Houston Community College Health Information Technology Program Coding and Reimbursement Methodologies HITT 2335 Spring 2016 (crn 93445)

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1 Houston Community College Health Information Technology Program Coding and Reimbursement Methodologies HITT 2335 Spring 2016 (crn 93445) Instructor Information Jeannie Helton, MA RHIT Office Hours: By Appointment Telephone: Days: Wednesday Times: 4:00-10:00 Room: Coleman 538 Please make sure that you are on campus Wednesday April 6 th from 4-8pm for mandatory Health Information Professionals Week Celebration. Course Description Development of advanced coding techniques with emphasis on case studies, health records, and federal regulations regarding perspective payment systems and methods of reimbursement Learning Outcomes Sequence codes according to established guidelines and standards; and demonstrate knowledge in reimbursement methodologies. Prerequisites HPRS 2301 HITT1341 Course Goals (includes competencies, incorporation of SCANS, etc.) 1. Students will be knowledgeable to nomenclatures and classification systems ICD-10-CM and CPT-4 and demonstrate knowledge of through accurate coding of diagnosis and procedures. SCANS F9-Problem Solving Given a medical record, student will determine correct code. 2. Will apply ICD-10-CM and CPT-4 to inpatient, outpatient, emergency room and ambulatory coding competencies. SCANS F8-Decision Making Given a medical record, student will determine correct coding scheme to use. 3. Identify and describe the regulator of health care, including government and non-government entities. 1

2 SCANS F12-Reasonin Given lab values and drugs, student will determine the need to code complications and or co-morbidities. 4. Define and interpret test results, laboratory values, drug usage and treatment in assigning diagnoses and procedures for coding using 3M software and encoder. SCANS C-19- Applies technology to tasks Given encoder and medical record, student will correctly code diagnosis and procedure utilizing ICD-10-CM and CPT. 5. Read and understand Chapter 7- Abdelhak, and answer and understand objectives from chapter. SCANS F-1- Reading ; F-2- Writing; F-12- Reasoning Given textbooks, articles and other reading assignments, student will research and write a reports on drug utilization, complications and comorbidities. 6. Understand reimbursement methodologies. SCANS F-1- Reading; F-12- Reasoning Given encoder and medical records, student will properly sequence diagnoses and procedures to obtain accurate DRG. 7 Identify complications and co-morbid conditions to enhance reimbursement. SCANS F-8- Decision Making Given a medical record to analyze, identify complications and comorbidities not listed on the face sheet. Textbook Information ICD-10-CM Coding Book ICD-10 PCS Coding Book ICD-10-CM and ICD-10-PCS Coding Handbook CPT Coding Book 2015-Professional Edition- AMA HITT Journals- Advance for HIM Professionals For the Record- Journal of AHIMA Students with Disabilities Any student with a documented disability (e.g. physical, learning, psychiatric, vision, hearing, etc.) who needs to arrange reasonable accommodations must contact the Disability Services Office at the respective college at the beginning of each semester. Faculty is authorized to provide only the accommodations requested by the Disability Support Services Office. If you have any questions, please contact Donna Price at or the Disability Counselor for this college (Dr.Raj Gupta at 87631). Also visit the ADA web site at: 2

3 Discrimination Students should be aware that discrimination and/or other harassment based on race, sex, gender identity and gender expression, national origin, religion, age, disability, sexual orientation, color or veteran status is prohibited by HCC Policy G.1 Discrimination and Harassment and D.1.1 Equal Educational Opportunities. Any student who feels they have been discriminated against or harassed on the basis of race, sex, gender identity, gender expression, national origin, religion, age, disability, sexual orientation, color or veteran status including sexual harassment, has the opportunity to seek informal or formal resolution of the matter. All complaints/concerns should be directed to the Office of Institutional Equity, or Additional information may be obtained online. Visit Complaints involving sexual misconduct to include but not limited to: sexual assault, stalking, dating violence, sexual harassment or domestic violence should be directed to the HCC Title IX Coordinator, Renée Mack at or Academic Honesty Cheating and unethical conduct will result in automatic dismissal from the program. Attendance and Withdrawal Policies Students who are absent for more than four class sessions will be administratively dropped from the course without notification. Exceptions to this policy will be up to the discretion of the instructor. Attendance will be checked daily by the instructor. The instructor is required to report all absences for all students receiving financial aid (grants, VA, social security, etc.) Course Repetition Students who repeat a course for a third or more times may soon face significant tuition/fee increases at HCC and other Texas public colleges and universities. Please ask your instructor / counselor about opportunities for tutoring / other assistance prior to considering course withdrawal or if you are nor receiving passing grades. Course Requirements and Grading Policy 1. Read all assignments and understand all requirements for completing assignments prior to coming to class. 3

4 2. Bring all necessary workbooks, coding books, and other material to class each night. 3. Have the standard cover sheet attached to assignments to be turned in to instructor. 4. Complete assignments as scheduled. NO LATE WORK ACCEPTED. Assignments in Chisen will be checked before class. 5. There will be no makeups for tests missed. 6. Please see attendance policy in HCCS handbook Course Requirements and Grading Policy 1. Read all assignments and understand all requirements for completing assignments prior to coming to class. 2. Bring all necessary workbooks, coding books, and other material to class each night. 3. Have the standard cover sheet attached to assignments to be turned in to instructor. 4. Complete assignments as scheduled. NO LATE WORK ACCEPTED. 5. There will be no makeup s for tests missed. 6. Please see attendance policy in HCCS handbook 4

5 GRADING POLICY Final exam: 30% Exam 1: 15% Exam 2: (midterm)15% Exam 3: 15% Assignments 10% Quizzes 15% GRADING SCALE A B C 74 and below F (no Ds will be given) Testing Students absent from the class during the time of a major examination for test will have NO MAKE-UP EXAMINATIONS, except upon the discretion of the instructor. One and a half (1.5) hours will be schedule for each exam except the final which is 3 hours. Students late for the exam will be allowed to take the exam with the remaining scheduled time. The percentage of each activity will weight in the final grade regardless if the student participated in the activity or test. Make-up policy No make up exams or quizzes. AHIMA DOMAINS, SUBDOMAINS, AND TASKS I. Domain: Healthcare Data A. Subdomain: Data Structure, Content, and Use 1. Validate coding accuracy using clinical information found in the health record. III. B. Subdomain: Clinical Classification Systems-ICD-9-CM 1. Assign diagnosis/procedure codes using ICD-9-CM. Domain: Healthcare Environment C. Subdomain: Healthcare Information Requirements and standards 5. Ensure facility-wide adherence to health information services compliance with regulatory requirements (for example, ICD-9-CM Cooperative Parties coding 5

6 guidelines, HCFA Compliance Plan, Correct Coding Initiative). Lesson Assignments: Students will be able to demonstrate an understanding of intermediate ICD- 9-CM coding principles by utilizing coding case studies and mock charts in the following areas: Intermediate Coding Gastrointestinal System Intermediate Coding Urinary Diseases Intermediate Coding Newborns Intermediate Coding Musculoskeletal Intermediate Coding Pediatrics Intermediate Coding Neurology Intermediate Coding Pregnancy Intermediate Coding Neoplasms Intermediate Coding Respiratory System Intermediate Coding Cardiac Conditions Intermediate Coding Endocrine System Intermediate Coding Circulatory System Intermediate Coding Digestive System Intermediate Coding: Blood Intermediate Coding: Hernias and Intestinal obstructions Intermediate Coding: Diseases of Liver and Biliary Tract Intermediate Coding: Genital Disorders Intermediate Coding: Gastrointestinal Hemorrhage Intermediate Coding: E codes Intermediate Coding: Infectious Diseases Intermediate Coding: HIV Infection Intermediate Coding: Herpes Intermediate Coding: Lyme Disease Intermediate Coding: Injuries Intermediate Coding: Poisons Intermediate Coding: Reproductive System Intermediate Coding: Gastrointestinal System Intermediate Coding: Urinary Diseases Intermediate Coding: Reimbursement Methodologies for inpatients Intermediate Coding: Sequencing Students will be able to demonstrate an understanding of CPT coding principles by utilizing coding case studies and mock charts to code in the following areas: Procedural terminology Modifiers Evaluation and Management services 6

7 Surgery Radiology Pathology Lab Medicine Anesthesia HCPCS Reimbursement methods for the ambulatory care setting Other Student Information (clubs, tutoring, web resources, etc.) Website addresses: Advance for Health Information Professionals- For the Record- Journal of AHIMA- 7