Program Overview

Career Step has been training quality healthcare professionals for almost 20 years and offers two medical coding and billing education programs:

• Inpatient and Outpatient Medical Coding and Billing is a comprehensive program that prepares you for a career in both inpatient and outpatient medical coding and billing, making you more flexible and marketable after graduation.
• Outpatient Medical Coding and Billing is designed to help students gain the knowledge and skills necessary to smoothly transition to the workplace as an outpatient medical coder and biller.

Both of these programs offer you 24/7 online access to all program materials, providing the flexibility to study on your own schedule and at your own pace.

Inpatient and Outpatient Medical Coding and Billing Syllabus

The Inpatient and Outpatient Medical Coding and Billing online training program consists of 20 course modules. The modules you will study in the program are as follows:

• Program Orientation

  In the Introduction and Program Orientation module the student will be introduced to the healthcare coding and billing industries, the inpatient and outpatient medical coding and billing training program, and the format of the online program. A learning objective for each of the modules in the program is presented. Information for navigating, using the features and functions of the online program, and understanding tests and feedback is presented. Skills necessary to be a successful coder/biller are outlined. Available resources are presented along with a detailed study guide designed to make the learning experience a successful one.

• Technology and the Medical Professional

  In the Technology and the Medical Professional module, the student will become familiar with basic computer skills, including the use of hardware, software, peripherals, and wireless technology; the Internet as a resource; and various methods of data storage and networking. The student will also study the multiple software and hardware products developed specifically for the healthcare environment.

• Learning and Mastering Medical Terminology – Block 1

  In the first block of Medical Terminology, the student will learn how to use resources (e.g., medical dictionaries and online resources), how to look up words, how words are structured, and how medical words are built using suffixes and prefixes.

• Documentation, Confidentiality, and Ethics

  The Documentation, Confidentiality, and Ethics module provides the student with an overview of documentation and confidentiality requirements within the healthcare environment and the impact advances in technology have had on the healthcare profession. The student will become familiar with healthcare documentation standards, HIPAA compliance regulations, and the adaptation of the electronic health record (EHR) in institutions throughout the United States and the world. The student will explore the role of the medical coding and billing professional in maintaining the integrity and confidentiality of the medical record.

• Learning and Mastering Medical Terminology – Block 2

  In the second block of Mastering Medical Terminology, the student will begin learning medical word building through the study of root words. The module will be broken down into the root words A through Ir and Is through X. A review of block 1 of Learning and Mastering Medical Terminology will also be presented.

• Evolution of Coding in the Healthcare Environment

  In the Evolution of Coding in the Healthcare Environment module, the student will learn the history of healthcare coding in the United States and throughout the world. Learning objectives, career opportunities, and certification will be introduced. The coding systems utilized in the United States will be explored, including ICD-9-CM, CPT®, HCPCS Level II, DSM-IV, and ICD-O. The future implementation of ICD-10-CM and ICD-10-PCS will be presented.

• Learning and Mastering Medical Terminology – Block 3

  In the third block of Mastering Medical Terminology, the student will learn about medical plurals, medical slang and jargon, foreign medical terms, word differentiation, and medical abbreviations. A review of blocks 1 and 2 of Learning and Mastering Medical Terminology will also be presented.

• Healthcare Structure and Organization

  In the Healthcare Structure and Organization module, the student will learn about the structure and organization of the healthcare system in the United States. The student will study healthcare consumers, healthcare providers, governing and regulatory agencies, third-party payers, healthcare vendors, and trade associations.

• Anatomy, Pathophysiology, and Disease Processes – Block 1

  In the first block of Anatomy, the student will learn basic anatomical structures with a body system approach, including pathophysiology and disease processes affecting the human body. Disease entities, diagnosis, and treatment will be emphasized. The body systems in this module include skeletal, muscular, digestive, respiratory, and reproductive. Throughout the module, there will also be graphic representations of the various systems and structures to improve student understanding.

• Exploring Pharmacology

  The Exploring Pharmacology module introduces the student to the science of pharmacology and provides an overview of basic pharmacologics, including drug actions and effects, absorption, distribution, metabolism, excretion, and drug classifications and formulary. This module also gives the student the opportunity to see and reference pharmaceutical terms in the context of medical reports with exposure to commonly prescribed drugs.

• Anatomy, Pathophysiology, and Disease Processes – Block 2

  In the second block of Anatomy, the student will continue learning basic anatomical structures with a body system approach, including pathophysiology and disease processes affecting the human body. As in block 1, disease entities, diagnosis, and treatment will be emphasized. The body systems in this module include urinary, cardiovascular, endocrine, nervous, and integumentary/sensory organs. Throughout the module, there will also be graphic representations of the various systems and structures to improve student understanding.

• Medical Record Content

  In the healthcare setting, various reports make up a patient's medical record. The Medical Record Content module will provide an overview and detailed discussion of each of these reports. This module will also present the composition of each of the report types and how they relate to medical coding.

• Diagnostic Coding with ICD-9-CM – Block 1

  Students will be introduced to the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codebook. Block 1 gives students a thorough understanding of this critical reference book and introduces and explores important information regarding the general guidelines and several chapter-specific guidelines for coding and reporting healthcare services.

• Diagnostic Coding with ICD-9-CM – Block 2

  Block 2 continues the detailed instruction on the concepts presented in the ICD-9-CM codebook and explores the remaining chapter-specific guidelines and procedure codes for coding and reporting healthcare services.

• Medical Procedural Coding – Block 1

  In the first block of the Medical Procedural Coding module, students will be introduced to the Current Procedural Terminology (CPT®) codebook. This module provides a thorough understanding of the structure of the codebook and introduces some of the critical coding guidelines presented in the text.

• Medical Procedural Coding – Block 2

  The second block of the Medical Procedural Coding module continues the detailed instruction of the procedural codes presented in the Current Procedural Terminology (CPT®) codebook. This module also provides a thorough explanation of the structure and application of the HCPCS Level II codebook.

• Exploring Healthcare Reimbursement

  The Exploring Healthcare Reimbursement module provides detailed information about the various types of third-party payers that reimburse healthcare facility and physician services. Additionally, the module introduces information about claims processing and coding, billing for healthcare services, and auditing and monitoring the coding process.

• Skill Building for Outpatient Coding

  The Skill Building for Outpatient Coding module consists of actual outpatient medical records, which the students will be required to code. The reports in this module are drawn from medical reports across a wide variety of outpatient settings that a coding professional would come across as an outpatient coder. The reports are divided into levels of difficulty – and the student builds skills as they work through increasing levels of complexity.

• Skill Building for Inpatient Coding

  The Skill Building for Inpatient Coding module consists of authentic inpatient medical charts that the student will be required to code. The records in this module are drawn from inpatient records across a wide variety of specialties. The students will gain hands-on experience with encoding software as they use it to assign diagnosis and procedure codes and DRGs. Records are, again, divided into levels of difficulty – and the student builds skills as they work through increasing levels of complexity.

• Final Exam Overview and Preparation

  Upon completion of the program, students have the opportunity to assess their skills through a final exam. The Final Exam Overview and Preparation module contains information about the structure of the exam, tips for passing the exam, and instruction on how to schedule the exam.

Outpatient Medical Coding and Billing Syllabus

All of the curriculum material included in the Outpatient Medical Coding and Billing program is included the Inpatient and Outpatient Medical Coding and Billing program, making the program syllabi very similar. However, the Outpatient Medical Coding and Billing course does not include any inpatient specific curriculum or practicum.

• Program Orientation

  In the Program Orientation module, you will be introduced to the healthcare coding and billing industry, the medical coding and billing training program, and the format of the online program. A syllabus for each of the 19 modules in the program is presented. Information for navigating, using the features and functions of the online program, and understanding tests and feedback is presented. Skills necessary to be a successful coding and billing specialist are outlined. Available resources are presented along with a detailed study guide designed to make your learning experience a successful one.

• Technology and the Medical Professional

  In the Technology and the Medical Professional module, you will become familiar with basic computer skills, including using hardware, software, peripherals, and wireless technology, utilizing the Internet as a resource, and operating various facilities for data storage and networking. You will learn of the multiple software and hardware products available specifically developed for the healthcare environment.

• Learning and Mastering Medical Terminology – Block 1

  In Block 1 of Medical Terminology, you will learn how to use resources (for example, medical dictionaries), how to look up words, how words are structured, and how medical words are built using suffixes and prefixes.

• Documentation, Confidentiality, and Ethics

  The Documentation, Confidentiality, and Ethics module provides you with an overview of documentation and confidentiality requirements within the healthcare environment and the impact advances in technology have had on the healthcare profession. You will become familiar with the healthcare documentation standards, HIPAA compliance regulations, and the adaptation of the electronic health record (EHR) in institutions throughout the United States and the world. You will understand the role of the medical coding and billing professional in maintaining the integrity and confidentiality of the medical record.

• Learning and Mastering Medical Terminology – Block 2

  In Block 2 of the Medical Terminology module, you will learn medical word building: root words. These will be broken down into the root words A through Ir and Is through X. A review of Block 1 of Learning and Mastering Medical Terminology will also be presented.

• Evolution of Coding in the Healthcare Environment

  In the Evolution of Coding in the Healthcare Environment module, you will learn the history of healthcare coding in the United States and throughout the world. Learning objectives, career opportunities, and certification will be introduced. The coding systems utilized in the United States will be explored, including ICD-9-CM, CPT®, HCPCS Level II, DSM-IV, and ICD-O. The future implementation of ICD-10-CM and ICD-10-PCS will be presented.

• Learning and Mastering Medical Terminology – Block 3

  In Block 3 of the Medical Terminology module, you will learn about medical plurals, slang and medical jargon, foreign medical terms, word differentiation, and medical abbreviations. A review of Blocks 1 and 2 of Learning and Mastering Medical Terminology will also be presented.

• Healthcare Structure and Organization

  In the Healthcare Structure and Organization module, you will learn about the structure and organization of the healthcare system in the United States. You will study healthcare consumers, healthcare providers, governing and regulatory agencies, third-party payers, healthcare vendors, and trade associations.

• Anatomy, Pathophysiology, and Disease Processes – Block 1

  In Block 1 of Anatomy, you will learn basic anatomical structures using a body system approach, including pathophysiology and disease processes affecting the human body. Disease entities, diagnosis, and treatment will be emphasized. The body systems in this module include skeletal, muscles, digestive, respiratory, and reproductive. Throughout this module there will be graphic representations of the various systems and structures for ease of understanding.

• Exploring Pharmacology

  The Exploring Pharmacology module introduces you to the science of pharmacology and provides an overview of basic pharmacologics, including drug actions and effects, absorption, distribution, metabolism, excretion, and drug classifications and formulary. This module also gives you the opportunity to see and reference pharmaceutical terms in the context of medical reports with exposure to commonly prescribed drugs.

• Anatomy, Pathophysiology, and Disease Processes – Block 2

  In Block 2 of Anatomy, you will learn basic anatomical structures utilizing a body system approach, including pathophysiology and disease processes affecting the human body. Disease entities, diagnosis, and treatment will be emphasized. The body systems in this module include urinary, cardiovascular, endocrine, nervous, and integumentary/sensory organs. Throughout this module there will be graphic representations of the various systems and structures for ease of understanding.

• Medical Record Content

  In the physician-based setting, various reports make up a patient's outpatient medical record. The Medical Record Content module provides you with an overview and detailed discussion of each of these reports. This module will also present the composition of each of the report types and how they relate to medical coding and billing.

• Diagnostic Coding with ICD-9-CM – Block 1

  You will be introduced to the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codebook. Block 1 gives you a thorough understanding of this critical reference book and introduces and explores important information regarding the General Guidelines and several Chapter-Specific Guidelines for coding and reporting outpatient services.

• Diagnostic Coding with ICD-9-CM – Block 2

  Block 2 continues the detailed instruction of the concepts presented in the ICD-9-CM codebook and explores the remaining Chapter-Specific Guidelines and procedure codes for coding and reporting outpatient services.

• Exploring Healthcare Reimbursement

  The Exploring Healthcare Reimbursement module provides detailed information about the various types of payment systems used to reimburse outpatient services. Additionally, the module introduces you to information about claims processing and coding, billing for healthcare services, auditing, and monitoring the coding process.

• Medical Procedural Coding – Block 1

  In Block 1 of the Medical Procedural Coding module, you will be introduced to the Current Procedural Terminology (CPT®) codebook. This module provides a thorough understanding of the structure of the codebook and introduces some of the critical coding guidelines presented in the text.

• Medical Procedural Coding – Block 2

  Block 2 of the Medical Procedural Coding module continues the detailed instruction of the procedural codes presented in the Current Procedural Terminology (CPT®) codebook. This module also provides you with a thorough understanding of the structure and application of the HCPCS Level II codebook.

• Skill Building for Outpatient Coding

  The Skill Building module consists of actual outpatient medical records that you will be required to code. The reports in this module are drawn from medical reports across a wide variety of outpatient settings, which a coding professional would come across as an outpatient coder. The reports are divided into levels of difficulty–and you build skills as they work through increasing levels of complexity.

• Final Exam Overview and Preparation

  Upon completion of the program, you have the opportunity to assess your skills through a final exam. The Final Exam Overview and Preparation module contains information about the structure of the exam, tips for passing the exam, and how to schedule the exam.

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