Course

10-530-165 Intermediate 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 (Course Outcomes)
  1. ASSIGN reportable diagnosis and procedure codes for cases with moderate to advanced clinical complexity
    Assessment Strategies
    Coding case study or medical record
    Criteria
    code assignment is supported by medical documentation
    multiple codes are sequenced to ensure maximum allowable reimbursement
    code assignment and sequencing complies with official coding guidelines/conventions and reimbursement rules
    code assignment and sequencing complies with national standards of ethical coding (e.g., AHIMA, AAPC, ACDIS)

  2. INTERPRET coding advice (Coding Clinic, CPT Assistant, Clinical indicators, etc.) in the process of coding cases with moderate to advanced clinical complexity
    Assessment Strategies
    Coding case study or medical record
    Criteria
    identify all pertinent guidance for the given scenario
    apply the guidance for the given scenario
    code assignment and sequencing complies with official coding guidance/conventions and reimbursement rules

  3. ABSTRACT data elements for the purpose of coding, reimbursement, and data collection
    Assessment Strategies
    Coding case study or medical record
    Criteria
    abstract is complete
    abstracted data is accurate
    abstracted data complies with reporting and reimbursement guidelines

  4. PERFORM coding and grouping processes using electronic applications for cases with moderate to advanced clinical complexity
    Assessment Strategies
    Coding case study or medical record
    Criteria
    code assignment is supported by medical documentation
    multiple codes are sequenced to ensure maximum allowable reimbursement
    code assignment and sequencing complies with official coding guidelines/conventions and reimbursement rules
    code assignment reflects application of national standards of ethical coding (e.g., AHIMA, AAPC, ACDIS)

  5. VALIDATE the accuracy of coding (coder/CAC), abstraction and grouping of cases with moderate to advanced clinical complexity
    Assessment Strategies
    Coding case study or medical record
    Criteria
    resolve coding, grouping, and abstracting discrepancies
    determine the root cause of coding errors
    evaluate the financial impact of coding errors
    provide recommendation to improve coding, abstraction and grouping quality

  6. PREPARE compliant physician queries
    Assessment Strategies
    Coding case study or medical record
    Criteria
    identify  scenarios that require a physician query
    query complies with regulatory guidelines (e.g., AHIMA, ACDIS, CMS)