coding qualification. United States ; the typical qualification for an entry-level medical coder in the United States is completion of a diploma or certificate, or, where they are offered, an associate degree. The diploma, certificate, or degree will usually always include an Internet-based and/or in-person internship at some form of a medical office or facility. Some form of on-the-job training is also usually provided in the first months on the job, until the coder can earn an intermediate or advanced level of certification and accumulate time on the job. For further academic training, a baccalaureate or master's degree in medical information technology, or a related field, can be earned by those who wish to advance to a supervisory or academic role. A nosologist (medical coding expert) in the U.S. will usually be certified by either AHIMA or the AAPC (often both) at their highest level of certification and speciality inpatient and/or outpatient certification (pediatrics, obstetrics/gynecology, gerontology, oncology are among those offered by AHIMA and/or the AAPC), have at least 3-5 years of intermediate experience beyond entry-level certification and employment, and often holds an associate, bachelor's, or graduate degree. The AAPC offers the following entry-level certifications in the U.S.: Certified Professional Coder (CPC); which tests on most areas of medical coding, and also the Certified Inpatient Coder (CIC) and Certified Outpatient Coder (COC). Both the CPC and COC have apprentice designations (CPC-A and COC-A, respectively) for those who pass the certification exams but do not have two years of on the job experience. There is no apprentice designation available for the CIC. After completing two years of on the job experience the apprentice credential holder can request to have the apprentice designation removed from their credential. There are also further specialist coding certifications; for example, the CHONC credential for those who specialize in hematology and oncology coding and the CASCC credential for those who specialize in ambulatory surgery center coding. The other main organization is American Health Information Management Association (AHIMA) which offers the Certified Coding Specialist (CCS), Certified Coding Specialist-Physician-based (CCS-P), and the entry-level Certified Coding Associate (CCA). Some U.S. states now mandate or at least strongly encourage certification from either AAPC or AHIMA or a degree from a college to be employed. Some states have registries of medical coders, though these can be voluntary listings. This trend was accelerated in part by the passage of HIPAA and the Affordable