Official Course Description: MCCCD Approval: 5-26-2009
HIM211  2009 Fall – 2011 Fall	L+L  4.0 Credit(s)  6.0 Period(s)  5.4 Load  Occ
Advanced Applications of Coding and Reimbursement
Use of references, source documents, and computers for International Classification of Diseases (ICD) code assignment. Uniform Hospital Discharge Data Set and diagnostic-related group guidelines and federal regulations for hospital-based settings. Coding guidelines, code sets, and code assignment for home health, long term care, rehabilitation, and other health care settings. Identification of care provider documentation that supports code assignment. Use of codes for administrative purposes, reimbursement, marketing, and meeting regulatory requirements. Prerequisites: (BIO202, HCC204, and HIM209), or permission of Program Director.

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MCCCD Official Course Competencies:
HIM211  2009 Fall – 2011 Fall	Advanced Applications of Coding and Reimbursement

 

1.         Use a variety of references to assist in research for accurate code assignment. (I)

2.         Describe the Uniform Hospital Discharge Data Set (UHDDS) requirements and its use. (II)

3.         Apply the UHDDS requirements in selecting a principal diagnosis, principal procedure, and sequencing codes. (II)

4.         Differentiate among various prospective payment systems. (III)

5.         Describe the relevance and appropriate use of complications and comorbidities (CCs) in Diagnostic Related Group (DRG) assignment. (IV)

6.         Identify appropriate code sets and describe coding guidelines used in a variety of health care settings. (IV-X)

7.         Assign appropriate International Classification of Diseases (ICD) diagnosis and procedure codes in a variety of health care settings. (IV-X)

8.         Assign codes using other classification systems including the Diagnostic and Statistical Manual (DSM), International Classification of Diseases - Oncology (ICD-O), and Systematized Nomenclature of Medicine (SNOMED). (IV-XI)

9.         Use DRG, case mix, severity of illness, report evaluation, and case selection findings for administrative reporting. (IV, XI)

10.       Evaluate codes for accuracy and completeness and reconcile codes with documentation. (XI)

11.       Participate in revenue cycle/reimbursement monitoring and chargemaster maintenance. (XI)

12.       Describe the role of Local Medical Review Policies (LMRP), Local Medical Determination (LMD), and peer review groups in reimbursement management. (XI)

13.       Describe components of a coding compliance program. (XI)

14.       Appropriately use software programs for code and DRG assignment. (XI)

 

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MCCCD Official Course Outline:
HIM211  2009 Fall – 2011 Fall	Advanced Applications of Coding and Reimbursement

 

I.          Coding References Update

            A.        Pharmaceuticals

            B.        Disease processes

            C.        New procedures

            D.        Terminology and acronyms

            E.         Regulations

II.        Uniform Hospital Discharge Data Set (UHDDS)

            A.        Requirements

            B.        Use

III.       Prospective Payment Systems

            A.        Background

            B.        Regulations

            C.        Current systems

                        1.         Hospital inpatient

                        2.         Skilled nursing facility (SNF)

                        3.         Home health agency

                        4.         Rehabilitation hospital

                        5.         Other

IV.       Hospital Inpatient Diagnostic Related Groups (DRGs)

            A.        Definitions and organization

            B.        Case mix and severity of illness

            C.        Application of coding guidelines

            D.        Encoder, grouper, and other software programs

            E.         Complications and comorbidities

            F.         Abstracting

V.        SNF Resource Utilization Groups (RUGs)

            A. Definitions and organization

            B. Data reporting systems

            C. Coding guidelines and application

VI.       Home Health Resource Groups (HHRG)

            A. Definitions and organization

            B. Data reporting systems

            C. Coding guidelines and application

VII.     Rehabilitation Hospital Case Mix Groups (CMGs)

            A. Definitions and organization

            B. Data reporting systems

            C. Coding guidelines and application

VIII.    Psychiatric Care Code Sets

            A.        Definitions and organization

            B.        Data reporting systems

            C.        Diagnostic and Statistical Manual (DSM) coding guidelines and application

IX. Oncology Code Sets

            A.        Definitions and organization

            B.        Data reporting systems

            C.        International Classification of Diseases-Oncology (ICD-O) coding guidelines and application

            D.        Tumor Registry

X.        Additional Settings and Code Sets

            A.        Systematized Nomenclature of Medicine (SNOMED)

            B.        Other

XI.       Administrative Functions

            A.        Quality management

                        1.         Monitoring

                        2.         Data compilation

                        3.         Reporting

                        4.         Data analysis

            B.        Reimbursement management

                        1.         Revenue cycle monitoring

                        2.         Chargemaster maintenance

                        3.         External groups and policies

            C.        Compliance programs

                        1.         Structure

                        2.         Application

            D.        Software comparisons and selection

                        1.         Encoder

                        2.         Grouper

                        3.         Abstracting

                        4.         Reporting