MEAS 203 - Advanced Insurance Coding

1. Define the purpose of the CPT, HCPCS and ICD-10-CM coding systems.
2. Define and use all coding terminology, conventions, and abbreviations accurately.
3. Utilize medical terminology and abbreviations accurately.
4. Accurately use ICD-10, CPT, and HCPCS Level II coding systems.
5. Accurately code primary and principal diagnoses using ICD-10.
6. Identify modifiers for HCPCS Levels I and II.
7. Learn official coding and reporting principles and guidelines for claim reimbursement.
8. Abstract coding information from patient’s medical records.
9. Develop advanced coding skills by assigning codes to medical, surgical, and diagnostic services.
10. Identify coding errors on insurance claim forms, superbills, and EOB’s.
11. Code in compliance with the Health Insurance Portability and Accountability Act. (HIPAA)

1. HCPCS
   1. Review of coding system and purpose
      1. Levels I: CPT
      2. Levels II: Medicare National Level II Codes
   2. Modifiers and Guidelines
      1. Level I modifiers
      2. Level II modifiers
   3. Medicare and Medicaid National Code requirements
   4. Glossary terminology
2. CPT
   1. Purpose and updating CPT manual
   2. Manual format
      1. Sections
         1. Evaluation and Management Section(E/M)
            1. Subsections
            2. Factors and key components
            3. Levels of E/M services
            4. Identify documentation guidelines
         2. Anesthesia Section
            1. Payment formula
            2. Modifiers
         3. Surgery Section and Integumentary System
            1. Format
            2. Coding guidelines
            3. Modifiers
               1. Musculoskeletal system
                  1. Format
                  2. Coding guidelines
                  3. Modifiers
               2. Respiratory system
                  1. Format
                  2. Coding guidelines
                  3. Modifiers
               3. Cardiovascular system
                  1. Format
                  2. Coding guidelines
                  3. Modifiers
               4. Female genital system
                  1. Maternity care and delivery
                  2. Format
                  3. Coding guidelines
                  4. Modifiers
               5. General surgery coding
                  1. Procedural terminology
                  2. Coding guidelines
                  3. Modifiers
         4. Radiology Section
            1. Radiology subsections
            2. Radiology terminology
            3. Radiological coding guidelines
            4. Planes
            5. Modifiers
         5. Pathology and Laboratory Section
            1. Format
            2. Subsections
            3. Pathology and laboratory terminology
            4. Coding guidelines
         6. Medicine Section
            1. Format
            2. Subsection Coding guidelines
   3. Unlisted Procedures
      1. Special Reports
3. ICD-10
   1. Coding format
      1. Volume I Diseases: Tabular List
         1. Classification of diseases and injuries
            1. Chapters
            2. Sections
            3. Category
         2. Supplemental classification
            1. V codes
            2. E codes
         3. Appendices
            1. Appendix A: Morphology of Neoplasms
            2. Appendix B: Glossary of Mental Disorders
            3. Appendix C: Classification of Drugs
            4. Appendix D: Classification of Industrial Accidents
            5. Appendix E: List of Three-Digit Categories
         4. Volume II Diseases: Alphabetic Index
         5. Volume III Procedures: Tabular List and Alphabetic Index
   2. Coding conventions
   3. Inpatient and outpatient official coding and reporting guidelines
   4. Principal and primary diagnosis
   5. Diagnosis and procedural terminology
   6. Coding and claim processing
4. Third Party Reimbursement
   1. Medicare Parts A and B
   2. Fraud and abuse: Office of the Inspector General (OIG)
   3. Coding for medical necessity
   4. Participating and nonparticipating provider reimbursement
   5. Coding and payment systems