10-530-165Intermediate Coding
Course Information
Description
Prepares learners to assign ICD and CPT/HCPCS codes supported by medical documentation and official coding guidance to support appropriate reimbursement. Learners will participate in CDI activities, including preparation of appropriate physician queries in accordance with compliance guidelines.
Total Credits
3
Course Competencies
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ASSIGN reportable diagnosis and procedure codes for cases with moderate to advanced clinical complexityAssessment StrategiesCoding case study or medical recordCriteriacode assignment is supported by medical documentationmultiple codes are sequenced to ensure maximum allowable reimbursementcode assignment and sequencing complies with official coding guidelines/conventions and reimbursement rulescode assignment and sequencing complies with national standards of ethical coding (e.g., AHIMA, AAPC, ACDIS)
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INTERPRET coding advice (Coding Clinic, CPT Assistant, Clinical indicators, etc.) in the process of coding cases with moderate to advanced clinical complexityAssessment StrategiesCoding case study or medical recordCriteriaidentify all pertinent guidance for the given scenarioapply the guidance for the given scenariocode assignment and sequencing complies with official coding guidance/conventions and reimbursement rules
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ABSTRACT data elements for the purpose of coding, reimbursement, and data collectionAssessment StrategiesCoding case study or medical recordCriteriaabstract is completeabstracted data is accurateabstracted data complies with reporting and reimbursement guidelines
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PERFORM coding and grouping processes using electronic applications for cases with moderate to advanced clinical complexityAssessment StrategiesCoding case study or medical recordCriteriacode assignment is supported by medical documentationmultiple codes are sequenced to ensure maximum allowable reimbursementcode assignment and sequencing complies with official coding guidelines/conventions and reimbursement rulescode assignment reflects application of national standards of ethical coding (e.g., AHIMA, AAPC, ACDIS)
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VALIDATE the accuracy of coding (coder/CAC), abstraction and grouping of cases with moderate to advanced clinical complexityAssessment StrategiesCoding case study or medical recordCriteriaresolve coding, grouping, and abstracting discrepanciesdetermine the root cause of coding errorsevaluate the financial impact of coding errorsprovide recommendation to improve coding, abstraction and grouping quality
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PREPARE compliant physician queriesAssessment StrategiesCoding case study or medical recordCriteriaidentify scenarios that require a physician queryquery complies with regulatory guidelines (e.g., AHIMA, ACDIS, CMS)