HIM 176 - CPT Coding

Description: Overview and introduction to the principles of Current Procedural Terminology (CPT) coding techniques, conventions, and modifiers. Review of reimbursement trends, ethical coding and compliance, and the National Correct Coding Initiative (NCCI). Documentation guidelines in relationship to assignment of CPT and Evaluation and Management (E/M) codes. Includes hands-on practical skills in the assignment of CPT codes following coding rules and guidelines.

Prerequisites: AHS 160 /BIO 160  (or BIO 201  and BIO 202  ) and AHS 130  and HIM 110  and AHS 240 .

Credits: 3
Lecture: 3
Course Content:

1. Structure and use of health information
2. Data sources
3. Classifications, taxonomies, nomenclatures, terminologies and clinical vocabularies
4. Principles and applications of CPT coding
5. Compliance strategies, auditing and reporting
6. Quality monitors and reporting
7. Commercial managed care and federal insurance plans
8. Payment methodologies and systems, RBRVS
9. Billing processes and procedures
10. Chargemaster maintenance
11. Regulatory guidelines
12. Reimbursement monitoring and reporting

1. Analyze the health record to ensure that it supports the patient's diagnosis, progress, clinical findings, discharge status and coding disposition. (1) Domain I.A.2
2. Discern timeliness, completeness, accuracy and appropriateness of data and data sources for patient care, management, billing reports, registries and/or databases. (2) I.A.4
3. Explain the use and maintenance of applications and processes to support clinical classification and nomenclature systems. (3) Domain. I.C.6
4. Apply diagnosis/procedure codes according to current nomenclature. (4) Domain I.C.2
5. Support the reasons to adhere to current CPT coding regulations and established guidelines in code assignment. (5) Domain I.C.4
6. Validate coding accuracy and solve discrepancies between coded data and supporting documentation. (6) Domain I.C.7
7. Distinguish and apply policies and procedures for the use of clinical data required in reimbursement and prospective payment systems (PPS) in health care delivery. (7) Domain I.D.2
8. Apply policies and procedures to comply with changing regulations among various payment systems for healthcare services. (5,8) Domain I.D.2
9. Break down billing using resources from coding, the Chargemaster, claims management, and bill reconciliation processes. (9,10) Domain I.D.3
10. Use established guidelines to comply with reimbursement and reporting requirements. (11,12) Domain I.D.4
11. Compile patient data and perform data quality reviews to validate code assignment and compliance with reporting requirements. (12) Domain I.D.5

*Domains listed refer to CAHIIM Curriculum Requirements.