Medical Billing and Coding

This course expands the basic diagnostic and procedural coding fundamentals already introduced. Students will use the ICD-10-CM, CPT 4, and HCPCS Level II coding manuals to apply principles of diagnosis and procedural coding. Students learn diagnosis coding systems with detailed instruction on how to code and properly apply the guidelines for ICD-10- CM, Volumes I and II. It also provides in-depth coverage of procedural coding systems with detailed instruction on CPT 4 coding for Anesthesia, Evaluation and Management services, surgical procedures, Pathology, Laboratory, Radiology and Medicine. HCPCS Level II coding for procedures, services, and supplies is also taught.

This course provides the student with practical applications of Diagnostic and Procedural Coding Systems for facilities. Students will expand their knowledge of coding by abstracting the appropriate information from hospital records, surgical/operative reports, and medical case studies to accurately assign diagnoses and procedure codes to be used on the hospital CMS-1450 insurance claim form and for electronic claims. Students will also acquire a working knowledge of MS-DRGs (Medicare Severity Diagnosis Related Groups) assignment.

This course reviews the different types of insurance programs, payer specific guidelines, and reimbursement issues. This will include review of diagnostic and procedural coding and Medicare Severity Diagnosis Related Groups (DRGs), explanation of the Resource Based Relative Value Scale (RBRVS), Ambulatory Payment Classifications (APCs), and the National Correct Coding Initiative (NCCI). Review of insurance claims processing steps, patient billing, payment determinations, and calculations for insurance and private pay payments, and interpretation of the explanation of benefits (EOB) are integral parts of this course. Through application exercises, the student will evaluate and respond to claims denials and site resubmission requirements and will endorse the ability to process appeals. A review of insurance plans and regulation, insurance math, claims administration organizations, billing concepts, and terminology associated with accounts receivable and accounts payable are integrated into the course.

This course allows the student to apply what they have learned in the program curriculum to practical use in a healthcare facility under the direct supervision of a preceptor on the site. Through the externship experience, the student gain first- hand knowledge of the workplace and perform the assigned duties to meet the expectations in a professional setting. Students are expected to adapt to the work environment and reflect regularly on their learning and observations. The externship work performed is not to be paid.