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HIM 121 Coding II

This is the second course in a three-course sequence. Principles and guidelines are reinforced for using the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM), International Classification of Diseases, Tenth Revision, Procedure Coding System (ICD-10-PCS), and Current Procedural Terminology/Healthcare Common Procedure Coding System (CPT/HCPCS) systems to assign and correctly sequence codes in outpatient and inpatient settings. Emphasis is placed on the coding guidelines for assigning and sequencing codes and coding and sequencing both diagnoses and procedures from case scenarios.

Credits

3

Prerequisite

Prerequisite: HIM 120 and HIM 135

See Course Syllabus

Course Number and Title:

HIM 121 Coding II

Campus Location

  • Wilmington

Effective Date

2022-51

Prerequisites

Prerequisite: HIM 120 and HIM 135

Course Credits and Hours

3 credit(s)

2 lecture hours/week

2 lab hours/week

Course Description

This is the second course in a three-course sequence. Principles and guidelines are reinforced for using the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM), International Classification of Diseases, Tenth Revision, Procedure Coding System (ICD-10-PCS), and Current Procedural Terminology/Healthcare Common Procedure Coding System (CPT/HCPCS) systems to assign and correctly sequence codes in outpatient and inpatient settings. Emphasis is placed on the coding guidelines for assigning and sequencing codes and coding and sequencing both diagnoses and procedures from case scenarios.

Additional Materials

Allied Health/Science Department Program Student Policy Manual

Health Information Management Program Policy Manual

Instructor Handouts

Required Text(s)

Obtain current textbook information by viewing the campus bookstore - https://www.dtcc.edu/bookstores online or visit a campus bookstore. Check your course schedule for the course number and section.

Disclaimer

AHIMA Virtual Lab and Neehr Perfect EHR are used for this course

Core Course Performance Objectives (CCPOs)

  1. Apply ICD-10-CM diagnosis codes, ICD-10-PCS procedure codes, CPT procedure codes, or HCPCS service code, given an outpatient health record. (CCC 1; HIM PGC 1, 6)
  2. Develop appropriate physician queries to resolve data and coding discrepancies. (CCC 1; HIM PGC 1, 6)
  3. Apply diagnostic and/or procedural groupings. (CCC 1; HIM PGC 1, 6)
  4. Evaluate the accuracy of diagnostic and/or procedural coding and grouping. (CCC 1; HIM, PGC 1, 5, 6)
  5. Adhere to ethical standards of coding practice and the legal and regulatory requirements related to coding quality monitoring, compliance strategies, and reporting. (CCC 1; HIM PGC 1, 5, 6)
  6. Calculate coder productivity based on volume and accuracy. (CCC 2; HIM PGC 1, 5)

See Core Curriculum Competencies and Program Graduate Competencies at the end of the syllabus. CCPOs are linked to every competency they develop.

Measurable Performance Objectives (MPOs)

Upon completion of this course, the student will:

  1. Apply ICD-10-CM diagnosis codes, ICD-10-PCS procedure codes, CPT procedure codes, or HCPCS service code, given an outpatient health record.
    1. Given an outpatient health record, determine what diagnosis and procedures are to be coded.
      1. Read the record to obtain an understanding of the case.
      2. Identify the reason for visit.
      3. Identify the primary diagnosis.
      4. Identify any secondary diagnoses.
      5. Identify the primary procedure or service.
      6. Identify any additional procedures or services.
      7. Associate each identified procedure with the diagnosis that justified it.
      8. Identify the rules, conventions, instructions, and guidelines that apply to the assignment of the diagnosis codes.
      9. Identify the rules, conventions, instructions, and guidelines that apply to the assignment of the procedure codes.
    2. Assign the ICD-10-CM diagnosis codes.
    3. Assign the ICD-10-PCS, CPT, or HCPCS procedure and service codes.
    4. Identify local coverage determinations (LCDs) that pertain to the codes being assigned to a case.
    5. Assign appropriate modifiers to a case in order to comply with National Correct Coding Initiative (NCCI) edits.
    6. Abstract the coded data into the appropriate data entry screen.
      1. Validate the demographic data.
      2. Validate the service dates based on the documentation and charges.
      3. Enter the coded data into the computer.
  2. Develop appropriate physician queries to resolve data and coding discrepancies.
    1. Given an outpatient record, identify any discrepancies between supporting documentation and coded data.
    2. Explain the role of the clinical documentation improvement process in ensuring the quality of coded data.
    3. Construct a physician query to obtain clarification or additional information.
  3. Apply diagnostic and/or procedural groupings.
    1. Validate the demographic data.
    2. Validate the service dates based on the documentation and charges.
    3. Enter the coded data into the grouper software.
    4. Apply the grouper edit function to determine the optimum group assignment.
  4. Evaluate the accuracy of diagnostic and/or procedural coding and grouping.
    1. Review the record.
    2. Validate the codes.
    3. Re-group the case using appropriate software.
    4. Develop an audit log sheet.
    5. Record audit findings.
    6. Summarize audit findings: error rate by record, error rate by code, and error rate by error type.
  5. Adhere to ethical standards of coding practice and the legal and regulatory requirements related to coding quality monitoring, compliance strategies, and reporting.
    1. Given a case scenario, describe the ethical issues presented.
    2. Describe the legal and regulatory requirements related to coding quality monitoring, coding compliance strategies, and reporting of quality and compliance deficiencies.
  6. Calculate coder productivity based on volume and accuracy.
    1. Develop a productivity log sheet.
    2. Record volume productivity.
    3. Summarize volume productivity.

Evaluation Criteria/Policies

The grade will be determined using the Delaware Tech grading system:

90-100 = A
80-89 = B
70-79 = C
0-69 = F
Students should refer to the Catalog/Student Handbook for information on the Academic Standing Policy, the Academic Integrity Policy, Student Rights and Responsibilities, and other policies relevant to their academic progress.

Final Course Grade

Calculated using the following weighted average

Evaluation Measure

Percentage of final grade

Class Participation (Formative)

  15%

Homework Quizzes (Formative)

  20%

Test Your Knowledge (TYK) (Summative)

  20%

CPT / HCPCS Assignments (Summative)

  20%

Midterm Exam: 1 exam weighted at 10% (summative)

  10%

Final Exam: 1 exam weighted at 15% (summative)

15%

TOTAL

100%

Program Graduate Competencies (PGCs are the competencies every graduate will develop specific to his or her major)

AHTAASHIM Program Graduate Competencies:

  1. Synthesize knowledge of medical sciences, clinical classification systems, vocabularies, and terminologies to effectively use, apply, and interpret health data.
  2. Analyze data to identify trends through the use of health information technologies.
  3. Apply legal, regulatory, privacy, and security standards to employ policies and procedures for health information collection, access, and disclosure.
  4. Synthesize knowledge of health data and payment methodologies to evaluate the efficiency and effectiveness of revenue cycle processes.
  5. Interpret regulatory, coding, legal, and clinical documentation standards to develop, implement, and evaluate compliance.
  6. Consistently demonstrate leadership through the appropriate interpretation and evaluation of professional behaviors and ethical standards.

Core Curriculum Competencies (CCCs are the competencies every graduate will develop)

  1. Apply clear and effective communication skills.
  2. Use critical thinking to solve problems.
  3. Collaborate to achieve a common goal.
  4. Demonstrate professional and ethical conduct.
  5. Use information literacy for effective vocational and/or academic research.
  6. Apply quantitative reasoning and/or scientific inquiry to solve practical problems.

Students in Need of Accommodations Due to a Disability

We value all individuals and provide an inclusive environment that fosters equity and student success. The College is committed to providing reasonable accommodations for students with disabilities. Students are encouraged to schedule an appointment with the campus Disabilities Support Counselor to request an accommodation needed due to a disability. The College's policy on accommodations for persons with disabilities can be found in the College's Guide to Requesting Academic Accommodations and/or Auxiliary Aids Students may also access the Guide and contact information for Disabilities Support Counselors through the Student Resources web page under Disabilities Support Services, or visit the campus Advising Center.

Minimum Technology Requirements

Minimum technology requirements for online, hybrid, video conferencing and web conferencing courses.

Academic Integrity

https://dtcc.smartcatalogiq.com/Current/Catalog/Academics/Academic-Integrity

Attendance

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Cell phone/Electronic Device

https://dtcc.smartcatalogiq.com/Current/Catalog/Student-Policy/Cell-Phone-and-Electronic-Device-Policy

Tuition Adjustment Policy

https://dtcc.smartcatalogiq.com/Current/Catalog/Financial/Tuition-Fee-Adjustment-Policy-Course-or-Semester-Withdrawal