This Advanced Hospital Coding course prepares students to take the American Health Information Management Association's (AHIMA) official certification exam to become a Certified Coding Specialist (CCS). This program covers advanced ICD-9 coding procedures and is designed to help students meet the challenge of today's changing standards while learning and improving their coding skills. Click here to read a list of FAQs about CCS and CCA credentials.

Facility coding (hospital coding) is one of the best paying sectors of the coding profession. This course is designed for the coder who wishes to further develop their facility coding skills.

If you are already performing some aspect of facility coding, this course will fill in the gaps so that your skills are properly rounded. This "rounding" of skills makes a more marketable employee and is essential to successful completion of the American Health Information Management Association's mastery level credentialing exam, the Certified Coding Specialist (CCS).

If you are currently working in a physician office or billing service, this course will give you the edge you need to advance in the workplace. Most hospitals will only hire coders with previous exposure to facility coding or are already certified. Training on the job is a luxury most hospitals are unable to offer. Coders of all levels must undergo continuing education to stay current with the constantly changing regulations.

This course will utilize your existing knowledge of medical terminology and health care sciences. Your coding skills will be heightened and focused preparing you for employment testing, job performance, and successful completion of the CCS exam.

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FEATURES

This nationally recognized Advanced Hospital Medical Coding online certification training course prepares medical coding students to take the American Health Information Management Association's (AHIMA) official certification exam to become a Certified Coding Specialist (CCS). This program covers advanced ICD-9 Medical coding procedures and is designed to help students meet the challenge of today's changing standards while learning and improving their coding skills. This online program is only offered in partnership with major colleges and universities.

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TOPIC HIGHLIGHTS

I. Introduction

II. Facility Orientation

1. Introduction
2. Objectives
3. Table of Contents
4. Reading
5. Assignments
6. Information Flow
7. Hospital Overview
8. Facility Records
9. Reimbursement
10. Ethics
11. HIPAA
12. Section Test
13. References

III. Health Care Facility Medical Record

1. Introduction
2. Objectives
3. Table of Contents
4. Reading
5. Assignments
6. Definition of Medical Record
7. Documentation in the Medical Record
8. Legalities
9. Test
10. References

IV. Diagnosis Related Groups

1. Introduction
2. Objectives
3. Table of Contents
4. Reading
5. Assignments
6. Glossary
7. Overview
8. DRG
9. Test
10. References

V. Using the Guidelines/Impatient Coding

1. Introduction
2. Objectives
3. Table of Contents
4. Reading
5. Assignments
6. Coding Guidelines
7. General Guidelines
8. Infections
9. Neoplasm's
10. Circulatory
11. Pregnancy/Childbirth
12. Injury
13. Poisoning
14. V-Codes
15. Principal Diagnosis
16. Additional Diagnoses
17. References

VI. Outpatient Coding Guidelines

1. Introduction
2. Objectives
3. Table of Contents
4. Reading
5. Assignments
6. Outpatient Record
7. 72 Hour Rule
8. Outpatient System
9. CPT-4
10. Reference

VII. Prepare for the CCS Exam

1. Introduction
2. Objectives
3. Table of Contents
4. Reading
5. Assignments
6. Procedure Coding
7. Diabetes Mellitus
8. System Specifics
9. Psychometrics
10. Final Practice
11. Additional Preparation
12. References

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CERTIFICATE REQUIREMENTS

A 70% or better must be achieved in order to receive a Certificate of Completion.

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COURSE OBJECTIVES

• Understand how health information travels within departments of a facility
• List the types of healthcare professionals, both administrative and clerical
• Define the roles and responsibilities of a coder in an in- and out-patient facility
• Understand the standards, ethics, and legal responsibilities of a coder
• Learn the opportunities available for coders, and the importance of credentialing.
• Learn to interpret health record documentation using knowledge of anatomy, physiology, clinical disease processes, and medical terminology
• Determine when additional clinical information is needed
• Obtain further clinical information to assist with code assignment
• Consult reference materials to facilitate code assignment
• Identify patient encounter type(s) to assign codes
• Identify etiology and manifestation(s) of clinical conditions
• Learn the current coding and reporting requirements for inpatient services
• Interpret conventions, formats, instructional notations, tables and definitions of the classification system to select diagnoses, conditions, problems, or other reasons for encounter
• Sequence diagnoses and other encounter reasons according to notations and conventions of the classification system and standard data set definitions (UHDDS - Uniform Hospital Discharge Data Sets)
• Determine if signs, symptoms or manifestations require separate code assignments
• Recognize when classification system does not provide a precise code for the condition documented (residual categories or non-classified syndromes)
• Select principal diagnosis, principal procedure, complications and comorbid conditions and other significant procedures that require coding according to UHDDS definitions and official coding guidelines
• Evaluate the effect of code selection on Diagnosis Related Group (DRG_ assignment
• Verify DRG assignment based on Prospective Payment System (PPS) definitions
• Apply guidelines for bundling and unbundling of codes
• Determine proper use of Modifiers, CPT vs HCPCS Level II codes, and Medical Necessity (linking diagnosis to procedure/service)
• Assess quality of coding
• Understand reimbursement methodologies and documentation rules and regulations
• Analyze health record documentation for quality and completeness of coding
• Evaluate health record documentation to substantiate claims processing and appeals
• Understand the differences between the hospital Inpatient and Outpatient Record, and identify outpatient record components
• Determine proper use of Modifiers, CPT vs HCPCS Level II codes, and Medical Necessity (linking diagnosis to procedure/service)
• Identify the Charge Master and its components
• Understand the CPT guidelines, with special emphasis on Evaluation and Management (E&M) and surgery coding.
• Identify coding considerations and guidelines for diagnostic tests

CODING COMPETENCIES
Hospital-based competencies
A. Data identification

1. Read and interpret health record documentation to identify all diagnoses and procedures that affect the current inpatient stay/outpatient encounter visit
2. Assess the adequacy of health record documentation to ensure that it supports all diagnoses and procedures to which codes are assigned
3. Apply knowledge of anatomy and physiology, clinical disease processes, pharmacology, and diagnostic and procedural terminology to assign accurate codes to diagnoses and procedures
4. Apply knowledge of disease processes and surgical procedures to assign nonindexed medical terms to the appropriate class in the classification/nomenclature system.

B. Coding guidelines

1. Apply knowledge of current approved "ICD-9-CM Coding and Reporting Official Guidelines"* to assign and sequence the correct diagnosis and procedure codes for hospital inpatient services
2. Apply knowledge of current "Diagnostic Coding and Reporting Guidelines for Outpatient Services"*
3. Apply knowledge of CPT format, guidelines, and notes to locate the correct codes for all services and procedures performed during the encounter/visit and sequence them correctly
4. Apply knowledge of procedural terminology to recognize when an unlisted procedure code must be used in CPT

C. Regulatory guidelines

1. Apply Uniform Hospital Discharge Data Set (UHDDS) definitions to select the principal diagnosis, principal procedure, complications and comorbid conditions, other diagnoses and significant procedures which require coding
2. Select the appropriate principal diagnosis for episodes of care in which determination of principal diagnosis is not clear because the patient has multiple problems
3. Apply knowledge of the Prospective Payment System to confirm DRG assignment which accurately reflects the occurrence of events and ensures appropriate reimbursement
4. Refuse to fraudulently maximize reimbursement by assigning codes that do not conform to approved coding principles/guidelines*
5. Refuse to unfairly maximize reimbursement by unbundling services and codes that do not conform to basic coding principles and the National Correct Coding Initiative (CCI)
6. Apply knowledge of the Ambulatory Surgery Center (ASC) Payment Groups to confirm ASC assignment which ensures appropriate reimbursement
7. Apply policies and procedures on health record documentation, coding, and claims processing and appeal
8. Use the HCFA Common Procedural Coding System (HCPCS) to appropriately assign HCPCS codes for outpatient Medicare reimbursement.

D. Coding

1. Exclude from coding diagnoses, conditions, problems, and procedures related to an earlier episode of care which have no bearing on the current episode of care
2. Exclude from coding ICD-9-CM nonsurgical, noninvasive procedures which carry no operative or anesthetic risk
3. Exclude from coding information such as symptoms or signs characteristic of the diagnosis, findings from diagnostic studies, or localized conditions, which have no bearing on the current management of the patient
4. Apply knowledge of ICD-9-CM instructional notations and conventions to locate and assign the correct diagnosis and procedural codes and sequence them correctly
5. Facilitate data retrieval by recognizing when more than one code is required to adequately classify a given condition
6. Exclude from coding these procedures which are component parts of an already assigned CPT procedure code

E. Data quality

1. Clarify conflicting, ambiguous, or nonspecific information appearing in a health record by consulting the appropriate physician
2. Participate in quality assessment to ensure continuous improvement in ICD-9-CM and CPT coding and collection of quality health data
3. Demonstrate ability to recognize potential coding quality issues from an array of data
4. Apply policies and procedures on health record documentation and coding that are consistent with official coding guidelines*
5. Contribute to development of facility-specific coding policies and procedures

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PDF BROCHURE

Please click here to download the PDF brochure for the Gatlin online courses offered by OCPE.

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WHO SHOULD ATTEND

The Advanced Hospital course is not an entry-level course. This course is designed specifically for students with previous coding experience, previous education, or the GES Administrative Medical Specialist course.

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Carline Dalgleish has been employed in the Allied Healthcare profession since 1970 and is a part-time George Mason University , OCPE, Gatlin instructor. She began in the Medical Records department of the Army/Air Force Hospital in Nuremberg, Germany and moved "through the ranks" over the years, performing insurance billing, coding and accounts receivable management services for physicians, clinics, hospitals and even the Healthcare Financing Administration (now CMS). She has real-time experience in physician and hospital coding, as well as management experience in compliance, information technology and services, and procedural and diagnostic coding instruction.

In the early 90's, Carline moved full-time into curriculum development, teaching and management of allied health education programs, with special emphasis on Medical Billing and Coding.

Carline is a Certified Medical Assistant - Administrative, a licensed practical nurse, and holds a bachelor's degree in business information systems. She is a member of the National Dean's Scholars List, AHIMA, PAHCOM, AAMA, AAPC, CCST, AAMT, and AMTIE. She currently owns and operates COUGAR-Ed.net, which specializes in development and delivery of continuing education products, seminars, and services.

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1. How do I register for a Gatlin online course?

Please contact our office on the Fairfax campus in Northern Virginia (NOVA) or call 703-993-2113. Click here for more information or to download a copy of the registration form.

2. How much do Gatlin online courses cost?

To view the prices for all Gatlin courses that are offered by George Mason University, please click here.

3. Why do I have to take Gatlin courses through a participating school?

Gatlin does not offer courses directly to the public. They partner with major colleges and universities to offer their programs.

4. Do I have to travel to register for or to attend a Gatlin online course?

All Gatlin courses are delivered entirely online, you do not have to go to a class or travel to a school. If you are unable to visit our office on the Fairfax campus in Northern Virginia (NOVA), please contact us at 703-993-2113 or click here for more information or to register for a course.

5. How long does it take to complete a Gatlin course?

All of our Gatlin courses are asynchronous. You can start and finish the course at your own pace. Most courses are designed to be completed within 180 days. You may request an extension if you think you will need more time to complete a course (fees may apply). Please contact us at 703-993-2113 or click here if you have any questions or if you would like to register for a course.

6. Do I have to buy additional materials?

Please refer to the green Included Materials box located on the upper right hand side of this page. If materials are included in this course, they will be shipped by Gatlin to you via UPS ground service after you have registered for a course.

7. Can I get financial aid for Gatlin courses?

Gatlin courses are non-credit and therefore are not eligible for Federal Student Aid. However there are a number of loan programs that can be used to fund your course. Click here to view a list of these options or call 703-993-2113 for more information. Gatlin also provides a loan opportunity for students (www.collegeloanapplication.com).

8. What happens when I complete the course?

If you obtain a final passing grade of 70% or greater in a course, we will award you a George Mason University certificate of completion.

9. Who will be my instructor?

Each student is paired up with a facilitator for one-on-one interaction. The facilitator will be available (by e-mail) to answer any questions you may have and to provide feedback on your performance. Facilitators are all successful working professionals in the fields in which they teach.

10. What are the system requirements in order to take an online course?

Please see the "PC requirements" section listed for individual courses.

11. When can I start the course?

Registrations are rolling. Please send us your registration form at the time you wish to start your course. Registrations take five to seven business days to process.

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