Coding and Reimbursement

Course Number: MA 180
Transcript Title: Coding and Reimbursement
Created: September 1, 2012
Updated: October 17, 2016
Total Credits: 2
Lecture Hours: 20
Lecture / Lab Hours: 0
Lab Hours: 0
Satisfies Cultural Literacy requirement: No
Satisfies General Education requirement: No
Grading options: A-F (default), P-NP
Repeats available for credit: 0

Course Description

Introduces CPT, ICD and HCPCS coding and reimbursement systems for physician offices and medical clinics. Prerequisite: MP111; Corequisite: MA117

Intended Outcomes

Students who successfully complete this course will be able to:

  1. Apply the usage of coding systems in physician’s offices and medical clinics.
  2. Correctly assign CPT codes and E/M level of service codes to physician office and medical clinic's encounters.
  3. Correctly code medical diagnoses utilizing ICD.
  4. Apply the relationship between coding systems and reimbursement for services.

Outcome Assessment Strategies

Fulfillment of these outcomes will be assessed by:

  1. Answering theoretical and application questions on the information covered in lecture, graded assignments and reading assignments
  2. Case study coding exercises from physician offices and medical clinics

Course Activities and Design

To complete the outcomes, the student must have skills and knowledge in medical terminology and basic anatomy and physiology.

Course Content (Themes, Concepts, Issues and Skills)

The following list outlines the concepts, themes and issues you need to understand and be able to use appropriately. You will have the opportunity to demonstrate your understanding in written and oral form, individually and in groups.

  1. Procedure and diagnostic coding
    • Describe how to use the most current procedural coding system
    • Describe how to use the most current diagnostic coding classification system
    • Describe how to use the most current HCPCS level II coding system
    • Perform both procedure and diagnostic coding using real like examples
    • Discuss the effects of upcoding and downcoding
    • Perform procedure and diagnostic reporting on exams and practice billing forms.
    • Understand the importance of being tactful when discussing code selection with providers
    • Understand the correlation between procedure and diagnostic codes
  2. Apply managed care policies and procedures to billing and coding.
    • Define medical necessity as it applies to procedural and diagnostic coding
  3. Understand the characteristics of third party guidelines
    • Prepare orders, prior authorizations, and referrals using appropriate classifications systems.
    • Demonstrate knowledge of documentation requirements to supplement code selection
  4. Complete a clean health insurance claim form.
  5. Prepare a diagnostic coding collage that demonstrates understanding of the correlation between diagnostic and procedural coding with actual medical conditions

Department Notes

This is a required course which fulfills a portion of the curriculum for the certificate in Medical Assisting. The extent of transferability or credit allowed for the course would be dependent upon the institution and the program to which the student is transferring.