AHE 221 - Procedural Coding in Outpatient Settings

1. Apply the research process in the selection of proper CPT codes using the Index and Tabular List in the CPT® code book.  
2. Analyze medical record documentation and assign correct CPT and HCPCS codes and modifiers using chapter guidelines, coding conventions, parenthetical instructions, modifier use, and appendices in the CPT® code book.  
3. Correctly assign HCPCS codes for pharmaceuticals, supplies, procedures, and durable medical equipment, per Centers for Medicare and Medicaid Services (CMS) regulations.  
4. List and describe the key components and classifications used for Evaluation and Management (E/M) coding utilizing the CPT® code book.  
5. Apply Evaluation and Management (E/M) codes using correct section, subsection, and category for type of service, place of service, and patient status.  
6. Coordinate use of CPT and HCPCS coding systems in a variety of patient care settings; acute, inpatient, outpatient, and ancillary departments (imaging centers and pathology/laboratories) using provider notes, and laboratory and radiologic results.  
7. Accurately code Evaluation and Management (E/M) services per the Centers for Medicare and Medicaid Services (CMS) guidelines and CPT instructions for leveling E/M services utilizing internal audit forms to ensure data compliance with all coding rules, laws, and guidelines.

1. Abstracting pertinent information to accurately code health care records for billing purposes.
2. Assignment and sequencing of HCPCS Level II codes for pharmaceuticals, supplies, procedures, and services.
3. Common medical terminology and abbreviations used in medical record documentation.
4. Assignment and sequencing of CPT Level I modifiers.
5. Assignment and sequencing of HCPCS Level II modifiers.  
6. Appendices of the CPT and HCPCS coding manuals.
7. Category II and Category III codes.
8. Medical necessity linkage between diagnosis codes and CPT/HCPCS codes.