Medical Coding Specialist

Hours: 330 / Access Length: 12 Months / Delivery: Online, Self-Paced
Retail Price: $1,780.00

Course Overview:

This course will help you develop advanced skills in medical coding and compliance to support accurate documentation and reporting in healthcare settings. Throughout the lessons, you learn how to navigate the ICD-10-CM, CPT, and HCPCS coding systems, applying guidelines and conventions to assign precise diagnostic and procedural codes. This course covers key core concepts such as identifying first-listed diagnoses, coding for chronic and coexisting conditions, and applying Z codes and modifiers for complex procedures. In addition, you will practice working with specialized codes for evaluation and management services, surgical interventions, diagnostic imaging, and laboratory tests. You will practice interpreting medical documentation, apply compliance standards such as HIPAA, and recognize indicators of fraud or coding errors.

Students will:

• Identify Medicare Parts A-D and key HIPAA regulations impacting reimbursement and compliance.
• Locate and use the Outpatient Resource-Based Relative Value Scale (RBRVS) for coding and reimbursement.
• Navigate the ICD-10-CM Alphabetic Index and Tabular List to apply instructional notations.
• Assign Z codes and symptom codes for unconfirmed outpatient diagnoses based on guidelines.
• Code infectious diseases, including sepsis, antibiotic resistance, and HIV, using combination codes.
• Apply CPT modifiers such as -22, -50, and -51 for complex and staged procedures.
• Assign accurate codes for procedures involving fractures, endoscopies, and complex surgical interventions.
• Select appropriate codes for cardiovascular procedures, including catheter placements and pacemaker services.
• Apply guidelines for diagnostic imaging and distinguish between professional and technical radiology components.
• Use pathology and laboratory coding for tests like hematology panels, therapeutic drug monitoring, and molecular pathology.

Prerequisite: Medical Terminology.  If you do not know Medical Terminology, you can purchase our course at an additional cost.

Course Outline:

Lesson 1: Reimbursement, HIPAA, and Compliance

In this lesson, you develop understanding of Medicare's structure, including Parts A through D, and interpreting essential HIPAA rules. You will learn how to locate information in the Federal Register, explain the Outpatient Resource-Based Relative Value Scale (RBRVS), recognize Medicare fraud indicators, and identify key aspects of managed health care.

Lesson 2: An Overview of ICD-10-CM

In lesson 2, you explore the structure and application of the ICD-10-CM diagnostic coding system. You will learn how to navigate its Alphabetic Index and Tabular List, effectively use official instructional notations, and understand the importance of coding conventions to ensure accurate and compliant coding practices.

Lesson 3: ICD-10-CM Outpatient Coding and Reporting Guidelines

In this lesson, you determine the first-listed diagnosis for various scenarios, including outpatient surgery, observation stays, and prenatal visits. You will learn to apply Z codes, report unconfirmed diagnoses using symptom codes, differentiate between diagnostic and therapeutic services, and accurately code for chronic and coexisting conditions based on official ICD-10-CM guidelines.

Lesson 4: Using ICD-10-CM

In this lesson, you practice assigning accurate ICD-10-CM codes by using both the Alphabetic Index and Tabular List. You will apply conventions, understand the importance of specificity, report acute and chronic conditions, identify combination codes, distinguish integral from non-integral conditions, and correctly sequence codes for residual effects and laterality.

Lesson 5: Chapter-specific Guidelines (ICD-10-CM Chapters 1-10)

In lesson 5, you review coding for infectious and parasitic diseases, including proper use of combination and multiple codes. You will analyze neoplasm codes to distinguish between primary, secondary, and in-situ malignancies. Additionally, you will apply guidelines for coding conditions such as sepsis, antibiotic resistance, viral hepatitis, and HIV.

Lesson 6: Chapter-specific Guidelines (ICD-10-CM Chapters 11-14)

In this lesson, you code gastrointestinal hemorrhages by utilizing site-specific and combination codes for conditions such as diverticulitis with perforation. You will apply multiple coding for cellulitis with infectious agents, identify and report pressure ulcer stages, distinguish between traumatic and pathological fractures, and document chronic kidney disease according to its severity stages.

Lesson 7: Chapter-specific Guidelines (ICD-10-CM Chapters 15-22)

In this lesson, you document conditions related to pregnancy, childbirth, and the puerperium by applying rules for pre-existing versus pregnancy-related conditions. You will assign codes for complications such as ectopic pregnancies and postpartum conditions, code congenital anomalies, and sequence diagnoses involving signs, symptoms, injuries, and external causes.

Lesson 8: Introduction to CPT

In lesson 8, you navigate the CPT manual by identifying its purpose, sections, and structure. You will locate codes using the CPT index, interpret guidelines and symbols such as add-on and modifier exemptions, apply appropriate modifiers to procedures, and differentiate between Category I, II, and III codes for reporting services and emerging technologies.

Lesson 9: Introduction to the Level II National Codes (HCPCS)

In this lesson, you examine the structure and purpose of Level II HCPCS codes. You will classify codes based on their groupings, including those for durable medical equipment, drugs, and transportation services. You will also differentiate temporary codes, apply appropriate modifiers, and navigate the Table of Drugs to report administered medications.

Lesson 10: Modifiers

In lesson 10, you apply CPT modifiers to enhance procedural accuracy and reimbursement. You will assign modifiers such as -22 for increased procedural services, -50 for bilateral procedures, and -51 for multiple procedures. Additionally, you will learn to document complex scenarios involving staged or discontinued procedures and mandated services.

Lesson 11: Evaluation and Management (E/M) Services

In this lesson, you apply evaluation and management coding by determining the place and type of service, identifying patient status, and selecting the appropriate service level based on either medical decision-making or total time spent. You will analyze key components such as the number of problems addressed, data reviewed, and risk assessment to ensure accurate coding.

Lesson 12: Anesthesia

In this lesson, you define types of anesthesia, including general, regional, and monitored anesthesia care. You will analyze how the anesthesia payment formula incorporates base units, time units, and modifying factors. You will also learn how to apply qualifying circumstance codes, physical status modifiers, and understand the unique process of reporting multiple concurrent procedures.

Lesson 13: Surgery Guidelines and General Surgery

In this lesson 13, you interpret surgical package components, including preoperative visits, intraoperative services, and postoperative care. You will learn to apply modifiers for staged or related procedures, understand unique differences between separate and bundled procedures, and use special reports to document unlisted surgical services requiring detailed descriptions.

Lesson 14: Integumentary System

In this lesson, you document integumentary procedures, including coding incision and drainage for abscesses and wound debridement based on depth and body area. You will differentiate excision codes for benign versus malignant lesions, apply rules for lesion size and margins, classify repairs by complexity, and sequence grafts and flaps according to recipient and donor site requirements.

Lesson 15: Musculoskeletal System

In this lesson, you analyze procedures within the musculoskeletal system, focusing on treatment types for fractures and dislocations. You will distinguish between open, closed, and percutaneous fracture treatments, identify when grafting or fixation is required, apply traction techniques, and code procedures like arthroscopy, cast application, and tendon repair based on anatomical site and procedure details.

Lesson 16: Respiratory System

In lesson 16, you examine how procedural approach and anatomical extent affect code selection within the respiratory system. You will cover the differences between diagnostic and surgical endoscopies, analyze modifiers for multiple procedures performed through the same scope, apply guidelines for coding complex procedures like thoracotomy and lobectomy, and report procedures based on nasal, tracheal, and lung sites.

Lesson 17: Cardiovascular System

In this lesson, you explore cardiovascular coding across the Surgery, Medicine, and Radiology sections of the CPT manual. It covers the important considerations of invasive and noninvasive procedures, understand how to report catheter placements within vascular families, apply guidelines for pacemaker and cardiac valve procedures, and interpret codes for electrophysiology and nuclear cardiology services.

Lesson 18: Hemic, Lymphatic, Mediastinum, and Diaphragm

This lesson focuses on coding procedures within the hemic and lymphatic systems, mediastinum, and diaphragm. You will learn when to apply specific codes for splenectomy types, bone marrow harvesting, and limited versus radical lymphadenectomy. Additionally, you will code mediastinal biopsies by approach and diaphragmatic repairs for conditions such as hernias or eventration.

Lesson 19: Digestive System

In this lesson, you learn various procedures throughout the digestive system, focusing on distinctions such as diagnostic versus surgical endoscopies. You will determine code selection based on gastro-intestinal anatomical sites, including esophageal dilations, intestinal resections with anastomosis, and specialized procedures like Roux-en-Y gastric bypass and laparoscopic cholecystectomy.

Lesson 20: Urinary and Male Genital Systems

In this lesson, you analyze procedures involving the urinary and male genital systems by focusing on surgical techniques and anatomical classifications. You will assess methods for procedures such as pyeloplasty for ureteropelvic junction obstruction, complex nephrolithotomy for staghorn calculi, and radical nephrectomy, while interpreting bundled services and the appropriate use of modifiers.

Lesson 21: Reproductive, Intersex surgery, Female Genital System, and Maternity care and Delivery

In this lesson, you focus on key procedures within the reproductive, genital, and maternity care systems. You work with procedures such as brachytherapy for cervical cancer, staged intersex surgeries, and vulvectomies based on size and tissue depth. Finally, you will review bundled services in global maternity care and situations requiring separate reporting, like pregnancy-related diagnostic visits.

Lesson 22: Endocrine and Nervous Systems

In this lesson, you review surgical and diagnostic procedures related to the endocrine and nervous systems. You explore thyroidectomy techniques, including subtotal and total removal of thyroid tissue based on disease severity. This lesson also covers procedures such as cerebrospinal fluid shunting, craniotomies, and neuroplasty, focusing on procedural variations by anatomical site and purpose.

Lesson 23: Eye, Ocular Adnexa, Auditory, and Operating Microscope

This lesson covers procedural concepts related to the eye, ocular adnexa, and auditory systems. You learn how procedural choices, such as lamellar versus penetrating keratoplasty, affect surgical coding. Techniques for treating retinal conditions with photocoagulation and managing auditory issues like eustachian tube dysfunction with tympanostomy will also be addressed, along with the use of an operating microscope for precision surgeries.

Lesson 24: Radiology

In this lesson, you explore the Radiology section of the CPT manual, focusing on diagnostic imaging, ultrasound, radiation oncology, and nuclear medicine procedures. You will interpret terms related to radiology positioning and projections, distinguish between professional and technical components, and apply guidelines for using modifiers like -26 and -TC for component reporting.

Lesson 25: Pathology/Laboratory

In this lesson, you will learn how to categorize pathology and laboratory services based on test types, such as organ panels, therapeutic drug monitoring, and molecular pathology. You will learn distinctions between qualitative and quantitative analyses, evaluate drug assay procedures, and identify how tests like hematology panels, microbiological cultures, and pathology consultations are applied in clinical practice.

Lesson 26: Medicine

In this lesson, you learn how to navigate the broad range of services within the Medicine section, including immunization protocols, biofeedback therapy, and dialysis management. You explore the structure of various subsections, understand the two-code system for immunization reporting, and identify active and passive immunizations based on purpose and delivery methods.

Lesson 27: Inpatient Coding

In this lesson, you learn how to identify the principal diagnosis in complex inpatient scenarios, such as cases with multiple interrelated or uncertain conditions. You interpret how Present on Admission indicators impact hospital reimbursement and review scenarios where the original treatment plan is not carried out due to complications or other factors.

All necessary materials are included.

System Requirements:

Internet Connectivity Requirements:

• Cable, Fiber, DSL, or LEO Satellite (i.e. Starlink) internet with speeds of at least 10mb/sec download and 5mb/sec upload are recommended for the best experience.

NOTE: While cellular hotspots may allow access to our courses, users may experience connectivity issues by trying to access our learning management system.  This is due to the potential high download and upload latency of cellular connections.   Therefore, it is not recommended that students use a cellular hotspot as their primary way of accessing their courses.

Hardware Requirements:

• CPU: 1 GHz or higher
• RAM: 4 GB or higher
• Resolution: 1280 x 720 or higher.  1920x1080 resolution is recommended for the best experience.
• Speakers / Headphones
• Microphone for Webinar or Live Online sessions.

Operating System Requirements:

• Windows 7 or higher.
• Mac OSX 10 or higher.
• Latest Chrome OS
• Latest Linux Distributions
  

NOTE: While we understand that our courses can be viewed on Android and iPhone devices, we do not recommend the use of these devices for our courses. The size of these devices do not provide a good learning environment for students taking online or live online based courses.

Web Browser Requirements:

• Latest Google Chrome is recommended for the best experience.
• Latest Mozilla FireFox
• Latest Microsoft Edge
• Latest Apple Safari

Basic Software Requirements (These are recommendations of software to use):

• Office suite software (Microsoft Office, OpenOffice, or LibreOffice)
• PDF reader program (Adobe Reader, FoxIt)
• Courses may require other software that is described in the above course outline.