Instructor Manual: Advanced Medical Coding Practicum, 2026 Edition, 2027, 9798214605982; Chapter 1: Coding in the Real World
Instructor Manual
Advanced Medical Coding Practicum, 2026 Edition, 2027, 9798214605982;
Chapter 1: Coding in the Real World
TABLE OF CONTENTS
Purpose and Perspective of the Chapter......................................................................2
Chapter Objectives........................................................................................................2
Chapter Outline.............................................................................................................3
Additional Discussion Questions..................................................................................4
© 2027 Cengage Learning, Inc. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly 1
accessible website, in whole or in part.
, Instructor Manual: Advanced Medical Coding Practicum, 2026 Edition, 2027, 9798214605982; Chapter 1: Coding in the Real World
PURPOSE AND PERSPECTIVE OF THE CHAPTER
Chapter 1 serves as an overview of key coding concepts the coder is expected to have already learned in
prior studies. CPT, ICD-10, and HCPCS coding are reviewed and guidelines for each are discussed. The
chapter takes these concepts and demonstrates how these coding guidelines are actually applied in the real
world of coding and billing, taking into consideration additional concepts such as medical necessity,
reimbursement methodology, and the differences in physician and facility coding/billing. The chapter also
discusses proper use of physician queries as well as the different career paths the coder might consider in
coding/billing.
CHAPTER OBJECTIVES
At the end of this chapter, the student should be able to:
1. Identify various medical coding careers.
2. Explain the importance of clinical documentation for medical coding.
3. Interpret ICD-10-CM coding conventions and the Official Guidelines for Coding and Reporting to
assign ICD-10-CM codes to diseases.
4. Assign CPT codes and modifiers to procedures.
5. Assign HCPCS Level II codes, modifiers, and quantities.
6. Interpret ICD-10-PCS coding conventions and the Official Guidelines for Coding and Reporting to
assign ICD-10-PCS codes.
7. Sequence diagnosis and procedure codes.
8. Explain how facility coding differs from physician coding.
9. Explain the types of reimbursement methods used to reimburse for inpatient, outpatient, and
physician services.
10. Explain the process for determining medical necessity.
11. Identify the types of claim forms used to submit health insurance claims.
12. Write a properly formatted physician query when appropriate.
13. Identify differences in coding for different places of service.
[return to top]
© 2027 Cengage Learning, Inc. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly 2
accessible website, in whole or in part.
, Instructor Manual: Advanced Medical Coding Practicum, 2026 Edition, 2027, 9798214605982; Chapter 1: Coding in the Real World
CHAPTER OUTLINE
I. From Learning to Code to Coding in the Real World
a. Poor Documentation
b. Inaccurate or Inconsistent Documentation
c. Lack of Information
d. Need for Physician Queries
e. Accuracy and Proficiency
II. Coding Careers
III. Basic Coding Guidelines
a. ICD-10-CM
b. ICD-10-PCS
c. CPT
d. HCPCS
IV. Physician vs. Facility
V. Reimbursement Methodologies
a. CMS 1500 vs. CMS 1450
VI. Specific Coding Guidelines for Real-World Coding
a. Documentation
b. Authoritative Sources
c. Physician Queries
VII. Billing in the Real World
a. Split Shared Services
b. Incident-to Services
c. Teaching Hospital
d. Assistant Surgeon
VIII. Special Considerations for Coding in Different Settings
a. Physician Office
b. Emergency Department
c. Ambulatory Surgery
d. Inpatient Physician Services
IX. Chapter Review
a. Summary
[return to top]
ADDITIONAL DISCUSSION QUESTIONS
The following are discussion questions that do not appear in the text, PPTs, or courseware (if courseware
exists)—they are for you to use as you wish. You can assign these questions in several ways: in a
© 2027 Cengage Learning, Inc. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly 3
accessible website, in whole or in part.
, Instructor Manual: Advanced Medical Coding Practicum, 2026 Edition, 2027, 9798214605982; Chapter 1: Coding in the Real World
discussion forum in your LMS; as whole-class discussions in person; or as a partner or group activity in
class.
1. What different career paths might a coder consider? What paths would be appropriate for the
beginning, intermediate, and advanced coder, and what type of certification and training would be
necessary for those paths? Which of these paths are you interested in pursuing and why?
2. What is the purpose of a physician query? When would it be appropriate to create a physician
query and what components should/should not be included in a proper physician query?
[return to top]
© 2027 Cengage Learning, Inc. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly 4
accessible website, in whole or in part.
Instructor Manual
Advanced Medical Coding Practicum, 2026 Edition, 2027, 9798214605982;
Chapter 1: Coding in the Real World
TABLE OF CONTENTS
Purpose and Perspective of the Chapter......................................................................2
Chapter Objectives........................................................................................................2
Chapter Outline.............................................................................................................3
Additional Discussion Questions..................................................................................4
© 2027 Cengage Learning, Inc. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly 1
accessible website, in whole or in part.
, Instructor Manual: Advanced Medical Coding Practicum, 2026 Edition, 2027, 9798214605982; Chapter 1: Coding in the Real World
PURPOSE AND PERSPECTIVE OF THE CHAPTER
Chapter 1 serves as an overview of key coding concepts the coder is expected to have already learned in
prior studies. CPT, ICD-10, and HCPCS coding are reviewed and guidelines for each are discussed. The
chapter takes these concepts and demonstrates how these coding guidelines are actually applied in the real
world of coding and billing, taking into consideration additional concepts such as medical necessity,
reimbursement methodology, and the differences in physician and facility coding/billing. The chapter also
discusses proper use of physician queries as well as the different career paths the coder might consider in
coding/billing.
CHAPTER OBJECTIVES
At the end of this chapter, the student should be able to:
1. Identify various medical coding careers.
2. Explain the importance of clinical documentation for medical coding.
3. Interpret ICD-10-CM coding conventions and the Official Guidelines for Coding and Reporting to
assign ICD-10-CM codes to diseases.
4. Assign CPT codes and modifiers to procedures.
5. Assign HCPCS Level II codes, modifiers, and quantities.
6. Interpret ICD-10-PCS coding conventions and the Official Guidelines for Coding and Reporting to
assign ICD-10-PCS codes.
7. Sequence diagnosis and procedure codes.
8. Explain how facility coding differs from physician coding.
9. Explain the types of reimbursement methods used to reimburse for inpatient, outpatient, and
physician services.
10. Explain the process for determining medical necessity.
11. Identify the types of claim forms used to submit health insurance claims.
12. Write a properly formatted physician query when appropriate.
13. Identify differences in coding for different places of service.
[return to top]
© 2027 Cengage Learning, Inc. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly 2
accessible website, in whole or in part.
, Instructor Manual: Advanced Medical Coding Practicum, 2026 Edition, 2027, 9798214605982; Chapter 1: Coding in the Real World
CHAPTER OUTLINE
I. From Learning to Code to Coding in the Real World
a. Poor Documentation
b. Inaccurate or Inconsistent Documentation
c. Lack of Information
d. Need for Physician Queries
e. Accuracy and Proficiency
II. Coding Careers
III. Basic Coding Guidelines
a. ICD-10-CM
b. ICD-10-PCS
c. CPT
d. HCPCS
IV. Physician vs. Facility
V. Reimbursement Methodologies
a. CMS 1500 vs. CMS 1450
VI. Specific Coding Guidelines for Real-World Coding
a. Documentation
b. Authoritative Sources
c. Physician Queries
VII. Billing in the Real World
a. Split Shared Services
b. Incident-to Services
c. Teaching Hospital
d. Assistant Surgeon
VIII. Special Considerations for Coding in Different Settings
a. Physician Office
b. Emergency Department
c. Ambulatory Surgery
d. Inpatient Physician Services
IX. Chapter Review
a. Summary
[return to top]
ADDITIONAL DISCUSSION QUESTIONS
The following are discussion questions that do not appear in the text, PPTs, or courseware (if courseware
exists)—they are for you to use as you wish. You can assign these questions in several ways: in a
© 2027 Cengage Learning, Inc. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly 3
accessible website, in whole or in part.
, Instructor Manual: Advanced Medical Coding Practicum, 2026 Edition, 2027, 9798214605982; Chapter 1: Coding in the Real World
discussion forum in your LMS; as whole-class discussions in person; or as a partner or group activity in
class.
1. What different career paths might a coder consider? What paths would be appropriate for the
beginning, intermediate, and advanced coder, and what type of certification and training would be
necessary for those paths? Which of these paths are you interested in pursuing and why?
2. What is the purpose of a physician query? When would it be appropriate to create a physician
query and what components should/should not be included in a proper physician query?
[return to top]
© 2027 Cengage Learning, Inc. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly 4
accessible website, in whole or in part.
