HITT 1342 - Ambulatory Coding

HITT 1342:

Description

Fundamentals of ambulatory coding rules, conventions, and guidelines.

Corequisites

BIOL 2404, HITT1305

Semester Offered
Spring semester only
Credits 3 Lecture Hours 2 Lab Hours 2
Extended Hours
0
Contact Hours
64
State Approval Code
5107130000
Alternate Operations During Campus Closure

In the event of an emergency or announced campus closure due to a natural disaster or pandemic, it may be necessary for Panola College to move to altered operations. During this time, Panola College may opt to continue delivery of instruction through methods that include, but are not limited to: online learning management system (CANVAS), online conferencing, email messaging, and/or an alternate schedule. It is the responsibility of the student to monitor Panola College's website (www.panola.edu) for instructions about continuing courses remotely, CANVAS for each class for course-specific communication, and Panola College email for important general information.

Class Attendance

Regular and punctual attendance of classes and laboratories is required of all students. When a student has been ill or absent from class for approved extracurricular activities, he or she should be allowed, as far as possible, to make up for the missed work. If a student has not actively participated by the census date, they will be dropped by the instructor for non-attendance. This policy applies to courses that are in-person, online, hybrid, and hyflex.

Attendance in online courses is determined by submission of an assignment or participation in an activity. According to federal guidelines, simply logging into a distance learning course without participating in an academic assignment does not constitute attendance. Distance learning is defined as when a majority (more than 50%) of instruction occurs when the instructor and students are in separate physical locations. Students must engage in an academic activity prior to the course census date. 

When an instructor feels that a student has been absent to such a degree as to invalidate the learning experience, the instructor may recommend to the Vice President of Instruction that the student be withdrawn from the course. Instructors may seek to withdraw students for non-attendance after they have accumulated the following number of absences: 

Fall or spring semesters: 

3 or more class meeting times per week - 5 absences

2 class meeting times per week - 3 absences

1 class meeting per week -  2 absences

The student is responsible for seeing that he or she has been officially withdrawn from a class. A student who stops attendance in a class without officially withdrawing from that class will be given a failing grade; consequently, the student must follow official withdrawal procedures in the Admissions/Records Office.

Please note: Health Science and Cosmetology courses may require more stringent attendance policies based on their accreditation agencies. Please see the addendum and/or program handbook for further information concerning attendance.  

Pregnant/Parenting Policy

Panola College welcomes pregnant and parenting students as a part of the student body. This institution is committed to providing support and adaptations for a successful educational experience for pregnant and parenting students. Students experiencing a need for accommodations related to pregnancy or parenting will find a Pregnancy and Parenting Accommodations Request form in the Student Handbook or may request the form from the course instructor.

Instructional Goals and Purposes

The purpose of this course is to provide students with knowledge of how to accurately report ambulatory procedure codes through the application of official coding guidelines. Upon successful completion of this course, students will have achieved the goal of being able to effectively identify, understand, and utilize medical codes as they will be applicable to outpatient hospital reimbursement in the field of health care.

Learning Outcomes
  1. Apply nomenclatures and classification systems and assign codes.
  2. Discuss the format and conventions for CPT/HCPCS and successfully complete class assignments have exercises, and exams.
  3. Identify and apply current coding practices for CPT-4.
Specific Course Objectives (includes SCANS)

After studying all materials and resources presented in the course, the student will be able to:

*Lab objectives are in italics.

  1. Discuss the format and conventions for CPT/HCPCS and successfully complete class assignments, exercises, and exams. (SCANS 1a-iv. 1a-v. 1bi. 1bii. 1b-iii. 1b-iv. 1b-v. 1c-i. 1c-ii. 1c-iii. 1c-iv. 1c-v. 2a-i. 2a-iii. 2b-i. 2b-ii. 2b-iv. 2b.vi. 2c-i. 2c-ii. 2c-iii. 2c-iv.)
    1. Discuss CPT coding rules and the basic CPT coding guidelines
    2. Distinguish between CPT Codes and National Codes
    3. Identify the purpose and uses of CPT
    4. Identify the official publication for CPT coding
    5. Differentiate between CPT and ICD-10-CM/PCS
    6. Identify the contents of CPT: sections, subsections, subcategory, etc.
    7. Differentiate between Category I, Category II, and Category III CPT codes
    8. Discuss the purpose of modifiers and state the uses of modifiers for surgical procedures
  2. Identify and apply current coding practices for CPT-4. (SCANS 1a-iv. 1a-v. 1bi. 1b-ii. 1b-iii. 1b-iv. 1b-v. 1c-i. 1c-ii. 1c-iii. 1c-iv. 1c-v. 2a-i. 2a-iii. 2b-i. 2b-ii. 2b-iv. 2b-vi. 2c-i. 2c-ii. 2c-iii. 2c-iv.)
    1. Demonstrate ability to identify and apply basic CPT coding steps by correctly abstracting pertinent clinical information from operative reports
    2. Demonstrate ability to identify and apply basic CPT coding guidelines by correctly referencing official coding guidelines to support accurate code assignment
    3. Demonstrate ability to identify and apply basic CPT coding steps by appropriately appending a CPT code with the correct modifier, as applicable
    4. Demonstrate ability to code specific types of ambulatory services, which include the following:
      1. Surgery
        1. List components of a surgical package
        2. Distinguish between the CPT definitions of surgical package and Medicare definition
        3. Define National Correct Coding Initiative
        4. Identify guidelines for coding surgical procedures
        5. Differentiate between simple, intermediate, and complex wound repairs
        6. Differentiate between surgical and diagnostic endoscopies
      2. Radiology, Pathology, and Laboratory, Medicine, Anesthesia
        1. Assign modifiers associated with radiological procedures
        2. Discuss the appropriate use of organ or disease oriented panels
        3. Discuss guidelines to identify injections and infusions
        4. Discuss the need for “qualifying circumstances” and “physical status” codes and apply the codes to anesthesiology records
        5. Identify that a procedure/service has been successfully assigned CPT codes for all of the above listed ambulatory services
      3. HCPCS Level II
        1. Identify the structure of HCPCS Level II codes
        2. Discuss the general guidelines for HCPCS Level II coding assignment
      4. Evaluation and Management Services
        1. Differentiate between a new and established patient
        2. Identify the components listed included in the descriptions for the levels of E/M services
        3. Assign appropriate E/M codes, when provided with a case scenario

After studying all materials and resources presented in the course, the student will be able to:

  1. Chapter 2
    1. Define key terms.
    2. Explain the purpose of diagnosis coding.
    3. Explain the purpose of procedure coding.
    4. Apply correctly the steps to accurate coding.
    5. Abstract documentation thoroughly.
    6. Use official guidelines to apply the best, mode accurate code.
    7. Interpret notations and symbols to code accurately.
  2. Chapter 3
    1. Define key terms.
    2. Determine when a modifier is required.
    3. Apply personal modifiers per the guidelines.
    4. Correctly use anesthesia physical status modifiers.
    5. Implement HCPCS modifiers correctly.
    6. Append multiple modifiers in the proper sequence.
    7. Identify circumstances that require a supplemental report.
  3. Chapter 4
    1. Define key terms.
    2. Abstract documentation to identify the location of the encounter.
    3. Distinguish between new and established patients.
    4. Calculate the appropriate level of service.
    5. Determine when to report prolonged services.
    6. Ascertain the appropriate way to report a consultation.
    7. Determine the appropriate level of medical decision making provided by the physician.
  4. Chapter 5
    1. Define key terms.
    2. Apply the guidelines for coding different types of evaluation and management services.
    3. Determine the most accurate long-term care service codes.
    4. Abstract the physician’s notes to determine the correct nursing facility service code.
    5. Calculate the correct code or codes for critical care services.
    6. Apply evaluation and management modifiers correctly.
  5. Chapter 6
    1. Define key terms.
    2. Interpret the types of anesthesia as they relate to the coding process.
    3. Correctly apply the guidelines for proper anesthesia coding.
    4. Apply the formula for suing time to report anesthesia services.
    5. Correctly use qualifying circumstances add-on codes.
    6. Properly report the administration of moderate (conscious) sedation.
    7. Abstract the notes to determine the correct physical status modifiers.
  6. Chapter 7
    1. Define key terms.
    2. Distinguish among the types of surgical procedures.
    3. Determine which services are included in the global surgical package.
    4. Interpret the impact on coding of the global time frames.
    5. Identify unusual services and treatments and report them accurately.
    6. Apply the guidelines to determine the meaning of a separate procedure.
    7. Abstract physician documentation of procedures on the integumentary system.
  7. Chapter 8
    1. Define key terms.
    2. Correctly apply the guidelines for coding procedures on the musculoskeletal system. Recognize the details required to accurately report procedures on the respiratory system.
    3. Identify guidelines to direct reporting services to the cardiovascular system.
    4. Distinguish the various procedures on the digestive system.
    5. Ascertain the elements of coding services to the urinary system.
    6. Determine how to accurately report procedures to the male genital system.
    7. Apply the guidelines to report procedures to the female genital system.
    8. Interpret documentation to accurately report procedures on the nervous system.
    9. Recognize the necessary details to report procedures on the eye and ocular adnexa.
    10. Report accurately procedures on the auditory system.
  8. Chapter 9
    1. Define key terms.
    2. Distinguish between technical components from professional components.
    3. Correctly apply guidelines regarding screening versus diagnostic services.
    4. Apply the guidelines to determine how to code the administration of contrast materials.
    5. Recognize diagnostic radiologic services.
    6. Decide when to code radiation treatments.
    7. Determine how to accurately report nuclear medicine services.
  9. Chapter 10
    1. Define key terms.
    2. Translate the guidelines for accurately coding clinical chemistry procedures.
    3. Apply the in-section guidelines regarding molecular diagnostic testing.
    4. Correctly apply guidelines for reporting hematology and coagulation tests.
    5. Discern cytopathology and cytogenetic studies.
    6. Interpret the guidelines for accurately coding surgical pathology.
    7. Determine how and when to use modifiers.
  10. Chapter 11
    1. Define key terms.
    2. Interpret the guidelines for coding the administration of immunizations.
    3. Apply the guidelines to accurately report injections and infusions.
    4. Determine the correct coding parameters for reporting psychiatric services.
    5. Abstract physicians’ notes to accurately report dialysis services.
    6. Identify specifics to correctly report ophthalmology services.
    7. Determine how to accurately report cardiovascular services.
  11. Chapter 13
    1. Define key terms.
    2. Identify the scope of categories reported with HCPCS Level II codes.
    3. Correctly use the alphabetic index within HCPCS Level II codes.
    4. Confirm codes suggested by the index in the alphanumeric listing.
    5. Interpret the meanings of the notations and symbols.
    6. Apply the additional information provided by the appendixes.
Course Content

Students in all sections of Ambulatory Coding will be required to do the following:

  1. Students will demonstrate knowledge of course material by completing course examinations given over lecture and textbook material.
  2. Students will complete all daily assignments as instructed.
Methods of Instruction/Course Format/Delivery

This class is delivered entirely online. You will use the Canvas Learning Management System to access all materials and assignments for this course. The resources provided, for this class, through Canvas include:

  • A calendar displaying assignments each week
  • Email (totally contained within Canvas)
  • Announcements
  • Grades
  • Learning Modules
  • Assignments
  • Quizzes
  • Major exams

Assignments

  1. Homework assignments for chapters 1,2,3,4,5,6,7,8,9,10,11,13
  2. Quizzes for chapters 2,3,4,5,6,7,8,9,10,11,13
  3. Case Study assignment

Assessments

  1. 3 Major Exams
  2. Final Exam
Course Grade

The grading scale for this course is as follows:

  • Assignments – 20%
  • Quizzes – 10%
  • Major Exams – 40%
  • Final Exam – 30%
Texts Materials, and Supplies
  • Safian, Shelley C. and Johnson, Mary A., The Complete Procedure Coding Solution, 3rd Edition, McGraw Hill Education, ISBN 978-0-07-802071-1
  • American Medical Association, CPT 2021 Professional Edition, ISBN 9781640160491
Required Readings
  • Safian, Shelley C. and Johnson, Mary A., The Complete Procedure Coding Solution, 3rd Edition, McGraw Hill Education, ISBN 978-0-07-802071-1
  • American Medical Association, CPT 2021 Professional Edition, ISBN 9781640160491
Recommended Readings
  • Medical Dictionary
Other
SCANS Criteria
  1. Foundation skills are defined in three areas: basic skills, thinking skills, and personal qualities.
    1. Basic Skills: A worker must read, write, perform arithmetic and mathematical operations, listen, and speak effectively. These skills include:
      1. Reading: locate, understand, and interpret written information in prose and in documents such as manuals, graphs, and schedules.
      2. Writing: communicate thoughts, ideas, information, and messages in writing, and create documents such as letters, directions, manuals, reports, graphs, and flow charts. 
      3. Arithmetic and Mathematical Operations: perform basic computations and approach practical problems by choosing appropriately from a variety of mathematical techniques.
      4. Listening: receive, attend to, interpret, and respond to verbal messages and other cues.
      5. Speaking: Organize ideas and communicate orally.
    2. Thinking Skills: A worker must think creatively, make decisions, solve problems, visualize, know how to learn, and reason effectively. These skills include:
      1. Creative Thinking: generate new ideas.
      2. Decision Making: specify goals and constraints, generate alternatives, consider risks, and evaluate and choose the best alternative.
      3. Problem Solving: recognize problems and devise and implement plan of action.
      4. Visualize ("Seeing Things in the Mind's Eye"): organize and process symbols, pictures, graphs, objects, and other information.
      5. Knowing How to Learn: use efficient learning techniques to acquire and apply new knowledge and skills.
      6. Reasoning: discover a rule or principle underlying the relationship between two or more objects and apply it when solving a problem.
    3. Personal Qualities: A worker must display responsibility, self-esteem, sociability, self management, integrity, and honesty.
      1. Responsibility: exert a high level of effort and persevere toward goal attainment.
      2. Self-Esteem: believe in one's own self-worth and maintain a positive view of oneself.
      3. Sociability: demonstrate understanding, friendliness, adaptability, empathy, and politeness in group settings.
      4. Self-Management: assess oneself accurately, set personal goals, monitor progress, and exhibit self-control.
      5. Integrity and Honesty: choose ethical courses of action.
  2. Workplace competencies are defined in five areas: resources, interpersonal skills, information, systems, and technology.
    1. Resources: A worker must identify, organize, plan, and allocate resources effectively.
      1. Time: select goal-relevant activities, rank them, allocate time, and prepare and follow schedules.
      2. Money: Use or prepare budgets, make forecasts, keep records, and make adjustments to meet objectives.
      3. Material and Facilities: Acquire, store, allocate, and use materials or space efficiently. Examples: construct a decision timeline chart; use computer software to plan a project; prepare a budget; conduct a cost/benefits analysis; design an RFP process; write a job description; develop a staffing plan.
    2. Interpersonal Skills: A worker must work with others effectively.
      1. Participate as a Member of a Team: contribute to group effort.
      2. Teach Others New Skills.
      3. Serve Clients/Customers: work to satisfy customer's expectations.
      4. Exercise Leadership: communicate ideas to justify position, persuade and convince others, responsibly challenge existing procedures and policies.
      5. Negotiate: work toward agreements involving exchange of resources, resolve divergent interests.
      6. Work with Diversity: work well with men and women from diverse backgrounds. Examples: collaborate with a group member to solve a problem; work through a group conflict situation, train a colleague; deal with a dissatisfied customer in person; select and use appropriate leadership styles; use effective delegation techniques; conduct an individual or team negotiation; demonstrate an understanding of how people from different cultural backgrounds might behave in various situations.
    3. Information: A worker must be able to acquire and use information.
      1. Acquire and Evaluate Information.
      2. Organize and Maintain Information.
      3. Interpret and Communicate Information.
      4. Use Computers to Process Information. Examples: research and collect data from various sources; develop a form to collect data; develop an inventory record-keeping system; produce a report using graphics; make an oral presentation using various media; use on-line computer databases to research a report; use a computer spreadsheet to develop a budget.
    4. Systems: A worker must understand complex interrelationships.
      1. Understand Systems: know how social, organizational, and technological systems work and operate effectively with them.
      2. Monitor and Correct Performance: distinguish trends, predict impacts on system operations, diagnose deviations in systems' performance and correct malfunctions.
      3. Improve or Design Systems: suggest modifications to existing systems and develop new or alternative systems to improve performance. Examples: draw and interpret an organizational chart; develop a monitoring process; choose a situation needing improvement, break it down, examine it, propose an improvement, and implement it.
    5. Technology: A worker must be able to work with a variety of technologies.
      1. Select Technology: choose procedures, tools or equipment including computers and related technologies.
      2. Apply Technologies to Task: understand overall intent and proper procedures for setup and operation of equipment.
      3. Maintain and Troubleshoot Equipment: Prevent, identify, or solve problems with equipment, including computers and other technologies. Examples: read equipment descriptions and technical specifications to select equipment to meet needs; set up and assemble appropriate equipment from instructions; read and follow directions for troubleshooting and repairing equipment.