2005 Ingenix Coding Lab: Medical Billing

This comprehensive entry-level education module helps beginning and aspiring coders in the office or the classroom. Designed to allow the user to understand and master the basic skills needed to be an effective coder, this module includes a CD containing a student workbook and a teacher's guide.

Introduction

1

(1)

Welcome to the Career of Medical Coding

1

(1)

The Nature of Medical Coding

1

(1)

Coding and the Financial Picture

2

(1)

Supporting Organizations

3

(2)

Opportunities in Coding

5

(2)

Medical Terminology

7

(58)

Introduction

7

(1)

History

7

(1)

Spelling

8

(1)

Introduction to Human Anatomy

8

(4)

Integumentary System

12

(2)

Musculoskeletal System

14

(8)

Respiratory System

22

(5)

Cardiovascular System

27

(5)

Lymphatic System

32

(3)

Digestive Tract

35

(10)

Urinary System

45

(6)

Endocrine System

51

(3)

Nervous System

54

(3)

Eye---Ocular---Auditory

57

(4)

Planes

61

(1)

Approaches to Medical Terminology

62

(2)

Summary

64

(1)

Discussion Questions

64

(1)

Insurance Basics

65

(10)

Introduction

65

(1)

History

65

(1)

Medicare and Medicaid

65

(1)

Health Insurance Today

66

(1)

Payer Comparisons

66

(4)

The Reimbursement Process

70

(1)

Coverage Issues

70

(1)

Payment Methodologies

71

(1)

Fee Schedules and Relative Values

71

(1)

Capitation

72

(1)

Inpatient and Ambulatory Systems

72

(1)

Claim Submission

72

(1)

Common Insurance Terminology

73

(1)

Fraud and Abuse Issues

74

(1)

Summary

74

(1)

Discussion Questions

74

(1)

Coding Physician Services and Procedures

75

(42)

Introduction

75

(1)

CPT History

75

(1)

Who Uses CPT Codes?

76

(1)

Documentation and the CPT Code Book: Reviewing the Source Document

77

(1)

CPT Conventions

78

(2)

Guidelines

80

(1)

Code Changes

81

(1)

Modifiers

81

(1)

Modifier Impact on Reimbursement

82

(1)

Add-on and Modifier 51 Exempt Codes

83

(1)

Unlisted Procedures

84

(1)

The CPT Code Book Index

84

(1)

The 10 Steps to Basic CPT Coding

85

(1)

Evaluation and Management Services

86

(1)

E/M Service Guidelines

87

(2)

Evaluation and Management Service Levels

89

(1)

Selecting a Visit Code

89

(1)

New and Established Patient Services

89

(1)

SOAP Note

90

(5)

Main Categories of the Evaluation and Management Section

95

(3)

Anesthesia

98

(2)

Surgery

100

(3)

Surgery Section Guidelines

103

(3)

Ancillary Services

106

(1)

Technical and Professional Components

106

(1)

Radiology

107

(3)

Pathology

110

(3)

Medicine

113

(1)

Summary

114

(1)

Discussion Questions

114

(3)

Diagnosis Coding and ICD-9-CM

117

(20)

Introduction

117

(1)

History

117

(1)

ICD-9-CM Diagnosis Coding

118

(1)

Organization

119

(1)

Coding Guidelines

119

(1)

Documentation and Diagnosis Coding

120

(1)

ICD-9-CM Volume 2

120

(3)

ICD-9-CM Volume 1

123

(2)

Supplemental Classification: V Codes

125

(2)

Appendixes to Volume 1

127

(1)

Conventions

128

(3)

Assigning Diagnosis Codes

131

(3)

Clinical Applications of Coding Guidelines

134

(1)

Summary

135

(1)

Discussion Questions

135

(2)

HCPCS Level II Coding

137

(10)

Introduction

137

(1)

HCPCS Level I /CPT Coding System

137

(1)

HCPCS Level II National Codes

137

(1)

The HCPCS National Codes in Detail

138

(1)

HCPCS Codes

139

(1)

Use of HCPCS

140

(1)

How to Use HCPCS

140

(1)

Color-Coded Coverage Instructions

140

(1)

Modifiers

141

(1)

Unlisted HCPCS Codes

142

(1)

Practicing the Principles

142

(1)

Hospital Outpatient Services

143

(1)

Physician Office Services

143

(1)

DMEPOS

143

(2)

The HCPCS Level II Codes

145

(1)

Summary

146

(1)

Discussion Questions

146

(1)

Medical Coding and Practice Management

147

(20)

Introduction

147

(1)

Registration

147

(1)

Encounter Forms

148

(1)

Precertification and Preauthorization

148

(1)

Claims Submission and Processing

149

(2)

Problem Claims

151

(1)

Advance Beneficiary Notice

151

(1)

Charge Amounts

152

(1)

Physician Reimbursement Methodologies

152

(1)

Inpatient Reimbursement Methodologies

153

(1)

Diagnosis-Related Group

154

(2)

Postpayment Process

156

(2)

The Medical Record and Documentation

158

(3)

Inpatient Charting

161

(3)

Compliance and Legal Considerations

164

(1)

Summary

165

(1)

Discussion Questions

166

(1)

Inpatient Coding

167

(20)

Introduction

167

(1)

The Coding Process

167

(1)

Inpatient Reimbursement Overview

168

(1)

New Medical Services and Technologies

168

(1)

ICD-9-CM Volume 3

169

(6)

Reviewing the Operative Report

175

(1)

Sequencing Procedure Codes

176

(2)

Using the Index

178

(1)

Using the Tabular Listing

179

(3)

Putting ICD-9-CM Procedure Coding to Work

182

(2)

Using Software in Code Assignment

184

(1)

ICD-10 Coding System: The Possible Future of Coding

184

(1)

Summary

185

(1)

Discussion Questions

185

(2)

Coding for Outpatient Facility Services--APCs and ASCs

187

(14)

Introduction

187

(1)

Outpatient Services Defined

187

(1)

Claims Processing

188

(1)

APCs and the Outpatient Prospective Payment System (OPPS)

189

(2)

Services Covered in an APC

191

(2)

APC Cost Controls

193

(2)

Ambulatory Surgery Center

195

(1)

Legislation Affecting Reimbursement

196

(1)

ASC Payment Groups

197

(3)

Summary

200

(1)

Discussion Questions

200

(1)

Appendix A: Insurance Commissioners

201

(4)

Appendix B: Valid Three-Digit ICD-9-CM Codes

205

(2)

Appendix C: The Office of Inspector General 2005 Work Plan for Medicare Physicians and Other Health Professionals

207

(4)

Glossary

211

(24)

Index

235

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2005 Ingenix Coding Lab: Medical Billing Basics : Comprehensive instruction to entry-level coding and billing

Summary

Table of Contents

Supplemental Materials