Coding Specialist — Certificate

Program director
Braden Tabisula

Advisory committee
Barbara Pinkowitz, Chair
Susan Armstrong
Angela Barker
Debra Hamada                                                                                                                                                                                                                                                                                         Deanna Klure
Tanya McCandish
Diana McWaid-Harrah
Diana Medal
Beverly Miller
Evelia Munoz                                                                                                                                                                                                                                                                                                Carel Randolph
Patricia Small
Guadalupe Valdepena

Medical coding professionals

Health-care facilities need coders who accurately select ICD-10-CM/PCS codes, CPT codes, and HCPCS codes; and identify appropriate DRG or APC assignments for diagnostic and surgical information recorded in health records. In most instances, financial reimbursement is directly tied to these numeric codes. The statistical information generated from these codes is also used in research, quality improvement in patient care, education, and administrative decision making.

Opportunities

Coding specialists are in demand in acute care and ambulatory care facilities, physicians' office practices, and long-term care facilities. A variety of government agencies require coding expertise as well. The need for accurate, skilled coders is acute in California and throughout the nation. Information about job opportunities is provided to alumni as it becomes available.

The program

The Coding Specialist Program is nine quarters in length. Classes meet one night a week. The last two quarters of the program consist of an internship-like laboratory experience: HLCS 961 Coding Practicum I and HLCS 962 Coding Practicum II. These practicums meet one-to-two times per week. Prior to beginning coding courses, the student is introduced to health-care records, confidentiality, ethics, and pharmacology.

Program objectives

Upon completion of the program, the graduate should be qualified to:

  1. Use with understanding the instructions in format, organization, and mechanics of the ICD-10-CM/PCS, CPT, E & M, and HCPCS coding systems.
  2. Code records with accuracy and consistency.
  3. Analyze medical records to identify significant medical conditions and surgical procedures; correctly select the principal diagnosis and procedure; and appropriately sequence other diagnoses, complications, and procedures.
  4. Supervise health data collection and processing through coding, indexing, and maintaining disease and operation statistics.
  5. Develop policies and procedures for coding, including a plan for coding quality.
  6. Follow federal, state, and professional association guidelines for coding in the health-care environment.
  7. Understand the concepts of the prospective payment system and perform diagnostic-related group and ambulatory patient-classification assignments using decision trees and computerized patient-data groupers.
  8. Delineate the difference between optimization of coding in compliance with governmental regulations and fraudulent coding.

Professional certification

Upon successful completion of the program, the student is eligible to take the national entry-level certification examination of the American Health Information Management Association.

Special course work/credit

Credit for life experience may be offered through waiver or equivalency examination.

The Loma Linda University Coding Specialist Certificate Program is approved by the AHIMA Foundation's Professional Certificate Approval Program. This designation acknowledges the coding program as having been evaluated by a peer-review process against a national minimum set of standards for entry-level coding professionals. This process allows academic institutions, health-care organizations, and private companies to be acknowledged as offering an approved coding certificate program.

In addition to Loma Linda University and School of Allied Health Professions admissions requirements, the applicant must also complete the following requirement:

  • High School Diploma or GED

Corequisite

The following prerequisites/courses must be completed at a regionally accredited college or university:

  • Human anatomy and physiology (must be completed before Summer Quarter of first year)
  • Medical terminology
  • Introduction to computer applications (must be completed before HLCS 961 Coding Practicum I)
  • Essentials of human diseases/pathophysiology (must be completed before Fall Quarter of second year)
Required
HLCS 236Pharmacology3
HLCS 239Introduction to Health Records Science3
HLCS 242Coding I4
HLCS 243Coding II4
HLCS 245Coding III4
HLCS 254Evaluation and Management Coding for Billing and Reimbursement3
HLCS 257Coding Special Topics3
HLCS 291Computer Applications in Health Care I1
HLCS 292Computer Applications in Health Care II1
HLCS 961Coding Practicum I2
HLCS 962Coding Practicum II2
RELE 257Health Care Ethics2
Total Units32

A minimum grade of C (2.0) is required for all courses in the program.

Normal time to complete the program

2.5 years based on less than half-time enrollment

Courses

HLCS 236. Pharmacology. 3 Units.

Introduces pharmacology, including a review of pharmaceuticals used in diagnosis, prevention, and treatment of disease as commonly encountered in medical records.

HLCS 238. Essentials of Human Diseases. 3 Units.

Surveys human diseases, including the etiology, pathogenesis, and clinical manifestations of commonly encountered diseases.

HLCS 239. Introduction to Health Records Science. 3 Units.

Introduces health-care facilities and the information systems involving health records. In-depth study of health record content, confidentiality of health-care information, and professional ethics.

HLCS 241. Medical Terminology. 2 Units.

Prefixes, suffixes, and root words used in the language of medicine. Terms pertaining to pathology and surgery. Terms studied by body system: gastroenterology, cardiology, neurology, musculoskeletal, dermatology, ophthalmology, otorhinolaryngology, and respiratory.

HLCS 242. Coding I. 4 Units.

Principles and conventions of ICD-10-CM and ICD-10-PCS coding in diseases and procedures pertaining to infectious diseases; diseases of blood, endocrine, respiratory, digestive, genitourinary, skin, and musculoskeletal systems; and mental disorders.

HLCS 243. Coding II. 4 Units.

Principles and conventions of ICD-10-CM and ICD-10-PCS coding in diseases and procedures pertaining to pregnancy, perinatal conditions, poisonings, injuries, complications of medical and surgical care, the circulatory system, and neoplasms.
Prerequisite: HLCS 242.

HLCS 245. Coding III. 4 Units.

Principles of current procedural coding terminology (CPT) at the intermediate level, including: surgical coding for all body systems; medical procedures; anesthesia coding; radiology, pathology, and laboratory coding for inpatient and outpatient health-care settings. Modifier assignment. Also includes laboratory practice on 3M software.
Prerequisite: HLCS 243.

HLCS 254. Evaluation and Management Coding for Billing and Reimbursement. 3 Units.

Principles of billing and third-party reimbursement as they relate to physician professional coding and APC assignment for health-care institutions. Includes E & M coding conventions and modifiers. Coding for physician practice settings—including outpatient, inpatient, ER, observation, SNF, and other common settings. Covers principles of health service billing, including billing terminologies, the billing process, and universal billing forms. Includes laboratory practice using actual patient records and 3M encoding software to enhance student proficiency.

HLCS 257. Coding Special Topics. 3 Units.

Coding-system usage by reimbursement agencies, laws governing these processes, and federally supervised coding auditing to assure that the laws of coding are followed. Health-care delivery systems and internal billing and reimbursement in these settings. Requirements of state and federal coding regulatory agencies, ethics of coding, coding quality, and coding compliance. Content varies to accommodate the changing nature of health care reimbursement processes and laws.
Prerequisite: HLCS 245.

HLCS 291. Computer Applications in Health Care I. 1 Unit.

Introduces health-care information systems concepts and applications. Focuses on software application in the health-care arena. Specific topics addressed include: general system theory; interoperability; specific health record applications (encoder, ADT-R, ROI, etc); electronic health records; personal health records; and patient informatics applications.

HLCS 292. Computer Applications in Health Care II. 1 Unit.

Introduces health-care information systems concepts and applications. Focuses on software application in the health-care arena. Specific topics addressed include: general system theory; interoperability; specific health record applications (encoder, ADT-R, ROI, etc); electronic health records; personal health records; and patient informatics applications. One hour required each week.

HLCS 961. Coding Practicum I. 2 Units.

Twelve-week (six hours per week) coding laboratory provides a capstone experience for students who have completed all academic course work in coding. Enables students to apply all state and national coding and reimbursement regulations to a variety of inpatient and outpatient records. Provides students the opportunity to improve speed and accuracy prior to entering the job force.
Prerequisite: HLCS 257.

HLCS 962. Coding Practicum II. 2 Units.

Continues HLCS 961. HLCS 962 includes an additional twelve-week (six hours per week) coding laboratory experience under direct supervision of an instructor.
Prerequisite: HLCS 961.