Course Title: Medical Coding and Billing WVEIS Code 0728

21st Century Standards Profile

Health Science Technology Education

Course Title: Medical Coding and Billing WVEIS Code 0728

Student’s Name______

School______Instructor______

Course Description: Instructional content within this course will focus on policies and procedures necessary for ICD-9-CM and CPT-4 Coding and a tutorial of the billing software known as Medical Manager. Students will utilize problem-solving techniques and participate in hands-on activities to develop an understanding of course concepts. Teachers will provide each student with real world learning opportunities and instruction related to the study of medical information management. The West Virginia Standards for 21st Century Learning include the following components: 21st Century Content Standards and 21st Century Learning Skills and Technology Tools. All West Virginia teachers are responsible for classroom instruction that integrates learning skills, technology tools, and content standards and objectives. Students are encouraged to become active members of Health Occupations Students of America (HOSA), the Career and Technical Student Organization (CTSO) for Health Science Technology Education students.

Level of Competence:

Above Mastery: The student demonstrates exceptional and exemplary performance with distinctive and sophisticated application of knowledge and skills that exceed standard. The student can independently solve problems and is self-directed.

Mastery:The student demonstrates competent and proficient performance and shows a thorough and effective application of knowledge and skills that meet standard. Application of knowledge and skills is thorough and effective and the student can work independently.

Partial Mastery: The student demonstrates basic but inconsistent performance of fundamental knowledge and skills characterized by errors and/or omissions.Performance needs further development and supervision.

Content Standards and Objectives / Above Mastery / Mastery / Partial Mastery / Date / Comments
Standard 1: ICD-9-CM Coding
Objectives / The student will
HSTE.O.MCB.1.1 / utilize the official coding principles.
HSTE.O.MCB.1.2 / use Volumes 1, 2, and 3 of the ICD-0-CM procedure codes for inpatient coding.
HSTE.O.MCB.1.3 / prioritize principal and primary diagnosis.
HSTE.O.MCB.1.4 / research reporting other (additional) diagnosis.
HSTE.O.MCB.1.5 / assign ICD-9-CM codes to the highest level of specificity.
HSTE.O.MCB.1.6 / prioritize ICD-9-CM codes.
HSTE.O.MCB.1.7 / apply ICD-9-CM guidelines and coding conventions.
HSTE.O.MCB.1.8 / apply basic coding guidelines to classifying outpatient services.
HSTE.O.MCB.1.9 / recognize the importance of physician documentation in the coding process.
HSTE.O.MCB.1.10 / relate the signature requirements component of the documentation process.
HSTE.O.MCB.1.11 / determine components of the medical chart needed for documentation in both office and hospital settings.
HSTE.O.MCB.1.12 / assess the importance of identifying documentation deficiencies.
HSTE.O.MCB.1.13 / recognize the difference between signs, symptoms, and diagnoses.
HSTE.O.MCB.1.14 / examine the reasons for the establishment of a uniform coding system.
HSTE.O.MCB.1.15 / implement correctly locating diagnoses in the ICD-9-CM code book.
HSTE.O.MCB.1.16 / recognize the use of the tabular and alphabetical sections of the code book.
HSTE.O.MCB.1.17 / utilize the terminology unique to ICD-9-CM.
HSTE.O.MCB.1.18 / differentiate diagnostic codes and procedural codes.
HSTE.O.MCB.1.19 / determine use of V codes.
HSTE.O.MCB.1.20 / determine use of E codes.
HSTE.O.MCB.1.21 / determine use of the Drugs and Chemicals Table.
HSTE.O.MCB.1.22 / use Hypertension Table located in the ICD-9-CM book.
HSTE.O.MCB.1.23 / implement rules and guidelines for assigning codes to neoplasms.
HSTE.O.MCB.1.24 / determine the use of the neoplasm table in the ICD-9-CM book.
HSTE.O.MCB.1.25 / determine rules and guidelines for assigning codes for pregnancy and pregnancy complications.
HSTE.O.MCB.1.26 / differentiate types of fractures and dislocations.
HSTE.O.MCB.1.27 / determine correct terminology of first, second, and third degree burns and the ICD-9-CM codes that coincide.
HSTE.O.MCB.1.28 / determine types of mental disorders defined for ICD-9-CM.
HSTE.O.MCB.1.29 / demonstrate abstraction of medical data using the 3M Health Care Coding System.
Standard 2: CPT-4 Coding
Objectives / The student will
HSTE.O.MCB.2.1 / recognize the purpose of the CPT manual.
HSTE.O.MCB.2.2 / articulate the importance of using the current-year CPT manual.
HSTE.O.MCB.2.3 / recognize the symbols used in the CPT manual.
HSTE.O.MCB.2.4 / examine the major sections found in the CPT manual.
HSTE.O.MCB.2.5 / relate information in the appendices of the CPT manual.
HSTE.O.MCB.2.6 / compare diagnostic codes and procedural codes.
HSTE.O.MCB.2.7 / differentiate the levels of HCPCS codes used.
HSTE.O.MCB.2.8 / compare global and starred procedures.
HSTE.O.MCB.2.9 / establish the concept and application of modifiers.
HSTE.O.MCB.2.10 / apply the concepts of evaluation and management coding to practical cases.
HSTE.O.MCB.2.11 / examine types of evaluation and management.
HSTE.O.MCB.2.12 / determine definitions of new and established patients for CPT-4 coding purposes.
HSTE.O.MCB.2.13 / apply key concepts for determining evaluation and management levels of service.
HSTE.O.MCB.2.14 / apply correct modifiers to evaluation and management service codes.
HSTE.O.MCB.2.15 / characterize the relationship of time to levels of service for evaluation and management services.
HSTE.O.MCB.2.16 / recognize the concepts of “covering physician” and “consultation” as it relates to CPT-4 evaluation and management.
HSTE.O.MCB.2.17 / distinguish “critical care” as it pertains to evaluation and management services.
HSTE.O.MCB.2.18 / apply the principal elements of anesthesia coding.
HSTE.O.MCB.2.19 / apply the surgery coding guidelinesincluding bundled services.
HSTE.O.MCB.2.20 / use basic steps for coding radiology services.
HSTE.O.MCB.2.21 / use basic steps for coding pathology services.
HSTE.O.MCB.2.22 / demonstrate basic steps for coding medicine services.
HSTE.O.MCB.2.23 / relate rules and application of modifiers to the coding process.
HSTE.O.MCB.2.24 / contrast level I CPT-4 modifier codes and HCPCS modifier codes.
HSTE.O.MCB.2.25 / differentiatesignificant differences between inpatient and physician coding.
HSTE.O.MCB.2.26 / apply coding guidelines for assigning DRG codes.
Standard 3: Practice Management Softward
Objectives / The student will
HSTE.O.MCB.3.1 / determine the flow of information in a medical office.
HSTE.O.MCB.3.2 / articulate the importance of the appointment schedule.
HSTE.O.MCB.3.3 / differentiate three methods for collecting insurance payments.
HSTE.O.MCB.3.4 / examine types of health insurance coverage.
HSTE.O.MCB.3.5 / research the role of computers in today’s medical office including that of communicating medical information.
HSTE.O.MCB.3.6 / demonstrate the inputting and processing of data.
HSTE.O.MCB.3.7 / print reports from support files.
HSTE.O.MCB.3.8 / implement back-up for daily data files.
HSTE.O.MCB.3.9 / navigate through practicemanagement software.
HSTE.O.MCB.3.10 / demonstrate entering patient account information.
HSTE.O.MCB.3.11 / demonstrate entering data into supplemental screens.
HSTE.O.MCB.3.12 / relate the importance of entering data correctly.
HSTE.O.MCB.3.13 / examinethe use of help windows.
HSTE.O.MCB.3.14 / demonstrate the retrieval of patient accounts.
HSTE.O.MCB.3.15 / demonstrate running the daily report.
HSTE.O.MCB.3.16 / articulate the process of posting accounts.
HSTE.O.MCB.3.17 / modify or correct an account.
HSTE.O.MCB.3.18 / demonstrate the scheduling and cancellation of individual and multiple appointments.
HSTE.O.MCB.3.19 / demonstrate printing a list of daily appointments.
HSTE.O.MCB.3.20 / examine the importance of insurance billing.
HSTE.O.MCB.3.21 / prepare an insurance billing worksheet.
HSTE.O.MCB.3.22 / demonstrate printing claim forms for insurance companies.
HSTE.O.MCB.3.23 / post payments from patients and insurance carriers.
HSTE.O.MCB.3.24 / demonstrate posting adjustments.
HSTE.O.MCB.3.25 / examine the available reports function.
HSTE.O.MCB.3.26 / prepare printed statements.
HSTE.O.MCB.3.27 / demonstrate posting unique payments.
HSTE.O.MCB.3.28 / characterize the account aging process.
HSTE.O.MCB.3.29 / display and print patient data.
Standard 4: Information Technology Applications
Objectives / The student will
HSTE.O.MCB.4.1 / implement the use of software and hardware.
HSTE.O.MCB.4.2 / utilize the Internet as a resource/
research tool.
Standard 5: Career and Technical Student Organization
Objectives / The student will
HSTE.O.MCB.5.1 / participate in the appropriate Career and Technical Student Organization (CTSO).
HSTE.O.MCB.5.2 / use parliamentary procedures in chapter meetings.
HSTE.O.MCB.5.3 / demonstrate team membership/leadership and problem solving skills.
HSTE.O.MCB.5.4 / participate in local, state, and national projects impacting healthcare and healthcare education.