SYLLABUS. Credits: 4 Lecture Hours: 3 Lab/Studio Hours: 2

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SYLLABUS

Code: HITC 224 Title: Coding & Classification Systems II Division: Health Sciences Department: Allied Health

Course Description: In this course the student will study the principles of coding and classification systems with an emphasis on the Health Care Financing Administration’s Common Procedural Coding System (HCPCS) and Current Procedural Coding (CPT).

Prerequisites: HITC 221 Corequisites:

Prerequisites or Corequisites:

Credits: 4 Lecture Hours: 3 Lab/Studio Hours: 2

REQUIRED TEXTBOOK/MATERIALS:

Bowie, M. & Schaffer, R. Understanding Procedural Coding: A Worktext, 3rd Edition. Clifton Park, NY: Delmar Cengage Learning, 2013.

Current Procedural Terminology 2015 or 2016 Professional Edition. American Medical Association.

COURSE LEARNING OUTCOMES:

Upon completion of this course, students will be able to: • Compile patient data for appropriate code assignment.

• Apply diagnosis and procedure codes using CPT and HCPCS.

• Identify the need for collaboration with clinical staff to resolve coding discrepancies and documentation issues.

• Apply legal and ethical guidelines as they relate to medical coding and reimbursement. • Use anatomy, physiology and pathophysiology knowledge when coding health information. GRADING STANDARD:

In addition to the Academic Progress Policy in the Brookdale Health Information Technology Handbook the following policies apply to HITC 224.

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2. The course grade will be derived as follows:

Quizzes 10% Discussions 10% Lab Assignments 25% Homework Assignments 25% Midterm Examination 15% Final Course Examination 15%

3. All students are required to meet examination schedule requirements as stated on the course calendar. Any student who is unable to meet this schedule must speak personally to the instructor responsible for the examination prior to the exam.

4. A final course examination will be given.

5. Students have the opportunity to review exams by contacting the instructor. Unit exams may be reviewed for a two-week period following the examination.

6. All College Laboratory skills and all assignments must be completed prior to taking the final examination.

8. In order to pass this course, the student must:

a. complete all College Laboratory skills and all assignments;

b. achieve an averaged grade of 74% in all exams and course assignments.

Grade Determinants: Quizzes

Quizzes will be comprised of multiple choice, fill-in-the-blanks, and true/false questions. Quiz questions will be developed to engage students in problem-solving and critical thinking skills. Overall application of all skills will also be evaluated. Quiz questions will be derived from reading, lectures, activities, and assignments.

Midterm Exam

Midterm exam will be comprised of multiple choice, fill-in-the-blanks, true/false, and coding scenarios. Exam questions will be cumulative of all units covered during the first half of the semester. Questions will be developed to engage students in problem-solving, critical thinking, and overall application skills. Grade will be based on the number of correct answers.

Final Exam

Final Examination will be comprised of multiple choice, fill-in-the-blanks, true/false, matching, and coding scenarios. Exam questions will be cumulative of all units covered during the second half of the semester. Questions will be developed to engage students in problem-solving, critical thinking, and overall application skills. Grade will be based on the number of correct answers. Lab and Homework Assignments

Assignments will consist of various techniques to measure the competencies in understanding the basic principles of CPT and HCPCS coding. In addition the assignments will measure the competencies to utilize an encoder product for applying the appropriate APC.

Discussions

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COURSE CONTENT:

Unit 1: Introduction to CPT Coding

Unit 2: Coding for Specific Services, Surgeries, Procedures and Tests Unit 3: The Impact of Coding on Reimbursement, and Managed Health Care

COURSE COMPETENCIES:

• Use and maintain electronic applications and work processes to support clinical classification and coding. (Domain I: Subdomain C:1)

• Apply procedure codes using CPT/HCPCS. (Domain I: Subdomain C:3)

• Ensure accuracy of diagnostic/procedural groupings such as DRG, APC, and so on. (Domain I: Subdomain C:4)

• Adhere to current regulations and established guidelines in code assignment. (Domain I: Subdomain C:5)

• Validate coding accuracy using clinical information found in the health record. (Domain I: Subdomain C:6)

• Use and maintain applications and processed to support other clinical classification and nomenclature systems (ex. ICD-10-CM, SNOMED, etc.) (Domain I: Subdomain C:7) • Resolve discrepancies between coded data and supporting documentation.

(Domain I: Subdomain C:8)

• Apply policies and procedures for the use of clinical data required in reimbursement and prospective payment systems. (Domain I: Subdomain D:1)

• Support accurate billing through coding, chargemaster, claims management and bill reconciliation processes. (Domain I: Subdomain D:2)

• Use established guidelines to comply with reimbursement and reporting requirements such as the National Correct Coding Initiative. (Domain I: Subdomain D:3)

• Compile patient data and perform data quality reviews to validate code assignment and compliance with reporting requirements such as outpatient prospective payment systems. (Domain I: Subdomain D:4)

DEPARTMENT POLICIES:

Health Information Technology Student Handbook COLLEGE POLICIES:

For information regarding:

♦ Brookdale’s Academic Integrity Code ♦ Student Conduct Code

♦ Student Grade Appeal Process

Please refer to the BCC STUDENT HANDBOOK AND BCC CATALOG.

NOTIFICATION FOR STUDENTS WITH DISABILITIES:

Brookdale Community College offers reasonable accommodations and/or services to persons with disabilities. Students with disabilities who wish to self-identify must contact the Disabilities

Services Office at 732-224-2730 (voice) or 732-842-4211 (TTY) to provide appropriate

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Name of Unit 1: Introduction to CPT Coding

Method of Evaluation: Examination and Assignments Time to Achieve: Three Weeks

Learning Outcomes Content Learning Experiences

The student will:

1. Understand the history and purpose of the Current Procedural Terminology (CPT) coding system and Healthcare Common Procedure Coding System (HCPCS). 2. Recognize the need for

determination of medical necessity with ICD-9-CM diagnosis codes when using CPT.

3. Recognize the difference between the ASC, APG, APC and RBRVS reimbursement systems. 4. Define the significance of

upcoding and unbundling.

5. Define the symbols used in CPT coding system. 6. Explain the importance of

modifiers to maximum allowable

reimbursement. 7. Assign the correct CPT

modifiers when appropriate.

8. Identify Common Reports in CPT coding process 9. Identify administrative

and clinical data contained in records 10. Demonstrate coding for

the technical component with a real world hospital

A. CPT Codes • History of CPT • How CPT is Used • Process of Using CPT • Modifiers B. The CPT Manual • Unlisted Codes • E&M Services • Anesthesia • Surgery • Radiology

• Pathology and Laboratory • Medicine

• Appendices

• Coding Conventions and Symbols

C. Reimbursement

• Coding and Reimbursement • Compliance Plans

• Fraud and Abuse • UACDS

D. HCPCS • Modifiers E. Medical Records • Format and Content

• Technical Component of CPT • Professional Component of

CPT

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outpatient surgery medical records

11. Demonstrate the use of a Coder/Abstract Summary Form and a

Physician/Coder

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Name of Unit 2: Coding for Specific Services, Surgeries, Procedures and Tests Method of Evaluation: Examination and Assignments

Time to Achieve: Ten Weeks

The student will:

1. Describe the format of each section within the CPT book.

2. Understand the terminology used in each section. 3. Understand the concept of

medical necessity and its importance to CPT codes. 4. Apply appropriate local and

national coverage determinations to verify medical necessity. 5. Learn when to obtain an

Advance Beneficiary Notice for Medicare patients. 6. Recognize the significance

of the Chargemaster. 7. Correctly assign CPT codes

and modifiers to procedures.

8. Understand the difference between diagnostic and therapeutic radiology, including the need for supervision and

interpretation and surgical code assignment.

9. Define types of anesthesia. 10. Understand the term of the

surgical package. 11. Recognize the elements

required for complete injection and infusion CPT code assignment.

12. Understand the various noninvasive and invasive

A. Pathology and Laboratory • Medical Necessity

• Advanced Beneficiary Notice • Clinical Laboratory Improvement Act • Modifiers B. Radiology • Modalities • Contrast Media

• Supervision and Interpretation • Charge Master • Mammography Coding • Interventional Radiology Coding • Modifiers C. Anesthesia • Types of Anesthesia • Time Reporting • Modifiers • Documentation Requirements D. Surgery • Surgical Package • Reporting more than one

service

• Category III Codes • Unlisted Codes • Surgical Destruction

E. Evaluation and Management • Documentation Guidelines • Commonly Used E&M Terms • Modifiers

F. Medicine

• Injections and Infusions • Chemotherapy • Special Services G. HCPCS • Level II Codes • Cardiovascular • CPT Category II Codes • CPT Category III Codes

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cardiology procedures and correctly assign the applicable CPT medicine codes.

13. Describe the purpose and format of CPT Category II tracking codes.

14. Describe the purpose and format of CPT Category III temporary codes.

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Name of Unit 3: The Impact of Coding on Reimbursement, and Managed Health Care Method of Evaluation: Examination and Assignments

Time to Achieve: Two Weeks

The student will:

1. Describe the evolutions of coding and health-care reimbursement systems. 2. Define the data

requirements needed to support provider reimbursement, communication among diverse providers, and research,

3. Identify landmark federal legislation that resulted in alternative health-care settings and prospective payment systems. 4. Define managed care

and the various types of managed care

organizations. 5. Recognize the

significance the inpatient prospective payment system had on outpatient services and on the use of CPT coding.

6. Understand and explain the difference between the MS-DRG, ASC, APG, APC and RBRVS

reimbursement systems. 7. Describe reasons for the

shift from inpatient to outpatient services that occurred during the 1980s and 1990s. 8. Recognize the

significance of upcoding. 9. Identify the major

obstacles to precise

A. Landmark Health Care Legislation

B. Shift to Integrated Delivery Systems and Managed Care

C. Medical Coding, Managed Care and Quality

Improvement

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