This course provides an overview of coding and reporting guidelines for diagnostic and screening services. It will cover documentation requirements and medical necessity criteria that help differentiate between screening and diagnostic services.
The information in this course applies to facility-based outpatient coders, billers, and revenue cycle managers. This lesson will include outpatient coding information using the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) diagnosis codes and guidelines. ICD-10-CM codes establish medical necessity by communicating the reason for the screening or diagnostic exam. Learners should have a basic knowledge of facility-based outpatient coding and/or billing regulations before completing this course.
The goal of this course is to provide an overview of coding and reporting guidelines for screening and diagnostic testing.
This course provides an overview of coding and reporting guidelines for diagnostic and screening services. It will cover documentation requirements and medical necessity criteria that help differentiate between screening and diagnostic services. The information in this course applies to facility-based outpatient coders, billers, and revenue cycle managers. This lesson will include outpatient coding information using the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) diagnosis codes and guidelines. ICD-10-CM codes establish medical necessity by communicating the reason for the screening or diagnostic exam. Learners should have a basic knowledge of facility-based outpatient coding and/or billing regulations before completing this course. The goal of this course is to provide an overview of coding and reporting guidelines for screening and diagnostic testing.
“This program has been approved for 0.5000 continuing education unit(s) for use in fulfilling the continuing education requirements of the American Health Information Management Association (AHIMA). Granting prior approval from AHIMA does not constitute endorsement of the program content or its program sponsor.”
This activity is approved for 0.5000 contact hours.
Outline:
Section 1: Introduction
About This Course
Learning Objectives
Section 2: Definitions
Differentiating Between Screening and Diagnostic Services
CMS Definition of Diagnostic Services
Review
Section 3: Guidelines
ICD-10-CM Coding and Medical Necessity
Outpatient Coding Guidelines
Coding Guidelines for Screening Services
Coding Guidelines for Diagnostic Services
Coding Examples for Diagnostic Services
Review
Section 4: Documentation
Source Documents
Physician Orders
Other Sources of Documentation
How Documentation Supports Screening vs Diagnostic Reporting
Review
Relationship of High-Risk Criteria to the Coverage of Screening Exams
Frequency of Screening Exams
Review
Section 5: Conclusion
Course Summary
Course Contributors
Resources
References
Tamara has twenty-seven years of multi-specialized medical coding and Corporate Compliance experience. She is the founder of Abraham Medical Coach LLC, where she provides medical coding and healthcare compliance consulting services to healthcare organizations across the United States. In addition to consulting, Tamara prepares individuals to sit for their medical coding certification via her online course curriculum. She is an adjunct educator for a local community college based in Texas. Her area of instruction includes Introduction to Medical Law, Medical Terminology, ICD-10-CM and Procedural Coding. Tamara’s credentials include AAPC Approved Instructor, Certified General Surgery Coder and Certified Professional Coder with the Academy of Professional Coders Association (AAPC). She has authored three books specific to the medical coding industry.
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