COURSE OUTLINE
A.
Unit code and suggested title:
MR 203 Advanced Coding, Classification and Reimbursement Systems
B.
Curriculum/Program:
Health Information Technology
C.
Course/Catalog Description
This is an advanced application of the guidelines and conventions used in
ICD-9-CM. CPT coding conventions and guidelines will also be presented.
Various reimbursement systems (DRGs, ASCs, RBRVS, APCs) for a
variety of patient encounters will be discussed as well as coding quality
control systems. Prerequisites: MR 105, MR 106, MA 115, BI 152, BI153
Co-requisites: MR204 and MR 250
D.
Duration of Instructional Period:
Lecture: 50 minutes, 3 class meetings per week, 15 weeks
E.
Academic Credit Hours: 3
Contact Hours: 3
(3-0-3)
F.
Suggested Text(s):
1.
2.
3.
4.
G.
2012 Hospital Generic ICD-9-CM Codebook, Three volume set, Channel
Publishing, US Department of Health and Human Services.
American Medical Association, CPT-IV, American Medical
Association.
MedLearn, CPT Coding Workbook (2012), MedLearn
Health Information Management Technology: An Applied Approach,
edited by. Sayles, fourth edition 2013
Course Outcomes:
Upon completion of this course, the student will be able to:
1.
Identify the purposes of a disease and operation classification systems.
PC: 6, 10, 11
2.
3.
4.
6.
7.
8.
9.
H.
6.
10.
11.
I.
Identify, differentiate and apply general information regarding various
classification systems and nomenclatures utilized in the health care field.
PC: 6, 10, and 11 LO: 3
Identify the content and arrangement of the major divisions of CPT and
ICD-9-CM PC: 6, 10, and 11
Differentiate among the following types of CPT and ICD-9-CM codes:
Category, Subclassification, Ecodes, Vcodes, and procedure codes.
PC: 6, 10, 11
Assign ICD-9-CM and CPT codes for diseases, conditions, operations and
non-surgical procedures according to accepted guidelines and principals.
(Manually and using computerized encoder)
PC: 6, 10, 11
Define primary disease, principal diagnosis, principal procedure, and
correctly sequence CPT and ICD-9-CM codes according to official
sequencing guidelines. PC: 6, 10, 11
Abstract, code and sequence diagnostic information from health records
using CPT and ICD-9-CM. PC: 6, 10, and 11 LO: 3
Monitor compliance with governmental, regulations and accreditation
standards relative to coding.
PC: 6, 10, and 11 LO: 6
Program Competencies:
Direct and monitor classifying, indexing, coding, and related activities to
assure quality.
Apply coding rules to diagnoses and procedures.
Sequence diagnoses and procedures to ethically and accurately optimize
reimbursement.
SUNY General Education Ten Knowledge Areas
Not applicable to this curriculum.
J.
ECC Learning Outcomes (LO):
3.
6.
K.
Information Literacy. (Course Outcomes 2, 9)
Technological Competence (Course Outcomes 6)
Assessment of Student Learning:
Achievement of the course objectives will be measured by written
examinations, outside reading /written assignments, class
discussion and presentations.
K2.
Exam 1Exam 2Exam 3Exam 4Assignments
20%
20%
20%
20%
20%
TOTAL
100%
Assessment of Student Learning:
Course will be assessed using tests, projects, and rubrics described on the
program's assessment plan as submitted to the College Assessment
Committee
L.
Library Resources:
Library reference materials specifically from the Health Science
holdings will be utilized for reading assignments and research
projects for this course.
Each of the three ECC campuses has a library staffed with professional
librarians and modern resources such as off-site access to database
searches and access to EBooks and electronic journal. Students may
borrow books and other materials for up to 4 weeks with the use of their
student ID. Each library’s resources vary to meet the needs of the specific
campus. Interlibrary loan is available.
Specific databases available through the ECC Library system include,
Medline and other health related databases
http://libguides.ecc.edu/content.php?pid=142597&sid=266473
http://libguides.ecc.edu/content.php?pid=169540&sid=1427934
For additional information, visit the Library Resource Center at
http://elinks.ecc.edu/lbrary/.
M. Topical Outline:
DATE
Week 1,2
TOPIC
CPT Coding:
Organization
Uses
History
HCPCs
Format of Book
Coding Conventions
Modifiers
ASSIGNMENT
Chapter 1 and CPT manual
Introduction
Week 2-10
Week 4
Week 8
Week 11, 12
How to Assign a CPT Code
Coding Guidelines:
Chapter 3 and surgery section
-Surgery Section
in CPT manual
Apply coding Conventions and Principals
of ICD-9-CM, CPT, and HCPCS Coding
to Assign Codes to Diagnoses, Physician
Services and Procedures
Exam 1 Surgery Section/Intro
Exam 2 Surgery Section
Evaluation and Management
Chapter 7 and E/M section in
CPT manual
Week 12
Week 13
Exam 3 Evaluation/Management
Reimbursement Methodologies utilizing
CPT Codes:
APCs (Ambulatory Patient Categories)
RBRVS (Resource Based Relative Value
Scale)
Week 14
Quality Control/Coding Validation
Processes
Departmental Policies
Audits
Education
Review and Exam:
Week 15
N.
PREPARED BY:
Gail Lauritsen, Ed.M., RHIA, CCS
Professor Dept. Head Health Information Technology
Date Prepared: May 2014
Last updated: Spring 2008 10/26
Sayles Chapter 7
Sayles Chapter 11