STANDARD COMPETENCIES:

 

 1. Demonstrate an understanding of the purpose of the CPT nomenclature and the difference between a nomenclature and classification system.

 2. Identify the basic characteristics, conventions, and principles of CPT/HCPCS coding system.

 3. Describe the hospital outpatient prospective payment (OPPS) system, what it is and how it relates to CPT coding.

 4. Apply Diagnosis/procedure codes according to current CPT and HCPCS guidelines.

 5. Evaluate the accuracy of diagnostic and procedural coding.

 6. Analyze the documentation in the health record to ensure it supports the diagnosis and reflects the patient’s progress,

    clinical findings, and discharge status

 7. Apply policies and procedures to ensure the accuracy and integrity of health data both internal and external to the health system

 8. Apply policies and procedures for the use of data required in healthcare reimbursement (payment methodologies and systems, i.e. PPS, OPPS)

 9. Apply policies and procedures to ensure organizational compliance with internal and external regulations and

    standards (i.e. National Correct Coding Initiative and other Compliance initiatives)

 10. Identify discrepancies between supporting documentation and coded data

 

 

 TOPICAL OUTLINE:

 

 I. Introduction to CPT, Billing and Reimbursement (PPS and OPPS), NCCI edits and Modifiers

 II. Evaluation and Management (E&M)codes

 III. Surgery codes

 IV. Anesthesia (Category codes and HCPCS codes)

 V. Radiology, Pathology and Laboratory codes

 VI. Medicine codes