Medical

Coding

Technical

Skills

C O R E

C O M P ET EN C IES

G L AN C E

ICD

-10-

ICD

-10-

PCS

CPT

HCPCS

Level

Leveling

Modifiers

Medical

Terminology

Anatomy

Physiology

Pathophysiology

Clinical

Documentation

Review

DRG

Assignment

Claims

Denials

Coding

Audit

Compliance

EHR

Encoder

Systems

Diagnosis

Coding

—

ICD

-10-

S KILLS

ICD

-10-

Code

Lookup

—

alphabetical

index

and

tabular

list

navigation

Chapter

Specific

Guidelines

—

Chapters

1–21

conventions

applied

correctly

Excludes

1 /

Excludes

Notes

—

non

billable

pairings

versus

reportable

diagnoses

Seventh

Character

Extension

—

encounter

type

and

episode

care

Combination

Code

Selection

—

single

code

representing

etiology

and

manifestation

Sequela

Coding

—

late

effects

injury

stroke

and

chronic

disease

Signs

Symptoms

Coding

—

when

definitive

diagnosis

has

not

been

established

Principal

Diagnosis

Selection

—

Uniform

Hospital

Discharge

Data

Set

rules

Neoplasm

Diabetes

Coding

—

complex

hierarchy

and

assumed

relationship

rules

Procedure

Coding

—

ICD

-10-

PCS

S KILLS

Seven

Character

Build

—

section

body

system

root

operation

approach

device

qualifier

Root

Operation

Identification

—

defined

root

operations

for

inpatient

procedures

Inpatient

Procedure

Sequencing

—

ordering

significance

and

resource

use

Anastomosis

Bypass

Coding

—

vascular

and

urologic

reconstructions

Device

Graft

Coding

—

autografts

synthetic

materials

and

implants

Qualifier

Assignment

—

diagnostic

versus

therapeutic

distinction

1 / 4

Medical Coding Technical Skills — page 2

Physician

Outpatient

Coding

—

CPT

S KILLS

CPT

Section

Navigation

—

Surgery

Radiology

Pathology

Medicine

sections

Integumentary

Musculoskeletal

—

wound

repair

size

fracture

care

arthroscopy

Surgical

Package

Concept

—

global

days

bundled

services

and

separate

reporting

Radiology

Coding

—

professional

versus

technical

component

split

Laboratory

Pathology

Coding

—

panel

versus

individual

test

reporting

Medicine

Section

Coding

—

injections

infusions

chemotherapy

administration

Category

III

Codes

—

performance

tracking

and

emerging

technology

codes

Specialty

Coding

—

cardiology

oncology

orthopedics

GYN

and

pediatrics

HCPCS

Level

Coding

S KILLS

Supply

Durable

Medical

Equipment

—

codes

and

codes

Code

Drug

Coding

—

unit

based

dosing

and

billing

increments

Ambulance

Transport

Codes

—

origin

destination

modifiers

and

mileage

Payer

Specific

HCPCS

—

Medicaid

and

commercial

plan

code

variations

Evaluation

Management

(

)

Coding

S KILLS

2021

AMA

Guidelines

—

office

and

outpatient

visit

leveling

Medical

Decision

Making

(

MDM

)

—

number

and

complexity

problems

risk

data

review

Time

Based

Leveling

—

total

time

the

date

the

encounter

History

Exam

Leveling

—

legacy

guidelines

for

inpatient

and

nursing

facility

codes

Prolonged

Services

Coding

—

add

codes

99417

and

99418

Preventive

Wellness

Visits

—

AWV

IPPE

and

annual

physical

with

problem

visit

Modifiers

Code

Linkage

S KILLS

CPT

Modifier

Application

—

-25, -26, -59, -76,

-78, -79

HCPCS

Modifiers

—

, -

National

Correct

Coding

Initiative

—

NCCI

edits

MUEs

and

modifier

overrides

Bilateral

Multiple

Procedure

Rules

—

payment

reduction

sequencing

Diagnosis

Procedure

Linkage

—

medical

necessity

support

for

each

claim

line

Global

Surgery

Modifiers

—

staged

and

unrelated

returns

surgery

2 / 4

Medical Coding Technical Skills — page 3

Clinical

Knowledge

Base

S KILLS

Medical

Terminology

—

prefixes

roots

suffixes

and

abbreviations

Human

Anatomy

Physiology

—

all

body

systems

and

their

normal

function

Pathophysiology

—

disease

processes

and

clinical

progression

Pharmacology

Basics

—

drug

classifications

routes

and

dosage

forms

Laboratory

Diagnostic

Interpretation

—

reading

reports

values

and

impressions

Surgical

Technique

Knowledge

—

operative

report

reading

and

approach

recognition

Radiology

Report

Interpretation

—

modality

contrast

and

anatomic

site

recognition

Clinical

Documentation

Integrity

(

CDI

)

S KILLS

Provider

Query

Writing

—

compliant

non

leading

clarification

queries

Documentation

Review

—

identifying

specificity

and

linkage

gaps

Severity

Illness

Capture

—

SOI

and

ROM

impact

payment

and

quality

metrics

Present

Admission

(

POA

)

—

POA

assignment

and

hospital

acquired

condition

review

ICD

-10-

PCS

Reconciliation

—

aligning

coded

data

the

clinical

record

Interdisciplinary

Collaboration

—

working

with

physicians

CDI

specialists

and

quality

teams

Reimbursement

Methodologies

S KILLS

DRG

Assignment

—

inpatient

prospective

payment

grouping

logic

APC

Payment

Methodology

—

hospital

outpatient

prospective

payment

system

RVU

Fee

Schedule

Knowledge

—

Medicare

Physician

Fee

Schedule

components

Medicare

Severity

MCC

—

complication

and

comorbidity

tier

impact

Value

Based

Care

Reporting

—

quality

measures

MIPS

and

risk

adjustment

Case

Mix

Index

Analysis

—

CMI

drivers

and

trending

Risk

Adjustment

HCC

Coding

—

hierarchical

condition

Medical Coding Technical Skills

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