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Apr 23, 2024
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HE 255 - Clinical Coding and Classification II(4)
Classification and coding systems for most health care settings; focus on accurate coding as major anti-fraud measure by substantiation of diagnoses and service through documentation and as a legitimate reimbursement optimizer.; class 3 hours, lab 3 hours. CPT-4 coding and documentation, relationship of coding to managed care, compliance, and chargemasters; APCs, groupers, encoders, and coding references. Although ICD-9-CM is utilized in case studies, emphasis is placed on accurate CPT-4 (including EandM and HCPCS) coding as an antifraud measure along with substantiation of services by documentation. The relationship of coding to managed care, compliance and chargemaster is explored. Thorough coding with documentation substantiation as a legitimate reimbursement optimizer is stressed. Prereq(s): HE-211, 245; or instructor’s consent [S]
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