MASTER SYLLABUS
2017-2018
A.
Academic Division: Health Sciences
B.
Discipline: Health Services Technology
C.
Course Number and Title: HITP 1030 – Advanced Coding and Billing
D.
Course Coordinator: Kelly Gray, MS, RN, CNE
Assistant Dean: Kelly Gray, DNP, RN, MS, CNE
Instructor Information:
 Name:
 Office Location:
 Office Hours:
 Phone Number:
 E-Mail Address
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E.
Credit Hours: 3
F.
Prerequisites: HITP 1010
G.
Syllabus Effective Date: Fall 2017
H.
Textbook(s) Title:
Effective Management of Coding Services
 Author(s): Lou Ann Schraffenberger, MBA, RHIA, CCS, CCS-P and Lynn Kuehn, MS, RHIA,
CCS-P
 Copyright Year: 2011
 Edition: 4th
 ISBN #: 978-1584262343
Clinical Coding Workout: Practical Exercises for Skill Development
 Author(s): AHIMA
 Copyright Year: 2013
 Edition: 1st
 ISBN #: 978-1584264187
(optional) Health Information Management Technology: An Applied Approach
 Author(s): AHIMA
 Copyright Year: 2012
 Edition: 3rd
 ISBN #: 978-1584263524
ICD-9-CM Code Book Volumes 1-3
 Author(s): Carol J. Buck, MS CPC CPC-H CCS-P
 Copyright Year: 2014
 Edition: 1st
Updated: 2/15/2017
Page 1 of 7

ISBN #: 978-0323186742
CPT Professional Edition
 Author(s): American Medical Association
 Copyright Year: 2013
 Edition: 1st
 ISBN #: 978-1-60359-684-8
Recommended Readings: (found in the AHIMA Body of Knowledge)
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HIM and Health IT
ICD-10-CM Primer
Managing an Effective Query Process
Terms for Terms
Snomed
Snomed Clinical Terms Fundamentals
Coordination of SNOMED and ICD-10
ICD-9-CM Lecture Powerpoints
CPT Lecture Powerpoints
AHIMA Code of Ethics
HIM Competencies
I.
Workbook(s) and/or Lab Manual: None
J.
Course Description: This course provides the student with advanced knowledge and coding practice in
clinical classification systems; in-depth prospective payment system; data quality, fraud and abuse in
coding; advanced case studies. This course builds upon concepts learned in ICD-9-CM and CPT coding
course. It focuses upon the management of coded data in clinical databases, for use in reimbursement and
decision-support in various healthcare settings. SNOMED and additional classification systems are also
introduced. The student will also be introduced to the revenue cycle, data presentation and report
generation as well as coding quality and coding compliance.
K.
College-Wide Learning Outcomes:
College-Wide Learning Outcome
Communication – Written
Communication – Speech
Intercultural Knowledge and Competence
Critical Thinking
Information Literacy
Quantitative Literacy
L.
Assessments - - How it is met & When it is met
Course Outcomes and Assessment Methods:
Upon successful completion of this course, the student shall:
Outcomes
1.
Describe the requirements for
maintaining a healthcare organization’s
clinical data, and understand policies and
procedures for managing the
organization’s clinical database.
Updated: 2/15/2017
Assessments – How it is met
& When it is met
Weekly Assignments
Mid-Term Exam – Week 9
Page 2 of 7
Outcomes
2.
3.
4.
5.
6.
7.
M.
Describe a health care organization’s financial
management system, illustrate the steps in the
revenue cycle and flow chart the process from
coding through reimbursement.
C o m p l e t e Coding for advanced cases utilizing
ICD-9-CM and CPT-4.
Describe a plan to effectively and efficiently
manage the coding services involving a healthcare
organization’s coding and data reporting functions.
Identify potential abuse or fraudulent trends through
data analysis
Design a sample coding quality
management/performance improvement plan.
Design a coding compliance plan based upon
internal and external coding requirements,
regulations, and guidelines,
Assessments – How it is met
& When it is met
Weekly Assignments
Mid-Term Exam – Week 9
Weekly Assignments
Mid-Term Exam – Week 9
Weekly Assignments
Mid-Term Exam – Week 9
Weekly Assignments
Final Exam – Week 16
Weekly Assignments
Final Exam – Week 16
Weekly Assignments
Final Exam – Week 16
Topical Timeline (Subject to Change):
Course Schedule
Week
Readings
Week 1 The Coding Function: Chapter One discusses the coding
Chapter
professional in the context of the work environment. Although
1
the reader may infer that the focus is acute care, the text is
geared towards presenting the coder as a member of the HIM
team in any clinical setting. This chapter is particularly useful for
users whose sole exposure to coding has been in the academic
environment or by association in the work place.
Week 2 Chapter 2 addresses the many practical issues involved in
Chapter
recruiting and retaining coding staff. While there are certainly
2
many theoretical points, the chapter focuses on sharing the
authors’ experiences in various settings and in helping the reader
understand some of the issues from the point of view of
contractors.
Week 3 Alternative Staffing and Coding/Billing Issues and Coding in
Chapter
Specialized Care Settings - Chapter 3 discusses several common
3
alternatives to full-time employee staffing.
Week 4 Chapter 4 provides an overview of the various coding and billing Chapter
issues in a variety of practice settings in which coders may find
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themselves employed. It can be difficult for instructors to assist
students to absorb this widely diverse topic and all may benefit
from more in-depth review of the characteristics of the settings
as each one is explored.
Week 5 Classifications and Terminologies: The purpose of this chapter is Chapter
to provide an overview of and reference for clinical
5
classification, nomenclatures, and terminologies.
Week 6 Use of Coded Data - The purpose of Chapter 6 is to provide an
Chapter
overview of risk adjustment and payment systems, particularly
6
as they pertain to prospective payment systems and CMS PPS.
Updated: 2/15/2017
Assignments
Weekly
Assignment
Weekly
Assignment
Weekly
Assignment
Weekly
Assignment
Weekly
Assignment
Weekly
Assignment
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Course Schedule
Week
Readings
Week 7 Charge Description Master - Chapter 7 serves as an introduction Chapter
to the concepts and vocabulary rather than the mechanics of the
7
systems discussed. This chapter discusses the nature, purpose,
uses, and maintenance of a charge description master including
LCDs, NCDs, and other regulatory guidelines.
Week 8 Midterm Exam
Week 9 Performance and Process Improvement and Data Quality Chapter
Chapter 8 focuses on the always-thorny issue of performance
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management. What constitutes productivity?
Week 10 The purpose of Chapter 9 is to acquaint the reader with the
issues and processes involved in conducting both internal and
external coding quality reviews.
Week 11 Chapter 10 contains an overview of Clinical Documentation
Improvement (CDI) programs: how and why they are needed
and who is involved. Fundamental to the success of a CDI
program is the support of both administrative and medical
leadership. Although it is not emphasized in the chapter, the cost
justification of a CDI program lies in the accuracy of the case
mix index (i.e., coding), the defense against RAC audits, and the
accurate reflection of patient severity of illness (for
benchmarking purposes). As CDI programs tend to be
expensive, cost justification cannot be ignored.
Week 12 Compliance and Reporting - Chapter 11 discusses the regulatory
as well as the practical issues surrounding the development and
implementation of a coding compliance program. As with some
of the other chapters, there is a lot of material to digest.
Week 13 Chapter 12 defines the sources of data as they relate to the
coding process, identifies the type of information needed to
create reports based on coded data, and describes where and how
various users inside and outside the healthcare facility need and
use coded information.
Week 14 The Revenue Cycle - Chapter 13 discusses the revenue cycle
management model as well as the basic concepts of the model.
Members of the revenue cycle model and their functions are also
discussed. Students will be able to identify the relationship
between accounts receivable and the various forms and tools
used in the coding process.
Week 15 Case-Mix Management
Chapter 14 is entirely devoted to the development of various
case-mix indexes and how these indexes can be used to analyze
performance. Students who intend to pursue HIM management
roles or positions in clinical data analysis must be comfortable
with the concepts and calculations involved in case-mix analysis.
Week 16 Final Exam, Clinical Coding Workout Exercises
Assignments
Weekly
Assignment
Midterm Exam
Weekly
Assignment
Chapter
9
Mid-Term Exam
Weekly
Assignment
Chapters
10
Weekly
Assignment
Chapter
11
Weekly
Assignment
Chapter
12
Weekly
Assignment
Chapter
13
Weekly
Assignment
Chapter
14
Weekly
Assignment
NOTE: In case of events beyond the control of faculty that interfere with class times and teaching,
adjustments may be made to date of coverage, order of coverage, and date of exams and
assignments to ensure full coverage of course content.
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N.
Course Assignments:
1.
2.
O.
Weekly assignments – papers, coding activities, development of procedures
Exams
Recommended Grading Scale:
NUMERIC
93–100
90–92
87–89
83–86
80–82
77–79
73–76
70-72
67–69
63-66
60-62
00-59
P.
GRADE
A
AB+
B
BC+
C
CD+
D
DF
POINTS
4.00
3.67
3.33
3.00
2.67
2.33
2.00
1.67
1.33
1.00
0.67
0.00
DEFINITION
Superior
Superior
Above Average
Above Average
Above Average
Average
Average
Below Average
Below Average
Below Average
Poor
Failure
Grading and Testing Guidelines:
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Examination Policy:
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R.
Class Attendance and Homework Make-Up Policy:
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S.
Classroom Expectations:
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College Procedures/Policies:
Attendance Requirements: All students are required to attend all scheduled classes and examinations.
Each faculty member has the right to establish regulations regarding attendance that he/she considers
necessary for successful study.
Students who do not attend classes may be administratively withdrawn from those classes. However,
failure to attend classes does not constitute withdrawal, and students are expected to process a formal
withdrawal though the Student Records Office in Kee Hall.
Student engagement requirements:
Student engagement is based on the “active pursuit” of learning which can be measured by class
attendance, class participation (in class or online), taking required quizzes/examinations, and submission of
work assignments or papers. Student engagement consists of a student attending at least 60% of the class
sessions (there should be attendance throughout the term) and/or completing 75% of the assignments listed
on the syllabus at the midpoint in the term. Exceptions can be made when there is on-going
communication between the student and faculty member. The communication must be documented and the
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faculty member and student must be in agreement regarding the exception. Students not meeting the
expectation will be administratively withdrawn from class. If a student believes he/she was
administratively withdrawn in error, he/she may file an appeal. Being administratively withdrawn may
have program and financial aid implications.
Academic Misconduct is any activity that tends to compromise the academic integrity of the college, or
subvert the educational process. Examples of academic misconduct include, but are not limited to:
1.
Violation of course or program rules as contained in the course syllabus or other information provided
to the student; violation of program requirements as established by departments and made available to
students.
2.
Plagiarism including, but not limited to, submitting, without appropriate acknowledgment, any written,
visual or oral material that has been copied in whole or in part from the work of others (whether such
source is published or not) even if the material is completely paraphrased in one’s own words. This
includes another individual’s academic composition, compilation, or other product, or a commercially
prepared paper. Plagiarism also includes submitting work in which portions were substantially
produced by someone acting as a tutor or editor.
Such practices constitute plagiarism regardless of motive. Those who deny deceitful intent, claim not
to have known that the act constituted plagiarism, or maintain that what they did was inadvertent are
nevertheless subject to penalties when plagiarism has been confirmed.
3.
Cheating and dishonest practices in connection with examinations, papers and projects, including but
not limited to using unauthorized notes, study aids or information on an examination; obtaining help
from another student during an examination; taking an exam or doing work for another student;
providing one’s own work for another student to copy and submit as his/her own; or allowing another
student to do one’s work and then submitting the work as one’s own. Also included would be altering
a graded work after it has been returned, then submitting the work for re-grading; or submitting
identical or similar papers for credit in more than one course without prior permission from the course
instructors.
4.
Fabrication including but not limited to falsifying or inventing any information, data or citation;
presenting data that were not gathered in accordance with defined appropriate guidelines, and failing to
include an accurate account of the method by which data were collected.
5.
Obtaining an Unfair Advantage including, but not limited to stealing, reproducing, circulating, or
otherwise gaining access to examination materials prior to the time authorized by the instructor;
unauthorized collaborating on an academic assignment; taking, hiding or altering resource material; or
undertaking any activity with the purpose of creating or obtaining an unfair advantage over another
student’s academic work.
6.
Aiding and Abetting Academic Dishonesty including, but not limited to providing material,
information or other assistance to another person with the knowledge that such aid could be used in
any of the violations stated above, or providing false information in connection with any inquiry
regarding academic integrity.
7.
Alteration of Grades or Marks including but not limited to, action by the student in an effort to change
the earned credit or grade.
In addition, cases of academic dishonesty may involve photocopied materials. Materials used may fall
under the Copyright Act. Violations of said Act may subject the user and/or the College to sanctions.
Statement on Disabilities: Any student who requires reasonable accommodations related to a disability
should inform the course instructor and the Coordinator of Specialized Services (Room 138 in Kee Hall;
phone 419-755-4727).
Updated: 2/15/2017
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Students who encounter difficulty in any of their courses are encouraged to visit the Tutoring Resource
Center (Room 119 in Fallerius Technical Education Center) for tutoring assistance, and the Student Success
Center (Room 136 in Kee Hall) for academic assistance, advising services, referrals for personal counseling
and Learning Disability (LD) Testing.
Statement on Withdrawals: As a student, you are expected to attend class. If you are unable or choose not
to attend class, or if for whatever reason you are unable to keep up with the requirements of a course, you
need to officially drop the class at the Student Records Office. Refund dates and withdrawal dates will
vary slightly from term to term. Contact the Student Records Office for applicable dates. Additionally
these dates are posted on the academic calendar available on the college’s website,
www.ncstatecollege.edu, under the Academics heading on the home page and are available at the Student
Records Office in Kee Hall,. Students should go to the Student Records Office (Room 142 in Kee Hall) to
process their withdrawal from any class.
If you choose to walk away from your class without officially withdrawing from it, the faculty member
teaching the class must grade your classroom performance on the material available to him or her. This
normally results in an "F" grade. An "F" grade can lower your grade point average considerably depending
on the total credits accumulated.
Updated: 2/15/2017
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