HIM 273 - CPT and HCPCS Coding

5 Credit(s)

Students gain a working knowledge of CPT and HCPCS coding with exposure in abstracting and identifying correct outpatient procedure (C PT) codes and HCPCS codes per guidelines and will utilize encoder programs.

Prerequisite: (HP 100  and HP 150  and HP 152 ) or (BI 231  and BI 233 ) with a grade of C or better
Learning Outcomes
 

Upon successful course completion, the student will:

1. Identify organizations that address the content of the physician office health record
2. Understand the definitions pertaining to evaluation and management (E/M) services
3. Apply knowledge of E/M services guidelines to locate the correct code for the level of service provided during the encounter or visit
4. Describe the contents and structure of all sections of the CPT code book
5. Identify the modifiers that are most commonly used for CPT coding
6. Differentiate between modifiers for physician use and modifiers for hospital outpatient use
7. Append modifiers appropriately
8. Interpret health record documentation to identify codable diagnostic and procedure statements resulting from a physician service
9. Define what HCPCS codes are, including their format and publishing body
10. Demonstrate how to assign HCPCS codes while observing the coding hierarchy
11. Identify ways to obtain regulatory agency and payer-specific guidelines for use in the coding and reimbursement process
12. Describe the process flow of claims generation and processing from patient visit to final payment
13. Recognize potential coding quality issues as reported on payer remittance reports (for example, explanation of benefits)
14. Identify ways to obtain or create tools to clarify conflicting, ambiguous, or missing health record documentation and/or billing information from the physician
15. Explain the concept of compliance