GAP Analysis
Program Name/School: Office Technologies Medical Coding Certificate/Allegany College of Maryland
Length of Program:
Please identify in weeks/months the time typically needed to complete the coding certificate.
This is a one year/2 semester program comprised of 30-31 college credit hours.
Contact Name, &Title: Mrs. Peggy Hughes, Program Director
Phone: 301-784-5319
Email: phughes@allegany.edu
Program does not indicate if they seek Comprehensive or Physician Coding Approval – please indicate such on the CEPA
response.
Model Curriculum:
The column below represents the
knowledge cluster components
(KCs) of the model coding
curriculum.
Contact
Hours
Required
Your
program’s
Contact
Hours
 = Comprehensive Coding
Program
 = Physician Coding Program
Anatomy and Physiology


Study of the structure and
function of the human
body systems

Course needs to cover all
body systems; ( lab not
required)
45-60
45-90
Program Equivalent:
NOTES:
Please complete this column. Identify in which course this
content is covered, and how many contact hours are
devoted TO THIS CONTENT. Where you have combined
multiple KCs into a single class you must identify how many
hours of instruction are dedicated for each KC. Make your
entries in blue font.
Please use this column if there are comments
you wish to provide about the program
equivalents. Add your comments in blue font.
Students are required to take a Biology Elective from the
following list:

Human Biology (3 credit)

Principles of Biology (4 credit with lab)

Human Anatomy and Physiology (4 credit with
lab)

Anatomy and Physiology of the Human (4 credit
with lab)
Note: A&P is a foundation course for the
coding process and should be taken prior to
the coding classes.
Due to the 2-semester nature of our program,
this course is taken concurrently with the
Introduction to Medical Coding course. Oneyear certificate programs at our school are
discouraged from having prerequisite courses
as this would make them selective admission
programs. Additionally, a large number of our
students come to us on federal or state
retraining funds (i.e. TAA, WIA, and voc.
rehab). These funds are limited to 12 months
of instruction. Adding prereqs to the coding
certificate program would eliminate the ability
of these students to enroll in the program.
The majority of the students who are enrolled
in the Medical Coding Certificate curriculum
take the 3-credit Human Biology course.
However, some of the students who graduate
with a coding certificate are also enrolled in
other 2-year allied health curricula that require
the 4-credit biology electives. These students
come from a variety of backgrounds including
Medical Assistant, Medical Office Systems, and
Pre-Nursing.
I would prefer if the Med Term and
Anatomy were not being taken
concurrently with the intro to
Coding class – does not state if
these four options include a full
body review (12 major body
systems are required to meet
domain)
Medical Terminology


Spell, define, and
pronounce (through
supplemental CD tools),
medical terms as well as
understanding the
concepts of
root/suffix/prefix word
builds.

Common medical terms of
major disease processes,
diagnostic procedures,
laboratory tests,
abbreviations, drugs, and
treatment modalities.
30-45
34 of 45
(11 hours
remain)
Medical Terminology I—This is a 45 contact hour course
that concentrates on building student understanding of
basic medical terms including prefixes, suffixes and root
words. Approximately 11 hours of this course are
dedicated to the study of pharmacology as it relates to
disease of the body systems that are studied in Medical
Terminology I.
Note: Medical Terminology is a foundation
course for the coding process and should be
taken prior to the coding classes.
Due to the 2 semester nature of our program,
this course is taken concurrently with the
Introduction to Medical Coding course. Oneyear certificate programs at our school are
prohibited from having prerequisite courses as
this would make them selective admission
programs. Additionally, a large number of our
students come to us on federal or state
retraining funds (i.e. TAA, WIA, and voc.
rehab). These funds are limited to 12 months
of instruction. Adding prereqs to the coding
certificate program would eliminate the ability
of these students to enroll in the program.
34 hours meets minimum –
again concerned about student
retention given course
sequencing.
Pathophysiology


Specific disease
processes

By human body system

Causes, diagnosis, and
treatment of disease.
30-45
30 of 45
(15 hours
remain)
Medical Terminology II—This is a 45 contact hour course
which further develops the student’s understanding of
medical terminology, pathophysiology and pharmacology.
Students concentrate more on the disease process and
treatment during this course as they have already studied
basic terminology in Med Term I. 2 hours per week are
devoted to the disease process and 1 hour per week is
devoted to pharmacology for these diseases.
Note: Pathophysiology (Disease Processes) is
a foundation course for the coding process
and should be completed prior to the coding
classes, or during the first coding class.
Due to the 2 semester nature of our program,
this course is taken in the second semester of
the program as Med Term I (taken in the first
semester) is a prerequisite for Med Term II.
One-year certificate programs at our school are
discouraged from having prerequisite courses
as this would make them selective admission
programs. Additionally, a large number of our
students come to us on federal or state
retraining funds. These funds are limited to 12
months of instruction. Adding prereqs to the
coding certificate program would eliminate the
ability of these students to enroll in the
program.
Patho in a medical term course;
concern about depth of coverage.
States 2 hours per week on patho;
for how many weeks, again
concern of depth of coverage for
this important topic for coding –
what textbook is used for disease
process?
Pharmacotherapy


Emphasis is placed on the
understanding of the
action of drugs such as:
absorption, distribution,
metabolism and excretion
of drugs by the body.

Drug classifications

Most commonly
prescribed drugs

What is a formulary
20-30
26
(11 hours
Pharmo from
MT-I)
(15 hours
Pharmo from
MT-II)
Medical Terminology I—(11 hours) This course introduces
students to the study of pharmacology in relation to the
organ systems diseases that are covered in this class.
Students have one 3-hour class devoted to the study of
general pharmacology along with an additional 8 hours that
focus on the study of pharmacology for each organ system
studied in Med Term I
Medical Terminology II— (15 hours) This course combines
instruction of pathophysiology and pharmacology with one
hour each week devoted to the study of pharmacology as
related to the disease process being taught during that
week.
Pharmocotherapy as inbedded in a
MT course – what textbook is used,
do the exams reflect this domain?
CEPA results examination will
answer these questions.
Information Technology


Introduction to
Computers -Concepts related to
hardware and
software, the impact
of computers on
society and computer
systems/data
communications
networks.

Computer Software
Applications in
Healthcare Overview of
commonly available
software tools used
in health care,
including introduction
to encoding tools
and computer
assisted coding
software used in
health care data
processing today.
Introduction to the
electronic health
record.
(Recommend 45
contact hours)
Intro to Computers may be waived
through a pretesting placement process – for
example testing level of competence of prior
knowledge of Microsoft Office Suite, or else, a
beginning computer course is required.
Note:
75 (0 hours)
45 hours on
Intro – being
cancelled
Fall 2007
30 - 45
30 hours on
Front Office
Application
Students are required to take Computer Literacy (45
hours) which introduces them to basic e-mail, Internet,
word processing, spreadsheet, data base and
presentation software. Please see notes**.
Medical Office Financial Management (30 hours)
Students learn to use Medisoft Advanced Patient
Accounting to perform a variety of front office skills
including scheduling, patient registration, transaction
entry, and billing procedure. Please see notes *.
Students are required to use encoding software in
Intermediate and Advanced Coding. This instruction is
provided on an as needed basis in these classes at the
beginning of the semester and students then use both
Encoder Pro and 3M to assign codes to coding
problems and cases throughout the semester.
NOTE: The intent of the Computer software
applications in healthcare knowledge cluster
is to introduce the concepts of computer
technology related to healthcare and the tools
and techniques for collecting, storing and
retrieving healthcare data. Taking a keyboard
course, or a standard intro to computers course
will not satisfy this KC.
*Medical Office Financial Management is
currently undergoing a curriculum change
that will result in changing the objectives to
cover not only Medisoft but also variety of
software packages available for both
inpatient and outpatient administrative
functions, including encoders and
electronic health records and basic
Microsoft Office functions. The course will
be renamed Administrative Medical
Software and will be available in the Fall
2007 semester.
**Computer Literacy--We will be deleting
Computer Literacy and adding the computer
concepts to the Administrative Medical
Software class. This will reduce the number
of contact hours from 75 to 30. This change
will be effective Fall 2007
Where does student gain knowledge about
eHIM, imaging (which affects coding
processes) and grouper software? This
domain appears underrepresented as
planned.
Introduction to Health Information
Management & Healthcare Data
Content and Structure


Emphasis is placed on
content and components
of the health record
including:

Content of the health
record

Documentation
requirements

Primary vs. secondary
records

Legal/ethics issues

Privacy, confidentiality
and computer security

HIPAA requirements

Release of information

Code of Ethics of the
AHIMA

Standards of Ethical
Coding of the AHIMA
Healthcare Delivery Systems &
Computer Applications in
Healthcare (eHIM)






A thorough understanding
of the types and levels of
Healthcare Delivery
Systems in the U.S., and
of the governing bodies
that regulate the HIM
processes, and
understanding the eHIM
environment:
Organization of healthcare
delivery
Accreditation standards
Licensure/regulatory
agencies
Identify the issues
involving the migration
45-60
45
Introduction to Health Records—(30 hours)
This course introduces students to health records in a
variety of settings including inpatient, ambulatory surgery
and physician office. The students do a unit on HIPAA as
well as legal issues surrounding health records both in
paper and electronic format.
Will need to see how much of the content
reflects acute care needs – this appears to
be designed as an outgrowth of a medical
office environment – will program grow to
include necessary knowledge of acute care
processes? Is the RHIT on staff being
consulted in the development of this
domain?
Principles of Medical Insurance—(15 hours)
This course includes information about HIPAA in
relationship to reimbursement issues. We also look at
ethical issues surrounding coding and billing in addition to
requirements for release of patient information and
computer security.
30-60
30
Introduction to Health Records—(15 hours)
In this course we spend approximately 15 hours
looking at healthcare delivery systems models and
organization in the United States, accreditation
standards and accrediting and licensing organizations
for each healthcare setting. We also look at electronic
health records. These subjects are covered in addition
to those required by the Introduction to Health
Information Management & Healthcare Data Content
and Structure knowledge cluster.
Medical Office Financial Management—(15 hours)
Students in this class look at various types of medical
office software, encoders and electronic health records
systems. The name of this course is being changed to
more accurately reflect the nature of the course
(Administrative Medical Software). Please see the note
about this curriculum change in the Information
Technology knowledge cluster.
NOTE: As a separate course, this is optional for
Physician Coding Programs, but required for
the Comprehensive Coding Programs. The
fundamental KCs in this domain should be
introduced to the Physician Coding Program
student in their Medical Office Procedures
course with special emphasis on the agencies
and practices that affect physician coding and
billing issues.
Program already used the hours in previous
domain – this reflects strong background on
physician practice environment – this domain
deals with acute care regulatory processes –
see bullets in column one. These are the areas
that must be covered to satisfy this domain – at
this time this is a non-represented domain.
from a paper-based HIM
to an electronic HIM

The student should be
aware of the major acute
care environment vendors
and their system
strengths.

Knowledge of different
types of encoder systems,
and the effect of natural
language processing on
the coding process.
Basic Diagnosis Coding Systems

Detailed Instruction in:

Student will learn about
the International
Classification of Diseases
ICD-9-CM, how to code,
and guidelines for usage.

Volumes I, II, and III
The topic of encoders and electronic health records
and other healthcare computer applications is
interspersed in many of our courses including Intro to
Health Records, Medical Office Financial Management,
Principles of Medical Insurance, Intermediate and
Advanced Medical Coding.
45-60
15
Introduction to Medical Coding--Basic diagnostic
coding is covered in a combination course where
students spend the first half of the semester working
on basic procedural coding and the second half of the
semester working on basic diagnostic coding. We
currently offer this general introduction course to
students in a variety of allied health courses including
Medical Assistant and our 2-year Medical Office
Systems course.
**Please see the notes column.
Note: Coding courses must include hands-on
experience to computerized encoding systems –
local and distance students must have equal access
to the encoding application. The encoder may be
introduced in the basic or advanced coding
coursework, or both. Explain how your program
uses encoders:
Encoders are introduced to students in the
Intermediate Medical Coding course. We
use both Encoder Pro and the 3M
Reimbursement System. Once students
have basic knowledge of these encoders,
they are used in both Intermediate and
Advanced Coding courses to assign codes
to coding worksheets as well as coding
cases.
** We currently offer this general
introduction course to students in a variety
of allied health courses including Medical
Assistant and our 2-year Medical Office
Systems course.
In completing the gap analysis, we realize
that we are missing 45 hours of basic
coding that is vital to the coding students’
success. Therefore, we are adding a new
course to our curriculum which will be
available in the Fall 2007 semester that will
increase the number of hours for both basic
diagnostic and basic procedure coding.
The new course, Acute Care Coding, will be
specifically for students in the coding
curriculum and will include instruction
specifically geared toward inpatient and
ambulatory care coding. Since the primary
focus of this course is the acute care
setting, we will spend 30 hours in ICD-9-CM,
concentrating instruction around the official
coding guidelines.
Only 15 hours; new course being
added. Need syllabi, textbook, and
sample testing instruments with
CEPA manual to evaluate this
course and requirement.
Agree, it is critical that enough time
be spent of coding skills
development.
Basic Procedure Coding Systems
45-60


Student will focus on
Basic HCPCS coding,
with a focus on CPT-4
coding (Anesthesia, E&M,
Surgical,
Pathology/Laboratory,
Radiology and Medicine)
and HCPS II codes.
30
Introduction to Medical Coding--Basic procedural
coding is covered in a combination course where
students spend the first half of the semester working
on basic procedural coding and the second half of the
semester working on basic diagnostic coding. We
currently offer this general introduction course to
students in a variety of allied health courses including
Medical Assistant and our 2-year Medical Office
Systems course.
**Please see the notes column.
Note: Students must attain a minimum of 45
hours of diagnosis training, and an additional
45 hours of procedure training. Programs that
combine the diagnosis and procedure KCs into
a single basic coding course should have a
minimum of 90 hours of instruction.
** We currently offer this general
introduction course to students in a variety
of allied health courses including Medical
Assistant and our 2-year Medical Office
Systems course.
In completing the gap analysis, we realize
that we are missing 45 hours of basic
coding that is vital to the students’ success.
We are adding a new course to our
curriculum which will be available in the Fall
2007 semester that will increase the number
of hours for both basic diagnostic and basic
procedure coding. The new course, Acute
Care Coding, will be specifically for
students in the coding curriculum and will
include instruction in coding ambulatory
surgery and emergency room visits. The
course will add 15 contact hours to
procedural coding which will then bring this
total up to 45 hours
Only 30 hours; new course being
added. Need syllabi, textbook, and
sample testing instruments with
CEPA manual to evaluate this
course and requirement.
Has not met minimal number of
hours in procedural coding – will
need to see the final categories
from the CEPA to see if program
will be compliant.
Intermediate (or Advanced)
Diagnosis Coding





Having attained basic
coding skills, this course
focuses on case studies
using more complex code
assignments to determine
the correct diagnoses.
Students should be
exposed to medical
records and learn how to
interpret actual charts.
Student should be
introduced to diagnostic
based prospective
payment groupers: DRG,
APR-DRG, & RUGS.
An introduction to
International Classification
of Diseases ICD-10-CM,
and other diagnosis
coding systems (DSM-IV,
ICD-0)
Introduction to
Systematized
Nomenclature of Medicine
(SNOMED) – Includes a
brief overview of its role in
the health care delivery
45-60
40
(30 hours
from IMC)
(10 hours
from MCPP)
Intermediate Medical Coding—30 hours

Intermediate Medical Coding is a 60 contact
hour course in which students learn to assign
codes from both CPT and ICD-9-CM to basic,
intermediate and advanced case studies. It is
in this class that students also are introduced
to Encoder Pro and the 3M encoder systems.
Students gain a working knowledge of both
types of encoders while also sharpening their
coding skills using coding books. We also
cover HCPCS Level II coding and payment
groups.
Medical Coding Professional Practice—10 hours

This course is a 60 contact hour course in
which the majority of time is spent in a
simulated coding environment. However, 10
hours of this class at the beginning of the
semester is spent introducing students to the
various coding references that are available to
them (Coding Clinic, CPT Assistant, etc) as
well as going over the basic changes that will
accompany ICD-10 and ICD-10-PCS. We also
touch on SNOMED and its importance in the
future of electronic records.
Note: Students must attain a minimum of 45
hours of intermediate/advanced diagnosis
training, and an additional 45 hours of
intermediate/advanced procedure training.
Programs that combine the diagnosis and
procedure KCs into a single
intermediate/advanced coding course should
have a minimum of 90 hours of instruction.
Physician programs will emphasize physician
based coding issues while comprehensive
programs will emphasize acute care and
ambulatory setting coding.
Note: Coding courses must include hands-on
experience to computerized encoding systems
– local and distance students must have equal
access to the encoding application. The
encoder may be introduced in the basic or
advanced coding coursework, or both. Explain
how your program uses encoders
Encoders are introduced to students in the
Intermediate Medical Coding course. We
use both Encoder Pro and the 3M
Reimbursement System. Once students
have basic knowledge of these encoders,
they are used in both Intermediate Medical
Coding and Medical Coding Professional
Practice courses to assign codes to coding
worksheets as well as coding cases.
system as the basis for an
electronic health record ,
Even with the combining of hours
from two different courses, the
program fails to meet the absolute
minimum of 45 contact hours for
diagnosis coding – see if this is
resolved in the CEPA.
Intermediate (or Advanced)
Procedure Coding

45-60


Using case studies,
students should practice
more complex procedure
code assignments with
ICD-9-CM and CPT-4..
Student should be
introduced to procedure
based payment systems:
RBRVS, E&M codes, and
APC assignments and the
impact coding and
sequencing has on
reimbursement.
40
(30 hours
from IMC)
(10 hours
from MCPP)
Intermediate Medical Coding—30 hours

Intermediate Medical Coding is a 60 contact
hour course in which students learn to assign
codes from both CPT and ICD-9-CM to basic,
intermediate and advanced case studies. It is
in this class that students also are introduced
to Encoder Pro and the 3M encoder systems.
Students gain a working knowledge of both
types of encoders while also sharpening their
coding skills using coding books. We also
cover HCPCS Level II coding and payment
groups.
Medical Coding Professional Practice—10 hours

This course is a 60 contact hour course in
which the majority of time is spent in a
simulated coding environment. However, 10
hours of this class at the beginning of the
semester is spent introducing students to the
various coding references (CPT Assistant,
Coding Clinic, etc) that are available to them.
We also spend time evaluating E&M
worksheets, going over the difference
between the 1995 and 1997 E&M Guidelines,
and look at sequencing procedures to
maximize reimbursement.
Note: Students must attain a minimum of 45
hours of intermediate/advanced diagnosis
training, and an additional 45 hours of
intermediate/advanced procedure training.
Programs that combine the diagnosis and
procedure KCs into a single
intermediate/advanced coding course should
have a minimum of 90 hours of instruction.
Physician programs will emphasize physician
based coding issues while comprehensive
programs will emphasize acute care and
ambulatory setting coding.
Even with the combining of two courses, the
program fails to meet minimum number of
contact hours for procedural coding – see if
this is resolved in the CEPA.
Reimbursement Methodologies

(30 – 45 contact hours)















30-45
Prospective payment
system
Diagnosis Related Groups
Ambulatory Payment
Classifications
ASC Groups
Resource Based Relative
Value Scale
Third party payers
Billing and insurance
procedures
Explanation of benefits
Quality Improvement
Organizations (QIO) and
their role in the payment
process
Charge master description
and maintenance
Managed care/capitation
Compliance issues
Health plan claims
processing and coding
Billing for healthcare
services using codes
Auditing and monitoring
the coding process for
regulatory compliance
Medical Office Procedures

(45 – 60 contact hours)
Provide a working knowledge of
concepts, processes and procedures
encountered in the physician office
management setting, to include:
physician payment systems, scheduling,
End of Month Reporting, insurance
processes, EOB explanation, series
billing, filing appeals, and auditing and
monitoring of coding for regulatory
30
Principles of Medical Insurance—In this course we
concentrate on basic principles of billing in both the
inpatient and the outpatient setting. The students are
introduced to all major third party payers as well as
billing processes and collection procedures.
NOTE: As a separate course, this is optional for
Physician Coding Programs, but required for
the Comprehensive Coding Programs. The
fundamental KCs in this domain should be
introduced to the Physician Coding Program
student in their Medical Office Procedures
course with special emphasis on the
reimbursement issues that directly affect
physician coding and billing.
Does this course reflect groupers such as those
noted on bullets? It appears an outgrowth of
Medical Office program – will need to see if the
domain is met in the CEPA for this category of
content. The intent of this domain is beyond
processing a bill – it is understanding the critical
nature of grouping assignments to inpatient and
outpatient coding in the acute care environment
– failure to appreciate the coder’s obligations
can lead to criminal violations.
45-60
This knowledge cluster is covered in Principles of
Medical Insurance and Medical Office Financial
Management courses that have been used in the
Reimbursement Methodology and Healthcare Delivery
System/Computer Applications in Health knowledge
clusters.
NOTE: Optional for Comprehensive Coding
Programs but required for Physician Coding
Programs. It is in this course the Physician
Coding Program student covers the
Reimbursement Methodology and the
Healthcare Delivery System/Computer
Applications in Healthcare knowledge clusters
(KCs) from the perspective of physician
practice.
In this course, the student must have an
opportunity to experience hands-on learning
with a computerized physician office
application. Local and distance students must
have equal access to the practice management
application.
compliance.
Professional Practice
Experience/Practicum/Internship
(40 - 60 dedicated hours)



40-60
40
Field Based PPE: To
provide the student with
coding practice experiences
in a hospital, physician’s
office, clinic or other
healthcare setting with
directed projects common to
a clinical coding specialist
on the job.
Virtual PPE: Review
presentations from coding
specialist guest speakers
(CCS, CCS-P) either prerecorded or live.
Practicum hours to focus
on building speed and
accuracy using paper and
scanned medical records.
 Comprehensive Coding
Program =
495 program
hours
Note: Lab hours that focus on coding workbook
assignments in the basic and intermediate
coding courses do not satisfy the virtual PPE
practicum hours.
Technically this is a 60 contact hour class, however, for
the first 20 hours of the semester, we spend time
reviewing intermediate coding principles along with the
use of E/M worksheets, coding references, and official
coding guidelines as well as the future of coding.
The virtual PPE plan fulfills this
domain – the CEPA will be
reviewed to see how students are
exposed to actual records, and
how the encoder systems are used
in their assignments.
Students should gain experience coding a
variety of record types including: acute care,
ambulatory surgery, emergency records, and
physician office.
Practicum hours should be based on analysis
of actual medical records with a learning focus
on coding accuracy and speed.
Programs should calculate their total contact
hours and indicate the total hours in the
program equivalent column .
Minimum Contact Hours:
 Physician Coding Program =
465 program hours
Medical Coding Professional Practice—Due to the rural
area that Allegany College of Maryland serves, we have
been unsuccessful in contracting providers that will
serve as internship sites in which the students would
actually gain coding experience. Unfortunately, most
of our sites would only allow student to file patient
records. As an alternative, we have set up a coding
simulation wherein the students come to the coding lab
and work on coding a variety of sample records
including inpatient, emergency room, ambulatory
surgery, and physician office records. The students
apply ICD-9-CM, CPT-4, and HCPCS Level II codes as
needed to these sample records.
480-525
Program needs to either add considerable
content to meet acute care needs, or should
pursue a Physician Coding Certificate approval
which would free them from being accountable
for the depth of materials.
SYNOPSIS OF CURRICULUM
Include all courses required in their appropriate sequence
Course
Title:
Primary
Instructor
Total
Contact
Hours:
Lab Hours
Component:
Biological
Science
Elective
Various
instructors
45-90
*45
Medical
Holly
Terminology I McDonald,
RN, BSN
Introduction Cindy
to Medical
Zumbrun,
Coding
MEd, RHIT,
CCS-P
Introduction to Cindy
Health
Zumbrun,
Records
MEd, RHIT,
CCS-P
Computer
Various
Literacy
instructors
Medical
Holly
Terminology McDonald,
II
RN BSN
Intermediate Cindy
Medical
Zumbrun,
Coding
MEd, RHIT,
CCS-P
Medical
Cindy
Coding
Zumbrun,
PPE Hours
Component:
Comments
*If the student takes the 4-credit
biology electives with labs, the lab
component is 45 hours. However,
students who choose to take Human
Biology will not have the lab
component
45
45
45
45
45
60
60
*60
*40
*40 hours of this lab class are devoted
to a simulated PPE with students
Professional
Practice
Principles of
Medical
Insurance
MEd, RHIT,
CCS-P
Cindy
Zumbrun,
MEd, RHIT,
CCS-P
Medical
Cindy
Office
Zumbrun,
Financial
MEd, RHIT,
Management CCS-P
independently coding simulated
records from a variety of healthcare
settings
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