I. General Information

1. Course Title:
Intro to Diagnosis & Procedure Coding

2. Course Prefix & Number:
HINS 1150

3. Course Credits and Contact Hours:

Credits: 3

Lecture Hours: 3

4. Course Description:

This course will introduce students to the basic medical coding principles and conventions of ICD-10-CM/PCS, CPT, and HCPCS coding. Students will learn the application of coding principles using examples and hands-on exercises. The course will require students to apply their knowledge of medical terminology and human biology.

5. Placement Tests Required:

Accuplacer (specify test):

No placement tests required

Score:

6. Prerequisite Courses:

9. Co-requisite Courses:

There are no corequisites for this course.

II. Transfer and Articulation

1. Course Equivalency - similar course from other regional institutions:

Alexandria Technical College, MEDS 1626 Intro to ICD Coding, 2 credits
Alexandria Technical College, MEDS 1633 Intro to CPT Coding, 2 credits

2. Transfer - regional institutions with which this course has a written articulation agreement:

College of St. Scholastica, June 2014 (CSS course equivalent HIM 3211 Classification of Health Data)

III. Course Purpose

1. Program-Applicable Courses – This course is required for the following program(s):

Healthcare Administrative Specialist, AAS
Healthcare Administrative Specialist, Diploma
Medical Assistant, AAS

IV. Learning Outcomes

1. College-Wide Outcomes

College-Wide Outcomes/Competencies	Students will be able to:
Analyze and follow a sequence of operations	Select correct codes using approved coding books and/or computerized coding program.
Apply ethical principles in decision-making	Code for accuracy, not for reimbursement.

2. Course Specific Outcomes - Students will be able to achieve the following measurable goals upon completion of the course:

• Demonstrate professionalism;
• Demonstrate different ways to locate CPT & ICD codes through the use of the codebook's index;
• Identify wayst to ensure accurate code assignment through the application of coding guidelines from the AMA and CMS;
• Interpret information in the medical documentation to apply correct codes;
• Maintain confidentiality according to HIPAA (Health Insurance Portability and Accountability Act);
• Assess and apply regulatory and legal process when coding documents;
• Analyze and determine the need for requesting additional clarification when coding;
• Assess whether information is reported within legal, ethical, and regulatory guidelines;
• Manage the accuracy, effectiveness, and timeliness of medical information within regulatory guidelines;
• Choose correct coding references; and
• Demonstrate an understanding of the revenue cycle and how coding plays a key role in it.

V. Topical Outline

Listed below are major areas of content typically covered in this course.

1. Lecture Sessions

1. Reimbursement and Compliance
• Avoiding fraud and abuse
• Coding regulations
• Federal Register
• Compliance plan
• Strategies for coding compliance
• HIPAA
• Basic structure of the Medicare program
• Medicare fraud and abuse
• Managed healthcare
• Outpatient Resource-Based Relative Value Scale (RBRVS)
2. Overview of ICD-10-CM
• Development
• ICD-10-CM outpatient coding and reporting guidelines
• Structure of the system
• Mapping
• Index
• Tabular
• Instructional notations in the ICD-10-CM
3. ICD-10-CM Outpatient Coding and Reporting Guidelines
• First-listed diagnosis
• Unconfirmed diagnosis
• Outpatient surgery
• Additional diagnoses
• Z codes
• Observation stay
• First-listed diagnosis and coexisting conditions
• Uncertain diagnoses
• Documented conditions
• Diagnostic services
• Therapeutic services
• Preoperative evaluations
• Prenatal visits
4. Using ICD-10-CM
• Organization of the guidelines
• Accurate coding
• Alphabetic index and tabular list
• Level of specificity
• Integral conditions
• Multiple coding
• Acute and chronic
• Combination codes
• Late effects
• Reporting same diagnosis code more than once
• Laterality
5. ICD-10-CM Chapters 1-10
• Certain infectious and parasitic diseases
• Neoplasms
• Diseases of the blood and blood-forming organs
• Disorders involving the immune mechanism
• Endocrine, nutritional, and metabolic diseases
• Mental and behavioral disorders
• Disease of the nervous system
• Diseases of the eye and adnexa
• Diseases of the ear and mastoid process
• Diseases of the circulatory system
• Diseases of the respiratory system
6. ICD-10-CM Chapters 11-14
• Diseases of the digestive system
• Diseases of the skin and subcutaneous tissue
• Diseases of the musculoskeletal system and connective tissue
7. ICD-10-CM Chapters 15-21
• Pregnancy, childbirth, and puerperium
• Certain conditions originating in the perinatal period
• Congenital malformations, deformations, and chromosomal abnormalities
• Symptoms, signs, and abnormal clinical and laboratory findings, NEC
• Injury, poisoning, and certain consequences of external causes
8. Introduction to the CPT and Level II National Codes (HCPCS)
• Purpose of the CPT manual
• CPT manual format
• HCPCS manual format
• Index
9. Modifiers
• CPT modifiers
10. Evaluation and Management (E/M) Services
• Contents of the E/M section
• Three factors of E/M coding
• Using the E/M codes
• Documentation guidelines
11. Radiology
• Format
• Radiology terminology and terms
• Planes
• Guidelines
• Diagnostic radiology
• Breast, mammography
• Diagnostic ultrasound
• Radiation oncology
• Nuclear medicine
12. Pathology/Laboratory
• Format
• Organ or disease oriented panels
• Drug testing
• Therapeutic drugs assays
• Evocation/suppression testing
• Consultation (clinical pathology)
• Urinalysis, molecular pathology, and chemistry
• Hematology and coagulation
• Immunology
• Transfusion medicine
• Microbiology
• Anatomic pathology
• Cytopathology and cytogenic studies (introduction)
• Surgical pathology
• Unspecified/other procedures
13. Inpatient Coding
• Differences between inpatient and outpatient coding
• Selection of principal diagnosis
• Reporting additional diagnoses
• Present on admission (POA)
• Development of ICD-10-PCS