Medical Coding Training

Course details

What is Medical / Clinical Coding?

Medical (or) Clinical Coding is the translation of clinical terminology as written by a clinician into statistical code. The term "clinical coder" is somewhat a misnomer as the actual role is that of a translator of clinical terminology as opposed to a clinical practitioner.
a clinician records a diagnosis for a patient as "calculus (or stone) in the urinary bladder. The clinical coder will translate that terminology into the ICD-10 (International Classification of Diseases V10) code Calculus in bladder. (The process is much more complex than this example implies.)

The schemes used are the ICD-10 (International Classification of Diseases V10), published by the World Health Organisation and the procedure/interventions coding scheme OPCS 4 (Office of Populations Census and Surveys V4) published by the Stationary Office and produced by NHS Connecting for Health.

What are the codes used for?

The Medically/Clinically Coded Data is used to support a variety of requirements:

• Epidemiology
• Generation of payment
• Resource management
• Casemix analysis
• Audit
• Information and Clinical governance

In this course, you'll learn how to use the CPT manual and ICD-10-CM to find medical codes for any disease, condition, treatment, or any surgical procedures. This knowledge will help prepare you to work almost anywhere in the medical field—doctors' offices, clinics, public health facilities, hospitals, labs, nursing homes, insurance agencies, or even at the comfort of your home.

To understand medical coding we need to have through knowledge on human anatomy and physiology ie., each of the main systems of the human body—integumentary (skin), musculoskeletal, respiratory, cardiovascular system, gastrointestinal, endocrine, and male and female genitourinary—outlining the medical terminology, conditions, diseases, injuries, treatments, and procedures.

Why Study Medical / Clinical Coding?

A clinical coder is responsible for reviewing the patient records of discharged patients, identifying the key clinical diagnoses and procedures (according to a set of international coding standards), and translating this clinical information into a set of codes.

These clinical codes are then used by a range of stakeholders (such as DHB management & clinical staff, and the Ministry of Health) for various purposes, such as clinical research, health service funding and planning.

Who is this Course for?

Individuals with the following skills and attributes are particularly suited to a career in clinical coding:

• Clinical staff looking for a career change
• Administrative staff with a clinical background
• Transcriptionists with excellent medical terminology skills
• Other staff with an aptitude for study and a genuine interest in a long‐term career in clinical coding

Pre‐requisites

Applicants for the course will require:

• A recognised qualification in medical terminology or a medical, nursing or allied health background
• English language (written and oral) proficiency
• An aptitude for study at a fast pace
• Ability to commit to full‐time study for the duration of the course
• Self‐discipline to successfully complete study via distance learning
• The ICD‐10 manuals

Who can apply?

This course is aimed at students who have no prior coding experience but is also suitable for coders who require some help. The course is open to all National & International students.

Course Contents:

Module 01 - Medical Coding Basics
Module 02 - Coding in the Healthcare industry
Module 03 - Getting to Know about CPT Manual
Module 04 - Getting to Know about ICD-10-CM
Module 05 -The Integumentary System
Module 06 - The Musculoskeletal System
Module 07 - The Respiratory System
Module 08 - The Cardiovascular System
Module 09 - The Digestive and Endocrine Systems
Module 10 - The Male and Female Genitourinary Systems 
Module 11 - Evaluation and Management (E/M) Codes
Module 12 - Surgical Packages and Modifiers

Course Outcomes:

At the end of the course the students should be able to

1. Identify sections and guidelines in the CPT Coding book
   • Review the current procedural terminology
   • Discuss the purpose of CPT
   • Verify the correct CPT code from the medical record
   • Describe problem areas and how to resolve hard to code issues.
   • Define modifiers and their uses.
   • Read an operation report, noting items such as diagnosis and surgical procedures.
   • Demonstrate efficient use of the CPT coding book to locate information.
2. Identify sections and guidelines of the ICD-10 CM book
   • Explain the purpose of the International Classification of Diseases (ICD - 10)
   • Relate the manner in which the ICD -10 supports the CPT code.
   • The ability to find the main term and sub term for the identification of the total patient diagnosis.
   • Identify the correct sixth and seventh digits for high level of specificity.
   • The need for using place holder "X"

Updated on 03 August, 2020