RN-Coder Network
Call 855-987-6268 Monday - Friday            8am - 4pm Pacific

CE Program Outlines

Certified RN-Coder Course Overview

Session 1. Introduction to Insurance Coding; CPT; Modifiers; E/M Coding By the end of this session,                                the student will be able to:

  • Understand the key elements of documentation that drive the assignment of CPT codes;
  • Understand the basic concept and format of the CPT coding manual;
  • Follow the basic steps in the CPT coding process;
  • Identify and understand the significance of signs & symbols used in the CPT manual;
  • Understand that all services in CPT are broken down into 6 categories, with specific guidelines 
  • for each group;
  • Differentiate between global and starred procedures, and explain their impact on coding in CPT;
  • Comprehend the different between diagnostic codes and procedure codes;
  • Understand how the proper use of both diagnosis and procedure codes of what services were 
  • performed and gives the medical necessity for those services;
  • Understand the importance of properly matching the descriptions for what services were 
  • performed,
  •  with those explaining why they were performed;
  • Comprehend the rules and application of modifiers to the coding process;
  • Know the proper application of each modifier;
  • Understand the appropriate reason for applying modifiers to services;
  • Grasp the reimbursement significance of the application of the proper modifiers;
  • Understand the key terms related to E/M coding;
  • Determine the method of visit documentation and visit level coding in Emergency Department 
  • vs. Clinic visits;
  • Understand the need for complete documentation for these services.

Session 2. Anesthesia Services; Surgery Services; Billing for Outpatient Services.  By the end of                                            the session,   the student will be able to:

  • Understand and apply the principal elements of anesthesia coding;
  • Comprehend the proper use of modifier codes for anesthesia services;
  • Know the basic differences that make anesthesia coding unique;
  • Understand the standard formula based on units;
  • Know and apply the surgery coding guidelines;
  • Understand the “technical component” of outpatient surgery coding;
  • Understand the usage and application of modifier codes in the surgery setting
  • Define diagnostic and therapeutic procedures, and the coding rules specific to each;
  • Learn how to avoid unbundling or fragmentation in billing;
  • Learn how hospitals are now paid for outpatient services; APCs;
  • Understand what drives coding in outpatient facilities;
  • Understand the role and function of Medical Records, Admitting & Business Offices in the                                             coding process;
  • Define what is a “clean” claim;
  • Comprehend the importance of the Charge Description Master (CDM);
  • Understand what goes on the UB-92 claim form;
  • Understand the differences between a hospital-based ambulatory surgery center and a                                                free-standing ambulatory surgery center;
  • Define the key aspects of the Ambulatory Payment Classifications;
  • Define the differences in E/M coding in the physician office vs. various outpatient departments;
  • Understand the need for complete documentation for these services.

Session 3. Introduction to Diagnostic Coding; ICD9CM; Medicare LMRPs; ICD10.  After completing                              this session, the student will be able to:

  • Identify key elements and words in documentation, using the guidelines outlined;
  • Identify which key elements and words should be used for diagnostic coding, using the                                             guidelines outlined;
  • Recognize the differences between signs, symptoms, and diagnoses;
  • Determine correct diagnostic code order, using the guidelines outlined;
  • Comprehend the reasons to establish a uniform coding system;
  • Use the ICD9-CM code book conventions and format;
  • Understand the use of the Tabular List and Alphabetical Index of the ICD9-CM code book;
  • Know the terminology unique to ICD9-CM;
  • Recognize the signs & symbols unique to ICD9-CM and their application in the diagnostic                                           coding process;
  • Understand the proper use of V codes; of E codes;
  • Comprehend the proper assignment of the chief reason for the encounter;
  • Understand the proper use of the Drugs & Chemicals Table;
  • Understand the method to determine the appropriate ICD9-CM codes for assigning the                                             adverse effects of drugs or poisonings;
  • Determine whether ingestion of drugs and chemicals is the result of: accidental poisoning,                                         Therapeutic use of drugs; suicide or assault; undetermined;
  • Properly use the Hypertension Table located in the ICD9-CM code book;
  • Comprehend the relationships of other medical conditions that complicate hypertension with                                    assumptions that are made in coding these conditions;
  • Understand the proper rules for assigning codes to neoplasms;
  • Grasp the proper coding of pregnancy and pregnancy complications;
  • Understand the importance of complete documentation.

Session 4. Radiology Services, Pathology & Laboratory, Medicine Services.  At the end of this session,                                   the student will be able to:

  • Grasp the proper usage of modifiers for radiology services;
  • Understand the appropriate application technical/professional component modifiers;
  • Identify the different types of radiology services;
  • Distinguish the components of interventional radiology;
  • Know when to report modifiers and x-ray consults;
  • Identify common radiology terms;
  • Understand the methodology used for reporting pathology and laboratory codes;
  • Recognize the difference between the professional and technical components of                                                        Pathology & Laboratory;
  • Learn the special instruction sin the code subsections;
  • Comprehend the various modifiers used for coding pathology services;
  • Understand the proper coding guidelines for each subsection of the medicine section;
  • Identify the services included in the medicine section;
  • Understand how to code medicine section services in conjunction with other services                                                   covered by the APCs;
  • Identify the special circumstances for coding psychiatric services;
  • Know when dialysis codes are reported and what services are included in a procedure code;
  • Learn how to report ophthalmology codes;
  • Recognize the coding rules for ENT services;
  • Understand the need for adequate documentation in all Medicine services.

Session 5. Medicine, HCPCS, Medicare Coding, APCs; Final Exam At the end of this session, the                                       student will be able to:

  • Understand the levels of the HCPCS system;
  • Know how HCPCS fits within the entire Medicare system;
  • Learn how HCPCS will be beneficial in obtaining accurate reimbursement;
  • Use of HCPCS codes in Outpatient Prospective Payment System;
  • Understand the differences between Medicare Part A and Part B coverage;
  • Learn to determine if Medicare is the Secondary Payer (MSP);
  • Determine the location of a Local Medical Review Policy (LMRP) for a particular outpatient                                      service;
  • Understand the payment system of the Ambulatory Payment Classifications;  Understand the                                           need for complete documentation for these outpatient services; Review sample certification exam.
  • Contact Hours Given: 40 hours Calif. CEP Provider #13482
  • Total Hours: 40 hrs classroom presentation; 45 hrs Independent Study

RN-Auditor Course Outline

Please Note: It is assumed at all Certified RN-Auditor Institute registrants have a basic                                      understanding of medical coding, CPT, ICD9 and HCPCS.

The reality of the healthcare system in the United States today is that the medical record is no longer                               used to support patient care. Today, what is contained in the medical record is used as an audit                                         tool to demonstrate  that services were provided, as well as reasonable and medically necessary. More                                      than ever before, the patient’s chart will provide the necessary information for coding and                                             reimbursement of hospital and physician services.

Usually working independently under indirect supervision of the hospital CFO, the RN-Auditor®                                                audits medical charts and records for compliance with federal coding regulations and guidelines.                                              The RN-Auditor® uses clinical knowledge of procedures and diagnoses to (1) assure everything                                            provided to the patient has been documented, then (2) provides a second level review of codes                                                 assigned to medical diagnoses and clinical procedures, ensuring that medical billing conforms to                                        legal and procedural requirements. The RN-Auditor® reviews, develops and/or modifies client                                                procedures, systems and protocols to achieve and maintain compatibility with Medicare billing                                            requirements and compliance standards.

In the unique RN-Auditor® Boot Camp, whether you are currently or working towards becoming a                                          provider auditor for the hospital/physician industry, or a cost containment auditor for the health                                            insurance industry, this course will give you the following basic information, leading to the                                                 certification by the American Association of Clinical Coders & Auditors, the nation’s only 

certification body for clinical  coders and auditors. AACCA is non-profit, tax-exempt 501(c)6                                                          and is a member in good standing   of  NOCA – the National Organization of Credentialing                                                     Agencies, Washington, D.C.

Each session is about 6 hours. You will be completing over 100 case studies from a variety of healthcare                                   settings. There is approximately 1.5-2 hours of “homework” each evening. There are 2 15-minute                                          breaks AM/PM (snacks provided), and lunch is on your own.

NOTE: Please allow 10 business days to receive USB supplemental materials.  
Online links emailed in 24-48 hours after funds clear and End-User License 
Agreement received by fax at 909-680-3157.  Thank you for following our policies.