CPT Coding I Course Outcome Summary

Transcription

1 CPT Coding I Course Outcome Summary Course Information Organization South Central College Revision History 2008 Course Number HC 1928 Division Health Careers Department Medical Coding Total Credits 3 Description This course is the introduction of CPTcoding and provides and in-depth review of the coding and reimbursement system used in outpatient facilities and physician billing. The course reviews all CPTsections and sub-sections. The student will learn the importance of physican documentation and impact of CPT coding on reimbursement and for both the medical facility and the physician. The student will gain knowledge of medical procedures and services and the importance of understanding medical terminology. Types of Instruction Instruction Type Contact Hours Credits Lecture 32 2 Lab 32 1 Prerequisites HC 1000 Exit Learning Outcomes Core Abilities A. Critical Thinking B. Professionalism C. Communication Competencies 1. Define CPT coding a. Describe CPT coding in physician billing both in outpatient and inpatient b. Review case problems to differentiate code linkage of diagnosis and procedure 2. Decribe CPT symbols a. Review the symbols for new code, code description change, and deleted codes b. Define the use of add-on codes and modifier -51 exempt codes in CPT 3. Define the CPTcoding manual format

2 a. Review the parent code, indented code format b. Define the semicolon and code structure 4. Define the relationship of ICD-9-CM coding and CPT coding a. Define code-linkage on charge tickets and encounter forms b. Review the CMS 1500 claim form and establishing code-linkage c. Define ICD-9-CM coding and CPT coding in case problems 5. Review CPT appendices a. Review the CPT appendices for reference to coding procedures b. Define specific section of the appendix for modifier definitions c. Review the appendix for code changes and code deletions 6. Define CPT modifiers a. Define the relationship of modifiers for billing services/procedures in CPT b. Review case problems that require modifiers for claim submission c. Demonstrate the CPT and HCPCS modifier useage 7. Describe CPT new procedures a. Review the category II and III sections of CPT b. Describe the unlisted procedure and claim filing procedure 8. Define CPT index structure a. Compare and contrast ICD-9-CM index and CPT index b. Demonstrate code selection from the CPT index and verifying codes c. Describe CPT index code ranges 9. Describe CPT revised procedures a. Review CPT symbols and descriptions for revised procedures b. Review the CPT appendix for verification of code revision from previous edition 10. Define CPT code changes a. Review modifiers that indicate codes changes b. Describe the appendix verification for code changes from previous editions 11. Demonstrate CPT section and subsections a. Demonstarte CPT sections and structure of code numbring b. Describe referencing of CPT sections versus the CPT index 12. Define new patient versus established patient a. Review CPT guidelines for new patient and established patients b. Review case problems indicating new versus established patients c. Define clinic records and multiple clinic structures 13. Define key components

3 a. Define history, exam, and medical decision-making in code selection b. Review the elements of history components of HPI, ROS, and PFSH c. Define elements of examination and CPT guidelines d. Define elements of diagnosis, data review, and level of risk 14. Define contributing factors a. Define the components of nature of presenting problem, counseling/coordination of care, time b. Review case problems that are determined on time and documentation requirements 15. Demonstrate E/M coding categories a. Review E/M code categories through case problems b. Define through case problems the code selection for E/M services c. Demonstrate through lab case problems the categories of E/M code selection 16. Review documentation for physical examinations a. Review the 1995 and 1997 documentation guidelines for E/M b. Define multi-system history and physical exams versus single-specialty examinations 17. Describe multi-system exam guidelines a. Demonstrate through case problem multi-specialty and single-specialty exams b. Review the outlines/templates established for determination of the exam component 18. Demonstrate E/M coding case problems a. Describe through E/M case problems the problem-oriented exams b. Describe through case problems split-billing c. Define preventive medicine/annual exams 19. Review E/M coding conventions and modifiers a. Define CPT coding conventions and modifier useage b. Review CMS-1500 claim form and code-linkage and modifiers 20. Define CPT versus CMS surgical packages a. Define the elements for CPT surgical package b. Compare and contrast the CPT surgical package and CMS surgical package 21. Define CPT surgical procedural terminology a. Review CPT surgical guideline section for coding of surgical procedures b. Review documentation of operative/procedural reports for clarification of coding 22. Describe unbundling of surgical procedural coding a. Define unbundling and fragmentation of CPT codes b. Review implications of unbundling

4 c. Demonstrate through case problems unbundling of procedures 23. Define surgical procedural modifiers a. Review the surgical modifiers useage b. Demonstrate surgical modifiers through case problems 24. Describe CPT definition of separate procedure a. Review surgical section of procedures that are determined as separate procedures b. Demonstrate through case problems procedures that cannot be coded together 25. Demonstrate case problems of surgical cases using CPT coding a. Review surgical cases that involve all sections of CPT surgery section b. Apply CPT coding to case problems of surgical procedures including modifiers 26. Define CPT coding of integumentary procedures a. Define the general section CPT category within integumentary section b. Define lesion removal procedures and the corresponding categories c. Review CPT coding guidelines for wound repairs d. Review through case problems coding of integumentary procedures 27. Describe CPT coding of musculoskeletal procedures a. Define the surgical package for fracture treatment b. Review through case problems procedures of musculoskeletal system c. Describe modifiers for CPT and HCPCS 28. Describe CPT coding of respiratory procedures a. Review organs that are included in the respiratory system b. Define endoscopic procedures of the sinsuses, bronchus, and lungs c. Demonstrate through case problems procedures of the respiratroy system 29. Define CPT coding of genitourinary procedures a. Review procedures that relate to male and female b. Define cystoscopic procedures of the GU system 30. Describe CPT coding of cardiovascular procedures a. Review the cardiovascular procedures related to the heart b. Describe coding of PTCA and EKG's in the medicine section of CPT c. Demonstrate through case problems procedures in the cardiovascular section 31. Describe CPTcoding of nervous system procedures a. Define surgical procedures of musculoskeletal/nervous system relationship b. Demonstrate neurolytic procedures 32. Describe CPT coding of the auditory/eye

5 a. Review CPT coding of cataracts b. Review CPT coding of the auditory canal and modifiers 33. Define CPT coding of the digestive system a. Define endoscopic procedures of the digestive system and modifiers b. Review case problems of the digestive tract through lab experience 34. Define CPT coding of the endocrine/lymphatic/hematological systems a. Define procedures involving fine needle aspirations b. Define venipuncture and arterial blood draws c. Describe lab procedures in annual/problem-oriented exams 35. Describe CPT coding of the male/female reproductive systems a. Review endoscopic procedures of the male and female b. Define OB packages and coding of deliveries/abortions 36. Review CPT coding of laboratory/pathology a. Review billing of lab/path procedures and charge master b. Demonstrate through case problems lab/path billing 37. Review coding of radiological procedures a. Define radiological CPT coding in the inpatient and outpatient settings b. Demonstrate through case problems procedures for diagnosis and treatment 38. Describe CPT coding in the medicine section a. Review the relationship of CPT medicine section with other sections of CPT b. Review the anesthesia modifiers and additional services in CPT c. Review CPT coding in the medicine section through case problems 39. Define CPT coding of anesthesia a. Review anesthesia modifiers for the MDA and CRNA b. Define CPT surgical coding versus anesthesia coding for billing c. Demonstrte through case problems lab anesthesia coding of surgical procedures 40. Describe the relationship of HCPCS coding a. Define the relationship of HCPCS and CPT b. Review HCPCS modifiers c. Review the HCPCS manual structure d. Demonstrate through case problems useage of HCPCS coding and modifiers e. Review CMS 1500 claim form for HCPCS modifiers 41. Review auditing of physician services a. Define documentation reviews of E/M services and surgical cases b. Review audit reports of coding trends and coding errors

6 42. Demonstrate auditing of E/M coding case problems a. Define upcoding and downcoding through lab case problems b. Complete E/M auditing forms and report findings and plan of compliance 43. Demonstrate auditing of surgical/procedural case problems a. Define through case problem review of surgical cases and document the results b. Describe plan for compliance and plans for physican/coder review 44. Define the NCCI a. Define CMS definition of comprehensive/component/column I/column II coding b. Review case problems and software applications for NCCI 45. Review Medicare outpatient edits a. Define Medicare code edits on claims b. Review case/claim submission and audting procedures 46. Describe CPT software/encoders a. Define software applications for coding accuracy b. Review case problems for claim submission and error correction 47. Review AHIMA CPT ethical coding guidelines a. Review ethical coding guidelines and unethical practices b. Review legal implications and qui tam legislation 48. Review case problems in surgical/procedural billing in the physician office a. Apply CPT coding skills to case problems and claim submission b. Review coding errors and correct code selection through lab exercises