Medical Coding

5 subjects · 12 chapters · 48 topics

1. 01

   Foundations

   1.1 Healthcare and coding

   • Role of a medical coder
   • Revenue cycle management
   • Payers, providers and claims
   • Compliance and confidentiality

   1.2 Medical terminology

   • Word roots, prefixes and suffixes
   • Abbreviations and symbols
   • Common clinical terms
   • Reading a medical record

   1.3 Anatomy and physiology

   • Body systems overview
   • Common conditions by system
   • Diagnostic procedures
   • Pharmacology basics for coders
2. 02

   Diagnosis Coding

   2.1 ICD-10-CM

   • Structure and conventions
   • Alphabetic index and tabular list
   • Coding guidelines chapter by chapter
   • Sequencing and principal diagnosis

   2.2 Applying ICD-10-CM

   • Signs, symptoms and definitive diagnoses
   • Combination and manifestation codes
   • External cause codes
   • Common coding errors
3. 03

   Procedure Coding

   3.1 CPT

   • Categories and sections
   • Evaluation and management coding
   • Surgery, radiology and pathology sections
   • Modifiers

   3.2 HCPCS Level II

   • Supplies, drugs and equipment
   • Modifiers in HCPCS
   • When HCPCS replaces CPT
   • Medicare-specific rules

   3.3 ICD-10-PCS

   • Structure of a PCS code
   • Root operations
   • Body systems and approaches
   • Inpatient procedure coding
4. 04

   Reimbursement

   4.1 Payment systems

   • Fee-for-service and capitation
   • DRGs and inpatient payment
   • APCs and outpatient payment
   • RVUs and physician payment

   4.2 Claims

   • The claim form and clean claims
   • Denials and appeals
   • Audits and documentation improvement
   • Fraud, abuse and the law
5. 05

   Practice and Certification

   5.1 Applied coding

   • Coding real case scenarios
   • Accuracy and productivity
   • Using an encoder
   • Quality assurance

   5.2 Certification

   • CPC and CCS pathways
   • Exam structure and preparation
   • Time management in the exam
   • Career progression