Maricopa Community Colleges  HSE201   20024-99999 
Official Course Description: MCCCD Approval: 03/26/02
HSE201 20024-99999 LEC 3 Credit(s) 3 Period(s)
Medical Coding for Specialty Areas
Advanced level medical coding and reimbursement. Privacy, security, and compliance requirements specific to medical coding. Interpretation of encounter forms and documentation of services provided. ICD-9, CPT-4 and HCPCS level two coding, medical specialty and related procedural coding. CPT- 4 modifier use and other complex coding. American Academy of Professional Coders (AAPC) competency testing protocol and practice testing. Prerequisites: HCE227 or previous medical coding course work and permission of the instructor.
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MCCCD Official Course Competencies:
 
HSE201   20024-99999 Medical Coding for Specialty Areas
1. Describe the responsibilities of medical office personnel related to legal and ethical medical coding and reimbursement. (I)
2. Describe effective privacy, security, and compliance requirements and safeguards specific to medical coding. (II)
3. Read and interpret encounter forms and medical record documentation ensuring all required services and procedures are provided. (III)
4. Identify the purpose and use of CPT-4 modifiers. (IV)
5. Explain the HCFA Common Procedural Coding System (HCPCS) and it's applications. (V)
6. Describe the criteria for the evaluation and management for correct service code selection. (VI)
7. Identify and assign complex ICD-9 and CPT-4 codes for specialty area diagnoses and related procedures. (VII)
8. Describe the AAPC competency testing protocol and characteristics and format of current competency tests. (VIII)
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MCCCD Official Course Outline:
 
HSE201   20024-99999 Medical Coding for Specialty Areas
    I. Medical Billing Responsibilities
        A. Establishing job descriptions
        B. Preventing fraud and abuse
        C. Identifying potential situations for error
        D. Understudying the standard reimbursement processes
      II. Privacy, Security and Compliance Issues
          A. Government requirements
          B. Third party interactions and communications
          C. Establishing internal safeguards
        III. Billing Forms and Record Documentation
            A. Identifying delivered services
            B. Guidelines for encounter forms
            C. Role of provider in maximizing reimbursement
          IV. CPT-4 Modifiers
              A. Purpose
              B. Application
            V. HPCPS System
                A. History and background
                B. Levels
                C. Keys to appropriate use
              VI. Evaluation and Management Code Usage
                  A. Definitions
                  B. Selecting level of services
                VII. Complex and Specialty Area Coding (ICD-9 and CPT-4)
                    A. General guidelines and instructions
                      1. separate procedures
                      2. unlisted procedures
                      3. coding packages
                    B. Anesthesia coding
                      1. general guidelines
                      2. physical status modifiers
                      3. qualifying circumstances
                    C. Integumentary system
                      1. grafts
                      2. lesions
                      3. repairs
                    D. Respiratory system
                      1. general guidelines
                      2. endoscopy
                    E. Radiology coding
                      1. diagnostic imaging
                      2. diagnostic ultrasound
                      3. radiation oncology
                    F. Reproductive systems
                      1. endoscopy
                      2. maternity coding
                      3. prostate surgery
                    G. Musculoskeletal system
                      1. general guidelines
                      2. arthroscopy
                      3. hand and foot procedures
                      4. fractures and dislocations
                    H. Nervous system
                      1. nerve blocks
                      2. carpal tunnel surgery
                    I. Cardiovascular system
                      1. heart catherizations
                      2. other procedures
                    J. Pathology and laboratory coding
                      1. chemistry and toxicology
                      2. automated multichannel tests
                      3. surgical specimens
                      4. consultations
                    K. Ocular and auditory systems
                      1. common ear procedures
                      2. common eye procedures
                    L. Digestive system
                      1. endoscopy
                      2. other procedures
                  VIII. AAPC Competency Testing Protocols
                      A. Requirements for testing
                      B. Test overview
                      C. Schedule of upcoming competency testing
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