Certified Medical Coder (CMC)®

This course includes the following resources:

• Certified Medical Coder course manual: tabbed sections, workbook exercises, and exam preparation handbook (shipped within 7 days of enrollment).
• Digital course recordings and materials: instructor-led recorded class sessions, pre-loaded in a password-protected PMI Portal Account, accessible online anytime. Login information is provided with purchase confirmation.
• A free supplemental course: Medical Terminology for Coders
• Coding exercises and a practice exam with answer key, testing tips, and course updates, when applicable.
• A proctored certification exam is included when scheduled within one year of course enrollment.

The following supplemental resources must be purchased separately and are required for use during this course and exam: Current year editions: CPT®, HCPCS, ICD-10-CM, and a medical dictionary (any year). See the "Requirements" tab for more information about these reference materials.

A payment plan is available for this course.

The Certified Medical Coder is a leading certification for medical coding professionals that work with outpatient claims. The training program prepares candidates with advanced knowledge of the reimbursement cycle from patient encounter to claim. These skills are imperative for proper claim submission and accurate payment for services rendered.

For employers, auditors, and business associates, CMC signifies an ongoing commitment to continued professional development. Those who continue to expand their professional knowledge will have an edge in today's ever-changing healthcare climate.

Benefits of becoming/hiring a Certified Medical Coder:

• A CMC protects the practice’s financial health by decreasing claim denials and improving billing accuracy and compliance with current guidelines
• A CMC does not rely on EHR presets, web searches or coding cheat sheets for coding assignments, which can cause repeat problems and trigger an audit
• A CMC communicates with confidence with physicians, third-party payers, patients, and business associates, which promotes advancement into chart auditing and supervisory roles.

The CMC online preparatory course consists of 24 hours of high-level coding instruction led by a PMI-approved Instructor and a vast number of hand-on coding practice exercises.

Course Outline:

Medical Terminology

• Makeup and pronunciation of medical terms/words
• Key review of the human body systems, illustrations, and review of anatomic position and directional terms
• Root words, prefixes, suffixes, and supplemental terms
• Combined forms associated with medical conditions
• Definitions for common medical abbreviations
• Analysis of physician orders and narratives

ICD-10-CM Coding

• Instruction on the guidelines, organization, and groupings of ICD-10-CM
• Accurate translation of medical terminology for diseases into codes
• Designation of symbols, punctuations, abbreviations, keywords, unspecified codes, and other coding conventions
• ICD-10-CM subcategories, classifications, and extensions
• Outline of the complete coding and reimbursement equation
• Primary vs. secondary code selection
• Diagnostic coding guidelines such as laterality, sequelae, etc.
• Differentiate between signs/symptoms and ill-defined conditions and a diagnosis
• Correct rules and guidelines for assigning codes for neoplasms, adverse effects, pregnancy, childbirth, wounds, burns, injuries, HIV/AIDS, etc.
• Unsubstantiated and borderline diagnoses
• Application of ICD-10 coding conventions
• How to determine the accurate diagnostic code order
• Proper use of tables
• Problem set coding exercises for hands-on comprehension

Procedural Coding - CPT® and HCPCS

• Key elements of physician documentation that drive the assignment of CPT codes
• Accurate code assignment through the application of coding guidelines
• HCPCS/CPT coding process and steps
• Format and conventions used in the HCPCS/CPT coding manuals
• Global and unbundled procedures, and their impact on coding in CPT
• Identify unlisted procedures and how to bill them
• Modifier usage for appropriate reimbursement and efficient claims processing
• Evaluation and management service types
• E/M guidelines and levels of service
• Medical record documentation as related to the application of E/M coding
• Bundled services guidelines for surgery coding
• New versus established patient guidelines
• Surgery coding guidelines
• Hands-on exercises coding common procedures and services provided by physicians

Ancillary Services & Advanced Coding

• Maternity and delivery services
• Types of radiology services
• Technical and professional component distinction
• Billing supervision and interpretation (S&I) services
• Laboratory procedure types
• Billing for qualitative detection versus quantitative detection
• Billing laboratory panel tests
• Types of pathology services
• Coding services in the medicine section
• Billing for the administration of vaccines and immunizations
• Types of dialysis
• Guidelines used to assign ophthalmologic examinations
• Advanced coding problem set exercises 

The Certified Medical Coder (CMC) is designed for experienced coders that have a minimum of one year of work experience in outpatient medical coding. All candidates are encouraged to complete PMI’s free online Medical Coding Assessment to test their base knowledge and identify areas of deficiency where training may be beneficial in advance of the course. 

*If you lack experience and want to build foundational coding knowledge, we recommend the Medical Coding Bundle - includes 6 foundation courses plus the CMC Certification course - a fantastic training value!

Fundamental Training Recommendation

Candidates with limited experience should complete the primer course included with CMC training: Medical Terminology for Coders

Required Self-Supplied Materials

Students must have access to current editions of CPT®, HCPCS, ICD-10-CM, and a medical dictionary throughout the course and on the exam day. These coding reference materials are updated annually. PMI certification course students should utilize coding resources that are current at the time of their participation in the course and exam. Candidates that schedule an exam appointment for the next calendar year should bring coding books that are current on the date of their exam.   

Students should be aware that the AMA publishes the only CPT® codebook with the official CPT guidelines. PMI does not sell medical coding books, but they are widely available for purchase or lease through a variety of nationwide publishers and retailers. 

Exam

Earning CMC certification requires a passing score of 70 percent or better on the written exam. All exams are proctored live in testing centers across the country. Candidates have up to six hours to review questions and coding books and write in their answers based on the criteria given. Codes selected must designate the highest degree of specificity based on the documentation provided using current coding reference books. Exams are hand-graded and verified twice. In an age of digitized grading systems designed to simplify the grading process, PMI stands by its resolute exam standards as the most accurate measure of a CMC candidate’s coding ability. 

Certified Professional Standards of Excellence

Practice Management Institute certified professionals are required to uphold high professional standards, established by the Practice Management Institute Advisory Board for Certification Programming. Ethics requirements include adherence to legal guidelines according to governmental and third-party payer organizations and contracts.

Maintaining the CMC Certification

Medical office professionals, particularly those working in reimbursement roles, must stay current on updates and changes each year. Keeping the CMC certification active requires an ongoing commitment to continuing education. Twelve hours of continuing education are required each year to maintain active certification status. For information about renewing the CMC certification, visit the “Certification Renewal” section of our website.