The healthcare industry, complex and rigorous even for the most knowledgeable and thorough of professionals, requires that paperwork be submitted both in a highly accurate and very timely manner.
The area of healthcare involving the completion of paperwork outlining patients' billing histories and submission of them to the individual's insurance company for reimbursement is known as 'medical billing'. Within medical billing there exists the practice of 'medical coding' whereby codes are assigned to medical procedures and diagnoses in order to relay--in a universally accepted medical language--information to the insurance company or in some cases, governmental agencies and/or consulting firms.
Also known as 'insurance coding', medical billing/coding is viewed to be essential to the healthcare industry for it creates and maintains a single, unified language by which all (physicians, medical administrators, insurance companies, government healthcare officials) integrated parties are able to effectively communicate.
In this course, we're going to learn medical coding from the ground up. Whether you are new to medical coding, or already have experience, this course is written in 'laymen's terms' yet is comprehensive enough to help even seasoned medical coders.
Lesson 1-INTRODUCTION TO MEDICAL CODING
A. Professional Overview
B. Specific Responsibilities
C. Education Training and Certification
Lesson 2-INTRODUCTION TO DIAGNOSIS CODING
A. Medical Diagnosis
B. Standardization in Coding
C. Relative Value Units (RVUs)
D. HIPAA Background & Explanation
Lesson 3-ICD-9-CM - WHAT IS IT?
A. Coding Overview
B. ICD-9-CM versus CPT: Documenting Medical Necessity
C. History of the ICD
D. Origins and Revisions of the ICD
E. ICD-9-CM Form and Function
F. Regulating and Financial
Lesson 4-INTRODUCTION TO ICD-9-CM CODING AND STRUCTURE
A. ICD-9-CM: Overview
B. ICD-9-CM: General Structure
C. ICD-9-CM: Basic Operating Guidelines6
D. V Codes
E. Categories of V Codes
F. Tips for Improving ICD-9-CM coding Accuracy
G. ICD: Punctuation
H. ICD: Instruction/Notes
I. ICD-9-CM: Coding Accuracy & Specificity
J. ICD-9-CM versus ICD-10-CM
Lesson 5-REIMBURSEMENT: INTRODUCTION AND OVERVIEW OF REIMBURSEMENT
A. Reimbursement: Introduction
B. Reimbursement: Overview
C. Healthcare Industry Billing/Reimbursement Climate
D. Top Ten Coding & Billing Errors
E. Step to Avoid Coding Billing Errors
F. More Efficient Billing Systems
Lesson 6- ICD-9-CM Coding Practice Problems
A. ICD-9-CM Practice Problems: Overview
B. ICD-9-CM Practice Problems
C. ICD-9-CM Practice Problems: Summary
Lesson 7-CURRENT PROCEDURAL TERMINOLOGY (CPT) - WHAT IS IT?
A. CPT Medical Coding: Purpose
B. What is a CPT Code?
C. CPT Medical Coding: History
D. Structure CPT Codes
E. AMA's Stance on CPT Codes
F. CPT Codes Glossary of Frequently Used Terms
Lesson 8-INTRODUCTION TO CPT CODING AND STRUCTURE
A. CPT Coding and Structure: Introduction
B. Three Categories of CPT Codes
C. CPT Codes: Category I
D. General Guidelines for Using the CPT Manual
E. Coding Multi-Disciplinary Approach
F. Absence of Codes
G. Special Cases
H. Daily Coding Rituals
I. Exercise Caution when Using 99215S
J. Correlation between Coding and Time
K. Troublesome Modifiers: -25 & -59
L. Prolonged Services
M. Critical Care Services
N. Emergency Department Services
O. Cautionary CPT Coding Areas
P. Reasonable and Necessary
Q. Documentation
R. Changes/Revisions to CPT Codes
S. National Correct Coding Initiative (NCCI)
Lesson 9-Evaluation & Management (E/M) Coding
A. Evaluation and Management (E/M): Introduction
B. Basic E/M Coding
C. Essential E/M Terminology
D. E/M Codes Used to Identify Five Presenting Problems
E. Selection of an E/M Problem Service Level
F. Six Steps to E/M Coding
Lesson 10-Surgery & Integumentary System Coding
A. Indexing of Surgeries
B. Surgery CPT Coding Guidelines
C. Separate Procedures
D. Subsections: Unlisted Procedures and Special Reports
E. Surgical Destruction
F. Surgeries: Integumentary System
G. Integumentary System Procedures
Lesson 11-Anesthesia
A. Anesthesia: Introduction
B. Anesthesia: Four Types
C. Anesthesia: CPT Coding of Anesthesia Services
D. Physical Status Modifiers
E. Qualifying Circumstances
F. Changes to CPT Anesthesia Codes
G. Monitored Anesthesia Care (MAC)
H. MAC Summary
Lesson 12-Cardiovascular, Respiratory, Musculoskeletal Systems
A. Cardiovascular, Respiratory and Musculoskeletal Systems: Overview
B. Cardiovascular System
C. Respiratory System
D. Respiratory Treatment Newly Assigned CPT Code
E. Musculoskeletal System
F. Musculoskeletal System: Definitions
Lesson 13-General Surgery, Radiology, Pathology Coding
A. Radiology: Definition
B. Radiology: Separate Procedures
C. Radiology: Subsection with Notes
D. Radiology: Categorical Subheadings
E. Radiology: Pre-Classifications
F. Exploding Costs in Diagnostic Imagery
G. Increasing Reimbursement Rates for Radiological Services
H. Pathology: Definition and Overview
I. Pathology: Categorical Listing of Subheading
J. New Pathology/Laboratory Codes for 2007
K. Pathology/Laboratory Subsection: General Guidelines
L. Pathology/Laboratory: Modifiers
Lesson 14-CPT Coding Practice Problems
A. CPT Coding Questions: Series Ranges
B. CPT Coding Questions: E/M Codes,
C. CPT Coding Questions: Anesthesia
D. CPT Coding Questions: Surgery
E. CPT Coding Questions: Radiology
F. CPT Coding Questions: Pathology| Laboratory & Modifiers
Lesson 15-Introduction to Documentation (Medical History)
A. Medical Record
B. Encounter Forms & SOAP Formatting
C. Medical Records Documentation: Writing a SOAP Note
D. SOAP Content
E. Online Interaction
F. AMA Guidelines for Physician-Patient Email Communications,
G. American Health Information Management Association (AHIMA)
H. Personal Health Record (PHR).
Lesson 16-Medical Examination, Decision Making, and Selecting the Correct Code
A. Medical Decision-Making
B. Deciding Factors
C. Precision Code Selection
D. Selecting the Right Code
E. Common Coding Mistakes
Lesson 17 Issues with Fraud and Abuse
A. Healthcare Fraud and Abuse Climate
B. Department of Health and Human Services' on Healthcare Fraud and Abuse
C. False Claims Act
D. Role of the Auditor
E. Solutions for Avoiding Medical Billing Fraud and Abuse
1. All lessons must be reviewed by student prior to completing the assignment.
2. All assignments must be completed in chronological order.
3. All exams must be taken following the related lesson.
4. Students are not allowed to skip assignments and only take the exam. After the 3rd incomplete assignment, the student will be dropped from the class.
5. The instructor reserves the right to change material anytime during the class course as changes are made in the coding industry.
6. Students are to utilize the lesson material and the coding manual(s) to obtain answers for exam questions.
The material contained in the lesson and assignments is copyright. Students may make a copy for their records but are not allowed to use the material for teaching purposes.
