Course Syllabus
Course Prefix/Number: ALHT 230
Course Title: Ambulatory/Emergency Room Coding
Division: Outreach and Workforce Development
Program: Health Information Technology
Credit Hours: 3.0
Initiation/Revised: Fall 2007
Vocational
This is a course that covers the study and practice of the principles of classification systems utilized in alternate health care facilities, including mental health facilities, pathology/laboratory settings, hospital outpatient and ED departments, physician offices, and stand-alone ambulatory care centers. The classification systems studied include: DSM, SNOMED, CPT, and HCPCS Level II.
BIOL 257 Human Anatomy & Physiology, BIOL 258 Human Anatomy & Physiology Lab, NURS 230 Pathophysiology, ALHE 105 Medical Terminology, ALHE 122 Introduction to Pharmacology, and ALHT 235 Ambulatory/Emergency Room Coding Lab
Johns, Merida L., PhD, RHIA, ed. Health Information Management Technology: An Applied Approach. Chicago: American Health Information Management Association, 2007.
Kuehn, Lynn. CPT/HCPCS Coding and Reimbursement for Physician Services. Chicago: American Health Information Management Association (AHIMA), current edition.
American Medical
Association (AMA), CPT (Current Procedural Terminology), current
edition, Washington, DC: AMA
Jones, Lolita M. Coding & Reimbursement for Hospital Outpatient Services. Chicago: AHIMA
2. Explain the definitions and apply clinical vocabularies and terminologies used
3. Compare and demonstrate proficiency in the use of electronic applications and work
processes to support clinical classification and coding.
a. Use and maintain applications and processes to support other clinical classification
and nomenclature systems (e.g., DSM, SNOMED, and so on).
5. Determine discrepancies between coded data and supporting documentation.
6. Support accurate billing through coding, charge master, claims management, and bill
reconciliation processes.
7. Use ICD-9-CM, CPT/HCPCS and Evaluation &
Management Coding to:
a. Correctly identify and apply the diagnosis
codes.
b. Correctly identify and apply the procedure
codes.
c. Correctly identify and apply the Evaluation
& Management (E&M) codes.
d. Correctly identify and apply V codes when
necessary.
AHIMA DOMAINS
Domain I: Health Data Management
Subdomain A. Health Data Structure, Content and Standards
3. Apply clinical vocabularies and terminologies used in the organization’s health
information systems
Subdomain C. Clinical Classification Systems
1. Use and monitor applications and work processes to support clinical classification and coding
2. Apply procedure codes using CPT/HCPCS
3. Ensure accuracy of diagnostic/procedural groupings (e.g., APC; DRG; IPF)
4. Adhere to current regulations and established guidelines in code assignment
5. Validate coding accuracy using clinical information found in the health record
6. Identify discrepancies between coded data and supporting documentation
Subdomain D. Reimbursement Methodologies
1. Apply policies and procedures for the use of clinical data required in reimbursement and prospective payment systems (PPS) in healthcare delivery (e.g., APC; DRG; RVU; RBRVS)
2. Support accurate revenue cycle through:
a. Coding
3. Use established guidelines to comply with reimbursement and reporting requirements (e.g., National Correct Coding Initiative {NCCI}; Local Medical Review Policies {LMRP})
Domain 2: Health Statistics, Biomedical Research and Quality Management
1. Abstract and maintain data for clinical indices/databases/registries
Domain 3: Health Services Organization and Delivery
Subdomain A. healthcare Delivery Systems
2. Apply policies and procedures to comply with the changing regulations among various payment systems for healthcare services such as Centers for Medicare and Medicaid Services (CMS), managed care
Domain 4: Information Technology and Systems
Subdomain A. Information and Communication Technologies
3. Use specialized software in the completion of HIM processes (e.g., chart management; coding; release of information)
Domain 5: Organizational Resources
Subdomain B. Financial and Physical Resources
4. Monitor coding and revenue cycle processes
I. Introduction to Coding Systems.
A. DSM coding principles and practice
B. HCPCS level II national coding principles and practice
C. SNOMED coding principles and practice
II. CPT Coding
A. Introduction and historical development
B. Organization
C. Sections
D. Guidelines
E. Notes
F. Index
G. Coding principles
H. Unlisted procedures
I. Evaluation & Management (E/M) Section
J. Anesthesia Section
K. Surgery Section
L. Radiology Section
M. Pathology & Laboratory Section
N. Medicine Section
III. Coding and Billing
A. Specialized software (e.g., encoder, APC calculator, CMS-1500 claims completion)
B. National Correct Coding Initiative and Outpatient Code Editor
C. Outpatient code validation
IV. Outpatient reimbursement methodologies
A. Ambulatory Payment Classifications (APCs)
B. Physician Fee Schedule (PFS, formerly called RBRVS)
SCHEDULE
This class meets online for weekly learning units. The class materials for each unit will be available for a minimum of eight days, starting __________________ and ending __________________.
|
Week |
Topic/Exam |
Readings/Activities |
|
1 |
OPPS & Claims Processing |
Jones Chapters 1 & 2 |
|
2 |
Review Guidelines, Sections, Notes, & Rules |
Online reading assignment and cases |
|
3 |
Anesthesia & Integumentary System |
Jones chapter 3 & online cases |
|
4 |
Musculoskeletal & Respiratory Systems |
Jones Chapters 4 & 5, online cases |
|
5 |
Cardiovascular & Digestive Systems |
Jones Chapters 6 & 7, online cases |
|
6 |
Urinary & Male Genital System |
Jones Chapter 8, online cases |
|
7 |
Female Genital System |
Jones Chapter 9, online cases |
|
8 |
Nervous System |
Jones Chapter 10, online cases |
|
9 |
Eye & Auditory System |
Jones Chapter 11, online cases |
|
10 |
Ancillary Services, Radiology, Pathology, and Laboratory |
Jones Chapter 12, online |
|
11 |
E/M coding, Medicine |
Online Reading and case studies |
|
12 |
Modifiers and coding with incomplete data |
Jones Chapter 14 and online reading assignment, online cases |
|
13 |
APC’s and Data quality |
Jones Chapter 13 & 15, online assignment |
|
14 |
Final Examination |
|
A cumulative point system is used. Your class assignments will include reading, review questions, written reports, case studies, Website research, projects, practice exercises, discussion questions, chapter quizzes and examinations. The chapter examinations will be a part of each learning unit and are completed after the unit assignments, and prior to starting the next unit. Possible points for written reports, case studies, projects, and exams will vary and tracking of your total points for each assignment or exam will be available on the course Website. Class assignments will be evaluated for accuracy, content, form, knowledge of subject matter, application of knowledge and ability to communicate effectively.
Class participation is an essential element to your success in this course. You are expected to complete practice exercises and respond to the discussion questions with at least one posting (5 points).
Complete assignments by the due date. Late assignments will be docked 10% and only accepted 1 day past due date. Make-ups for exams or assignments are only permitted under special circumstances and with prior approval by the instructor. Borderline grades will be viewed in terms of timely completion of assignments and class participation.
Total points accumulated during the semester will be calculated into a percent and graded on the scale below.
90-100% = A
80-89% = B
70-79% = C
60-69% = D
59% and below = F
Absences that occur due to students participating in
official college activities are excused except in those cases where outside
bodies, such as the State Board of Nursing, have requirements for minimum class
minutes for each student. Students who are excused will be given reasonable
opportunity to make up any missed work or receive substitute assignments from
the instructor and should not be penalized for the absence. Proper procedure should be followed in
notifying faculty in advance of the student’s planned participation in the
event. Ultimately it is the student’s
responsibility to notify the instructor in advance of the planned absence.
Unless students are participating in a school activity or are excused by the instructor,
they are expected to attend class. If a
student’s absences exceed one-hundred (100) minutes per credit hour for the
course or, in the case of on-line or other non-traditional courses, the student
is inactive for one-eighth of the total course duration, the instructor has the
right, but is not required, to withdraw a student from the course. Once the student has been dropped for
excessive absences, the registrar’s office will send a letter to the student,
stating that he or she has been dropped.
A student may petition the chief academic officer for reinstatement by
submitting a letter stating valid reasons for the absences within one week of
the registrar’s notification. If the
student is reinstated into the class, the instructor and the registrar will be
notified.
Student gain will be determined by student improvement in each of the areas of student competencies.
ACADEMIC INTEGRITY
NCCC expects every student to demonstrate ethical behavior
with regard to academic pursuits.
Academic integrity in coursework is a specific requirement. Definitions, examples, and possible
consequences for violations of Academic Integrity, as well as the appeals
process, can be found in the College Catalog, Student Handbook, and/or Code of
Student Conduct and Discipline.
This online class allows you to work independently or with other students in the class. For your own benefit, you need to complete all assignments on your own unless otherwise indicated. Do not use the work of others and submit it as your own. You may refer to the textbook and resources when taking tests online, however the tests are timed and you may lose points if you exceed the time limit. The true test of what you learn in this class will be demonstrated when you take the AHIMA certification exam to become a Registered Health Information Technician. The expectation for this class is for you to be professional and ethical – do your own work.
CELL PHONE POLICY:
Student cell phones and pagers must be turned off during
class times. Faculty may approve an exception for special circumstances.
DISCLAIMER:
This syllabus is a broad outline of subject matter intended to be covered. It does not mean that everything herein will be covered, nor does it limit the content of the class to the material described. Information and statements in this document are subject to change at the discretion of NCCC. Because Introduction to Health Information is basic to understanding many of the other courses in the Health Information Technology program, a grade of C or better is required to continue the program.
NOTE: If you are a student with a disability who may need
accommodation(s) under the Americans with Disabilities Act (ADA), please notify
the Director of Advising and Counseling,
Chanute Campus, Student Union, 620-431-2820 ext 280 or the Dean, Ottawa Campus, 785-242-2607 ext
312, as soon as possible. You will
need to bring your documentation for review in order to determine reasonable
accommodations, and then we can assist you in arranging any necessary
accommodations.
Note: Information and statements in this document
are subject to change at the discretion of NCCC. Changes will be published in writing and made
available to students.