Advanced Hospital Coding and CCS Prep (80 hours)

Course Overview/Description

This Advanced Hospital Coding Course prepares students to take the American Health Information Management Association's (AHIMA) official certification exam to become a Certified Coding Specialist (CCS). This program covers advanced ICD-9 coding procedures and is designed to help students meet the challenge of today's changing standards while learning and improving their coding skills. Click here to read a list of FAQs about CCS and CCA credentials.

Facility coding (hospital coding) is one of the best-paying sectors of the coding profession. This course is designed for coders who wish to further develop their facility coding skills.

If you are already performing some aspect of facility coding, this course will fill in the gaps so that your skills are properly rounded. This "rounding" of skills makes a more marketable employee and is essential to successful completion of the American Health Information Management Association's mastery level credentialing exam, the Certified Coding Specialist (CCS).

If you are currently working in a physician office or billing service, this course will give you the edge you need to advance in the workplace. Most hospitals will only hire coders with previous exposure to facility coding or who are already certified. Training on the job is a luxury most hospitals are unable to offer. Coders of all levels must undergo continuing education to stay current with the constantly changing regulations.

This course will utilize your existing knowledge of medical terminology and healthcare sciences. Your coding skills will be heightened and focused preparing you for employment testing, job performance, and successful completion of the CCS exam.

Course Objectives

• Understand how health information travels within departments of a facility.
  
• List the types of healthcare professionals, both administrative and clerical.
  
• Define the roles and responsibilities of a coder in both in- and out-patient facilities.
  
• Understand the standards, ethics and legal responsibilities of a coder.
  
• Learn the opportunities available for coders, and the importance of credentialing.
  
• Learn to interpret health-record documentation using knowledge of anatomy, physiology, clinical disease processes and medical terminology.
  
• Determine when additional clinical information is needed.
  
• Obtain further clinical information to assist with code assignment.
  
• Consult reference materials to facilitate code assignment.
  
• Identify patient encounter type(s) to assign codes.
  
• Identify etiology and manifestation(s) of clinical conditions.
  
• Learn the current coding and reporting requirements for inpatient services.
  
• Interpret conventions, formats, instructional notations, tables and definitions of the classification system to select diagnoses, conditions, problems, or other reasons for encounter.
  
• Sequence diagnoses and other encounter reasons according to notations and conventions of the classification system and standard data set definitions (UHDDS - Uniform Hospital Discharge Data Sets).
  
• Determine if signs, symptoms or manifestations require separate code assignments.
  
• Recognize when classification system does not provide a precise code for the condition documented (residual categories or non-classified syndromes).
  
• Select principal diagnosis, principal procedure, complications and comorbid conditions and other significant procedures that require coding according to UHDDS definitions and official coding guidelines.
  
• Evaluate the effect of code selection on Diagnosis Related Group (DRG_ assignment.
  
• Verify DRG assignment based on Prospective Payment System (PPS) definitions.
  
• Apply guidelines for bundling and unbundling of codes.
  
• Determine proper use of Modifiers, CPT vs. HCPCS Level II codes and Medical Necessity (linking diagnosis to procedure/service).
  
• Assess quality of coding.
  
• Understand reimbursement methodologies and documentation rules and regulations.
  
• Analyze health-record documentation for quality and completeness of coding.
  
• Evaluate health-record documentation to substantiate claims processing and appeals.
  
• Understand the differences between the hospital Inpatient and Outpatient Record, and identify outpatient record components.
  
• Identify the Charge Master and its components.
  
• Understand the CPT guidelines, with special emphasis on Evaluation and Management (E&M) and surgery coding.
  
• Identify coding considerations and guidelines for diagnostic tests.
  
  CODING COMPETENCIES - Hospital-based competencies
  
  A. Data identification
  1. Read and interpret health-record documentation to identify all diagnoses and procedures that affect the current inpatient stay/outpatient encounter visit.
  2. Assess the adequacy of health-record documentation to ensure that it supports all diagnoses and procedures to which codes are assigned.
  3. Apply knowledge of anatomy and physiology, clinical disease processes, pharmacology, and diagnostic and procedural terminology to assign accurate codes to diagnoses and procedures.
  4. Apply knowledge of disease processes and surgical procedures to assign non-indexed medical terms to the appropriate class in the classification/nomenclature system.
  
  
  B. Coding guidelines
  
  1. Apply knowledge of current approved "ICD-9-CM Coding and Reporting Official Guidelines" to assign and sequence the correct diagnosis and procedure codes for hospital inpatient services.
  2. Apply knowledge of current "Diagnostic Coding and Reporting Guidelines for Outpatient Services".
  3. Apply knowledge of CPT format, guidelines, and notes to locate the correct codes for all services and procedures performed during the encounter/visit and sequence them correctly.
  4. Apply knowledge of procedural terminology to recognize when an unlisted procedure code must be used in CPT.
  
  
  C. Regulatory guidelines
  1. Apply Uniform Hospital Discharge Data Set (UHDDS) definitions to select the principal diagnosis, principal procedure, complications and comorbid conditions, other diagnoses and significant procedures which require coding.
  2. Select the appropriate principal diagnosis for episodes of care in which determination of principal diagnosis is not clear because the patient has multiple problems.
  3. Apply knowledge of the Prospective Payment System to confirm DRG assignment which accurately reflects the occurrence of events and ensures appropriate reimbursement.
  4. Refuse to fraudulently maximize reimbursement by assigning codes that do not conform to approved coding principles/guidelines.
  5. Refuse to unfairly maximize reimbursement by unbundling services and codes that do not conform to basic coding principles and the National Correct Coding Initiative (CCI).
  6. Apply knowledge of the Ambulatory Surgery Center (ASC) Payment Groups to confirm ASC assignment which ensures appropriate reimbursement.
  7. Apply policies and procedures on health record documentation, coding, and claims processing and appeal. 8
  8. Use the HCFA Common Procedural Coding System (HCPCS) to appropriately assign HCPCS codes for outpatient Medicare reimbursement.
  
  
  D. Coding
  1. Exclude from coding those diagnoses, conditions, problems, and procedures related to an earlier episode of care which have no bearing on the current episode of care.
  2. Exclude from coding those ICD-9-CM nonsurgical, noninvasive procedures which carry no operative or anesthetic risk.
  3. Exclude from coding information such as symptoms or signs characteristic of the diagnosis, findings from diagnostic studies, or localized conditions, which have no bearing on the current management of the patient.
  4. Apply knowledge of ICD-9-CM instructional notations and conventions to locate and assign the correct diagnosis and procedural codes and sequence them correctly.
  5. Facilitate data retrieval by recognizing when more than one code is required to adequately classify a given condition.
  6. Exclude from coding those procedures which are component parts of an already assigned CPT procedure code.
  
  
  E. Data quality
  1. Clarify conflicting, ambiguous, or nonspecific information appearing in a health record by consulting the appropriate physician.
  2. Participate in quality assessment to ensure continuous improvement in ICD-9-CM and CPT coding and collection of quality health data.
  3. Demonstrate ability to recognize potential coding quality issues from an array of data.
  4. Apply policies and procedures on health-record documentation and coding that are consistent with official coding guidelines.
  5. Contribute to development of facility-specific coding policies and procedures.

Course Outline

I. Introduction

II. Facility Orientation

1. Introduction
2. Objectives
3. Table of Contents
4. Reading
5. Assignments
6. Information Flow
7. Hospital Overview
8. Facility Records
9. Reimbursement
10. Ethics
11. HIPAA
12. Section Test
13. References

III. Health Care Facility Medical Records

1. Introduction
2. Objectives
3. Table of Contents
4. Reading
5. Assignments
6. Definition of Medical Record
7. Documentation in the Medical Record
8. Legalities
9. Test
10. References

IV. Diagnosis Related Groups

1. Introduction
2. Objectives
3. Table of Contents
4. Reading
5. Assignments
6. Glossary
7. Overview
8. DRG
9. Test
10. References

V. Using the Guidelines/Inpatient Coding

1. Introduction
2. Objectives
3. Table of Contents
4. Reading
5. Assignments
6. Coding Guidelines
7. General Guidelines
8. Infections
9. Neoplasms
10. Circulatory
11. Pregnancy/Childbirth
12. Injury
13. Poisoning
14. V-Codes
15. Principal Diagnosis
16. Additional Diagnoses
17. References

VI. Outpatient Coding Guidelines

1. Introduction
2. Objectives
3. Table of Contents
4. Reading
5. Assignments
6. Outpatient Record
7. 72 Hour Rule
8. Outpatient System
9. CPT-4
10. Reference

VII. Prepare for the CCS Exam

1. Introduction
2. Objectives
3. Table of Contents
4. Reading
5. Assignments
6. Procedure Coding
7. Diabetes Mellitus
8. System Specifics
9. Psychometrics
10. Final Practice
11. Additional Preparation
12. References

Prerequisites/Audience

The Advanced Hospital course is not an entry-level course. This course is designed specifically for students with previous coding experience, previous education, or the GES Administrative Medical Specialist course.

Advanced Hospital Coding students should have:

• High school diploma/GED
• Minimum 2 years experience with:
  1. Medical Terminology
  2. Anatomy, Physiology, Pathology
  3. ICD-9-CM coding
  4. CPT-4 coding
  
  The intended audience for this course is the student who is seeking preparation for national certification or the student who wants to enhance their coding skills in order to become more marketable in the workplace.

PC Requirements/Materials Included

This course is compatible with Windows Vista Operating System.

This course can be taken on either a Mac or a PC; however, most medical offices currently use PCs.

GES will provide you with the textbooks you need for this course. You will receive Faye Brown's Coding Handbook and Workbook. GES will provide you with a current copy of AHIMA's Clinical Coding Workout: Practice Exercises for Skill Development to help you further prepare for the CCS Exam. As a current coder seeking more in-depth knowledge, you should already have a set of coding books. They are not provided by GES. You are expected to have your own current year CPT, HCPCS, and ICD-9-CM (Volumes I, II, and III) coding books.

Instructor Bio

Carline Dalgleish has been employed in the Allied Healthcare profession since 1970. She began in the Medical Records department of the Army/Air Force Hospital in Nuremberg, Germany and moved "through the ranks" over the years, performing insurance billing, coding and accounts receivable management services for physicians, clinics, hospitals and even the Healthcare Financing Administration (now CMS). She has real-time experience in physician and hospital coding, as well as management experience in compliance, information technology and services and procedural and diagnostic coding instruction.

In the early 90's, Ms. Dalgleish moved full-time into curriculum development, teaching and management of allied health-education programs, with special emphasis on Medical Billing and Coding.

She is a Certified Medical Assistant - Administrative, a licensed practical nurse, and holds a Bachelor's degree in Business Information Systems. She is a member of the National Dean's Scholars List, AHIMA, PAHCOM, AAMA, AAPC, CCST, AAMT and AMTIE. She currently owns and operates COUGAR-Ed.net, which specializes in development and delivery of continuing education products, seminars and services.

Frequently Asked Questions (FAQs)

1. How do I register?
Click on the register button at the top of the page and follow the directions. It is important that you type all your information in the boxes, then print it out to sign.  Payment and sending instructions are in the bottom right corner of the form.

2. How much do the courses cost?
The fee is in the pink box at the top of the page.

3. Can I register for courses if I live outside the United States?
Yes you can!

4. Do I ever have go to the school I register with?
All of our courses are delivered entirely online, so you never have to go to a class or travel to the school.

5. How long does it take to complete a course?
All of our courses are self-paced and open enrollment. You can start and finish the course at your own pace. When you register for a course, you are given 180 days (6 months) to complete the course. If you need more time, extensions are available.

6. Do I have to buy additional materials?
If you do not have access to current coding books, you will be responsible for obtaining them. Students who sit for the CCS exam will be responsible for paying AHIMA's examination fee.

7. Does this course prepare for National Certification?
Yes, the Advanced Hospital Coding course prepares students to sit for the Certified Coding Specialist exam offered by AHIMA.

8. Can I get financial aid?
GES courses are non-credit courses, so they do not qualify for federal aid. In some states, vocational rehab or workforce development boards will pay for qualified students to take our courses.

• GES provides a loan opportunity for students. Simply go to www.collegeloanapplication.com to apply for an easier qualifying loan at a slightly higher rate. Click here for more information on this loan program.

9. What happens when I complete the course?
Upon successful completion of the course, you will be awarded a certificate of completion from the school you registered with. You must obtain a final passing grade of 70% or greater to be awarded a certificate.

10. Am I guaranteed a job?
GES courses will provide you with the skills you need to obtain an entry-level position in most cases. We do not provide direct job placement services, but our instructors will help you build your resume and are available to give advice on finding your first job. Instructors will also be available to use as a professional reference upon completion of the course. Potential students should always do research on the job market in their area before registering.

11. Who will be my instructor?
Each student is paired up with a facilitator for one-on-one interaction. The facilitator will be available (via email or phone) to answer any questions you may have and to provide feedback on your performance. All of our facilitators are successful working professionals in the fields in which they teach.

12. What do I have to have in order to take an online course, and what are the system requirements?
In order to take our online courses, you must have access to a computer and the Internet (a dial-up connection is fine). You can access the course contents from any Web-enabled computer. There are no necessary plug-ins. You do not have to use the same computer to log in to the course every time. We recommend that you have a word-processing program (Microsoft Word is best) and the latest version of Internet Explorer.

13. Can this course be taken on a Mac?
Yes.

14. How can I get more information on the course?
All of the information we have is available online under our course catalog (www.gatlineducation.com). If you have questions that are not answered online, please feel free to email us at courseinfo@gatlineducation.com or call 817-870-2870. We will answer your questions promptly.

15. When can I start the course?
Our courses are all open enrollment. You can register and start the course as soon as you are ready.