A coder who obtains the Certified Professional Coder - Hospital Certification is familiar with both the Physician Office Coding as well as the Hospital Based Outpatient Coding. The CPC-H has experience with coding and reimbursement issues for outpatient facility services including use of the UB92 form vs. the CMS1500 form, and use of revenue codes. The hospital outpatient coder also understands APC's and procedural vs. diagnostic based payment philosophies. Also the hospital outpatient coder should have knowledge of professional as well as facility billing procedures and use of all coding resources, and Medicare guidelines.
The CPC-H®'s abilities in regard to outpatient facility services may include:
• Demonstration of proficiency in assigning accurate medical codes for diagnoses, procedures and services performed in the outpatient setting.
• Proficiency is required across a wide range of services, which include:
1. Evaluation and management
2. Anesthesia
3. Surgical services
4. Radiology
5. Pathology
6. Medicine
• A sound knowledge of coding rules and regulations go hand in hand with keeping current on issues regarding medical compliance, and reimbursement under outpatient grouping systems. A trained coding professional can best handle issues such as medical necessity, claims denials, bundling issues and charge capture.
• A CPC-H® will be able to integrate coding and reimbursement rule changes in a timely manner to include updating the Charge Description Master (CDM), fee updates and the Field Locators (FL) on the UB92.
• A CPC-H® will have a demonstrated a working knowledge of AHA Coding Clinic guidelines in the assignment of ICD-9-CM codes from Volumes 1 & 2.
• The CPC-H® can correctly complete a UB92, including the appropriate application of modifiers.
• A CPC–H® has demonstrated knowledge of anatomy, physiology and medical terminology commensurate with ability to correctly code provider services and diagnosis.
Specialty Credentials
