Worcester Partnership, P2P Pilot Program
Medical Billing and Coding
What’s the Right Code?
Background
Lesson Stage
Introduction to formal business writing.
Intended Audience
Adult basic education, no prior knowledge is required.
Designer’s Name & Contact Email
.
Kelly Herlihy
herlihyk@worc.k12.ma.us
Goals & Focus
General Topic
Composing a formal business letter
Central Questions/Overall Purpose/Key Content Ideas/Skills Taught in this Lesson
How do you research and compose a formal business letter?
Students will be able to complete a formal business letter, identify and be familiar with the five step writing process: pre-writing,
drafting, revising, editing and publishing.
Lesson Duration
The lesson is designed for a 90 minute block of time.
Related Learning Standards
W1.5b
W1.6c
Intended Learning Outcomes
Worcester Partnership, P2P Pilot Program
DEMONSTRATE UNDERSTANDING
Understand the five step writing process.
DO
Compose a formal business letter.
APPLY
Complete a professional complaint in writing using the five step writing process and acquire knowledge to obtain research
information.
Assessment/Demonstration of Competencies
The student’s business letter will be written with accuracy, appropriate tone and strong organization skills.
Implementation
Pre-Assessment
Students will discuss a formal complaint and what they have done in the form of writing to resolve the situation. Teacher will collect
an outline from the students.
Resources & Materials
White board, pen, projector, solution chart created during lesson. http://www.pti.edu/school_healthcare_medical_coding.php
Activities Plan
Teacher will discuss with class the skills and concepts as a medical coder and describe a scenario according to MCCWDTA,
“Since insurance companies want to ensure that they only pay for services that a patient has received they may require more
information or threaten not to pay for a service. This often means that you have to clarify information with the medical staff by
writing to them for more detail; you then write a rebuttal to the insurance company defending or correcting the billing. These
rebuttals must be well written, clear and professional.
Watch video, “What is Medical Coding and what is it like to be a Medical Coder.”
 Students will brainstorm on a dissatisfied medical experience service they’ve had, waiting for an appointment, denial of a
claim,
 Teacher will write medical complaints on the white board.
 Discuss the right of a consumer and how students can contact their healthcare provider to complain about a recent
dissatisfied service.
 Teacher will write the scenario on the white board. “ Patient called his/her Dermatologist to schedule an appointment for a
suspicious mole, patient told next available appointment is in 2 months” Patient called healthcare provider and was
informed complaint must be written and submitted within 7 days of incident, healthcare provider will review within 24 hrs
upon receiving complaint.
 Students will research their healthcare providers via internet or phone and discuss what is required in the event of an
appeal or a complaint.
 Each student will take notes and report back to class their findings.
 Teacher will share a sample complaint letter with students and highlight the structure of the letter and what the consumer
accomplished in his/her letter, share different strategies, clear to the point techniques, factual details and dates,
constructive positive statement, friendly/ cooperative writing.
 Students develop a solution charts: KWL we know 2 months for a suspicious is unacceptable, what do we want to
accomplish in this letter, what we’ve learned
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


Pre writing stage begins + questions and answers. Drafting stage+outline facts and details using the solution chart created
by the students.
Teacher will have students work in pairs during the revision stage. Students will make gentle suggestions to improve
partner’s draft. Teacher will assess works among partner groups. Proofread and correct any errors.
Students will publish their work and each student will share with the class their formal letter of complaint.
Reflection for Students
Students know how to research and acquire information about their rights and responsibilities as a consumer. They understand
how to compose a clear well organized business letter that will result in a solution to the situation using the five step writing
process.
Reflection for the Instructor
It is important to thoroughly review the five step writing process and allow students to work with a partner during the revision stage.
This is beneficial to both editor and writer and gives the students an opportunity to work with different styles of writing.
Worcester Partnership, P2P Pilot Program
Medical Billing and Coding
What’s the Right Code?
Background
Lesson Stage
Review of medical terminology
Intended Audience
ABE
Use prior knowledge of medical vocabulary
Designer’s Name & Contact Email
Kelly Herlihy
herlihyk@worc.k12.ma.us
Goals & Focus
General Topic
Medical Billing and Coding
Central Questions/Overall Purpose/Key Content Ideas/Skills Taught in this Lesson
How do you use word parts to understand medical terminology?
Identify, define and interpret medical terms and word part (prefix, suffix, root words.)
Give the students the opportunity to review, practice, pronounce, and understand medical word parts.
Lesson Duration
The lesson is designed for a 60 minute block of time.
Related Learning Standards
L2.5d
R1.4f
Worcester Partnership, P2P Pilot Program
Intended Learning Outcomes
DEMONSTRATE UNDERSTANDING
Identify root word, prefix or suffix.
Define medical terminology.
DO
Create scenarios using appropriate terms.
APPLY
Connect terminology with medical procedures.
Assessment/Demonstration of Competencies
Correctly identify 100% of medical terms and word parts on the terminology chart.
Implementation
Pre-Assessment
Prior knowledge is demonstrated by oral review with teacher/ class.
Resources & Materials
Medical Terminology Flash Cards for corresponding chapter, pencil, terminology chart, white board.
Activities Plan
Teacher reviews how skills and concepts are used in the workforce describing a scenario as a medical coder according to
MCCWDTA “ As a medical coder it is your job to read through a patient’s medical record, identify the services and treatment they
have received and determine the correct codes for each service. It is essential that you understand the medical terminology used in
the medical records so that you can identify the services that a patient received.”
 Teacher will do an oral review of vocabulary.
 Teacher distributes 15 flash cards to each student.
 Teacher will read the definition to the class from the medical terminology list.
 Ex. The word ‘heart’ is read. Student with ‘cardio’ flash card will place the card on their desk. (Heart =definition and
cardio= medical word part.)
 All students will write the medical term for ‘heart’ and identify the correct word part on their terminology chart.
 Continue with all cards in deck.
 The first student to place all cards on their desk is the “winner”.
 As a class, teacher will review and correct the terminology chart.
 After each student’s level of understanding is determined the teacher will divide the class into two groups. The students
with higher understanding will use the terminology chart to create words using the given word parts. The students who
need more support will have skills reinforced in a small group with the teacher.
Reflection for Students
Students will create example sentences and correctly use the new medical terminology.
Worcester Partnership, P2P Pilot Program
Reflection for the Instructor
It is important to break the class into the small groups to differentiate instruction for both levels of understanding. The lower group
really benefits from the extra support from the teacher.
Worcester Partnership, P2P Pilot Program
Medical Billing and Coding
What’s the Right Code?
Background
Lesson Stage
Introductory (follow up to lesson 1 Medical terminology word part game)
Intended Audience
Basic adult education, use prior knowledge of medical terminology * lesson 1 medical terminology flash cards*
Designer’s Name & Contact Email
Kelly Herlihy
Herlihyk@worc.k12.ma.us
Goals & Focus
General Topic
Medical coding and Current Procedural Terminology
Central Questions/Overall Purpose/Key Content Ideas/Skills Taught in this Lesson
How do you use proper medical coding for services with the knowledge of medical terminology.
Identify, define and become familiar with proper coding for different patient services while using the Current Procedural Terminology
Manual.
Lesson Duration
The lesson is designed for a 50 minute block of time.
Related Learning Standards
R1.4F
W1.6B
W1.6d
Intended Learning Outcomes
Worcester Partnership, P2P Pilot Program
DEMONSTRATE UNDERSTANDING
Identify medical vocabulary and use correct codes for services called.
DO
Students will be able to know how medical coding information accuracy is crucial for proper reimbursement.
APPLY
Connect medical terminology with proper medical procedure codes.
Assessment/Demonstration of Competencies
The student will be able to identify a range of medical procedure codes related to the medical terminology they
know and develop an awareness to detail while researching the correct codes in their CPT practice manual with
high accuracy.
Implementation
Pre-Assessment
Prior knowledge is demonstrated by an oral discussion with the class on being a medical coder and students will watch a video on “
what is medical coding and what’s it like to be a medical coder” Students will brainstorm and develop a medical coding scenario
while a student volunteer writes information on the white board. i.e. Mr Smith had an Arthrocentesis of a major joint, CPT 20600
submitted for payment, denied for incorrect CPT code, it should read CPT 20610 , different code for major joint vs small joint.
Students recognize the incorrect code for proper reimbursement and rely on accuracy and detail of each procedure.
Resources & Materials
CPT manual, encounter form, pencil and white board, http://www.pti/edu/school_healthcare_medical_coding.php Happy Medical
Coding website, play money
Activities Plan
Teacher will discuss the skills and concepts used as a medical coder and explain the importance of accuracy for proper
reimbursement.
Teacher then explains to students that billers use Current Procedural Terminology CPT codes as a way to accurately and efficiently
get reimbursement for physician’s services. Teacher describers the role of medical coder according to MCCWDTA “ As a medical coder
it is your job to read through a patient’s medical record identify the services and treatment they have received and determine the
correct codes for each service. It is essential that you understand medical terminology used in the medical record so that you can
identify the services that a patient receives, you also need to pay close to detail so that you don’t miss any CPT that should be
included or use the wrong code.”
Students then watch a video on “what is medical coding and what’s it like to be a medical coder”.
Hand out practice CPT manual ( Happy Coding, Medical Coding Practice Case) and review manual with students.
Hand out encounter form and explain the format, give examples of how to use the form. i.e. column 1: is for the *medical term,
column 2: *definition and column 3: is for the proper code. *based on prior knowledge of medical vocabulary (lesson 1).
Teacher calls out a medical term: arthrocentesis,
student then writes arthrocentesis in column 1,
student writes the definition in column 2, surgical puncture to remove fluid from a joint
student looks up CPT code in their practice manual and writes the correct code in column 3
Worcester Partnership, P2P Pilot Program
When students complete encounter form teacher explains that they are now to turn over their form and break down the medical
terminology in to proper word parts(lesson 1) ( prefix, word part/root word and suffix) i.e. . arthrocentesis= arthro=word part/root,
centesis is a suffix.
Teacher collects the encounter forms and reviews answers with the class.
Reflection for Students
Students work in groups of three, each group receives 1 encounter form and $200 in play money.
Teacher will follow activities above, call out medical term, students complete encounter form.
Teacher calls one term and allows 2 manes for each term called, no repeating terms, called only once
Students complete encounter forms and review answers with the teacher, each incorrect answer will result in a loss of $20, the group
with the most $ left over is the winner. The students become even more aware of the importance to detail when using play money
and recognize the value each correct CPT code.
Reflection for the Instructor
It is important to have the students work individually and in groups, being able to work as a team player and individually is very
important in the healthcare industry. There are many different aspects in a medical setting and being part of a team is an important
step in the medical field.
Adaptation based on curriculum developed as part of the Massachusetts Community Colleges and Workforce Development
Transformation Agenda (MCCWDTA) which s 100% funded by a $20 million grant from the U.S. Department of Labor, Employment &
Training Administration TAACCCT. Grant Agreement #TC-22505-11-60-A-25