Planning Notes: Advanced CPT Coding: Revenue Enhancement, Compliance &
The Charge Master
-------------------------------------
Planning Notes Advanced CPT Coding: Revenue Enhancement, Compliance & The
Charge Master
Title: Advanced CPT Coding: Revenue Enhancement, Compliance & The Charge
Master
Objective: To provide an in-depth, analytic approach to the process of coding for outpatient services under APCs. Concentration is on the use of the CPT/HCPCS coding system within various service areas to enhance the APC reimbursement process. The use of modifiers, point systems for E/M levels and HCFA’s Correct
Coding Initiative (CCI) are all considered. The presentation includes the current update and the coding to charge master interface.
Upon Completion the Participants Will:
1. Understand the overall process of the outpatient reimbursement process and how it works under APCs.
2. Be able to delineate the systematic steps in reading, assessing and addressing
CPT/HCPCS assignment.
3. Appreciate the difficulty and various nuances associated with review of medical documentation in the outpatient services area and difficulties associated with CPT coding.
4. Have reviewed various coding scenarios that address CPT coding conventions within the different surgery sections.
5. Recognize the impact of APCs on outpatient CPT/HCPCS coding including the charge master interface.
6. Understand the proper use of modifiers for hospital coding versus physician coding.
7. Appreciate the APC adjudication process and the influence of coding and the charge master on revenue generation.
8. Understand when the physician needs to be contacted for further clarification based upon ambiguous or inconsistent documentation.
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Planning Notes: Advanced CPT Coding: Revenue Enhancement, Compliance &
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9. Have reviewed the process of setting up point or narrative systems for hospital E/M coding.
10. Be able to relate the CPT/HCPCS coding to areas such as UR, QA, cost accounting and the new provider-based status (PBS) rules.
11. Understand how CMS’s Correct Coding Policies for physicians affects hospital outpatient coding.
12. Appreciate the role of proper coding for APCs and potential payment impact.
13. Be aware of the many compliance issues and the necessity for developing various coding/billing policies and procedures.
14. Knowledge of additional sources of assistance.
Audience: Hospital coders for both professional (physician) and facilities, medical records personnel, Charge Master coordinators, business office personnel, insurance clerks, nursing supervisors, nurses as appropriate, and administrative staff as appropriate.
Method of Presentation : The primary method is Lecture-Recitation with the use of detailed case studies. Interaction and questions from the audience are HIGHLY encouraged.
Course Materials : Extensive Class Notes (including copies of Overhead
Transparencies). Class Notes will include copies of selected readings and special materials as appropriate.
Student Materials : Current CPT Manual required. ICD-9-CM and HCPCS Manuals are optional.
Course Times : 9:00 a.m. to 12:00 p.m., 1:00 p.m. to 4:00 p.m.
Outline:
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Planning Notes: Advanced CPT Coding: Revenue Enhancement, Compliance &
The Charge Master
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I. Introduction
A. The Coding Systems
B. Development of CPT/HCPCS Codes
C. Outpatient Payment Reform
D. Physician Documentation
E. CMS’s Correct Coding Initiative
F. Review of APCs
II. CY2002/2003 Update
A. CPT Update
B. HCPCS Update
C. Modifier Update
D. Associated Coding Systems Update
E. APC Update
F. Anticipated Changes
III. Outpatient Reimbursement Process
A. UB-92 Processing
B. ASC Procedures
C. Reviewing Reimbursement
D. Post-Payment Audits
E. Coding and Compliance Concerns
F. Developing Coding Policies & Procedures
IV. Systematic Review Of Medical Documentation
A. Systematic Process
B. Key Words and Test Results
C. Physician Definition Of Procedures
D. Anesthesiologists Documentation
E. Pre- and Post-Diagnoses
F. Tracking 'Scopic' Procedures
G. Special CPT Definitions
V. Outpatient Coding Case Studies (Selected Areas)
A. Integumentary System
B. Orthopedic System
C. Fracture Care
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Planning Notes: Advanced CPT Coding: Revenue Enhancement, Compliance &
The Charge Master
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D. Ear, Nose, Mouth & Throat
E. Respiratory System
F. Circulatory System
G. Catheterization/Vascular Lab
H. Digestive System
I. Chemotherapy Coding
J. Interventional Radiology
K. Catheterization Laboratory
L. Vascular Laboratory
M. Selected Advanced Exercises
VI. APCs and Outpatient CPT Coding
A. CPT Coding Impact on APCs
B. Case Studies of APC Grouping
C. CPT/HCPCS Coding and the Charge Master
VII. Physician Involvement In Outpatient Coding
A. Complete, Accurate Documentation
B. Correlation Of Hospital Coding & Physician Coding
C. Review of HCFA’s Correct Coding Policies & Edits
D. Review of New Extended E/M Coding Documentation Guidelines
VIII. Outpatient Coding And Related Areas
A. Utilization Review
B. Quality Assurance
D. PRO Review
E. Provider-Based Status (PBS) And Coding
F. Cost Accounting & Internal Studies
Notes: 1. This is an intensive one-day workshop emphasizing practical applications with the use of a number of in-depth coding exercises.
2. Questions submitted prior to the class are encouraged!
3. Reference materials will be made available to class participants as a part of their notes.
Revised March , 1995; December , 1995, April, 1996, June, 1996, July, 1997, November, 1997,
October 1998, June 1999, March 2000, September 2000, January 2001, January 2002, March 2002,
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Planning Notes: Advanced CPT Coding: Revenue Enhancement, Compliance &
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June 2002
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