Advanced Hospital Coding and CCS Prep GES 104 » 80 hours

When you've successfully completed this program, you'll:

• Understand how health information travels within departments of a facility
• Be able to define the roles and responsibilities of a coder in both in- and out-patient facilities
• Know how to interpret health-record documentation using your knowledge of anatomy, physiology, clinical disease processes, and medical terminology
• Accurately assign codes for diagnoses, conditions, problems, or other reasons for patient encounters
• Select codes according to Uniform Hospital Discharge Data Sets (UHDDS) definitions and official coding guidelines
• Evaluate the effect of code selection on Diagnosis Related Group (DRG) assignment, and verify DRG assignment based on Prospective Payment System (PPS) definitions
• Determine proper use of Modifiers, CPT vs. HCPCS Level II codes, and Medical Necessity (linking diagnosis to procedure or service)
• Understand reimbursement methodologies and documentation rules and regulations
• Identify the Charge Master and its components
• Understand the CPT guidelines, with special emphasis on Evaluation and Management (E & M) and surgery coding

This program will help you become competent in these hospital-based coding areas:

Data Identification

• Read and interpret health-record documentation to identify diagnoses and procedures
• Apply your knowledge of anatomy and physiology, clinical disease processes, pharmacology, and diagnostic and procedural terminology to assign accurate codes
• Apply knowledge of disease processes and surgical procedures to assign non-indexed medical terms to the appropriate class

Coding Guidelines

• Use current approved coding guidelines to assign and sequence the correct diagnosis and procedure codes for hospital inpatient services
• Apply knowledge of CPT format, guidelines, and notes to locate the correct codes or correctly use an unlisted procedure code for a patient encounter, and sequence the codes correctly

Regulatory Guidelines

• Apply Uniform Hospital Discharge Data Set (UHDDS) definitions to select accurate codes
• Determine the appropriate principal diagnosis for patients who have more than one ailment
• Use the Prospective Payment System to confirm a DRG assignment
• Prevent fraud by maintaining approved coding principles and guidelines, including the National Correct Coding Initiative (CCI)
• Use the Ambulatory Surgery Center (ASC) Payment Groups to confirm ASC assignment and ensure appropriate reimbursement
• Use the HCFA Common Procedural Coding System (HCPCS) to appropriately assign HCPCS codes for outpatient Medicare reimbursement

Coding

• Understand which diagnoses, conditions, and procedures to exclude from coding
• Apply your knowledge of ICD-9-CM instructional notations and conventions to locate, assign, and correctly sequence codes
• Facilitate data retrieval by recognizing when more than one code is required to adequately classify a given condition

Data Quality

• Clarify conflicting, ambiguous, or nonspecific information appearing in a health record by consulting the appropriate physician
• Participate in quality assessment to ensure continuous improvement in ICD-9-CM and CPT coding and collection of accurate health data
• Demonstrate ability to recognize potential coding-quality issues from an array of data
• Apply policies and procedures on health-record documentation and coding that are consistent with official coding guidelines
• Contribute to the development of facility-specific coding policies and procedures