. Seek an entry-level clinical position after licensure before pursuing a coder position. Hospitals offer the best clinical experience. A clinic or physician’s practice can also provide experience.
Become a Certified Coder or Auditor
The American Academy of Professional Coders (AAPC) offers four medical coding certifications and additional ones in medical specialties. The Certified Professional Coding (CPC) Certification is the gold standard for RN coders. Nurse coders may also add outpatient, inpatient, or risk adjustment certifications.
Candidates need two years of experience as a medical coder for full CPC certification. Those without two years of experience are awarded an apprentice status until the two years are complete. Aspiring RN coders can sit for the CPC exam after paying the required fee and becoming an AAPC member.
Best Online Medical Coding Certificate Programs
RN Coder Education
Nurses can enter the nursing field with a two- or four-year degree. While either is acceptable, a four-year degree offers more flexibility, opportunities for advancement, and greater RN coder salary potential.
An associate degree in nursing is best for students who wish to start working as quickly as possible. This degree has a high clinical focus. It allows ADN nurses to work while completing a four-year degree if they choose. Although many employers accept an ADN, most prefer a BSN.
ADN applicants need a high school diploma or GED certificate. They must submit a personal essay and recent SAT scores. Applicants must have taken high school chemistry and biology. Some programs also require the Health Education Systems Incorporated test to evaluate learning style.
The ADN curriculum prepares students for a clinical role. Students take chemistry, microbiology, anatomy and physiology, and pharmacology. They also have to pass English, communications, behavioral health, and foundations in nursing. Students must complete clinical hours where they apply classroom knowledge in hospitals, rehabilitation centers, and nursing homes.
Time to Complete
Full-time students can complete an ADN program in two years.
Students learn how to perform basic clinical skills, such as how to make an occupied bed, take blood pressure and heart rate, give an injection, and insert a catheter.
This degree covers everything in the ADN program with more emphasis on critical thinking, research, management, and communication skills. The additional education can offer advantages for an RN coder.
Although admission requirements for a BSN degree differ among programs, many require a minimum high school GPA of 3.2 and prerequisite classes in science, English, sociology, and psychology.
BSN students take classes in anatomy and physiology, human development, microbiology, pathophysiology, health assessment, pharmacology, leadership and management, and mental health. Compared to ADN learners, BSN students spend more time completing a clinical and often have more clinical hours upon graduating.
Time to Complete
A BSN program takes around eight semesters (four years). It can take longer if a student attends part time.
BSN students learn to assess a patient's physical and mental status, apply critical thinking, and develop strong communication and leadership skills.
RN Coder Licensure and Certification
RNs are highly sought after in the medical billing and coding profession.
Maintaining an RN license and earning coder certification demonstrates commitment. It also helps protect an employer's compliance with insurance companies and agencies like the Centers for Medicare & Medicaid Services.
An RN license requires at least an ADN and a passing score on the NCLEX-RN. Employers, particularly in the nurse coding field, may prefer applicants who hold BSNs. Both an ADN or BSN provides eligibility for the NCLEX-RN.
Licensed RNs with ADNs can enroll in RN-to-BSN bridge programs to earn their nursing bachelor's degrees sooner.
Becoming certified entails taking the CPC or CCA exam. Both CPC and CCA credential holders qualify for entry-level coding positions.
To get a nursing license, candidates must master NCLEX-type test questions and pass the NCLEX-RN. This proves a job candidate has the competency to practice as a new nurse. The NCLEX-RN covers subjects learned in nursing school.
Nurses graduating from an accredited program are eligible to take the exam. Before registering for the exam, graduates must get an authorization to test and pay the required fee.
Each state may have additional eligibility requirements, so it is important to check with the state's nursing regulatory body.
Certified Professional Coder (CPC)
The AAPC does not have any eligibility requirements to take the CPC exam, but applicants must be an AAPC member. Student membership is $140 and individual membership is $205.
The test is 150 multiple-choice questions and takes five hours and 40 minutes. Exam locations are across the U.S. Certification is not official until two years of medical coding experience are completed.
Certified Coding Associate (CCA)
Offered by the American Health Information Management Association (AHIMA), Certified Coding Associate (CCA) certification requires a high school diploma. The AHIMA recommends, but does not require, either six months of coding experience or coding program completion.
The computer-formatted exam consists of 90-115 questions to be completed in two hours. Joining the AHIMA is optional, but non-members pay a $299 exam fee, while members pay $199.
AHIMA annual membership costs $49 for students, $135 for professionals, and $199 for the premier level.
RN coders often seek additional certifications in specialty areas. For example, the Certified Risk Adjustment Coder Examination focuses on codes in risk adjustment. Risk adjustment is important in patient populations where there is a greater burden of disease.
A certified professional medical auditor can be critical for a healthcare system's revenue cycles. This certification allows nurse coders to audit medical documentation for fraud and abuse.
Working as an RN Coder
It's helpful to have at least two years of experience as an RN coder before taking the CPC examination. AAPC grants full certification to those who pass the exam and can submit proof of experience. Full certification improves job options and salary potential.
Hospitals, doctors' offices, and medical coding companies advertise on job boards and job fairs for RN coders. Potential nurse coders can raise their job appeal by completing a medical coding course before certification.
The average annual salary for an RN coder is $83,680, according to ZipRecruiter data as of November 2022. This falls below the average annual salary of RNs ($82,750) according to the U.S. Bureau of Labor Statistics (BLS).
Additional certifications can increase job prospects. RN coders can find employment in several different settings:
RN coders work collaboratively with healthcare professionals. They help maintain patient confidentiality, review charts, and assign the right diagnosis codes for insurance reimbursements.
In a private physician's office, the RN coder may be responsible for both medical billing and coding. They prepare accurate medical codes for Medicaid, Medicare, and private insurance companies. They must also follow up on reimbursement and communicate with patients about outstanding balances.
Nurse coders can work in claims processing for insurance companies. They are responsible for analyzing a claim's validity. They then compare the codes against the patient's insurance policy. If the claim requires more information, the RN coder contacts the provider for the missing details.
Frequently Asked Questions About Becoming an RN Coder
How long does it take to become an RN coder?
Candidates who hold a BSN degree may complete AAPC's online course in six months. This can help potential nurse coders get their first coding job. After two years of experience, candidates may take the CPC exam.
How do you gain experience as an RN coder?
After completing an online or in-person medical coding training program, aspiring nurse coders can gain experience through job shadowing and internships. AAPC membership has networking access to RN coders across the country. Networking is a great way to find internships, job openings, or volunteer positions.
Those who pass the CPC exam without two years of experience can take part in the apprentice program which can also be an advantage for job seekers.
What qualities are important for RN coders?
RN coders have a strong attention to detail and high communication skills. These skills can help nurse coders perform research for coding and billing systems and work with healthcare professionals. RN coders should be able to work independently as many companies are moving to remote work. This means a nurse coder must be able to adapt to new technology and challenges.
Which certifications are most important for RN coders?
The CPC certification is the standard one that demonstrates competency to employers. Additional certifications can boost employability and salary potential. These include outpatient, inpatient, and risk adjustment coding. AAPC also has certifications for specialty areas like dermatology, cardiology, gastroenterology, and orthopedic surgery.
Page last reviewed December 19, 2022
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