HINF -411 CODING AND
REIMBURSEMENT
INTRODUCTION
Dr. Thamer AL-Edresee. MBBS, PhD.
About this course
■ This course complements the course HINF-313 to
completely cover the healthcare coding of diseases
and procedures.
Course requirements and
activities
■ Attendance.
■ Lecture times @?@
■ Quizzes, and Pop-Quizzes
■ Exams.
■ Assignments.
■ Study materials
■ Extra.
Syllabus
Session
Topics

1



Introduction, course opening and Course syllabus: quick review of the course HINF-313
and the relation of this course to it.
Importance of this course to the HI and HIM professional.
Explanation of the CPT and ACHI.
Main differences between ICD-10 CD and CPT.
2
ICD-10-PCS Coding – Medical and Surgical Section: Understand the code parts and how to
navigate the medical and surgical intervention sections.
3
ICD-10-PCS Coding- Other Sections of ICD-10-PCS and Selected Case Studies, and exercises
+ Quiz 1
4
ICD-10-PCS Coding- Other Sections of ICD-10-PCS and Selected Case Studies, and exercises.
5
6
7
HCPCS/CPT Coding, Into Modifiers, and Evaluation and Management (E&M) codes
Mid-Term
HCPCS/CPT Coding, Surgery Section.
9
HCPCS/CPT Coding, Medicine and Other Sections and Outpatient Reimbursement + quiz-2
10
11
12
13
Compliance and Data Quality Management
Course review
Final exam
Final exam
ICD-10 CM/AM
■ ICD10 and snomed:
Numerical &
alphabetical digits
– ICD10 is codes are made from :…………… and are used mainly
Reimbursement
for :…………
Numbers & Vocabulary
– Snomed codes are made from :…………….. And used mainly for
1. Standardizing the vocabulary used in healthcare
:…………….
2. Utilized in research papers & used also for statistics
Remember how to code?
CD-10-CM code for chronic gout due to renal impairment, left
shoulder, without tophus.
The cause, set of
causes, or manner of
causation of a disease
or condition
https://www.aapc.com/codes/
Differences between ICD and
CPT/ ACHI
Current Procedural
Terminology
Australian Classification of
Health Interventions
■ ICD is for coding:…………… / Codes are formed of:
…………….
Procedures (outpatient
& inpatient)
■ CPT is for coding: ………….. Codes are formed of:
Numbers!
…………….
Procedures In ....... And ………./
■ ACHI is for coding :…………
Numbers!
Codes are formed of:…………….
■ Other differences: modifiers and routes.
ICD 11 is coming!
■ Expect to see the ICD 11 in the kingdom soon.
■ Know what’s new in the 11th release of the ICD.
What are the major changes
Between ICD10 & ICD11
Codes look different
–
Alzheimer disease
–
ICD-10  G30
–
ICD-11  8A20
■ Simplified code structureExtension codes (e.g., temporality, severity, dimensions of injury
and external causes)
■ Clustering of codes –combining 2 or more codes to describe a diagnostic entity
What are the major changes
■ Some diseases have changed location
– E.g., Cerebrovascular diseases moved from circulatory to nervous system
chapter
6 new chapters
■ Diseases of blood and blood forming organs
■ Disorders of the immune system
■ Conditions related to sexual health
■ Sleep-wake disorders
■ Extension codes
■ Traditional medicine
These chapters and
categories expand the
variability & specificity
of the codes
Browse ICD11
■https://icd.who.int/browse11/l-m/en
ACHI
• Same system for inpatient and outpatient.
• Do you notice something about the codes?
Overview of the ACHI interventions:
 Australian Classification of Health Interventions (ACHI)
 It has 2 sections, tabular list and alphabetic index of interventions.  same as ICD-10/11
Chapters; each focuses
on a certain system
Lists conditions from A - Z.
(Organization based on
alphabetical order)
 Contains 20 chapters.
 Includes codes for all surgical operations, medical procedures, allied health intervention and dental
Performed by a physician - not a surgeon
Usually diagnostic
services.
 Codes are numeric only.
 Remember you should not code directly form the index, but always look up the code in the Tabular
List.
The end part of
book whose
content is
organized
alphabetically