Choosing the Correct Coding for Optimal Reimbursement

Lesson Content

• Lesson Plan Template:

  CTE Lesson Plan

• CTE Course Info and Benchmark Notes

  
  

  Medical Coder Biller II

  Course Number: HIM0092

  CIP: 0351071403

  CTE-HLTH.3031.HIM0092.1.3.

  Assign and/or verify diagnosis, procedure, HCPCS level II codes, and applicable modifiers and groupings in accordance with official guidelines.

  CTE-HLTH.3031.HIM0092.1.1 -

  Apply conventions and guidelines used in coding.

• Unit Outline

  
  

  This lesson is designed to be used with the case study, “Choosing Coding for Optimal Reimbursement.” See CPALMS resource ID# 215712.

• Career Connection

  
  

  Students will use investigative skills, critical thinking, computer literacy skills, as well as organizational skills to perform the tasks associated with using professional coding manuals and guidelines and analyzing medical records.

• Learning Objectives

  
  

  Students will be able to:

  • Research coding guidelines and conventions and correlate to appropriate codes

  • Select appropriate codes to code to the highest level of specificity.

  • Apply knowledge of human anatomy and physiology to choose correct diagnostic codes and procedure codes.

• Prior Knowledge

  
  

  Students should be familiar with/able to:.

  • Professional coding books; ICD-10, CPT, HCPCS and how to use the indexes and guidelines
  • Medical terminology, anatomy and physiology and medical abbreviations

• Guiding Questions

  
  
  • Which professional manual will you need use for choosing diagnosis codes? Which professional manual (s) will you need to code procedures, good and services?
  • What are the first 3 steps to finding a code in the ICD-10?

• Procedure

  
  

  1. To introduce the lesson, review what students already know about professional coding manuals, coding manual guidelines, medical terminology and code choosing process.

  2. Give students time to individually read the case study "Choosing Coding for Optimal Reimbursement.” See CPALMS resource ID# 215712.

  3. Discussion/comprehension questions: After students have read the case study, as an open class discussion have students:

  • Give examples of medical terminology prefixes, suffixes, define word roots and give examples of medical terms.
  • Name the three main coding manuals and align each with their purpose.
  • Where are the guidelines found in the CPT manual, HCPCS book and ICD-10 manual?
  • What steps are required to begin searching for appropriate codes?

  4. Student-centered activity: In groups, using current ICD-10, CPT, and HCPCS manuals, internet search engines and any available encoder software, students will research information relevant to the operative summaries attached to this lesson plan and other patient medical documents mentioned in the case study (See Special Materials).

  5. Students will then use the medical coding worksheet as a step-by-step method for assigning codes to diagnoses, procedures, goods and services.

  6. Once students have read the operative summaries, located codes, they will compare and contrast researched information to understand why there may have been descrepancies in reimbursements to the surgeons. Students will use the coding worksheets included with this lesson plan to track correlations (see Special Materials Diagnosis Coding Worksheet).

  6. To bring the lesson to a close, students will submit a summary of codes they chose or accepted for the case studies referenced in the case study. Students can also participate in a discussion on lesson takeaways that can be applied to the field of medical coding.

• Teacher Notes

  
  

  There are coding worksheet handouts and operative summaries attached to this lesson plan that correlate to the instructions for choosing the correct codes.

  Alternatively, students could work in groups working on each of the 4 operative summaries and patient medical documentation, then come together as a class to discuss findings.