MASTER SYLLABUS

2020-2021

A.	Academic Division: Health Sciences

B.	Discipline: Health Services Technology

C.	Course Number and Title: HITP 1030 – Advanced Coding and Billing

D.	Course Coordinator: Melinda Roepke, MSN, RN

Assistant Dean: Melinda Roepke, MSN, RN

Instructor Information:

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E.	Credit Hours: 3

F.	Prerequisites: HITP 1010

G.	Syllabus Effective Date: Fall 2020

H.	Textbook(s) Title:

Effective Management of Coding Services

Author(s): Lou Ann Schraffenberger, MBA, RHIA, CCS, CCS-P and Lynn Kuehn, MS, RHIA, CCS-P

Copyright Year: 2011

Edition: 4th

ISBN #: 978-1584262343

Clinical Coding Workout: Practical Exercises for Skill Development

Author(s): AHIMA

Copyright Year: 2013

Edition: 1st

ISBN #: 978-1584264187

(optional) Health Information Management Technology: An Applied Approach

Author(s): AHIMA

Copyright Year: 2012

Edition: 3rd

ISBN #: 978-1584263524

ICD-9-CM Code Book Volumes 1-3

Author(s): Carol J. Buck, MS CPC CPC-H CCS-P

Copyright Year: 2014

Edition: 1st

ISBN #: 978-0323186742

CPT Professional Edition

Author(s): American Medical Association

Copyright Year: 2013

Edition: 1st

ISBN #: 978-1-60359-684-8

Recommended Readings: (found in the AHIMA Body of Knowledge)

HIM and Health IT

ICD-10-CM Primer

Managing an Effective Query Process

Terms for Terms

Snomed

Snomed Clinical Terms Fundamentals

Coordination of SNOMED and ICD-10

ICD-9-CM Lecture Powerpoints

CPT Lecture Powerpoints

AHIMA Code of Ethics

HIM Competencies

Workbook(s) and/or Lab Manual: None

J.	Course Description: This course provides the student with advanced knowledge and coding practice in clinical classification systems; in-depth prospective payment system; data quality, fraud and abuse in coding; advanced case studies. This course builds upon concepts learned in ICD-9-CM and CPT coding course. It focuses upon the management of coded data in clinical databases, for use in reimbursement and decision-support in various healthcare settings. SNOMED and additional classification systems are also introduced. The student will also be introduced to the revenue cycle, data presentation and report generation as well as coding quality and coding compliance.

K.	College-Wide Learning Outcomes:

College-Wide Learning Outcome	Assessments - - How it is met & When it is met
Communication – Written
Communication – Speech
Intercultural Knowledge and Competence
Critical Thinking
Information Literacy
Quantitative Literacy

L.	Course Outcomes and Assessment Methods:

Upon successful completion of this course, the student shall:

Outcomes	Assessments – How it is met & When it is met
Describe the requirements for maintaining a healthcare organization’s clinical data, and understand policies and procedures for managing the organization’s clinical database.	Weekly Assignments Mid-Term Exam – Week 9
Describe a health care organization’s financial management system, illustrate the steps in the revenue cycle and flow chart the process from coding through reimbursement.	Weekly Assignments Mid-Term Exam – Week 9
Complete Coding for advanced cases utilizing ICD-9-CM and CPT-4.	Weekly Assignments Mid-Term Exam – Week 9
Describe a plan to effectively and efficiently manage the coding services involving a healthcare organization’s coding and data reporting functions.	Weekly Assignments Mid-Term Exam – Week 9
Identify potential abuse or fraudulent trends through data analysis	Weekly Assignments Final Exam – Week 16
Design a sample coding quality management/performance improvement plan.	Weekly Assignments Final Exam – Week 16
Design a coding compliance plan based upon internal and external coding requirements, regulations, and guidelines,	Weekly Assignments Final Exam – Week 16

M.	Topical Timeline (Subject to Change):

Course Schedule
Week	Readings	Assignments
Week 1	The Coding Function: Chapter One discusses the coding professional in the context of the work environment. Although the reader may infer that the focus is acute care, the text is geared towards presenting the coder as a member of the HIM team in any clinical setting. This chapter is particularly useful for users whose sole exposure to coding has been in the academic environment or by association in the work place.	Chapter 1	Weekly Assignment
Week 2	Chapter 2 addresses the many practical issues involved in recruiting and retaining coding staff. While there are certainly many theoretical points, the chapter focuses on sharing the authors’ experiences in various settings and in helping the reader understand some of the issues from the point of view of contractors.	Chapter 2	Weekly Assignment
Week 3	Alternative Staffing and Coding/Billing Issues and Coding in Specialized Care Settings - Chapter 3 discusses several common alternatives to full-time employee staffing.	Chapter 3	Weekly Assignment
Week 4	Chapter 4 provides an overview of the various coding and billing issues in a variety of practice settings in which coders may find themselves employed. It can be difficult for instructors to assist students to absorb this widely diverse topic and all may benefit from more in-depth review of the characteristics of the settings as each one is explored.	Chapter 4	Weekly Assignment
Week 5	Classifications and Terminologies: The purpose of this chapter is to provide an overview of and reference for clinical classification, nomenclatures, and terminologies.	Chapter 5	Weekly Assignment
Week 6	Use of Coded Data - The purpose of Chapter 6 is to provide an overview of risk adjustment and payment systems, particularly as they pertain to prospective payment systems and CMS PPS.	Chapter 6	Weekly Assignment
Week 7	Charge Description Master - Chapter 7 serves as an introduction to the concepts and vocabulary rather than the mechanics of the systems discussed. This chapter discusses the nature, purpose, uses, and maintenance of a charge description master including LCDs, NCDs, and other regulatory guidelines.	Chapter 7	Weekly Assignment
Week 8	Midterm Exam	Midterm Exam
Week 9	Performance and Process Improvement and Data Quality - Chapter 8 focuses on the always-thorny issue of performance management. What constitutes productivity?	Chapter 8	Weekly Assignment Mid-Term Exam
Week 10	The purpose of Chapter 9 is to acquaint the reader with the issues and processes involved in conducting both internal and external coding quality reviews.	Chapter 9	Weekly Assignment
Week 11	Chapter 10 contains an overview of Clinical Documentation Improvement (CDI) programs: how and why they are needed and who is involved. Fundamental to the success of a CDI program is the support of both administrative and medical leadership. Although it is not emphasized in the chapter, the cost justification of a CDI program lies in the accuracy of the case mix index (i.e., coding), the defense against RAC audits, and the accurate reflection of patient severity of illness (for benchmarking purposes). As CDI programs tend to be expensive, cost justification cannot be ignored.	Chapters 10	Weekly Assignment
Week 12	Compliance and Reporting - Chapter 11 discusses the regulatory as well as the practical issues surrounding the development and implementation of a coding compliance program. As with some of the other chapters, there is a lot of material to digest.	Chapter 11	Weekly Assignment
Week 13	Chapter 12 defines the sources of data as they relate to the coding process, identifies the type of information needed to create reports based on coded data, and describes where and how various users inside and outside the healthcare facility need and use coded information.	Chapter 12	Weekly Assignment
Week 14	The Revenue Cycle - Chapter 13 discusses the revenue cycle management model as well as the basic concepts of the model. Members of the revenue cycle model and their functions are also discussed. Students will be able to identify the relationship between accounts receivable and the various forms and tools used in the coding process.	Chapter 13	Weekly Assignment
Week 15	Case-Mix Management Chapter 14 is entirely devoted to the development of various case-mix indexes and how these indexes can be used to analyze performance. Students who intend to pursue HIM management roles or positions in clinical data analysis must be comfortable with the concepts and calculations involved in case-mix analysis.	Chapter 14	Weekly Assignment
Week 16	Final Exam, Clinical Coding Workout Exercises

NOTE:	In case of events beyond the control of faculty that interfere with class times and teaching, adjustments may be made to date of coverage, order of coverage, and date of exams and assignments to ensure full coverage of course content.

N.	Course Assignments:

Weekly assignments – papers, coding activities, development of procedures

Exams

O.	Recommended Grading Scale:

NUMERIC	GRADE	POINTS	DEFINITION
93–100	A	4.00	Superior
90–92	A-	3.67	Superior
87–89	B+	3.33	Above Average
83–86	B	3.00	Above Average
80–82	B-	2.67	Above Average
77–79	C+	2.33	Average
73–76	C	2.00	Average
70-72	C-	1.67	Below Average
67–69	D+	1.33	Below Average
63-66	D	1.00	Below Average
60-62	D-	0.67	Poor
00-59	F	0.00	Failure

P.	Grading and Testing Guidelines:

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Q.	Examination Policy:

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R.	Class Attendance and Homework Make-Up Policy:

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S.	Classroom Expectations:

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T.	College Procedures/Policies:

Important information regarding College Procedures and Policies can be found on the syllabus supplement located at

http://catalog.ncstatecollege.edu/mime/download.pdf?catoid=5&ftype=2&foid=3