HIM 280 - ICD-10-CM/PCS Medical Coding

Description: Principles of ICD-10-CM/PCS coding. Use and assignment of codes in compliance with federal, state and local rules and regulations. Coding conventions, features unique to ICD-10 and general and chapter specific guidelines to assure coding compliance. Assignment of accurate diagnostic and procedural codes using classroom materials and coding software applications.

Prerequisites: AHS 160 /BIO 160   (or BIO 201  and BIO 202  ) and AHS 130  and HIM 110  and AHS 240  or hold one of these coding credentials: CCA, CCS, CCS-P, RHIT, RHIA, CPC or CPC-H.

Credits: 4
Lecture: 4
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 ICD coding systems
5. Diagnostic and procedural groupings
6. Case mix analysis and indexes
7. Severity of illness systems
8. Compliance strategies, auditing and reporting
9. Quality monitors and reporting
10. Commercial managed care and federal insurance plans
11. Payment methodologies and systems, IPPS, OPPS
12. Billing processes and procedures
13. Chargemaster maintenance
14. Regulatory guidelines (NCDs and QUOs)
15. 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) Domain 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.1, I.C.2
5. Summarize the accuracy of diagnostic/procedural groupings and explain how the severity of illness is reflected in the case mix index. (5-7) Domain I.C.3, I.D.6
6. Support the reasons to adhere to ICD-10-CM/PCS coding guidelines, OIG compliance guidelines, CMS coding guidance and AHIMA code of ethics in code assignment. (8) Domain I.C.4
7. Validate coding accuracy and solve discrepancies between coded data and supporting documentation. (9) Domain I.C.7
8. Distinguish and apply policies and procedures for the use of clinical data required in reimbursement and prospective payment systems (PPS) in health care delivery. (10) Domain I.D.2
9. Apply policies and procedures to comply with changing regulations among various payment systems for healthcare services. (8, 11) Domain I.D.2
10. Break down billing by using resources from coding, the Chargemaster, claims management, and bill reconciliation processes. (12, 13) Domain I.D.3
11. Use established regulatory guidelines to comply with reimbursement and reporting requirements. (14,15) Domain I.D.4
12. Compile patient data and perform data quality reviews to validate code assignment and compliance with reporting requirements. (15) Domain I.D.1, I.D.5
     

*Domains listed refer to CAHIIM Curriculum Requirements.