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.
245-ICD-10-CM/PCS conventions, quality control, principal diagnosis identification, coding reference, DRGs, severity, sequencing and methodology. 255-CPT-4 coding and documentation, relationship of coding to managed care, compliance, and chargemasters; APCs, groupers, encoders, and coding references. Although ICD-10-CM/PCS is utilized in case studies, emphasis is placed on accurate CPT-4 (including) E&M and HCPS) coding as an anti-fraud measure along with substantiation of services by documentation. The relationship of coding to managed care, compliance and chargemaster is explored. Through coding with documentation substantiation as a legitimate reimbursement optimizer is stressed.
Prereq for 245: HE 115, BIOL 2010, 2020; or instructor’s consent. Coreq for 245: HE 211. Prereq for 255; HE-211, 245; or instructor’s consent. (245-F, 255-S). Prereq(s): HE-211, 245; or instructor’s consent [S]
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