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Upon completion of this course, the student will be able to:
1 .Code procedures related to all major body systems using ICD-9-CM.
2 .Code obstetrical and newborn diagnoses and procedures with ICD-9-CM.
3. Cite the definitions for principal diagnosis, complications, co-morbidities, principal procedure, and significant procedures.
4. Correctly choose and code the principal diagnosis and the principal procedure.
5. Correctly choose, code, and sequence secondary diagnoses and secondary procedures.
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1. Health Information Ethics
a. Code of Ethics
b. Standards of Ethical Coding
2. Procedural Coding
a. Organization of tabular list
b. Organization of alphabetical index
c. ICD-9-CM conventions
1. Code also
2. Omit code
d. Coding the operative approach
e. Codes for endoscopic procedures
f. Coding cancelled surgeries
g. Coding incomplete procedures
h. Coding failed procedures
i. Codes for biopsy with extensive surgical procedures
j. Codes for closed biopsy procedures
k. Bilateral procedural coding
l. Coding computer-assisted or robotic-assisted procedures
m. Definition and selection of the principal procedure and secondary procedures
n. Steps for procedural coding
3. Introduction to the Prospective Payment System (PPS) and the Uniform Hospital Discharge Data Set (UHDDS)
a. History and purpose of UHDDS
b. Components of UHDDS
c. UB-04 claim form
d. Definition and selection of the principal diagnosis
e. Definition and reporting of complications, co-morbidities, and other additional diagnoses
f. Prospective payment system (PPS)
g. Quality improvement organizations
h. Recovery audit contractors (RACs)
i. Coding for medical necessity
4. Neoplasm-Related Procedures
5. Procedures of the Nervous System and Sense Organ
6. Cardiovascular Procedures
a. Cardiac catheterizations
b. Percutaneous transluminal coronary angioplasty (PTCA)
c. Coronary artery bypass graft (CABG)
d. Cardiac pacemakers
e. Automatic implantable cardioverter defibrillators (AICD)
7. Respiratory Procedures
a. Endoscopic procedures
b. Mechanical ventilation
8. Gastrointestinal Procedures
a. Hernia repair
b. Endoscopic procedures
c. Ostomies
d. Resection and anastomosis
e. Laparotomy
f. Adhesion barrier
9. Procedures of the Genitourinary System
10.Complications and Procedures of Pregnancy, Childbirth, and the Puerperium
a. Abortion
b. Early onset of delivery
c. Pregnancy
d. Normal delivery
e. Outcome of delivery
f. Obstetrical and non-obstetrical complications
g. Labor and delivery
h. Obstetrical procedures
11. Congenital Anomalies and Certain Conditions Originating in the Perinatal Period
a. Newborn coding
b. Infant coding
c. Common congenital anomalies
d. Perinatal conditions
12. Operations on the Breast, Skin, and Subcutaneous Tissue
13. Procedures of the Musculoskeletal System and Connective Tissue
14. Injury-Related Procedures
15. Official Guidelines for Coding and Reporting
16. Coding of Inpatient and Outpatient Medical Records
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ICD-9-CM Basic Coding, Shraffenberger, L., 2012 (or current year)
ICD-9-CM Coding Book, 2012 (or current year)
CPT Coding Book, 2012 (or current year)