Medical Coding Professional

Hours: 442 / Access Length: 12 Months / Delivery: Online, Self-Paced

Course Overview:

Medical Coding is a growing career field with numerous job opportunities. Students will be prepared to take the American Health Information Management Association (AHIMA) Certified Coding Specialist (CCS) national certification exam. The CCS exam has a pass rate of over 80% for first-time testers and is the first step to a wide-ranging career path. In this comprehensive course, you will learn about the necessary medical terminology, insurance guidelines, compliance requirements, and legal and ethical issues that will prepare you to work as a Certified Coding Specialist in a professional medical office.

Course Outline:

Medical Coding Curriculum:

Lesson 1: Reimbursement, HIPAA and Compliance

In this lesson, you will learn about third-party reimbursement issues, such as Medicare, the definition of a participating provider, how to locate information in the Federal Register, the RBRVS system, the framework of Medicare Fraud, and the major components of managed health care. Finally, you will have the opportunity to put this information into practice by completing exercises and class activities.

Lesson 2: An Overview of ICD-10-CM

In this lesson, you will learn about t the ICD-10-CM format and the GEMs file, the Alphabetic Index and the Tabular List, and finally, you will have the opportunity to put this information into practice by using the I-9 to I-10 GEMs file and I-10 to I-9 GEMs file to map codes.

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

In this lesson, you will learn about ICD-10-CM Outpatient Coding and Reporting Guidelines. You will have the opportunity to put this information into practice by assigning codes to complete exercises and coding reports.

Lesson 4: Using ICD-10-CM

In this lesson, you will learn about ICD-10-CM Official Guidelines for Coding and Reporting, General Coding Guidelines. You will have the opportunity to put this information into practice by assigning codes to complete exercises and coding reports.

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

In this lesson you will learn how to apply ICD-10-CM Official Guidelines for Coding and Reporting of infectious diseases, neoplasms, endocrine, nutritional, and metabolic diseases, and immunity disorders, diseases of blood and blood-forming organs, mental disorders, diseases of the nervous system and sense organs, diseases of the circulatory system, and diseases of the respiratory system.

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

In this lesson, you will learn to apply ICD-10-CM Official Guidelines for Coding and Reporting of diseases of the digestive system, diseases of the skin and subcutaneous tissue, disease of the musculoskeletal system and connective tissues.

Lesson 7: Chapter-Specific Guidelines (ICD-10-CM Chapters 15-21)

In this lesson you will learn to apply ICD-10-CM Official Guidelines for Coding and Reporting of diseases of the pregnancy, childbirth, and the puerperium, certain conditions originating in the perinatal period, congenital malformations, deformations, and chromosomal abnormalities, symptoms signs and abnormal clinical and laboratory findings, not elsewhere classified, and injury and poisoning, and certain other consequences of external causes.

Lesson 8: Introduction to CPT and the Level II National Codes (HCPCS)

In this lesson, you will learn about the CPT manual, periodic updates to the manual, and the information that is required to properly code procedures and services. You will be introduced to the CPT manual format and categories of CPT codes, including proper use of modifiers. You will also have an opportunity to practice exercises to gain familiarity with how to locate terms in the CPT index and to identify content in the CPT appendices.

Lesson 9: Modifiers

In this lesson, you will learn about the use of modifiers to indicate delivery of services in nonstandard ways.

Lesson 10: Evaluation and Management (E/M) Services

In this lesson, you will learn about the information required to properly code procedures and services from the Evaluation and Management (E/M) section of the CPT. You will be exposed to the contents of the E/M section as well as the factors and conditions that affect the determination of the level of service. You will also have an opportunity to practice coding E/M services. Finally, you will be introduced to documentation guidelines for E/M services that apply to services delivered under Medicare/Medicaid.

Lesson 11: Anesthesia

In this lesson, you will learn about the methods of sedation and the formula used to determine to code for anesthesia services.

Lesson 12: Surgery Guidelines and General Surgery

In this lesson, you will learn about the Surgery section format, locate the notes and guidelines in the Surgery section, state the use of unlisted procedures, interpret elements of a special report, examine the designation of separate procedures, analyze the contents of a surgical package, and determine the contents of the General Subsection.

Lesson 13: Integumentary System

In this lesson, you will learn how to code the procedures and services described in the Surgery Section and Integumentary System subsection of the CPT.

Lesson 14: Musculoskeletal System

In this lesson, you will learn about the Musculoskeletal System, including how the subsection is coded. Additional attention will be paid to fracture types and repair, application of casts and strapping, the General Subheading, and endoscopic procedures. You will have an opportunity to learn about these subdivisions and to practice coding procedures and services categorized in these subdivisions.

Lesson 15: Respiratory System

In this lesson, you will learn about the format of the Respiratory System subsection of the CPT. Special attention will be paid to the surgical procedures coded in this subsection and to procedures coded under additional subheadings of the nose, accessory sinuses, larynx, trachea and bronchi, and lungs and pleura. Students will also have an opportunity to practice coding procedures from the Respiratory System subsection of the CPT.

Lesson 16: Cardiovascular System

In this lesson, you will learn about the coding of procedures affecting the Cardiovascular System. You will cover coding from the Surgery, Medicine, and Radiology sections, as well as the major classes of procedures that apply in each system.

Lesson 17: Hemic, Lymphatic, Mediastinum, and Diaphragm

In this lesson, you will learn about the codes used to report services involving the Hemic and Lymphatic Systems and the Mediastinum and Diaphragm. Subsection formats and subheadings are also discussed. Finally, you will have the opportunity to complete coding exercises that require the student to assign procedural and diagnostic codes.

Lesson 18: Digestive System

In this lesson, you will learn about the codes used to report services associated with the Digestive System. Coding for services involving the digestive system and subsection formats will be discussed. Finally, you will have the opportunity to practice applying the above information by assigning procedural and diagnostic codes for exercises and coding reports.

Lesson 19: Urinary and Male Genital Systems

In this lesson, you will learn about the codes used to report services associated with the Urinary and Male Genital Systems. Coding for services involving the urinary system and male genital system and subsection formats will be discussed. Finally, you will have the opportunity to practice applying the above information by assigning procedural and diagnostic codes for exercises and coding reports.

Lesson 20: Reproductive, Intersex Surgery, Female Genital System, and Maternity Care and Delivery

In this lesson, you will learn about coding procedures of the Reproductive System, Intersex Surgeries, and also those that affect the Female Genital System. Coding practices, critical terms, and services for maternity care and delivery will also be discussed. Furthermore, you will have the opportunity to analyze abortion procedures.

Lesson 21: Endocrine and Nervous Systems

In this lesson, you will learn about the codes used to report services associated with the Endocrine and Nervous systems. Subsection formats and subheadings are also discussed. Finally, you will have the opportunity to complete coding exercises that require you to assign procedural and diagnostic codes.

Lesson 22: Eye, Ocular Adnexa, Auditory, and Operating Microscope

In this lesson, you will learn about codes used to report services associated with the eye, ocular adnexa, auditory, and the operating microscope. Coding for services involving the eye and ocular adnexa and the auditory system is discussed. Finally, you will have the opportunity to complete coding exercises that require the student to assign procedural and diagnostic codes.

Lesson 23: Radiology

In this lesson, you will learn about codes used to report services associated with radiology services. You will be shown radiology terminology, component coding, elements of the global procedure, and appropriate coding of contrast material. Finally, you also will have the opportunity to put this information into practice by assigning codes to complete exercises and coding reports.

Lesson 24: Pathology/Laboratory

In this lesson, you will learn about codes used to report services associated with radiology services. You will be shown radiology terminology, component coding, elements of the global procedure, and appropriate coding of contrast material. Finally, you also will have the opportunity to put this information into practice by assigning codes to complete exercises and coding reports.

Lesson 25: Medicine

In this lesson, you will learn about the codes in the Medicine section of the CPT manual. You will have the opportunity to put this information into practice by completing exercises and coding reports that require the use of codes in the Medicine section.

Lesson 26: Inpatient Coding

In this lesson, you will learn about Inpatient Coding and Reporting while being able to differentiate between inpatient and outpatient coding and will examine the ICD-10-PCS system.

Coding and Reimbursement for Hospital Inpatient Services Curriculum:

Lesson 1: Introduction to Reimbursement for Hospital Inpatient Services

In this lesson, we will be introduced to the inpatient services available in the hospital setting. We will also look at the reimbursement options in hospitals, including the types of fee-based services and value-based purchasing.

Lesson 2: The Medicare System

This lesson includes a deeper dive into the Medicare system, including the structure of the payment systems and the types of Medicare available.

Lesson 3: Coding for Inpatient Services

In this lesson, we will start our exploration of coding for inpatient services. We will explore ethical coding, procedures for coding, and documentation involved in coding. Guidelines for reporting diagnoses will also be covered.

Lesson 4: Inpatient Coding and Reimbursement Processes

This final lesson is a deeper look at the processes involved in coding and reimbursement at hospitals. Topics include data quality management, compliance issues, including fraud prevention, and the healthcare record auditing process.

ICD-10 PCS: An Applied Approach Curriculum:

Lesson 1: System Definitions and Guidelines

This lesson will provide an overview of ICD-10-PCS system definitions and guidelines. You'll learn about the system structure and design, as well as the ICD-10-PCS coding guidelines.

Lesson 2: Root Operations

This lesson will provide in-depth instruction on the different root operations that are used within the medical and surgical section. The root operation is the character that comes between the body system and body part and designates the objective of the procedure. To properly code a procedure, it's important to fully understand the root operation.

Lesson 3: Coding Anatomical Regions, Nervous System, and Sense Organ Procedures

In this lesson, you'll learn how to properly code procedures for the anatomical regions, which are general locations in the body that are used when procedures are performed on multiple body parts. You'll also learn how to code procedures that are performed on the nervous system and sense organs.

Lesson 4: Coding Respiratory System and Circulatory System Procedures

This lesson will provide an overview of the coding guidelines for the respiratory system, including the mouth and throat. In addition, coding guidelines will be provided for the circulatory system, which includes the heart and great vessels, upper arteries, lower arteries, upper veins, and lower veins.

Lesson 5: GI and Hepatobiliary Systems, Endocrine and Lymphatic Systems, and the Integumentary System

This lesson will discuss the gastrointestinal system and describe procedures performed on the esophagus, stomach, intestines, anus, and rectum. Also included is a discussion of the hepatobiliary system because of its close connection with the gastrointestinal system. This lesson will also cover the subjects of the endocrine and lymphatic systems for coding in ICD-10-PCS. These systems are both fairly small but serve unique and important functions in the body. Finally, this lesson will discuss the integumentary system, which includes skin and breast, subcutaneous tissue, and fascia.

Lesson 6: System Structure and Design and the Skeletal System

This lesson will provide an overview of discussion of the musculoskeletal system with the musculature, the ICD-10-PCS sections on muscles, tendons, bursae, and ligaments. Also included is coverage of procedures performed on bones and joints.

Lesson 7: Urinary System, Male Reproductive System, and Female Reproductive System

This lesson will provide coding guidelines and information for procedures related to the urinary system, the male reproductive system, and the female reproductive system. The body parts associated with the urinary system are the kidneys, the ureters, the bladder, and the urethra. The male reproductive system in ICD-10-PCS contains the prostate, seminal vesicle, scrotum, tunica vaginalis, testis, spermatic cord, epididymis, vas deferens, penis, and prepuce. The female reproductive system in ICD-10-PCS contains the ovaries, uterine supporting structures, fallopian tubes, uterus, endometrium, cervix, cul-de-sac, vagina, clitoris, hymen, vestibular glands, vulva, and ova.

Lesson 8: Medical and Surgical Related Sections

This lesson will provide coverage on medical and surgical related sections of ICD-10-PCS. These sections include: obstetrics; placement, administration, measurement, and monitoring procedures; extracorporeal or systemic assistance, performance, and therapies; osteopathic, other procedures, and chiropractic sections. These procedures are covered separate from the individual body systems in previous lessons because they can be performed on various body parts and places throughout the body.

Lesson 9: Ancillary Sections

This lesson will provide a discussion of codes related to a variety of procedures including imaging, nuclear medicine, physical rehabilitation and diagnostic audiology, mental health, substance abuse treatment, and new technology. These procedures take various forms and require different codes.

Medical Terminology Curriculum:

Lesson 1: Medical Terminology Basics

This lesson will help you be able to Identify the four-word elements used to build medical words. You will also learn how to divide medical words into their component parts and apply the basic rules to define and build medical words. You will learn how to interpret pronunciation marks so you can pronounce medical terms presented in this chapter.

Lesson 2: Body Structures

One of the most important parts of the course is understanding the organization of the body. While each person is unique in their own right, the way we are assembled as humans (in a general sense are nearly the same). For this lesson, upon understanding the different levels, planes, and regions of the body, participants will learn how to properly pronounce terms related to a body structure. Documenting health care activities will conclude this part of the course through the assigned activities provided.

Lesson 3: Integumentary, Digestive and Respiratory Systems

The third lesson of the course begins the comprehensive review of the major parts of the body. In this case, the first three (3) in focus are the integumentary, digestive, and respiratory systems. Better put, this lesson will provide comprehensive details and knowledge to understand medical terms specific to one's skin, digestive, and breathing systems. Anatomy and physiology reviews are included in the reading material so participants can not only comprehend terminology but also view where it is often located in these parts of the body. Additional supplemental materials located in the back of the text are available as additional study aids and reference for this and other core portions of the course.

Lesson 4: Cardiovascular, Blood, Lymphatic and Immune Systems

Continuing the discussion of core body systems, the fourth lesson reviews more specific systems which blood commonly flows through. This includes cardiovascular systems such as the heart, lymphatic systems, and more. Similar to other course lessons that focus on body systems, one will need to comprehend the aforementioned knowledge plus an understanding of various diseases or body issues that may result when malfunctions may occur. As mentioned in the previous lesson, additional supplemental materials located in the back of the text are available as additional study aids and reference for this and other core portions of the course.

Lesson 5: Musculoskeletal, Urinary, and Reproductive Systems

The fifth lesson of the course continues the focus of core body systems that medical professionals must understand in order to properly convey and use terms correctly. This lesson goes into great detail about musculoskeletal, urinary, and reproductive systems. These body systems are often dependent on others working properly and failure of those having issues or deficiencies will likely cause these to do the same or at worse fail. Participants should pay particular focus to the reproductive systems and their respective terms as they only apply to their gender and at times, it can be easy to confuse their respective terminologies. As part of a major reoccurring theme for the course, additional supplemental materials located in the back of the text are available as additional study aids and reference.

Lesson 6: Endocrine Systems

The second to last part of the course focuses on an ever-increasing medical base within the United States and the world - endocrinology. Endocrine systems provide the necessary functionality to help keep equilibrium within one's body and nutrients (e.g. glucose and insulin) to keep that balance in place. Hence, thyroid and diabetes care increasing in need, medical professionals must have a strong grasp of common terminology used in this space so that it can be communicated properly and effectively to patients and other medical personnel. To aid in the learning experiences in this important section of the course, additional supplemental materials located in the back of the text are recommended to be used in conjunction with required reading assignments.

Lesson 7: Nervous System and Special Senses

In the final lesson, participants will learn about one body system and special senses. You will be able to locate the major organs of each and describe their structure and function. You will also better understand how each relates to others in the body. You will also learn how to pronounce, spell, and build words related to all both. You will gain an understanding of diseases, conditions, and procedures related to each one as well. You will learn about pharmacology related to the treatment of disorders in each.  One is encouraged to apply cumulative learning experiences to the comprehension of terms learned here as well as additional resources that immediately follow this chapter in the text.

All necessary course materials are included as eBooks.  Physical copies of HCPCS, CPT, ICD-10-CM, and ICD-10-PCS are included.

Please be aware that the 2024 textbooks required for the AHIMA exam—CPT Professional 2024, HCPCS 2024 Level II Professional Edition, ICD-10-CM 2024 The Complete Official Codebook, and ICD-10-PCS 2024 The Complete Official Codebook—are valid only until April 30, 2025.

If you plan to take the exam after May 1, 2025, you will need to obtain the 2025 versions of these textbooks at your own expense, as ProTrain will not cover the cost of the updated materials.

Certification Exam(s):

This course prepares a student to take the American Health Information Management Association (AHIMA) Certified Coding Associate (CCA) or Certified Coding Specialist (CCS) national certification exam.

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.