Outpatient Coding and Coverage Issues: Screening and Diagnostic Testing

Course Code: REL-RCC-REV-CCI-A07

Hours: 0.5

Type: Online Course

Content Expiration Date: 12/31/2026

Learning Objectives:
Define screening and diagnostic services and how they differ in purpose.
Recall outpatient coding guidelines for screening and diagnostic services.
Identify valid source documents and demonstrate how to use medical record documentation to determine whether a service is diagnostic or screening in nature.
Assess how ICD-10-CM diagnosis coding supports medical necessity for screening and diagnostic services.
Identify examples of high-risk criteria and describe how they affect the coverage of outpatient screening services.

Outline:

Section 1: Introduction

About This Course

Learning Objectives

Section 2: Definitions

Differentiating Between Screening and Diagnostic Services

CMS Definition of Diagnostic Services

Review

Section 3: Guidelines

ICD-10-CM Coding and Medical Necessity

Outpatient Coding Guidelines

Coding Guidelines for Screening Services

Coding Guidelines for Diagnostic Services

Coding Examples for Diagnostic Services

Review

Section 4: Documentation

Source Documents

Physician Orders

Other Sources of Documentation

How Documentation Supports Screening vs Diagnostic Reporting

Review

Relationship of High-Risk Criteria to the Coverage of Screening Exams

Frequency of Screening Exams

Review

Section 5: Conclusion

Course Summary

Course Contributors

Resources

References

Reviewer: Tamara Abraham, AS, BA, CPC-I, CGSC, CPC

Tamara has twenty-seven years of multi-specialized medical coding and Corporate Compliance experience. She is the founder of Abraham Medical Coach LLC, where she provides medical coding and healthcare compliance consulting services to healthcare organizations across the United States. In addition to consulting, Tamara prepares individuals to sit for their medical coding certification via her online course curriculum. She is an adjunct educator for a local community college based in Texas. Her area of instruction includes Introduction to Medical Law, Medical Terminology, ICD-10-CM and Procedural Coding. Tamara’s credentials include AAPC Approved Instructor, Certified General Surgery Coder and Certified Professional Coder with the Academy of Professional Coders Association (AAPC). She has authored three books specific to the medical coding industry.

Target Audience:
The target audience for this course is: Healthcare Billing and Coding; in the following settings: Hospitals: Acute.

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Course Delivery Method and Format
Asynchronous Distance Learning with interactivity which includes quizzes with questions/answers, and posttests.