Medical Coding Professional

MSM144 / Hours: 442 / Access Length: 12 Months / Delivery: Online, Self-Paced
Retail Price: $3,999.00 / Materials Included

Course Overview:

Medical Coding is a growing career field with numerous job opportunities. Students will be prepared to take the American Health Information Management Association (AHIMA) Certified Coding Specialist (CCS) national certification exam. The CCS exam has a pass rate of over 80% for first-time testers and is the first step to a wide-ranging career path. In this comprehensive course, you will learn about the necessary medical terminology, insurance guidelines, compliance requirements, and legal and ethical issues that will prepare you to work as a Certified Coding Specialist in a professional medical office.

The cost of the course INCLUDES the cost of the AHIMA Certified Coding Specialist (CCS) national certification exam.

Course Outline:

Medical Coding Specialist Curriculum:

Lesson 1: Reimbursement, HIPAA, and Compliance

In this lesson, you develop understanding of Medicare's structure, including Parts A through D, and interpreting essential HIPAA rules. You will learn how to locate information in the Federal Register, explain the Outpatient Resource-Based Relative Value Scale (RBRVS), recognize Medicare fraud indicators, and identify key aspects of managed health care.

Lesson 2: An Overview of ICD-10-CM

In lesson 2, you explore the structure and application of the ICD-10-CM diagnostic coding system. You will learn how to navigate its Alphabetic Index and Tabular List, effectively use official instructional notations, and understand the importance of coding conventions to ensure accurate and compliant coding practices.

Lesson 3: ICD-10-CM Outpatient Coding and Reporting Guidelines

In this lesson, you determine the first-listed diagnosis for various scenarios, including outpatient surgery, observation stays, and prenatal visits. You will learn to apply Z codes, report unconfirmed diagnoses using symptom codes, differentiate between diagnostic and therapeutic services, and accurately code for chronic and coexisting conditions based on official ICD-10-CM guidelines.

Lesson 4: Using ICD-10-CM

In this lesson, you practice assigning accurate ICD-10-CM codes by using both the Alphabetic Index and Tabular List. You will apply conventions, understand the importance of specificity, report acute and chronic conditions, identify combination codes, distinguish integral from non-integral conditions, and correctly sequence codes for residual effects and laterality.

Lesson 5: Chapter-specific Guidelines (ICD-10-CM Chapters 1-10)

In lesson 5, you review coding for infectious and parasitic diseases, including proper use of combination and multiple codes. You will analyze neoplasm codes to distinguish between primary, secondary, and in-situ malignancies. Additionally, you will apply guidelines for coding conditions such as sepsis, antibiotic resistance, viral hepatitis, and HIV.

Lesson 6: Chapter-specific Guidelines (ICD-10-CM Chapters 11-14)

In this lesson, you code gastrointestinal hemorrhages by utilizing site-specific and combination codes for conditions such as diverticulitis with perforation. You will apply multiple coding for cellulitis with infectious agents, identify and report pressure ulcer stages, distinguish between traumatic and pathological fractures, and document chronic kidney disease according to its severity stages.

Lesson 7: Chapter-specific Guidelines (ICD-10-CM Chapters 15-22)

In this lesson, you document conditions related to pregnancy, childbirth, and the puerperium by applying rules for pre-existing versus pregnancy-related conditions. You will assign codes for complications such as ectopic pregnancies and postpartum conditions, code congenital anomalies, and sequence diagnoses involving signs, symptoms, injuries, and external causes.

Lesson 8: Introduction to CPT

In lesson 8, you navigate the CPT manual by identifying its purpose, sections, and structure. You will locate codes using the CPT index, interpret guidelines and symbols such as add-on and modifier exemptions, apply appropriate modifiers to procedures, and differentiate between Category I, II, and III codes for reporting services and emerging technologies.

Lesson 9: Introduction to the Level II National Codes (HCPCS)

In this lesson, you examine the structure and purpose of Level II HCPCS codes. You will classify codes based on their groupings, including those for durable medical equipment, drugs, and transportation services. You will also differentiate temporary codes, apply appropriate modifiers, and navigate the Table of Drugs to report administered medications.

Lesson 10: Modifiers

In lesson 10, you apply CPT modifiers to enhance procedural accuracy and reimbursement. You will assign modifiers such as -22 for increased procedural services, -50 for bilateral procedures, and -51 for multiple procedures. Additionally, you will learn to document complex scenarios involving staged or discontinued procedures and mandated services.

Lesson 11: Evaluation and Management (E/M) Services

In this lesson, you apply evaluation and management coding by determining the place and type of service, identifying patient status, and selecting the appropriate service level based on either medical decision-making or total time spent. You will analyze key components such as the number of problems addressed, data reviewed, and risk assessment to ensure accurate coding.

Lesson 12: Anesthesia

In this lesson, you define types of anesthesia, including general, regional, and monitored anesthesia care. You will analyze how the anesthesia payment formula incorporates base units, time units, and modifying factors. You will also learn how to apply qualifying circumstance codes, physical status modifiers, and understand the unique process of reporting multiple concurrent procedures.

Lesson 13: Surgery Guidelines and General Surgery

In this lesson 13, you interpret surgical package components, including preoperative visits, intraoperative services, and postoperative care. You will learn to apply modifiers for staged or related procedures, understand unique differences between separate and bundled procedures, and use special reports to document unlisted surgical services requiring detailed descriptions.

Lesson 14: Integumentary System

In this lesson, you document integumentary procedures, including coding incision and drainage for abscesses and wound debridement based on depth and body area. You will differentiate excision codes for benign versus malignant lesions, apply rules for lesion size and margins, classify repairs by complexity, and sequence grafts and flaps according to recipient and donor site requirements.

Lesson 15: Musculoskeletal System

In this lesson, you analyze procedures within the musculoskeletal system, focusing on treatment types for fractures and dislocations. You will distinguish between open, closed, and percutaneous fracture treatments, identify when grafting or fixation is required, apply traction techniques, and code procedures like arthroscopy, cast application, and tendon repair based on anatomical site and procedure details.

Lesson 16: Respiratory System

In lesson 16, you examine how procedural approach and anatomical extent affect code selection within the respiratory system. You will cover the differences between diagnostic and surgical endoscopies, analyze modifiers for multiple procedures performed through the same scope, apply guidelines for coding complex procedures like thoracotomy and lobectomy, and report procedures based on nasal, tracheal, and lung sites.

Lesson 17: Cardiovascular System

In this lesson, you explore cardiovascular coding across the Surgery, Medicine, and Radiology sections of the CPT manual. It covers the important considerations of invasive and noninvasive procedures, understand how to report catheter placements within vascular families, apply guidelines for pacemaker and cardiac valve procedures, and interpret codes for electrophysiology and nuclear cardiology services.

Lesson 18: Hemic, Lymphatic, Mediastinum, and Diaphragm

This lesson focuses on coding procedures within the hemic and lymphatic systems, mediastinum, and diaphragm. You will learn when to apply specific codes for splenectomy types, bone marrow harvesting, and limited versus radical lymphadenectomy. Additionally, you will code mediastinal biopsies by approach and diaphragmatic repairs for conditions such as hernias or eventration.

Lesson 19: Digestive System

In this lesson, you learn various procedures throughout the digestive system, focusing on distinctions such as diagnostic versus surgical endoscopies. You will determine code selection based on gastro-intestinal anatomical sites, including esophageal dilations, intestinal resections with anastomosis, and specialized procedures like Roux-en-Y gastric bypass and laparoscopic cholecystectomy.

Lesson 20: Urinary and Male Genital Systems

In this lesson, you analyze procedures involving the urinary and male genital systems by focusing on surgical techniques and anatomical classifications. You will assess methods for procedures such as pyeloplasty for ureteropelvic junction obstruction, complex nephrolithotomy for staghorn calculi, and radical nephrectomy, while interpreting bundled services and the appropriate use of modifiers.

Lesson 21: Reproductive, Intersex surgery, Female Genital System, and Maternity care and Delivery

In this lesson, you focus on key procedures within the reproductive, genital, and maternity care systems. You work with procedures such as brachytherapy for cervical cancer, staged intersex surgeries, and vulvectomies based on size and tissue depth. Finally, you will review bundled services in global maternity care and situations requiring separate reporting, like pregnancy-related diagnostic visits.

Lesson 22: Endocrine and Nervous Systems

In this lesson, you review surgical and diagnostic procedures related to the endocrine and nervous systems. You explore thyroidectomy techniques, including subtotal and total removal of thyroid tissue based on disease severity. This lesson also covers procedures such as cerebrospinal fluid shunting, craniotomies, and neuroplasty, focusing on procedural variations by anatomical site and purpose.

Lesson 23: Eye, Ocular Adnexa, Auditory, and Operating Microscope

This lesson covers procedural concepts related to the eye, ocular adnexa, and auditory systems. You learn how procedural choices, such as lamellar versus penetrating keratoplasty, affect surgical coding. Techniques for treating retinal conditions with photocoagulation and managing auditory issues like eustachian tube dysfunction with tympanostomy will also be addressed, along with the use of an operating microscope for precision surgeries.

Lesson 24: Radiology

In this lesson, you explore the Radiology section of the CPT manual, focusing on diagnostic imaging, ultrasound, radiation oncology, and nuclear medicine procedures. You will interpret terms related to radiology positioning and projections, distinguish between professional and technical components, and apply guidelines for using modifiers like -26 and -TC for component reporting.

Lesson 25: Pathology/Laboratory

In this lesson, you will learn how to categorize pathology and laboratory services based on test types, such as organ panels, therapeutic drug monitoring, and molecular pathology. You will learn distinctions between qualitative and quantitative analyses, evaluate drug assay procedures, and identify how tests like hematology panels, microbiological cultures, and pathology consultations are applied in clinical practice.

Lesson 26: Medicine

In this lesson, you learn how to navigate the broad range of services within the Medicine section, including immunization protocols, biofeedback therapy, and dialysis management. You explore the structure of various subsections, understand the two-code system for immunization reporting, and identify active and passive immunizations based on purpose and delivery methods.

Lesson 27: Inpatient Coding

In this lesson, you learn how to identify the principal diagnosis in complex inpatient scenarios, such as cases with multiple interrelated or uncertain conditions. You interpret how Present on Admission indicators impact hospital reimbursement and review scenarios where the original treatment plan is not carried out due to complications or other factors.

Coding and Reimbursement for Hospital Inpatient Services Curriculum:

Lesson 1: Introduction to Reimbursement for Hospital Inpatient Services

In this lesson, we will be introduced to the inpatient services available in the hospital setting. We will also look at the reimbursement options in hospitals, including the types of fee-based services and value-based purchasing.

Lesson 2: The Medicare System

This lesson includes a deeper dive into the Medicare system, including the structure of the payment systems and the types of Medicare available.

Lesson 3: Coding for Inpatient Services

In this lesson, we will start our exploration of coding for inpatient services. We will explore ethical coding, procedures for coding, and documentation involved in coding. Guidelines for reporting diagnoses will also be covered.

Lesson 4: Inpatient Coding and Reimbursement Processes

This final lesson is a deeper look at the processes involved in coding and reimbursement at hospitals. Topics include data quality management, compliance issues, including fraud prevention, and the healthcare record auditing process.

ICD-10 PCS: An Applied Approach Curriculum:

Lesson 1: System Definitions and Guidelines

This lesson will provide an overview of ICD-10-PCS system definitions and guidelines. You'll learn about the system structure and design, as well as the ICD-10-PCS coding guidelines.

Lesson 2: Root Operations

This lesson will provide in-depth instruction on the different root operations that are used within the medical and surgical section. The root operation is the character that comes between the body system and body part and designates the objective of the procedure. To properly code a procedure, it's important to fully understand the root operation.

Lesson 3: Coding Anatomical Regions, Nervous System, and Sense Organ Procedures

In this lesson, you'll learn how to properly code procedures for the anatomical regions, which are general locations in the body that are used when procedures are performed on multiple body parts. You'll also learn how to code procedures that are performed on the nervous system and sense organs.

Lesson 4: Coding Respiratory System and Circulatory System Procedures

This lesson will provide an overview of the coding guidelines for the respiratory system, including the mouth and throat. In addition, coding guidelines will be provided for the circulatory system, which includes the heart and great vessels, upper arteries, lower arteries, upper veins, and lower veins.

Lesson 5: GI and Hepatobiliary Systems, Endocrine and Lymphatic Systems, and the Integumentary System

This lesson will discuss the gastrointestinal system and describe procedures performed on the esophagus, stomach, intestines, anus, and rectum. Also included is a discussion of the hepatobiliary system because of its close connection with the gastrointestinal system. This lesson will also cover the subjects of the endocrine and lymphatic systems for coding in ICD-10-PCS. These systems are both fairly small but serve unique and important functions in the body. Finally, this lesson will discuss the integumentary system, which includes skin and breast, subcutaneous tissue, and fascia.

Lesson 6: System Structure and Design and the Skeletal System

This lesson will provide an overview of discussion of the musculoskeletal system with the musculature, the ICD-10-PCS sections on muscles, tendons, bursae, and ligaments. Also included is coverage of procedures performed on bones and joints.

Lesson 7: Urinary System, Male Reproductive System, and Female Reproductive System

This lesson will provide coding guidelines and information for procedures related to the urinary system, the male reproductive system, and the female reproductive system. The body parts associated with the urinary system are the kidneys, the ureters, the bladder, and the urethra. The male reproductive system in ICD-10-PCS contains the prostate, seminal vesicle, scrotum, tunica vaginalis, testis, spermatic cord, epididymis, vas deferens, penis, and prepuce. The female reproductive system in ICD-10-PCS contains the ovaries, uterine supporting structures, fallopian tubes, uterus, endometrium, cervix, cul-de-sac, vagina, clitoris, hymen, vestibular glands, vulva, and ova.

Lesson 8: Medical and Surgical Related Sections

This lesson will provide coverage on medical and surgical related sections of ICD-10-PCS. These sections include: obstetrics; placement, administration, measurement, and monitoring procedures; extracorporeal or systemic assistance, performance, and therapies; osteopathic, other procedures, and chiropractic sections. These procedures are covered separate from the individual body systems in previous lessons because they can be performed on various body parts and places throughout the body.

Lesson 9: Ancillary Sections

This lesson will provide a discussion of codes related to a variety of procedures including imaging, nuclear medicine, physical rehabilitation and diagnostic audiology, mental health, substance abuse treatment, and new technology. These procedures take various forms and require different codes.

Medical Terminology Curriculum:

Lesson 1: Medical Terminology Basics

This lesson will help you be able to Identify the four-word elements used to build medical words. You will also learn how to divide medical words into their component parts and apply the basic rules to define and build medical words. You will learn how to interpret pronunciation marks so you can pronounce medical terms presented in this chapter.

Lesson 2: Body Structures

One of the most important parts of the course is understanding the organization of the body. While each person is unique in their own right, the way we are assembled as humans (in a general sense are nearly the same). For this lesson, upon understanding the different levels, planes, and regions of the body, participants will learn how to properly pronounce terms related to a body structure. Documenting health care activities will conclude this part of the course through the assigned activities provided.

Lesson 3: Integumentary, Digestive and Respiratory Systems

The third lesson of the course begins the comprehensive review of the major parts of the body. In this case, the first three (3) in focus are the integumentary, digestive, and respiratory systems. Better put, this lesson will provide comprehensive details and knowledge to understand medical terms specific to one's skin, digestive, and breathing systems. Anatomy and physiology reviews are included in the reading material so participants can not only comprehend terminology but also view where it is often located in these parts of the body. Additional supplemental materials located in the back of the text are available as additional study aids and reference for this and other core portions of the course.

Lesson 4: Cardiovascular, Blood, Lymphatic and Immune Systems

Continuing the discussion of core body systems, the fourth lesson reviews more specific systems which blood commonly flows through. This includes cardiovascular systems such as the heart, lymphatic systems, and more. Similar to other course lessons that focus on body systems, one will need to comprehend the aforementioned knowledge plus an understanding of various diseases or body issues that may result when malfunctions may occur. As mentioned in the previous lesson, additional supplemental materials located in the back of the text are available as additional study aids and reference for this and other core portions of the course.

Lesson 5: Musculoskeletal, Urinary, and Reproductive Systems

The fifth lesson of the course continues the focus of core body systems that medical professionals must understand in order to properly convey and use terms correctly. This lesson goes into great detail about musculoskeletal, urinary, and reproductive systems. These body systems are often dependent on others working properly and failure of those having issues or deficiencies will likely cause these to do the same or at worse fail. Participants should pay particular focus to the reproductive systems and their respective terms as they only apply to their gender and at times, it can be easy to confuse their respective terminologies. As part of a major reoccurring theme for the course, additional supplemental materials located in the back of the text are available as additional study aids and reference.

Lesson 6: Endocrine Systems

The second to last part of the course focuses on an ever-increasing medical base within the United States and the world - endocrinology. Endocrine systems provide the necessary functionality to help keep equilibrium within one's body and nutrients (e.g. glucose and insulin) to keep that balance in place. Hence, thyroid and diabetes care increasing in need, medical professionals must have a strong grasp of common terminology used in this space so that it can be communicated properly and effectively to patients and other medical personnel. To aid in the learning experiences in this important section of the course, additional supplemental materials located in the back of the text are recommended to be used in conjunction with required reading assignments.

Lesson 7: Nervous System and Special Senses

In the final lesson, participants will learn about one body system and special senses. You will be able to locate the major organs of each and describe their structure and function. You will also better understand how each relates to others in the body. You will also learn how to pronounce, spell, and build words related to all both. You will gain an understanding of diseases, conditions, and procedures related to each one as well. You will learn about pharmacology related to the treatment of disorders in each.  One is encouraged to apply cumulative learning experiences to the comprehension of terms learned here as well as additional resources that immediately follow this chapter in the text.

All necessary course materials are included as eBooks.  Physical copies of HCPCS, CPT, ICD-10-CM, and ICD-10-PCS are included.

The 2024 textbooks are required for the AHIMA exam(s) until April 30, 2025.   Here are the books that are required: CPT Professional 2024, HCPCS 2024 Level II Professional Edition, ICD-10-CM 2024 The Complete Official Codebook, and ICD-10-PCS 2024 The Complete Official Codebook.

If you were provided with the 2024 textbooks and plan to take the AHIMA exam after April 30th, 2025, you will need to obtain the 2025 versions of these textbooks at your own expense, as ProTrain will not cover the cost of the updated materials.

On May 1^st, 2025, the 2025 textbooks will be required for the AHIMA exam(s).  Here are the books that are required: CPT Professional 2025, HCPCS 2025 Level II Professional Edition, ICD-10-CM 2025 The Complete Official Codebook, and ICD-10-PCS 2025 The Complete Official Codebook—are valid only until April 30, 2026.

If you plan to take the exam after May 1, 2026, you will need to obtain the 2026 versions of these textbooks at your own expense, as ProTrain will not cover the cost of the updated materials.

Certification Exam(s):

This course prepares a student to take the AHIMA Certified Coding Specialist (CCS) national certification exam.  The cost of the course INCLUDES the cost of the AHIMA Certified Coding Specialist (CCS) national certification exam.

System Requirements:

Internet Connectivity Requirements:

• Cable, Fiber, DSL, or LEO Satellite (i.e. Starlink) internet with speeds of at least 10mb/sec download and 5mb/sec upload are recommended for the best experience.

NOTE: While cellular hotspots may allow access to our courses, users may experience connectivity issues by trying to access our learning management system.  This is due to the potential high download and upload latency of cellular connections.   Therefore, it is not recommended that students use a cellular hotspot as their primary way of accessing their courses.

Hardware Requirements:

• CPU: 1 GHz or higher
• RAM: 4 GB or higher
• Resolution: 1280 x 720 or higher.  1920x1080 resolution is recommended for the best experience.
• Speakers / Headphones
• Microphone for Webinar or Live Online sessions.

Operating System Requirements:

• Windows 7 or higher.
• Mac OSX 10 or higher.
• Latest Chrome OS
• Latest Linux Distributions
  

NOTE: While we understand that our courses can be viewed on Android and iPhone devices, we do not recommend the use of these devices for our courses. The size of these devices do not provide a good learning environment for students taking online or live online based courses.

Web Browser Requirements:

• Latest Google Chrome is recommended for the best experience.
• Latest Mozilla FireFox
• Latest Microsoft Edge
• Latest Apple Safari

Basic Software Requirements (These are recommendations of software to use):

• Office suite software (Microsoft Office, OpenOffice, or LibreOffice)
• PDF reader program (Adobe Reader, FoxIt)
• Courses may require other software that is described in the above course outline.