MAP 150 - Adv. Medical Billing/Coding

1. Identify the special circumstances and rules of specialty coding
   1. Understand rules of specialty coding
   2. Determine conditions that indicate specific codes
2. Understand the methodology used for reporting the ICD-9-CM codes for the various specialties
   1. Understand how to code to the highest level of specificity and why this is important
   2. Understand how diseases are indexed in ICD-9-CM
   3. Learn how to use the Table of Drugs & Chemicals
   4. Be proficient in the use of the Hypertension and Neoplasms tables
   5. Understand when to use E codes and V codes
   6. Appropriately interpret notes and guidelines of ICD-9-CM
3. Understand the methodology used for reporting the CPT codes for the various specialties
   1. See the practical application of anesthesia coding
   2. Know the proper use of modifiers and the definitions of frequently used modifiers
   3. Understand how to report the E/M services correctly
   4. Follow the surgical directions, notes and guidelines to ensure accurate coding
   5. Determine the difference between the technical and professional components in radiology procedures
   6. Understand the methodology used for reporting pathology and laboratory codes
   7. Understand the practical application of CPT medicine services coding
   8. Learn how HCPCS will be beneficial in obtaining accurate reimbursement
4. Understand the 3 levels of Health Care Financing Administration (HCFA) Common Procedural coding System
   1. Identify three levels
5. Define commonly used insurance abbreviations and acronyms
   1. Identify abbreviations and acronyms
   2. Demonstrate ability to use appropriate abbreviation and acronym
6. Understand the professional and ethical standards for diagnostic coding
   1. Demonstrate knowledge of the history of diagnostic coding
   2. Demonstrate knowledge of the proper use of the three volumes of the ICD-9-CM coding books
   3. Understand the format, symbols and instructions of the ICD-9-CM coding books
   4. Distinguish between the primary diagnosis, condition, problem or reason for the medical service or procedure
   5. Assign the highest code level of specificity to describe the diagnosis, symptom, complaint, condition, or other reason for the patient encounter
7. Understand the professional and ethical standards for procedural coding
   1. Demonstrate knowledge of the proper use of the CPT-4 (current year) coding book
   2. Demonstrate knowledge of the guidelines format, symbols, index, and terminology of the CPT-4 coding book
   3. Demonstrate knowledge of the history procedural coding
   4. Assign an accurate code to each procedure, service to be billed
   5. Define and distinguish between the 3 levels of HCPCS codes and their proper use
8. Demonstrate knowledge of the legal aspects of medical insurance and medical records
   1. Explain the Iowa regulations for maintaining medical records
   2. Explain the Iowa confidentiality regulations for release of patient?s medical records
9. Recognize important Medicare issues
   1. Understand medical eligibility issues
   2. Demonstrate advanced knowledge of Medicare policies and procedures
   3. Understand implications of Medicare as a secondary source of payment
   4. Demonstrate ability to file complex claims