What Courses are Required for Medical Billing and Coding?

To become a medical billing and coding specialist in 2025, you must complete foundational courses in medical terminology, anatomy & physiology, ICD‑10‑CM/PCS coding, CPT coding, HCPCS Level II coding, health insurance & reimbursement, electronic health records (EHR), and HIPAA & medical law & ethics. These courses form the essential curriculum required to sit for certifications like the Certified Coding Associate (CCA), Certified Professional Coder (CPC), Certified Coding Specialist (CCS), or Certified Billing and Coding Specialist (CBCS). Beginning with these core subjects ensures a strong grasp of the medical billing cycle, claims processing, compliance, and coding accuracy—the pillars of medical billing and coding education.

What Courses are Required for Medical Billing and Coding – Find Out!!!

This quick answer outlines exactly what courses you need and why they matter for mastering revenue cycle management, claims submission, and healthcare documentation standards. The sections below break down each subject area, explaining its purpose, typical credit/hours, and relevance to industry certifications and on-the-job responsibilities.

Core Foundational Courses

A. Medical Terminology & Anatomy & Physiology

Understanding medical language is the linchpin of coding and billing accuracy. A course in medical terminology breaks down word roots, prefixes, and suffixes—enabling you to decipher complex diagnoses like “gastroenteritis” or “arthroscopy.” Typically offered in two parts (e.g., Medical Terminology I & II), these courses span 3–6 credit hours.

Simultaneously, anatomy & physiology courses (often split into two semesters) cover bodily systems—cardiovascular, respiratory, musculoskeletal—and delve into disease processes. Many programs bundle these (e.g., Anatomy & Physiology I & II) into their core structure. Both AHIMA’s CCA/CCS prep and AAPC certification pathways emphasize proficiency here.

B. ICD‑10‑CM & ICD‑10‑PCS Coding

ICD‑10‑CM (Clinical Modification) identifies diagnoses, while ICD‑10‑PCS (Procedure Coding System) applies to inpatient procedures in hospitals. Most programs include separate beginner and advanced modules (e.g., ICD‑10‑CM Coding I & II).

• ICD‑10‑CM Coding for Beginners: introduces guidelines, conventions, and chapter-based coding nuances.

• ICD‑10‑PCS Coding for Beginners: focuses on hospital procedure codes with five characters representing body system, root operation, etc.

These courses often amount to 3–4 credit hours each and are explicitly required for CCA, CCS, and CCS‑P certification pathways.

C. CPT & HCPCS Level II Coding

Current Procedural Terminology (CPT) is used for outpatient services and physician procedures. CPT coding is typically split into CPT I and CPT II courses, each 3 credits. Meanwhile, HCPCS Level II codes cover supplies, durable medical equipment, and ambulance services.

Programs include practical exercises and case studies to simulate real-world billing. These are mandatory for CPC, COC (Certified Outpatient Coder), and medical billing specialist roles.

D. Health Insurance & Reimbursement

A Health Insurance & Reimbursement course dives into payer contracts, Medicare/Medicaid regulations, CPT modifiers, and revenue cycle workflows (verification, claims submission, denial management). This course typically carries 3 credits or is divided into two semesters: Billing Basics and Advanced Reimbursement Practices.

E. Electronic Health Records (EHR) & Practice Management

Healthcare increasingly relies on digital platforms. EHR courses train you on software navigation, data entry standards, claims software, and integrating coding into digital workflows. Practice management modules may cover patient scheduling, financial clearance, and insurance coordination. Programs like DeVry include labs where students practice on virtual EHR systems (e.g., EHRGo).

Read Also: How Long Is a Medical Billing and Coding Course?

Compliance, Ethics, and Legal Aspects

A. Medical Law & Ethics / HIPAA Compliance

Accurate coding isn’t just about labels—it’s about protecting patient privacy and ensuring legal compliance. Courses in medical law and ethics, along with specific HIPAA compliance training, cover:

• Privacy/ security rules

• Patient consent, confidentiality

• Fraud, waste, and abuse prevention

• Documentation and audit readiness

These topics are essential for accurate claims adjudication and have become mandatory in most programs due to regulations under HIPAA and CMS.

B. Coding Compliance & Audit Practices

A practical component often includes coding, audit, and quality assurance training. You’ll learn to evaluate clinical documentation, reconcile coding discrepancies, and justify coding decisions during internal or external audits. This training readies you for roles such as coding compliance officer and revenue integrity specialist.

C. Reimbursement Methodology & Revenue Cycle Management

In advanced curriculum sections, reimbursement methodology courses explore Diagnosis-Related Groups (DRGs), severity levels, and bundled payments. Meanwhile, revenue cycle management components track a patient’s financial journey—from eligibility verification to accounts receivable resolution. Combined, these prepare you for efficient billing operations and CPC/CPC‑A, CCS‑P career trajectories.

Certification Prep and Specialized Electives

A. Certification Preparation Paths

• AHIMA path: Programs geared toward CCA (Certified Coding Associate), CCS, or CCS‑P exams include bundled courses: anatomy, CPT, ICD‑10, reimbursement, and pathophysiology.

• AAPC path: Programs aiming at CPC or COC provide CPC prep courses, mock exams, and exam vouchers.

• NHA CBCS: Includes specialized modules and vouchers for Certified Billing & Coding Specialist exam.

B. Specialized Elective Courses

After core modules, students often choose 1–2 electives to specialize:

• Pathophysiology and Pharmacology: Explores disease mechanisms and drug therapies—essential for CCS/CCS‑P.

• Advanced Coding (Inpatient/Outpatient): Applies coding skills in case-based settings (e.g., inpatient hospital coding practicum at DeVry).

• Healthcare Data Analytics: Introduces data reporting, ICD‑10‑CM/PCS, and outcomes measurement—gaining prominence as payers require quality metrics.

• Practice Management/Compliance Leadership: Focuses on audit, coding compliance, and leadership in practice settings.

C. Practical Applicability & Capstone Projects

Some programs include simulations or capstone coding practicum, where learners apply ICD‑10 + CPT + HCPCS knowledge on real or simulated records. These hands-on experiences significantly increase coding effectiveness and prepare students for certification and employment.

Diploma vs. Certificate vs. Associate Degree

A. Diploma / Certificate Programs

• Diploma programs (usually less than 1 year) consist of 10–12 courses covering core competencies. For example, Penn Foster offers an 11-course diploma including body systems, EHR, and coding exercises.

• Certificate programs (often 10–13 credits), such as those at DeVry, prepare students for specific certification exams like CPC or CCS and include exam vouchers.

Read Also: How Long Does it Take to Become a Medical Biller?

B. Associate Degrees

Associate programs (typically 60+ credit hours over 18–24 months) include general education (English, math, sociology) alongside coding courses. They appeal to students seeking deeper academic grounding or more advanced roles like health information management.

C. Choosing the Right Path

Factors to consider:

• Time: Diploma/certificate = 6–12 months; associates = ~2 years.

• Cost: Diploma cheapest; associates cost more but may qualify for more job openings.

• Depth: Associates offer broader education; certificates are highly targeted.

• Job aim: For coding roles and CPC, a certificate often suffices; for supervisory or data roles, an associate is valuable.

Continuing Education, CEUs & Emerging Trends

A. Maintaining Certification Through CEUs

Certification is not perpetual. To maintain credentials:

• AHIMA (for CCA/CCS): Annual CEUs via professional development, webinars, and renewal fees.

• AAPC (for CPC/COC): Must earn CEUs and pay dues annually.

• NHA (CBCS): CEUs required, often via employer training or self-study.

These reinforce coding competency amid frequent updates to ICD‑10, CPT, and billing rules.

B. Trends in Medical Billing and Coding

1. AI-Enhanced Coding: Emerging AI tools assist coders in identifying clinical context and suggesting codes. Understanding their use in live workflows prepares coders for future automation.

2. ICD‑11 Readiness: Though the U.S. still uses ICD‑10, some international employers prepare for ICD‑11; elective courses in ICD‑11 may offer an edge.

3. Telehealth Coding & Remote Billing: With telemedicine lasting post-pandemic, coding for remote consultations (e.g., e-visits) has become a vital elective.

4. Data Analytics & Quality Metrics: Healthcare payers now emphasize outcomes and compliance. Courses teaching analytics prepare coders for roles in population health coding.

Read Also: 13 Best Free Online Medical Coding Courses with Certificates

C. Post-Course Outcomes and Career Prospects

Graduates enter roles such as:

• Medical Coder (inpatient/outpatient)

• Billing Specialist / Insurance Claims Coordinator

• Coding Auditor or Compliance Specialist

• Health Information Technician

• Remote/Work-From-Home Coder

In 2025, demand continues to grow: BLS projects ~8–9% growth over the decade. Certified professionals generally earn significantly more (often 20–30% higher) than their non-certified peers.

Conclusion — Summary and Action Plan

In summary, the essential course requirements for a successful career in medical billing and coding in 2025 are clear:

1. Core Courses: medical terminology, anatomy & physiology, ICD‑10‑CM/PCS, CPT, HCPCS, health insurance, EHR systems, and HIPAA/legal ethics.

2. Cert Prep: Tailored pathways for CCA, CCS, CPC, and CBCS that combine theory with hands-on coding labs and exam vouchers.

3. Professional Development: CEUs through AHIMA, AAPC, or NHA ensure certification longevity, relevancy, and compliance.

4. Specializations & Trends: electives in pathophysiology, AI coding tools, telehealth, analytics, and emerging ICD frameworks enhance career readiness.

Action Steps:

• Enroll in a recognized certificate or associate program that includes all core modules.

• Choose the certification (CPC, CCS, CCA, CBCS) aligned with your career goals.

• Take exam prep courses and secure an exam voucher.

• Begin earning CEUs immediately after certification and add value with an emerging trend study.

• Seek internships, volunteer roles, or remote entry-level positions to build experience.

Completing these courses and certifications ensures not only eligibility for the job market but also excellence in healthcare documentation, compliance, and billing accuracy, key for a fulfilling, in-demand career in medical billing and coding.