South Central College HC 1930 HC 1930 ICD-9-CM III/CPT Coding II Course Information Description Total Credits 4.00 Total Hours 80.00 Types of Instruction This course is a continuation of HC 1920, 1925, 1928 with emphasis on advanced coding of ICD-9-CM and CPT as it relates to the reimbursement in both inpatient and outpatient facilities. It further combines all previous discussions and coding experiences and applies them to reimbursement in RBRVS and DRG's. The student will further learn about DSM- IV cross-walk, ambulatory surgery coding, and Ambulatory Payment Classifications (APC's). Instruction Type Lecture Lab Credits/Hours Pre/Corequisites HC 1920, 1925, 1928, 2930, 1000, 1001, 1914, 1924 or enrolled Course Competencies 1 Define DRG's Describe UHDDS and elements of data capture Demonstrate through case example problem-solving and case mix 2 Diagram DRG grouper hierarchy Describe medical/surgical case examples Review present on admission criteria 3 Define Federal Registry guidelines
Review Federal Registry submission of DRG updates Describe payment methodologies 4 Describe data quality improvement Demonstrate data elements for coding of claims Define code linkage in each submission of the claim in each type of healthcare facility 5 Review ethical coding guidelines Define AHIMA's guidelines for ethical coding Demonstrate through case problems potential areas of concern 6 Review of coding and reimbursement under OPPS Provide legislative background and methodology in hospital outpatient payment system Describe the claims preparation and claims processing requirements 7 Define coding and billing integrity under OPPS Describe APC's and data quality Demonstrate coding and incomplete clinical data 8 Define APC compliance strategies Review patient access through admissions/registration Demonstrate chargemaster and ancillary service processing of claims 9 Define coding compliance Demonstrate fraud and abuse issues as related to reimbursement Describe components of a compliance plan 10 Demonstrate health record auditing processes Define plans of action for setting and updating health record auditing processes Describe methods of audits and review 11 Define physician query process and review Review principals of medical documentation Describe relationship between coding and documentation and proper use of physician queries 12 Review of basic beginning, intermediate, and advanced ICD-9-CM coding Define the coding conventions and guidelines Demonstrate the coding conventions through case examples
13 Define basic principles of beginning, intermediate, and advanced CPT coding Review of CPT organization, guidelines, and structure Demonstrate through case problem examples of data capture for submission of codes 14 Review case problems of infectious and parasitic diseases Differentiate between inpatient and outpatient coding requirements Define elements of documentation 15 Review case problems of endocrine, nutritional, and metabolic diseases Demonstrate coding between inpatient and outpatient coding requirements Define elements of documentation 16 Define coding problems of the blood system Describe coding of cases in both the inpatient and outpatient setting Review elements of documentation 17 Demonstrate coding of case problems of mental health Review DSM-IV requirements Describe documentation requirements of mental health consults 18 Demonstrate coding case problems of nervous system and sense organs Describe cases seen in both hospital and clinical settings Define elements of documentation 19 Review case problems of the circulatory system and heart Define coding of anomalies of the heart and related structures Describe documentation elements required for submission of the coded data 20 Demonstrate case problems of the musculoskeletal system Outline elements of documentation for coding the diagnoses and procedures Review data requirements for both inpatient and outpatient facilities 21 Describe case problems of the respiratory system Define coding guidelines for inpatient and outpatient claims Differentiate principal diagnosis for respiratory failure 22 Outline case problems of the genitourinary system
Define male and female diagnoses and procedures Describe documentation of elements required for both inpatient and outpatient facilities 23 Describe case problems of the integumentary system Demonstrate coding of the integumentary system and related structures Discuss elements of documentation for inpatient and outpatient settings 24 Review case problems of pregnancy, childbirth, and puerperium Differentiate between patient encounters and admissions for OB care Define management of pregnancy and complications of pregnancy and delivery 25 Review case problems of the newborn and congenital disorders Define perinatal conditions and congenital anomalies Review inpatient and outpatient coding of newborns 26 Define coding of injuries, burns, poisoning, adverse effects, and complications of medical/surgical care Describe severity of injury and burns as it relates to the PDx Differentiate between poisoning, adverse effects, and conditions related to complications of medical/surgical care 27 Review of evaluation and management CPT coding Define key components and new and established patient Demonstrate case problems of all categories of physician services of E/M coding 28 Review CPT anesthesia case problems Define anesthesia modifiers, physical status modifiers and qualifying circumstances Demonstrate anesthesia billing according to MDA and CRNA guidelines 29 Discuss CPT case problems of the integumentary system Review cases related to lesion removal/destruction of benign and malignant neoplasms Apply coding to cases related to skin grafting and adjacent tissue transfers 30 Outline CPTcases related to the musculoskeletal system Define fracture treatment procedures both open and closed Discuss orthopedic surgical packages as it relates to inpatient and outpatient settings 31 Define respiratory system CPT case procedures Review endoscopic procedures both diagnostic and surgical
Discuss respiratory procedures of the larynx and lungs 32 Review cardiovascular CPT case procedures Discuss pacemaker and cardiac defibrillator insertions and replacements Outline coronary artery bypass procedures of venous and arterial grafting 33 Review digestive system CPT case problems Define endoscopic procedures both diagnostic and surgical Review reimbursement and use of modifiers for multiple procedures 34 Discuss CPT case problems of the urinary system Contrast between endoscopic and open procedures Review coding of stent placement and removal 35 Discuss CPT case problems of male/female genital systems Recognize codes for procedures that are bundled and unbundling rules Define coding for deliveries 36 Discuss CPT coding of procedures for endocrine disorders Define fine needle aspiration and nore core biopsies Review modifiers for coding of surgical assistants and surgical teams 37 Review CPT case problems of the nervous system and sense organs Differentiate between surgical approach in spinal procedures Review neurological injections and pain management 38 Discuss CPT procedures of the eye and ear Define procedures of the ocular system Describe coding of procedures of the auditory system 39 Review CPT coding of radiological procedures Discuss ancillary service coding and chargemaster Review professional and technical component coding 40 Discuss CPT coding of pathological and laboratory services Define coding of quantitative and qualitative services of lab/path Review CMS guidelines for submitting panel testing codes 41 Discuss CPTcoding of services of the medicine section
Define eye, psychiatric, ENT, and osteopathic services Describe conventions specific to immunization injections and drug infusions 42 Describe HCPCS Level II coding Review of DME coding guidelines Discuss examples of HCPCS Level II modifiers 43 Review of certification competencies for coding professionals Discuss AHIMA's CCS certification Define AAPC certification criteria for CPC 44 Discussion of CPT/ICD-9-CM coding challenge tests Review coding exercise for beginner, intermediate and advanced levels Discuss case problems and problem-solving methods 45 Discussion of the Medical Coding Program Review of program format of Medical Coding Specialist Program List suggestions for program improvement and enhancement SCC Accessibility Statement If you have a disability and need accommodations to participate in the course activities, please contact your instructor as soon as possible. This information will be made available in an alternative format, such as Braille, large print, or cassette tape, upon request. If you wish to contact the college ADA Coordinator, call that office at 507-389-7222. Disabilities page http://southcentral.edu/academic-policies/disability-rights.html