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HIM 122 Coding III

This is the third 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. This course focuses on coding from complex case scenarios and emphasizes the reimbursement impact of coding as well as auditing for correct coding and reimbursement.

Credits

3

Prerequisite

Prerequisite: HIM 121

See Course Syllabus

Course Number and Title:

HIM 122 Coding III

Campus Location

  • Wilmington

Prerequisites

Prerequisite: HIM 121

Course Credits and Hours

3 credit(s)

2 lecture hours/week

2 lab hours/week

Course Description

This is the third 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. This course focuses on coding from complex case scenarios and emphasizes the reimbursement impact of coding as well as auditing for correct coding and reimbursement.

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. Analyze the documentation in the health record to ensure it supports the diagnosis and reflects the patient's progress, clinical findings, and discharge status. (CCC 1; HIM PGC 1, 5, 6)
  3. Develop appropriate physician queries to resolve data and coding discrepancies. (CCC 1; HIM PGC 1, 6)
  4. Apply diagnostic and/or procedural groupings. (CCC 1; HIM PGC 1, 6)
  5. Evaluate the accuracy of diagnostic and/or procedural coding and grouping. (CCC 1; HIM PGC 1, 5, 6)
  6. Analyze current regulations and established guidelines in clinical classification systems in order to adhere to the legal, regulatory, and ethical requirements related to coding quality monitoring, compliance strategies, and reporting. (CCC 1; HIM PGC 5, 6)
  7. Evaluate the accuracy of computer-assisted coding (CAC) assignments, and recommend corrective action. (CCC 1; HIM PGC 1, 5, 6)
  8. Evaluate 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. Read an inpatient health record in order to determine what diagnosis and procedures are to be coded. Given an inpatient record:
      1. Review the record to obtain an understanding of the case.
      2. Identify the principal diagnosis.
      3. Identify any secondary diagnoses.
      4. Identify the principal procedure or service.
      5. Identify any additional procedures or services.
      6. Associate each identified procedure with the diagnosis that justified it.
      7. Identify the rules, conventions, instructions, and guidelines that apply to the assignment of the diagnosis codes.
      8. 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 procedure codes.
    4. 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. Analyze the documentation in the health record to ensure it supports the diagnosis and reflects the patient's progress, clinical findings, and discharge status. Given a patient record:
    1. Review all physician progress notes to determine the medical decision making.
    2. Review all physician orders to identify the plan.
    3. Trace the medical decision making and plan to resulted diagnostic testing and any procedures.
    4. Map diagnostic testing, medications, and procedures to documented diagnoses.
    5. Identify any discrepancies within the supporting documentation.
    6. Query the physician to resolve discrepancies.
  3. Develop appropriate physician queries to resolve data and coding discrepancies.
    1. Explain the role of the clinical documentation improvement process in ensuring the quality of coded data.
    2. Given discrepancies identified in 2.5, construct a physician query to obtain clarification or additional documentation.
    3. Develop a clinical documentation improvement recommendation for physician education.
  4. 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.
  5. 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.
  6. Analyze current regulations and established guidelines in clinical classification systems in order to adhere to the legal, regulatory, and ethical requirements related to coding quality monitoring, compliance strategies, and reporting.
    1. Review current Official Guidelines for Coding and Reporting.
    2. Review the most recent four quarters of Coding Clinic.
    3. Review the most recent Office of the Inspector General's work plan.
    4. Analyze the recent guidelines in 6.1, 6.2, and 6.3 for changes from previous periods.
    5. Document the changes identified in 6.3 as a recommendation for any policy or procedure changes.
  7. Evaluate the accuracy of the computer-assisted coding (CAC) assignment, and recommend corrective action.
    1. Compare the CAC assignment with final codes on cases.
    2. List and describe any discrepancies between the CAC assignment and the final codes.
    3. Review the record to determine the source of the discrepancies.
    4. Prepare a report with corrective action to prevent similar errors in the future.
  8. Evaluate coder productivity based on volume and accuracy.
    1. Collect volume productivity data: develop a productivity log sheet, record volume productivity, and summarize volume productivity.
    2. Collect accuracy data from audit reports in 4.6 above.
    3. Develop benchmarks based on historical productivity.
    4. Develop corrective action plan based on variance from benchmarks.

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

Homework exercises (20%), equally weighted

 

Formative

6.7%

Summative

13.3%

Lab assignments (summative)

25%

Additional exercises (formative)

15%

Exams (Total 40%)

 

Exam I (summative)

10%

Exam II (summative)

15%

Exam III (summative)

15%

TOTAL

100%

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

HIM 

  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

https://dtcc.smartcatalogiq.com/Current/Catalog/Search?q=attendance

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