Course Syllabus
COURSE IDENTIFICATION
Course Prefix/Number:
Course Title:
Division:
Program:
Credit Hours:
Initiation/Revised Date:
Assessment Goal per Outcome(s):
Instructor
Contact Information:
ALHT 230
Introduction to CPT Coding
Outreach and Workforce Development
Health Information Technology
3.0
2009
80%
Jean Ann Jones, RHIT, CPC
jajones@neosho.edu
CLASSIFICATION OF INSTRUCTION
Vocational
COURSE DESCRIPTION
This course prepares students for entry level positions in a physician’s office or other medical
facility. The focus of this class is learning the coding rules for the Current Procedural Terminology
(CPT), and Level I (HCPCS) coding systems and then applying the rules to code patient services.
Students will need CPT and HCPCS Level II manuals for the course.
PREREQUISITIES AND/OR COREQUISITES:
None
REQUIRED TEXTBOOKS:
*The official list of textbooks and materials for this course are found on Inside NC.
Step by Step Medical Coding, Current Edition, By: Carol J Buck, Saunders: ISBN:978-1-41604566-3
CPT - Current Procedural Terminology Professional Edition. American Medical Association,
Current year edition: ISBN: 978-1-60359-064-8
HCPCS Level I, Medicare, American Medical Association Current year edition.
OTHER RESOURCES:
Flashcode/AHIMA Virtual Lab-Quantim: Review Tabular List for fourth or fifth digits. Use
Flashcode to verify correct code. Use Virtual Lab's Quantim Code to verify codes (can
verify procedure codes with Quantim Code). Also use these systems to review the Tabular
List for includes, excludes, and code also guides. These systems also provide references:
Coding Clinics, medical dictionary, drug index, anatomy, clinical indicators, lab values,
abbreviations, and ICD-9 guidelines. AHIMA’s Virtual Lab: http://ahima.demoservers.com
www.ahima.org American Health Information Management Association
Introduction to CPT Coding
2009
Chapman Library – Online Database, Magazine/Journals, ProQuest Nursing & Allied
Health (see Campus Announcements on Home Page of Inside NC for instructions and
access). http://www.neosho.edu/library/index.asp
COURSE OUTCOMES/COMPETENCIES (as Required)
Outcome I:
Demonstrate an understanding of CPT coding manual in order to assign valid procedure codes.
Competencies:
A.
Identify the purpose of the CPT manual and setting where use of CPT is required.
B.
Identify placement of CPT codes on CMS-1500 insurance form.
C.
Recognize the symbols used in the CPT manual.
D.
List the major sections found in the CPT manual.
E.
Interpret information in section Guidelines and notes.
F.
Apply and define purpose of modifier in code assignment.
G.
Determine what is meant by unlisted procedure/services.
H.
State the purpose and contents of a special report.
I.
List methods used to locate terms and codes in the CPT manual.
J.
Identify content of CPT appendices.
Outcome II:
Competencies:
A.
Delineate the three factors of E/M code assignment.
B.
Analyze the differences among new, established, inpatient, and outpatient.
C.
Explain the levels of E/M service.
D.
Analyze the key component and contributing factors.
E.
Identify critical elements of Documentation Guidelines.
F.
Assign E/M codes to services and procedures and use appropriate modifiers.
Outcome III:
Demonstrate an understanding of coding and classification systems in order to assign valid CPT
procedure codes (Anesthesia codes 00100-01999).
Competencies:
A.
Describe the anesthesia section and its codes.
B.
Incorporate the physical status modifiers and their use with anesthesia codes.
C.
List services included in the anesthesia code package.
D.
Discuss other anesthesia coding systems and their use by physicians.
E.
Assign Anesthesia codes to services and procedures.
Outcome IV:
Demonstrate an understanding of coding and classification systems in order to assign valid CPT
procedure codes (Surgery/Integumentary/Musculoskeletal/Respiratory/Cardiology/ Digestive/
Urinary/Male and Female Genital/Nervous/Eye and Ocular codes 10000-69999).
Introduction to CPT Coding
2009
Competencies:
A.
Describe the format and basic contents of the surgery section of the CPT codebook and its
subsections.
B.
Define the surgical package and the services included in it.
C.
Describe the coding conventions specific to each surgery subsection.
D.
Define terminology used in each surgery section and subsection.
E.
Understand the National Correct Coding Initiative and determining when a procedure is a
component of a larger procedure with the use of and encoder.
F.
Assign codes that apply to each surgery subsection.
Outcome V:
Demonstrate an understanding of coding and classification systems in order to assign valid CPT
procedure codes (Radiology codes 7000-79999)
Competencies:
A.
Describe the structure of the radiology section.
B.
Discuss the concept of radiological supervision, compared to interpretation only, as it is
used with radiology.
C.
Identify modifiers used in the radiology section.
D.
Understand the different types of radiology services (Diagnostic, Interventional, Radiation
Oncology, Nuclear Medicine).
E.
Assign Radiology codes to services and procedures.
Outcome VI:
Demonstrate an understanding of coding and classification systems in order to assign valid CPT
procedure codes (Pathology and Laboratory codes 80000-89356).
Competencies:
A.
Describe method used to locate pathology and laboratory codes in the CPT book.
B.
Distinguish between “quantitative” and “qualitative: in relation to pathology and lab
codes.
C.
Identify modifiers commonly used in the pathology/laboratory section.
D.
Assign appropriate codes for pathology and laboratory services/procedures.
Outcome VII:
Demonstrate an understanding of coding and classification systems in order to assign valid CPT
procedure codes (Medicine Codes 90281—90749, 90801-98943).
Competencies:
A.
Describe the medicine section and its codes.
B.
Identify conventions specific to the immunization injections.
C.
Discuss the use of hydration, therapeutic, prophylactic, and diagnostic injections and
infusions.
D.
Demonstrate understanding of the various specialty procedures.
E.
Explain the reporting of chemotherapy administration.
F.
Assign Medicine codes to services and procedures.
Introduction to CPT Coding
2009
Outcome VIII:
Demonstrate an understanding of coding and classification systems in order to assign valid
HCPCS Level II procedure codes
Competencies:
A.
Describe general guidelines for HCPCS Level II coding.
B.
Manage HCPCS modifiers.
Outcome IX:
Demonstrate an understanding of Third Party Reimbursement Issues
Competencies:
A.
Identify the basic components of the outpatient code editor.
B.
Explain the inpatient prospective payment system (IPPS), the MS-DRG/DRG and
understand the grouper of the ICD-9.
C.
Recognize and understand the outpatient Resource-Based Relative Value Scale
(RBRVS), Ambulatory Payments System (APC), and Prospective Payment System for the
Skilled Nursing Facility (RUG III).
D.
Explain the purpose of the Quality Improvement Organization
E.
Discuss Medicare Fraud and Abuse
F.
Identify major components of the Managed Health Care
AHIMA DOMAINS
Domain 1: Health Data Management.
Subdomain A: Health Data Structure, Content and Standards
4. Apply clinical vocabularies and terminologies used in the organization’s health
information systems.
Subdomain C: Clinical Classification Systems
1. Use and monitor applications and work processes to support clinical classification and
coding
2. Apply diagnosis/procedure codes using ICD-9-CM
3. Apply procedure codes using CPT/HCPCS
4. Ensure accuracy of diagnostic/procedural groupings such as DRG, APC, and so on.
5. Adhere to current regulations and established guidelines in code assignment.
6. Validate coding accuracy using clinical information found in the health record
8. Resolve discrepancies between coding data and supporting documentation
Subdomain D: Reimbursement Methodologies
1. Apply policies and procedures for the use of clinical data required in reimbursement
and prospective payment systems (PPS) in healthcare delivery
3. Use established guidelines to comply with reimbursement and reporting
requirements (e.g., National Correct coding Initiative [NCCI]; Local Medical
Review Policies[LMRP])
4. Compile patient date and perform data quality reviews to validate code
assignment and compliance with reporting requirements such as outpatient
prospective payment systems.
Domain 2: Health Statistics, Biomedical Research and Quality Management
Introduction to CPT Coding
2009
Subdomain A: healthcare Statistics and Research
1. Abstract and maintain data for clinical indices/databases/registries
Domain 3: Health Services Organization and Delivery
Subdomain A: Healthcare Delivery Systems
3. Apply policies and procedures to comply with the changing regulations among
various payment systems for healthcare services such as Centers for Medicare
and Medicaid Services (CMS), managed care
Domain 4: Information Technology Systems
Subdomain A: Information and Communication Technologies
2: Use specialized software in the completion of HIM processes (e.g.,coding)
Domain 5: Organizational Resources
Subdomain B: Financial and Physical Resources
3. Monitor coding and revenue cycle processes
COURSE OUTLINE
I. Current Procedural Terminology (CPT).
A. Introduction to the CPT
B. Evaluation and Management
C. Anesthesia Section and Modifiers
D. Intro to the Surgery Section and Integumentary System
E. Musculoskeletal System
F. Respiratory System
G. Cardiovascular System
H. Female Genital and Maternity Care and Delivery
I. General Surgery
J. Radiology Section
K. Pathology/Laboratory Section
L. Medicine Section and Level II National Codes
M. Overview of the ICD-9-CM
N. Using ICD-9-CM
O. Third Party Reimbursement Issues
SCHEDULE
This class meets online for weekly learning units. The class materials for each unit will be
available for a minimum of eight days, starting ___________________ and ending
_____________________.
Week
1
(Due
Date)
Introduction to CPT Coding
2009
Topic/Exam
Class Introductions, Completion of
necessary forms. Coding ethics.
Readings/Activities
*This course will make extensive use
of the electronic systems: Flashcode
and AHIMA’s Virtual Lab-Quantim.
*Post introduction on the
collaboration website. Read the
information provided regarding
coding ethics from the AHIMA
website.
2
(Due
Date)
Introduction to the CPT
3
(Due
Date)
Evaluation and Management Services
Modifiers
4
(Due
Date)
Anesthesia Section and Modifiers
5
(Due
Date)
Introduction to Surgery and
Integumentary System
6
(Due
Date)
Musculoskeletal System
Respiratory System
7
(Due
Date)
Cardiovascular System
8
(Due
Date)
Male and Female Genital System
Endocrine, Nervous System, Eye, and
Auditory System
Introduction to CPT Coding
2009
*Chapter 1
* Review Questions at the end of
the Chapter; submit answers to
instructor via e-mail.
*Read Chapter 2
*Complete Review Questions at
the end of the Chapter. (Turn in
answers via email to instructor)
*Test over Chapter 1
*Read Chapter 3.
*Complete Review Questions at
end of the Chapter. (Turn in
answers via email to instructor)
*Test over Chapter 2
*Read Chapter 4 pages 78 – 86
*Complete Exercise 4.16 – 4.21
(Turn in answers via email to
instructor)
* Complete Additional Practice
Exercises assigned by instructor
and turn in answers via email to
instructor
*Test over Chapter 3
*Read Chapter 5 and 6
*Complete Review Exercises at
end of Chapter (Turn in answers
via email to instructor)
*Complete Flash Code
Assignment, Introduction to the
software
* Test over Chapter 4
*Read Chapter 7 Complete
Review Exercises at end of
Chapter and use Flash Code
Software for the CPT coding
answers. (Turn in answers via
email to instructor)
* Complete Library assignment on
cardiac information
*Test over Chapter 5 and 6
*Read Chapter 8
*Complete Review Exercises at
end of Chapter using Flash Code
software with the CPT coding and
turn in answers via email to
instructor
9
(Due
Date)
10
(Due
Date)
Test Chapter 8
Mid-Term Exam
11
(Due
Date)
Radiology
Pathology/Laboratory Services
12
13
(Due
Date)
14
General Surgery
Medicine Section and HCPCS Level II
Overview of the ICD-9-DM
Using the ICD-9-CM
Overview of ICD-10-CM
15
Third Party Reimbursement Issues
Introduction to CPT Coding
2009
*Library Assignment over High
Risk Pregnancy
*Test over Chapter 7
* Exam Chapter 8
* Mid-Term Exam
*Read Chapters 9 & 10
*Complete Review Exercises at
end of chapter. (Turn in answers
via email to instructor)
*Introduction to AHIMAVirtual Lab
for the Quantim
*Test over Chapter 8
*Read Chapter 11 & 12
*Complete Review Exercise at end
of the chapter. (Turn in answers to
instructor via email)
*Complete the use of Virtual Lab
with the radiology and lab coding
*Test over Chapter 9 & 10
*Read Chapter 13
*Complete Review Exercises at
end of each chapter. (Turn in
answers via email to instructor)
*Complete Additional Practice
Exercises assigned by instructor
and sent to instructor via e-mail.
*Test Chapter 11 & 12
*Read Chapters 14
*Complete Review Exercises at
end of chapter. (Turn in answers
via email to instructor)
*Complete Additional Practice
Exercises assigned by instructor
and sent to instructor via e-mail.
Read Chapters 15
*Complete Review Exercises at
end of the chapters. *Complete
Additional Practice Exercises
assigned by instructor and turn in
answers via email to instructor
*Test Chapter 14
*Read Chapter 16
*Complete Review exercises at
end of Chapter (Turn in answers
16
Final
via email to instructor).
*Test over Chapter 15
*Test over Chapter 16
Final Exam
INSTRUCTIONAL METHODS
The instructional methods used include internet lecture, CD Activities, workbook completion,
group assignments, and collaborative projects. Students will be required to complete reading
assignments, chapter reviews, case studies, participate in threaded discussions with other
classmates on topics determined by instructor, complete assignments and examinations of
knowledge, and demonstrate skill competency using a specific internet platform. Students must
participate in all activities, as well as accurately complete assignments and examinations within
the internet platform in a timely manner. Therefore it is imperative that students have a reliable
internet provider, computer hardware, and email address to succeed in this course.
STUDENT REQUIREMENTS AND METHOD OF EVALUATION
Evaluation is directly related to the performance objectives.
Performance is measured by examination, assignments, and/or quizzes.
GRADE SCALE
The letter grade is based on the percentage of the total weighted points earned throughout the
semester based on the following scale:
A = 90 to 100%
B = 80 to 89%
C = 70 to 79%
D = 60 to 69%
F = 59% and below
Assignments
85 %
Students will be required to complete weekly assignments. Each assignment will be worth a
minimum of 10 and a maximum total of 100 points.
Midterm/Final Examination
15%
Students will take comprehensive midterm and final examinations. The examination will be worth
a maximum of 400 points.
282 pts. Questions/Assignments
386 pts. Exams
Total Points Possible: 778
Introduction to CPT Coding
2009
ASSESSMENT OF STUDENT GAIN
Student gain will be determined by student improvement in each of the areas of student
competencies.
ATTENDANCE POLICY
Absences that occur due to students participating in official college activities are excused except
in those cases where outside bodies, such as the State Board of Nursing, have requirements for
minimum class minutes for each student. Students who are excused will be given reasonable
opportunity to make up any missed work or receive substitute assignments from the instructor
and should not be penalized for the absence. Proper procedure should be followed in notifying
faculty in advance of the student’s planned participation in the event. Ultimately it is the student’s
responsibility to notify the instructor in advance of the planned absence.
Unless students are participating in a school activity or are excused by the instructor, they are
expected to attend class. If a student’s absences exceed one-hundred (100) minutes per credit
hour for the course or, in the case of on-line or other non-traditional courses, the student is
inactive for one-eighth of the total course duration, the instructor has the right, but is not required,
to withdraw a student from the course. Once the student has been dropped for excessive
absences, the registrar’s office will send a letter to the student, stating that he or she has been
dropped. A student may petition the chief academic officer for reinstatement by submitting a
letter stating valid reasons for the absences within one week of the registrar’s notification. If the
student is reinstated into the class, the instructor and the registrar will be notified.
NCCC EMAIL ACCOUNT
Students should set up their NCCC e-mail accounts (which is the only e-mail account NCCC
uses for students). Below is the link to a detailed handout that shows how to set it up.
http://www.neosho.edu/forms/Student_Email_Proceedure.pdf
ACADEMIC INTEGRITY
NCCC expects every student to demonstrate ethical behavior with regard to academic pursuits.
Academic integrity in coursework is a specific requirement. Definitions, examples, and possible
consequences for violations of Academic Integrity, as well as the appeals process, can be found
in the College Catalog, Student Handbook, and/or Code of Student Conduct and Discipline.
This online class allows you to work independently or with other students in the class. For your
own benefit, you need to complete all assignments on your own unless otherwise indicated. Do
not use the work of others and submit it as your own. You may refer to the textbook and
resources when taking tests online, however the tests are timed and you may lose points if you
exceed the time limit. The true test of what you learn in this class will be demonstrated when you
take the AHIMA certification exam to become a Registered Health Information Technician. The
expectation for this class is for you to be professional and ethical – do your own work.
Introduction to CPT Coding
2009
Note: Information and statements in this document are subject to change at the discretion of
NCCC. Changes will be published in writing and made available to students.
NOTE: If you are a student with a disability who may need accommodation(s)
under the Americans with Disabilities Act (ADA), please notify the Dean of
Student Development, Chanute Campus, Student Union, 620-431-2820, Ext.
213., or the Dean, Ottawa Campus, 785-242-2607 ext 312, as soon as possible.
You will need to bring your documentation for review in order to determine
reasonable accommodations, and then we can assist you in arranging any
necessary accommodations.
DISCLAIMER:
This syllabus is a broad outline of subject matter intended to be covered. It does not mean that
everything herein will be covered, nor does it limit the content of the class to the material
described. Information and statements in this document are subject to change at the discretion
of NCCC. Because Introduction to CPT Coding is required for the completion of the HIT
Program, a grade of C or better is required to continue the program.
Introduction to CPT Coding
2009