Certified Medical Coder

• Makeup and pronunciation of medical terms/words
• Key review of the human body systems, illustrations, and review of anatomic position and directional terms
• Root words, prefixes, suffixes, and supplemental terms
• Combined forms associated with medical conditions
• Definitions for common medical abbreviations
• Analysis of physician orders and narratives

ICD-10-CM Coding

• Instruction on the guidelines, organization, and groupings of ICD-10-CM
• Accurate translation of medical terminology for diseases into codes
• Designation of symbols, punctuations, abbreviations, keywords, unspecified codes, and other coding conventions
• ICD-10-CM subcategories, classifications, and extensions
• Outline of the complete coding and reimbursement equation
• Primary vs. secondary code selection
• Diagnostic coding guidelines such as laterality, sequelae, etc.
• Differentiate between signs/symptoms and ill-defined conditions and a diagnosis
• Correct rules and guidelines for assigning codes for neoplasms, adverse effects, pregnancy, childbirth, wounds, burns, injuries, HIV/AIDS, etc.
• Unsubstantiated and borderline diagnoses
• Application of ICD-10 coding conventions
• How to determine the accurate diagnostic code order
• Proper use of tables
• Problem set coding exercises for hands-on comprehension

Procedural Coding - CPT® and HCPCS

• Key elements of physician documentation that drive the assignment of CPT codes
• Accurate code assignment through the application of coding guidelines
• HCPCS/CPT coding process and steps
• Format and conventions used in the HCPCS/CPT coding manuals
• Global and unbundled procedures, and their impact on coding in CPT
• Identify unlisted procedures and how to bill them
• Modifier usage for appropriate reimbursement and efficient claims processing
• Evaluation and management service types
• E/M guidelines and levels of service
• Medical record documentation as related to the application of E/M coding
• Bundled services guidelines for surgery coding
• New versus established patient guidelines
• Surgery coding guidelines
• Hands-on exercises coding common procedures and services provided by physicians

Ancillary Services & Advanced Coding

• Maternity and delivery services
• Types of radiology services
• Technical and professional component distinction
• Billing supervision and interpretation (S&I) services
• Laboratory procedure types
• Billing for qualitative detection versus quantitative detection
• Billing laboratory panel tests
• Types of pathology services
• Coding services in the medicine section
• Billing for the administration of vaccines and immunizations
• Types of dialysis
• Guidelines used to assign ophthalmologic examinations
• Advanced coding problem set exercises

Jan Hailey, MHL, CMC, CMIS, CMOM

Jan Hailey has more than 30 years of experience in healthcare. She is proficient in administration, coding, and billing roles. Her affinity for teaching has helped countless healthcare providers and medical office professionals over the years. Jan served as Director of Quality for Saint Joseph Physician Network located in Mishawaka, IN, and Director of Care Management with Select Health Network, an entity of Saint Joseph Health System. As Care Management Director, Jan led the physician network and comprehensive interdisciplinary team across the health system working closely with providers, management, staff, community, and payers to develop strategies for process improvement, gap closures, and patient experience. She developed a documentation improvement program and a Hierarchical Condition Category (HCC) coding education program to predict future healthcare utilization by accurately reporting patient complexity.

Prior to joining Saint Joseph, Jan was the Director of Quality, Coding, and Compliance for one of the largest health systems in Northern Indiana. She has a Master of Health Leadership and four professional certifications in office management, coding, insurance processing, and compliance. She has also been instrumental in the development of PMI's Workforce Initiatives program. 

• CMC candidates must have a minimum of one year of work experience as an outpatient medical coder or successful completion of foundational coding training courses, included with enrollment.
• CMC candidates will need current editions of CPT®, HCPCS, ICD-10-CM code set manuals, and a medical dictionary through the course and on the exam day.