| A good medical coding and billing professional must | | | | use of the UB92 form vs. the CMS1500 form. |
| have good knowledge regarding correct application | | | | The hospital outpatient coder also has knowledge |
| of CPT, ICD-9-CM diagnosis codes and HCPCS | | | | of APC's and procedural vs. diagnostic based |
| codes that are used for billing professional medical | | | | payment theories. Also the hospital outpatient |
| services to insurance companies. | | | | coder has knowledge of professional billing |
| A Certified Professional Coder – Hospital | | | | procedures as well as facility billing procedures and |
| (CPC-H) is a medical coding and billing professional | | | | use of Medicare guidelines and all coding resources. |
| employed by a hospital. They are familiar with | | | | A CPC-H has the ability to integrate coding and |
| both the Physician Office Coding as well as the | | | | reimbursement rule changes in a timely manner to |
| Hospital Based Outpatient Coding. A CPC-H has | | | | include updating the Charge Description Master |
| knowledge of evaluation and management, | | | | (CDM), fee updates and the Field Locators (FL) on |
| anesthesia, surgical services, radiology, pathology, | | | | the UB92 along with a working knowledge of AHA |
| medicine, anatomy, physiology and medical | | | | Coding Clinic guidelines in the assignment of |
| terminology along with the ability to correctly | | | | ICD-9-CM codes from Volumes 1 & 2. |
| code the provider services and diagnosis. | | | | One can look for further details on various |
| The CPC-H has experience in coding and | | | | websites, and get oneself enrolled for a CPC |
| reimbursement issues for outpatient facility | | | | training camp that will help her get a CPC-H |
| services including the use of revenue codes and | | | | certification. |