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the learning experience, the instructor may recommend to the Vice President of Instruction that the student be withdrawn from the course.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 medical nomenclature and classification systems, including CPT-4 and HCPCS Level II, to abstract clinical documentation and accurately assign codes for facility and professional services.
  2. Interpret and apply CPT and HCPCS format, conventions, symbols, modifiers, NCCI edits, and bundling rules to ensure correct coding and reimbursement, including professional and technical components.
  3. Utilize current CPT-4 coding practices, official coding guidance, payer-specific and regulatory resources, and coding tools to demonstrate coding proficiency through successful completion of coding exercises, assignments, and examinations.
Specific Course Objectives (includes SCANS)

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

  1. Chapter 1
    1. Define various payment methodologies used for facility and professional reimbursement
    2. Describe the hospital outpatient prospective payment system (OPPS)
    3. Describe the function of the Medicare Outpatient Code Editor in outpatient facility billing
    4. Describe Medicare reimbursement for physician services
    5. Identify ways to obtain regulatory agency and payer-specific guidelines for use in the coding and reimbursement process
    6. Apply payer-specific guidelines to coding principles so that codes are assigned correctly for each visit
  2. Chapter 2
    1. Describe the general organization of CPT
    2. Define the common symbols used in the CPT code book
    3. Explain the use of unlisted codes
    4. Interpret the conventions and characteristics of CPT
    5. Apply the general rules and guidelines for coding assignments
    6. Given an operative report, abstract pertinent clinical information
    7. Reference official coding guidance (CPT Assistant) to support an accurate coding assignment
  3. Chapter 3
    1. Describe the uses of modifiers
    2. Differentiate between facility-only and physician-only modifiers
    3. Distinguish between CPT and HCPCS Level II modifiers
    4. Explain the uses of NCCI edits
    5. Demonstrate how to use the NCCI file to research codes
    6. Given a scenario, identify the applicable modifier that may be appended to a CPT code
  4. Chapter 4
    1. Describe the format and basic contents of the Surgery section of the CPT code book and its subsections
    2. Define the surgical package and the services included in it
    3. Describe the significance of add-on codes and separate procedures in the Surgery section
    4. Describe the coding conventions specific to each subsection of the Surgery section
    5. Understand and apply the definitions pertaining to the Surgery section
    6. Assign CPT codes to given procedures within the Surgery section
    7. Determine when a procedure is a component of a larger procedure
    8. Apply modifiers to codes within the Surgery section based on documentation provided
    9. Determine when HCPCS Level II codes are required in the Surgery section
  5. Chapter 5
    1. Describe the structure of the Radiology section
    2. Define supervision, and describe its use in the Radiology section
    3. Identify the modifiers used in conjunction with radiology codes
    4. Describe the concept of component billing for professional and technical services
    5. Describe the use of a hospital chargemaster for radiological services
    6. Define the term bundling in relationship to radiology coding
    7. Define contrast
    8. Read and interpret health record documentation to identify the services provided and procedures performed
  6. Chapter 6
    1. Describe the types of codes contained in the Pathology and Laboratory section of the CPT code book
    2. Describe the methods used to locate pathology and laboratory codes in the CPT Index
    3. Distinguish between the terms quantitative and qualitative in relation to pathology and laboratory codes
    4. Identify the modifiers that are most commonly used for pathology and laboratory coding
    5. Discuss the subsections of the Pathology and Laboratory section and specific coding guidelines for given subsections
    6. Discuss specific CMS guidelines for submitting panel-testing codes
    7. Describe HCPCS Level II codes used on a temporary basis for certain disease panel testing
    8. Describe the use of a chargemaster file for billing pathology and laboratory services
  7. Chapter 7
    1. Describe the format and organization of E/M services
    2. Differentiate between a new patient and an established patient in the office or other outpatient setting
    3. Differentiate between an initial service and a subsequent service in the facility setting
    4. Identify the elements of medical decision-making (MDM)
    5. Given a scenario, assign the correct E/M code(s)
  8. Chapter 8
    1. Describe the contents and structure of the Medicine section of the CPT code book
    2. Identify conventions specific to the Immunization Injections subsection
    3. Describe the use of specialized psychiatry codes and general E/M codes for these services
    4. Identify elements used in assigning dialysis codes
    5. Discuss the use of ophthalmology codes and the services that are included and coded separately in this subsection
    6. Identify the use of special otorhinolaryngologic service codes for services performed in addition to standard evaluations
    7. Discuss the contents and use of cardiovascular codes, including diagnostic tests such as cardiac catheterizations
    8. Discuss the components of noninvasive vascular diagnostic studies
    9. Describe the services reflected in codes for allergy and clinical immunology services
    10. Identify the types of services included in the codes for central nervous system assessments and tests
    11. Describe the use of hydration, therapeutic, or diagnostic infusion or injection codes
    12. Discuss the chemotherapy administration codes and circumstances in which additional codes are appropriate to reflect services provided
    13. Describe the contents and definitions associated with codes for the Physical Medicine and Rehabilitation, Osteopathic Manipulation Treatment, and Chiropractic Manipulative Treatment subsections
    14. Discuss the contents and limitations of codes in the Special Services and Reports subsection
  9. Chapter 9
    1. Describe the Anesthesia section and its codes
    2. List the services included in the anesthesia code package and describe services that may be included in addition to the anesthesia services
    3. Define modifiers and their use with anesthesia codes
    4. Describe the anesthesia code format and the arrangement of the section
    5. Assign anesthesia codes to given cases
    6. Calculate fees for anesthesia services
    7. Assign appropriate codes for analgesia services provided by the anesthetist
  10. Chapter 10
    1. Define HCPCS codes, including their format and publishing body
    2. Identify when HCPCS codes are updated and where to find the updates
    3. Describe when HCPCS codes are used
    4. Explain the effect of HIPAA on HCPCS
    5. List the sections of HCPCS that are inappropriate for coding of professional services billed on a CMS-1500 form and explain why
    6. Describe the concept of HCPCS temporary codes
    7. Demonstrate how to assign HCPCS codes while observing the coding hierarchy
    8. Define which HCPCS codes can be billed to the Medicare contractor and which need to be billed to durable medical equipment contractors using a different provider number
    9. Describe how medications are coded using HCPCS J codes
  11. Chapter 11
    1. Define various payment methodologies used for facility and professional reimbursement
    2. Describe the hospital outpatient prospective payment system
    3. Describe the function of the Medicare Outpatient Code Editor in outpatient facility billing
    4. Describe Medicare reimbursement for physician services
    5. Identify ways to obtain regulatory agency and payer-specific guidelines for use in the coding and reimbursement process
    6. Apply payer-specific guidelines to coding principles so that codes are assigned correctly for each visit
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

100% Online courses: Students enrolled in online courses are expected to actively engage in all required online learning activities and meet established deadlines. Successful completion of the course requires regular participation, timely preparation, and consistent engagement with course content. The instructor of record will provide instruction, clarification, and academic guidance through the online learning platform. Student performance will be evaluated through a combination of online assignments, quizzes, case studies, and other course activities, including a minimum of two (2) online proctored assignments and/or examinations, as well as additional assessments as determined by the instructor.

Students will use the Canvas Learning Management System to access all course materials and assignments. The resources provided, for this course, via Canvas, include:

  • Canvas Calendar (Time-Management tool; includes all assignment dates and a URL link to integrate the calendar with any device.)
  • Inbox Messaging (Allows for centralized course-specific online communication between instructor and student.)
  • Announcements (Instructors send notifications for timely updates, reminders, and important course-specific information to all students simultaneously.)
  • Gradebooks (Canvas online tool for grad monitoring of a course-specific interactive gradebook with a comments section for instructor feedback.)
  • Learning Modules (Each course consists of weekly modules to ensure a clear, organized, sequential structure for course content.)
  • Assignments
  • Quizzes
  • Major Exams
Assignments

Assigned Chapters 1,2,3,4,5,6,7,8,9,10,11

  1. Homework Assignments*
  2. Chapter Review/Quizzes*

  3. Case Study Assignments*

    *Assigned exercises, quizzes, and/or case studies as assigned by the instructor in Canvas to include all Chapters 1-11.

Assessments
  1. Three (3) Major Exams
  2. One (1) Final Exam
Course Grade

The grading scale for this course is as follows:

  • Assignments – 20%
  • Quizzes – 20%
  • Major Exams – 30%
  • Final Exam – 30%
Texts Materials, and Supplies
  • Huey, K., Current Procedural Terminology and HCPCS Coding for Physicians and Facilities, 2026, ISBN 9781939635228
  • American Medical Association, CPT 2026 Professional Edition, ISBN 9781640163225
Required Readings
  • Huey, K., Current Procedural Terminology and HCPCS Coding for Physicians and Facilities, 2026, ISBN 9781939635228
  • American Medical Association, CPT 2026 Professional Edition, ISBN 9781640163225
Recommended Readings
  • Merck Manual Professional/Consumer Online  https://www.merckmanuals.com/home
  • Taber's or Mosby Medical Dictionary (2020 or newer version)
Other
  • Courses conducted via video conferencing may be recorded and shared for instructional purposes by the instructor.
  • For current texts and materials, use the following link to access bookstore listings: https://www.panolacollegestore.com.
  • For testing services, use the following link: https://www.panola.edu/student-services/studentsupport/academic-testing-center.
  • The Accommodations & Disability Support (A&DS) Office at Panola College provides and facilitates support services and accommodations for students with disabilities. The A&DS office works under the federal guidelines included in Section 503 of the Rehabilitation Act of 1973 and the American with Disabilities Act.  Please contact the Accommodations & Disability Support (A&DS) Office located in the Charles C. Matthews Student Center or go to https://www.panola.edu/disabilitysupport for more information.
  • Withdrawing from a course is the student’s responsibility. Students who do not attend class and who do not withdraw will receive the grade earned for the course.
  • Student Handbook: https://www.panola.edu/ (located on at the bottom under student)
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.