CLUSTER
Health Science Education
COURSE
Medical Assistant Administrative Procedures II
WVEIS CODE
0736
COURSE DESCRIPTION
Instructional content will focus on policies and procedures necessary for medical reimbursement. Students will
be introduced to medical office coding, ICD-9-CM, CPT-4 Coding, CPT-4 Sections and the purpose of the
auditing processes. *This course is recommended as an elective for the Allied Health Sciences Concentration
(Medical Assisting Specialization).
SKILL SETS
Medical Terminology
Medical Insurance Claims
ICD-9-CM Coding
CPT-4 Coding
CPT-4 Sections
Reimbursement and Auditing
Medical Assistant Administrative Procedures II
Skill Set
Knowledge Objectives
0736.1
Performance Objectives
0736.2
0736.3
0736.4
Skill Set
Knowledge Objectives
0736.5
Performance Objectives
WVEIS 0736
Medical Terminology
Students will demonstrate knowledge of

medical terminology as necessary to interpret and submit medical insurance
claims.
Students will



interpret commonly used health insurance terms.
interpret commonly used abbreviations.
use standard medical terms and abbreviations to interpret and submit medical
insurance claims.
Medical Insurance Claims
Students will demonstrate knowledge of

basic coding used to complete and submit medical insurance claims.
Students will
 examine the evolution of medical insurance.
0736.6
 determine the significance of diagnosis-related groups.
0736.7
0736.8
 recognize the origin and function of coding.
0736.9
 differentiate the types of codes used in health care.
0736.10
 analyze the documentation tools used in the coding process.
0736.11
 utilize the proper technique for determining the physician’s diagnosis.
Skill Set
ICD-9-CM Coding
Knowledge Objectives Students will demonstrate knowledge of
0736.12
 basic concepts of ICD-9-CM coding.
Performance Objectives Students will
0736.13
0736.14
0736.15
0736.16
0736.17
0736.18
0736.19
Skill Set
Knowledge Objectives
0736.20


examine the ICD-9-CM code book format.
use correct symbols, punctuation and abbreviations in the ICD-9-CM code
book.
 utilize the steps for accurate coding from the ICD-9-CM code book.
 implement the CMS guidelines for ICD-9-CM coding.
 determine the purpose for V codes and E codes.
 use the Drug and Chemical Tables found in the ICD-9-CM code book.
 demonstrate the procedure for coding special complexities.
CPT-4 Coding
Students will demonstrate knowledge of

basic concepts of CPT-4 coding.
Performance Objectives
0736.21
0736.22
0736.23
0736.24
0736.25
Skill Set
Knowledge Objectives
Students will

demonstrate the technique for determining when procedures and services can
be coded.
 examine the CPT-4 code book format.
 use the CPT-4 code book signs and symbols.
 determine the use of modifiers to CPT-4 codes.
 compare starred, global and unlisted CPT-4 codes.
CPT-4 Sections
Students will demonstrate knowledge of
0736.26
 basic concepts of CPT-4 sections coding.
Performance Objectives Students will
0736.27
0736.28
0736.29
0736.30
0736.31
0736.32
0736.33
Skill Set
Knowledge Objectives
0736.34
Performance Objectives
0736.35
0736.36
0736.37
0736.38
0736.39
0736.40


utilize the concepts of evaluation and management coding.
apply the principle elements of anesthesia coding.




implement the surgery coding guidelines.
examine coding rules for pathology services.
select the coding guidelines for medicine services.
articulate the rules and application of modifiers to the coding process.
code a sample claim form.

Reimbursement and Auditing
Students will demonstrate knowledge of
 reimbursement and auditing processes.
Students will






distinguish reimbursement methods.
articulate the purpose of third party contracts.
demonstrate components for reimbursement calculations.
complete a claim form.
examine internal and external obstacles to accurate and timely reimbursement.
determine the purpose of audits.