Gloria G Anderson
Covers healthcare coding principles for International Classification of Diseases (ICD) and Current Procedural Terminology (CPT) code sets used in diagnosis and procedure code assignments for research and reimbursement by healthcare providers in all settings. Prerequisite: HIHIM 409.
This is a beginning level course which provides an overview of clinical vocabularies and classifications, detailed instruction on International Classification of Diseases, ninth revision, clinical modification (ICD-9-CM) and Current Procedural Terminology (CPT) coding principles, and a detailed discussion of revenue cycle management. ICD-9-CM diagnosis classification is used to code and bill diagnoses for services in acute care hospitals, long term care facilities, outpatient facilities, outpatient clinics, and physicians’ and other health care professionals’ offices. The ICD-9-CM procedure classification is used to code and bill diagnoses and procedures provided as inpatient services by acute care hospitals. The CPT coding system is used to code and bill procedures and services provided by acute care hospitals, long term care facilities, outpatient clinic facilities, physicians and other health care professionals. Revenue cycle management will build upon health care data principles, and identify the provider and payer roles in ensuring facilities are reimbursed accurately for the services provided.
Student learning goals
1. Define nomenclature, vocabulary, terminology and classification. 2. Recognize common clinical terminologies and classifications and know their purposes and uses. 3. Apply ICD-9-CM coding conventions, theory and guidelines to correctly assign diagnosis and procedure codes.
4. Apply CPT coding conventions, theory and guidelines to correctly assign procedures and services codes to procedure notes, operative reports, clinic notes, and other health record documentation. 5. Explain the difference between physician or professional services coding and facility services coding when billing for these services. 6. Identify and use official and unofficial resources for researching ICD-9-CM and CPT coding questions including AHA Coding Clinic and AMA CPT Assistant.
7. Demonstrate knowledge to extract pertinent information from health information documentation in order to assign the ICD-9-CM and CPT code. 8. Discuss ICD-10-CM and ICD-10-PCS in terms of its development, basic concepts, and implementation. 9. Discuss commercial, managed care and federal insurance plans.
10. Discuss retrospective and prospective payment methodologies. 11. Apply the prospective payment systems of Diagnosis Related Groups, Ambulatory Payment Classifications, and Resource Based Relative Value Scale to the appropriate health care setting.
12. Discuss the billing process: charge description master, fee schedules, coding, claim preparation, claim submission, and auditing.
Interpret items included on a facility claim for reimbursement. 14. Interpret items included on a clinician claim for reimbursement.
15. Explain the elements of a Facility Compliance Program and a Coding Compliance Program. 16. Discuss the specific roles of each facility department in the revenue cycle management process.
General method of instruction
• Web-based lecture and discussion • In-class exercises and case studies • Graded assignments
Class assignments and grading
Lesson assignments / quizzes (6 @ 10 pts each) 60 points Midterm exam 50 Final exam 50 Data sets, clinical vocabularies & terminologies assignment 50 Revenue cycle management project 50 Total Points 260 points