How Does COC Differs from CPC? — Medical Coding Question

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Q: How does COC differs from CPC?

Chandra: A: OK. So when we look at how the CPC differs from the COC. How these two things are different? You’re going to notice that everywhere that there’s a shaded box there was a difference. For example, if we take the surgery cases on the COC which the COC is that outpatient coder, so this is the outpatient facility side of things. This includes both hospital outpatient facilities as well as freestanding ambulatory surgery centers.

Both of these are included in that outpatient coding certification exam.

The difference between that and the CPC or the professional service, If you look at those surgery cases, the CPC has 20 more surgery cases than the COC does, so they dropped the number of questions. Instead of 60, 10 in each section, they say we’re going to ask you a total of 40 questions, they can come from anywhere, and quite frankly they’re going to come from those things that are typically done in an outpatient surgery center.

A hip and knee replacements, it kind of depends. Most knee replacements you stay in for three days, so that’s not the type of things you’re going to see. Lumbar discectomies, we do those oftentimes, same day surgery. The patient is in and out. Hernia repairs – maybe a same day surgery. Things like that are what you’re going to see in those surgical cases.

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Then they go down and they say “OK for CPT” which is funny to me. The surgery cases are still CPT, but if you go to their website, and actually drill down into what surgery cases are, the surgery cases replaced the surgical codes, so the 10,000 series through the 60,000 series. The CPT that they asked you about, they’ll ask you 20 questions on CPT. This replaces five areas. All those other areas of the CPT manual so your evaluation of management codes, anesthesia, radiology, path and lab, and medicine, so instead of the 48 questions that you have on the CPC you have 20 of the COC. I can see some people already going, “Oh! Fewer CPT codes. I like this question. I like this thought process.”

They do ask you, however, more questions on HCPCS codes. The reason for that being and the ambulatory surgery centers, those outpatient facilities at the hospital, oftentimes you’re billing for more components and more supplies. They want to make sure that you know how to report those screws for some of the surgeries that you’re doing, and the different prosthetics and orthotics and things like that, so instead of five questions there’s ten questions on HCPCS.

They ask you two more questions on medical terminology, they ask you two more questions on anatomy, they ask you 20 more diagnosis coding questions. Yes, now it is an ICD-10. Their website still said ICD-9 when we put this together, so that’s why it says ICD-9, but now that we’re on ICD-10 they ask you 20 and there’s no diagnosis coding questions over the CPC.

They actually ask you one last question on the coding guidelines. That leaves us with a difference of 20 questions, so they bumped a few up, they drop down several areas, but they left 20 questions, and they created a new category. They ask you 20 questions all about payment methodology, so if I were you, the first question I have is, “What counts as payment methodology?”

Let’s talk about the things that they’re going to ask you about. On the next page you’re going to see that these 20 questions on payment methodology include lots and lots of things. They can ask you questions about what services are covered under which piece of Medicare, so you’ve got to understand Medicare part A is typically our facility, our hospital charges. Medicare part B is our medical, so our physician services or outpatient services. Part C is our Medicare Advantage Plans, and part D is our prescription drug plans, so they can ask you about those.

They can ask you when is Medicare the secondary payer and when is it primary? You got to know those rules. Those things like, who’s carrying the insurance? Is the person employed? How many employees does their employer have? To know whether or not Medicare is primary or secondary. They can ask you about what goes on a UB-04. What goes on a CMS 1500? UB-04 is the facility form; the 1500 is that professional service claim.

Then, they can ask you about any of the payment methodologies, whether it be Outpatient Prospective Payment Methodologies, or inpatient. OPPS stands for Outpatient Prospective Payment System. OPPS is how the hospital outpatient departments get paid. These are based on APCs because we need more acronyms. APC stands for Ambulatory Payment Classifications.

You have to understand how revenue codes work and basically what they’re looking for when they talk about the Outpatient Prospective Payment Methodologies, they’re looking to see that you understand how the outpatient part of the facility gets paid because the outpatient part of the facility, not the physician, but the actual facility has to get paid for the room that they’re supplying, the overhead, for the lights, and the equipment and the supplies, all of those different things, and those are usually what’s reported on that UB-04.

They want to make sure that you understand how do CPT codes factor in to this ambulatory payment classifications, and drive the revenue codes. What are the different status indicators meet? Because there are different status indicators for each CPT code that tells you whether that can be done in an outpatient surgery center, or it may also tell you, well it can be done but there are different payment associated, or how they get paid for those things.

Payment Indicators – so that you know when it can be paid, when it can be paid with other situations, when it can’t. Condition codes – what conditions may a patient have, and I’m not talking about diagnoses necessarily, I’m talking about what conditions. Is the patient there after they’ve been told they should be discharged? Those hospital issued notifications of non-coverage; have one of those been issued? Things like that or what’s going to be in the condition codes. Calculations of proper payments – they want to make sure you understand outlier payments and all of those different pieces.

Inpatient Payment Methodology – they’re going to ask out of these 20 questions. They can ask you both about outpatient and inpatient while this exam is outpatient facility coding. Most of the questions are going to be about Outpatient Prospective Payment System. They do say that they will ask you some questions on inpatient. I have a lot of people go “What?! That doesn’t seem fair.” They’re doing it because it you work in the outpatient side of the facility you have to understand when your patient has crossed over some barrier, and now actually has to be reported on the inpatient side of things because of you’re working for an outpatient facility we may have intended that patient to be outpatient and have a day surgery, but something went wrong and they had to stay overnight, and now they’re actually hospital inpatient.

Well, now, you had to understand how that gets paid, so they want to make sure that you understand what goes in to figuring a DRG, what pieces, not that you have to figure the DRG itself, but what things factor in? You don’t know what things factor in? Three big things. What diagnoses does the patient have? Did the patient have surgery? What complications do they have? All of those things are going to factor into that.

Which code sets are required on inpatient claims? Do we put a CPT code on an inpatient claim? It’s a good question, and it depends on a lot of things. Most of the time, from a DRG payment prospective we don’t care about CPT codes, we’re worried about diagnosis codes and the ICD-10-PCS codes. Those inpatient hospital procedure codes, they’re different from CPT.

They will also ask you about reimbursement for teaching hospital. So, you understand those graduate medical education programs and how those factor in, and when the facility gets additional pay and when they don’t. It doesn’t have to be part of the med school program and how this all work together. And, they want to make sure that you understand – that says “change masters.” That is actually copied and pasted from the AAPC website but it is a typo. It should say “charge masters” because DRGs take into consideration lots of different things and one of the things that helps build that DRG are charges that come from a charge master and the hospital.

Charges in the charge master are those routine things that the hospital does day in and day out. Maybe the patient is here, they’re in the hospital, and why are they in the hospital. Let’s say they have an EMG done. Well, the neurology department is probably going to mark in the charge master, “Got an EMG while they’re here,” and help identify that so it gets paid.

Those are the types of things they can ask you 20 questions about payment methodology, but the biggest difference between the CPC exam and the COC exam when you look at what’s on those board exams it’s all about payment methodology. All of the other areas are the same. They simply decrease the number of codes or questions that you have to answer regarding CPT codes.

They increase the number of questions you have to answer about HCPCS and ICD-10, and they want a few more questions on med term and anatomy, but the biggest area is this whole brand new bucket they create for payment methodology. They want to ask you questions about how that facility is getting paid.

Alicia: I just think that’s so exciting. And you can see how these different credentials, these core credentials play into each other. If you have your CPC well it may be really easy to pick up the COC because you’re being tested on by far most of the same things.

Chandra: Exactly.

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