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General Information

Course ID (CB01A and CB01B)
HTEC D076B
Course Title (CB02)
Advanced Medical Coding II
Course Credit Status
Credit - Degree Applicable
Effective Term
Fall 2021
Course Description
This course introduces the advanced concepts and guidelines from the (AHA) American Hospital Association, (AHIMA) American Health Information Association, and (AMA) American Medical Association: ICD-10-CM Coding Systems. (AMA) American Medical Association CPT4 (Current Procedural Terminology) and HCPCS (Healthcare Common Procedure Coding Systems) Outpatient procedure coding systems.
Faculty Requirements
Course Family
Not Applicable

Course Justification

The course is in a CTE program that was developed based on the AHA, AHIMA, and AMA. It is a major preparation requirement in the discipline for using ICD-10-CM and to define the valuable information about the organization, financing, and delivery of the health care services in this essential course. This course belongs on the Insurance and Coding Certificate of Achievement.

Foothill Equivalency

Does the course have a Foothill equivalent?
No
Foothill Course ID

Course Philosophy

Formerly Statement

Course Development Options

Basic Skill Status (CB08)
Course is not a basic skills course.
Grade Options
  • Letter Grade
  • Pass/No Pass
Repeat Limit
0

Transferability & Gen. Ed. Options

Transferability
Transferable to CSU only

Units and Hours

Summary

Minimum Credit Units
1.5
Maximum Credit Units
1.5

Weekly Student Hours

TypeIn ClassOut of Class
Lecture Hours1.02.0
Laboratory Hours1.50.0

Course Student Hours

Course Duration (Weeks)
12.0
Hours per unit divisor
36.0
Course In-Class (Contact) Hours
Lecture
12.0
Laboratory
18.0
Total
30.0
Course Out-of-Class Hours
Lecture
24.0
Laboratory
0.0
NA
0.0
Total
24.0

Prerequisite(s)

HTEC D076A

Corequisite(s)

Advisory(ies)

Limitation(s) on Enrollment

Entrance Skill(s)

General Course Statement(s)

Methods of Instruction

Lecture and visual aids

Quiz and examination reviews

Discussion of assigned reading

Lecture and visual aids

Assignments

  1. Reading:
    1. Required readings from the text as preparation for class discussion and application of concepts in written analysis
    2. Assignments from the text and supplemental sources in preparation for class discussion
  2. Writing:
    1. Assignments from student mastery manual including key terminology assessment, evaluation of performance, and critical thinking
    2. Complete worksheets that include observations, results, and critical analysis
    3. Perform laboratory procedures as outlined in the student mastery manual

Methods of Evaluation

  1. Quizzes-Objective/Subjective quizzes that test comprehension of course material on a routine basis and help identify areas that may need extra attention, evaluated using a rubric.
  2. Final Exam- Written test requiring the student to demonstrate their ability to summarize, integrate, and critically analyze concepts throughout the course, evaluated using a rubric.

Essential Student Materials/Essential College Facilities

Essential Student Materials: 
  • None.
Essential College Facilities:
  • None.

Examples of Primary Texts and References

AuthorTitlePublisherDate/EditionISBN
Buck, Carol. "Step-by-Step Medical Coding". Elsevier, 2019.
"CPT Professional Edition". American Medical Association, 2019.
"ICD-10". Optum360, 2019.
"HCPCS Level II". Optum360, 2019.

Examples of Supporting Texts and References

AuthorTitlePublisher
None.

Learning Outcomes and Objectives

Course Objectives

  • Apply CPT4/HCPCS coding conventions and national guidelines to correctly assign procedures and services codes to operative reports, clinical notes, and other medical record documentation
  • Explain the advance purpose of ICD-10-CM and CPT4/HCPCS coding Systems
  • Review the differences between billing for physicians professional services and applicable coding
  • Describe the concept of medical necessity and importance of the link between ICD-10-CM and CPT4/HCPCS in coding patient records
  • Analyze the advanced coding conventions and guidelines from AHA, AMA, and AHIMA Associations
  • Demonstrate the correct sequence of ICD-10-CM codes according to (AHA)American Hospital Association,(AMA)American Medical Association, and (AHIMA) American Health Information Management Association
  • Identify the (PPS) Prospective Payment Systems; reimbursement methodologies
  • Explain advance explanation insurance terms
  • Explain the significance of HMO's, PPO's, Medicare, IPA's MediCal, and other health plans
  • Evaluate advance hypothetical patient situations and analyze treatments information to code the diagnoses
  • Describe the advanced explanation of ethical standard practice while coding
  • Compute the generic components of the content, use and structure of health care data and data sets and how these components relate to primary and secondary diagnostic codes, and CPT codes
  • List the valuable information about the organizations financing and delivery of the health care services
  • Discuss coding knowledge in the medical reimbursement and payment systems appropriate to all health care settings (acute, ambulatory, long-term care, behavioral health) and manage care

CSLOs

  • Explain the purpose of ICD-10-CM coding systems.

Outline

  1. Apply CPT4/HCPCS coding conventions and national guidelines to correctly assign procedures and services codes to operative reports, clinical notes, and other medical record documentation
    1. Apply guidelines for procedures and service codes for operative reports
    2. List the guidelines for procedures and service codes clinical notes
  2. Explain the advance purpose of ICD-10-CM and CPT4/HCPCS coding Systems
    1. Identify patient diseases
    2. Categorize the different guidelines for inpatient and outpatient visits
  3. Review the differences between billing for physicians professional services and applicable coding
    1. Interpret the rules governing coding in various health care settings
    2. Recognize billing guidelines
  4. Describe the concept of medical necessity and importance of the link between ICD-10-CM and CPT4/HCPCS in coding patient records
    1. Explain diseases
    2. Learn procedures
  5. Analyze the advanced coding conventions and guidelines from AHA, AMA, and AHIMA Associations
    1. Evaluate the structure and conventions of the classifications
    2. Examine the structure and conventions of the general guidelines
  6. Demonstrate the correct sequence of ICD-10-CM codes according to (AHA)American Hospital Association,(AMA)American Medical Association, and (AHIMA) American Health Information Management Association
    1. Review the ten steps for coding from the electronic medical record
    2. Define the guidelines of sequencing of ICD-10-CM and CPT4 codes for outpatient visits
  7. Identify the (PPS) Prospective Payment Systems; reimbursement methodologies
    1. Practice reimbursement formulas
    2. Learn reimbursement methodologies for services rendered
  8. Explain advance explanation insurance terms
    1. Explain Medicare
    2. Describe Medicaid
    3. Identify HMO'S
    4. Name PPO's
  9. Explain the significance of HMO's, PPO's, Medicare, IPA's MediCal, and other health plans
    1. Recognize the characteristics of HMO's, IPA's, and PPO's
    2. Differentiate the characteristics between Medical, Medicare, and other insurance health plans
  10. Evaluate advance hypothetical patient situations and analyze treatments information to code the diagnoses
    1. Apply the difference of coding with ICD-10CM and CPT4 systems
    2. Analyze treatment according to different patient scenarios
  11. Describe the advanced explanation of ethical standard practice while coding
    1. Identify the regulations, certifications, and licensing requirements applicable to professional work
    2. Review and respect existing federal, state and local laws
  12. Compute the generic components of the content, use and structure of health care data and data sets and how these components relate to primary and secondary diagnostic codes, and CPT codes
    1. Recognize the content to determine the primary diagnostic code
    2. Review the content to determine the secondary diagnostic code
  13. List the valuable information about the organizations financing and delivery of the health care services
    1. List information about the organization
    2. Review information about the financing of the health care services
    3. Compare information about the delivery of health care services
  14. Discuss coding knowledge in the medical reimbursement and payment systems appropriate to all health care settings (acute, ambulatory, long-term care, behavioral health) and manage care
    1. Express knowledge in medical reimbursement and payment services in an acute setting
    2. Practice medical reimbursement and payment services for ambulatory care
    3. Comprehend medical reimbursement and payment services for long term care
    4. Examine medical reimbursement and payment services for behavioral health care

Lab Topics

  1. Coding Patient Medical Records
  2. Researching medical conditions, diagnosis by way of ICD-10 coding book
  3. Researching the procedures done for various medical procedures and finding the appropriate CPT codes
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