South Central College HC 1928 CPT Coding I Course Information Description This course is the introduction of CPTcoding and provides and in-depth review of the coding and reimbursement system used in outpatient facilities and physician billing. The course reviews all CPTsections and sub-sections. The student will learn the importance of physician documentation and impact of CPT coding on reimbursement and for both the medical facility and the physician. The student will gain knowledge of medical procedures and services and the importance of understanding medical terminology. Total Credits 3.00 Total Hours 64.00 Types of Instruction Instruction Type Lecture Lab Credits/Hours Pre/Corequisites HC 1000, HC 1001/enrolled, HC 2930, HC 1914/enrolled Course Competencies 1 Define CPT coding. Describe CPT coding in physician billing both in outpatient and inpatient. Review case problems to differentiate code linkage of diagnosis and procedure. 2 Describe CPT symbols. Review the symbols for new code, code description change, and deleted codes. Define the use of add-on codes and modifier -51 exempt codes in CPT. 3 Define the CPTcoding manual format.
Review the parent code, indented code format. Define the semicolon and code structure. 4 Define the relationship of ICD-9-CM coding and CPT coding Define code-linkage on charge tickets and encounter forms. Review the CMS 1500 claim form and establishing code-linkage. Define ICD-9-CM coding and CPT coding in case problems. 5 Review CPT appendices Review the CPT appendices for reference to coding procedures. Define specific section of the appendix for modifier definitions. Review the appendix for code changes and code deletions. 6 Define CPT modifiers Define the relationship of modifiers for billing services/procedures in CPT. Review case problems that require modifiers for claim submission. Demonstrate the CPT and HCPCS modifier usage. 7 Describe CPT new procedures Review the category II and III sections of CPT. Describe the unlisted procedure and claim filing procedure. 8 Define CPT index structure Compare and contrast ICD-9-CM index and CPT index. Demonstrate code selection from the CPT index and verifying codes. Describe CPT index code ranges. 9 Describe CPT revised procedures Review CPT symbols and descriptions for revised procedures. Review the CPT appendix for verification of code revision from previous edition. 10 Define CPT code changes Review modifiers that indicate codes changes. Describe the appendix verification for code changes from previous editions. 11 Demonstrate CPT section and subsections
Demonstrate CPT sections and structure of code numbering. Describe referencing of CPT sections versus the CPT index. 12 Define new patient versus established patient Review CPT guidelines for new patient and established patients. Review case problems indicating new versus established patients. Define clinic records and multiple clinic structures. 13 Define key components Define history, exam, and medical decision-making in code selection. Review the elements of history components of HPI, ROS, and PFSH. Define elements of examination and CPT guidelines. Define elements of diagnosis, data review, and level of risk. 14 Define contributing factors Define the components of nature of presenting problem, counseling/coordination of care, time. Review case problems that are determined on time and documentation requirements. 15 Demonstrate E/M coding categories Review E/M code categories through case problems. Define through case problems the code selection for E/M services. Demonstrate through lab case problems the categories of E/M code selection. 16 Review documentation for physical examinations Review the 1995 and 1997 documentation guidelines for E/M. Define multi-system history and physical exams versus single-specialty examinations. 17 Describe multi-system exam guidelines Demonstrate through case problem multi-specialty and single-specialty exams. Review the outlines/templates established for determination of the exam component. 18 Demonstrate E/M coding case problems Describe through E/M case problems the problem-oriented exams. Describe through case problems split-billing. Define preventive medicine/annual exams. 19 Review E/M coding conventions and modifiers
Define CPT coding conventions and modifier usage. Review CMS-1500 claim form and code-linkage and modifiers. 20 Define CPT versus CMS surgical packages Define the elements for CPT surgical package. Compare and contrast the CPT surgical package and CMS surgical package. 21 Define CPT surgical procedural terminology Review CPT surgical guideline section for coding of surgical procedures. Review documentation of operative/procedural reports for clarification of coding. 22 Describe unbundling of surgical procedural coding Define unbundling and fragmentation of CPT codes. Review implications of unbundling. Demonstrate through case problems unbundling of procedures. 23 Define surgical procedural modifiers Review the surgical modifiers usage. Demonstrate surgical modifiers through case problems. 24 Describe CPT definition of separate procedure Review surgical section of procedures that are determined as separate procedures. Demonstrate through case problems procedures that cannot be coded together. 25 Demonstrate case problems of surgical cases using CPT coding Review surgical cases that involve all sections of CPT surgery section. Apply CPT coding to case problems of surgical procedures including modifiers. 26 Define CPT coding of integumentary procedures Define the general section CPT category within integumentary section. Define lesion removal procedures and the corresponding categories. Review CPT coding guidelines for wound repairs. Review through case problems coding of integumentary procedures. 27 Describe CPT coding of musculoskeletal procedures
Define the surgical package for fracture treatment. Review through case problems procedures of musculoskeletal system. Describe modifiers for CPT and HCPCS. 28 Describe CPT coding of respiratory procedures Review organs that are included in the respiratory system. Define endoscopic procedures of the sinuses, bronchus, and lungs. Demonstrate through case problems procedures of the respiratory system. 29 Define CPT coding of genitourinary procedures Review procedures that relate to male and female. Define cystoscopic procedures of the GU system. 30 Describe CPT coding of cardiovascular procedures Review the cardiovascular procedures related to the heart. Describe coding of PTCA and EKG's in the medicine section of CPT. Demonstrate through case problems procedures in the cardiovascular section. 31 Describe CPTcoding of nervous system procedures Define surgical procedures of musculoskeletal/nervous system relationship. Demonstrate neurolytic procedures. 32 Describe CPT coding of the auditory/eye Review CPT coding of cataracts. Review CPT coding of the auditory canal and modifiers. 33 Define CPT coding of the digestive system Define endoscopic procedures of the digestive system and modifiers. Review case problems of the digestive tract through lab experience. 34 Define CPT coding of the endocrine/lymphatic/hematological systems Define procedures involving fine needle aspirations. Define venipuncture and arterial blood draws. Describe lab procedures in annual/problem-oriented exams. 35 Describe CPT coding of the male/female reproductive systems
Review endoscopic procedures of the male and female. Define OB packages and coding of deliveries/abortions. 36 Review CPT coding of laboratory/pathology Review billing of lab/path procedures and charge master. Demonstrate through case problems lab/path billing. 37 Review coding of radiological procedures Define radiological CPT coding in the inpatient and outpatient settings. Demonstrate through case problems procedures for diagnosis and treatment. 38 Describe CPT coding in the medicine section Review the relationship of CPT medicine section with other sections of CPT. Review the anesthesia modifiers and additional services in CPT. Review CPT coding in the medicine section through case problems. 39 Define CPT coding of anesthesia Review anesthesia modifiers for the MDA and CRNA. Define CPT surgical coding versus anesthesia coding for billing. Demonstrate through case problems lab anesthesia coding of surgical procedures. 40 Describe the relationship of HCPCS coding Define the relationship of HCPCS and CPT. Review HCPCS modifiers. Review the HCPCS manual structure. Demonstrate through case problems usage of HCPCS coding and modifiers. Review CMS 1500 claim form for HCPCS modifiers. 41 Review auditing of physician services Define documentation reviews of E/M services and surgical cases. Review audit reports of coding trends and coding errors. 42 Demonstrate auditing of E/M coding case problems Define upcoding and downcoding through lab case problems. Complete E/M auditing forms and report findings and plan of compliance. 43 Demonstrate auditing of surgical/procedural case problems
Define through case problem review of surgical cases and document the results. Describe plan for compliance and plans for physician/coder review. 44 Define the NCCI Define CMS definition of comprehensive/component/column I/column II coding. Review case problems and software applications for NCCI. 45 Review Medicare outpatient edits Define Medicare code edits on claims. Review case/claim submission and auditing procedures. 46 Describe CPT software/encoders Define software applications for coding accuracy. Review case problems for claim submission and error correction. 47 Review AHIMA CPT ethical coding guidelines Review ethical coding guidelines and unethical practices. Review legal implications and qui tam legislation. 48 Review case problems in surgical/procedural billing in the physician office Apply CPT coding skills to case problems and claim submission. Review coding errors and correct code selection through lab exercises. 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