Pharma Coding Course

Lesson 1 • Regulatory Context for Drug Codes

Explains how regulatory agencies assign and govern drug identifiers. Grounds coders in compliance requirements that shape every coding decision.

Lesson 2 • Introduction to Drug Classification Systems

Covers the major frameworks used to classify drugs by therapeutic category and chemical structure. Establishes the vocabulary needed for all subsequent coding work.

Lesson 3 • Core Coding Terminologies and Standards

Introduces standardized drug coding vocabularies used in clinical and regulatory contexts. Connects terminology mastery to accurate data entry and retrieval.

Lesson 1 • Validation and Error Detection

Teaches systematic methods for detecting invalid or misassigned drug codes. Reduces downstream billing and dispensing errors through proactive validation.

Lesson 2 • Format Variations and Normalization

Addresses the multiple valid formats a drug code can take and how to normalize them. Prevents data mismatches caused by format inconsistencies.

Lesson 3 • Anatomy of a Drug Product Identifier

Breaks down each segment of a national drug identifier and its meaning. Provides the structural foundation for all validation and lookup tasks.

Lesson 4 • Code Lifecycle and Maintenance

Tracks how drug codes are created, updated, and retired over a product's life. Equips coders to manage historical data and avoid use of obsolete codes.

Lesson 1 • Prior Authorization Coding Workflows

Applies diagnosis and drug codes within prior authorization request processes. Demonstrates how accurate coding directly affects approval outcomes.

Lesson 2 • Linking Diagnoses to Drug Therapies

Teaches how to map diagnosis codes to appropriate drug therapies for coverage and authorization. Builds the analytical skill of indication-based code pairing.

Lesson 3 • Diagnosis Code System Fundamentals

Introduces the hierarchical structure of clinical diagnosis coding systems. Connects diagnosis codes to drug coverage and formulary placement decisions.

Lesson 1 • Coordination of Benefits Coding

Addresses coding requirements when a patient has multiple payers. Ensures correct sequencing and billing across primary and secondary benefit plans.

Lesson 2 • Claim Rejection and Adjudication Codes

Decodes the rejection and denial codes returned during claims adjudication. Teaches systematic resolution of the most common rejection categories.

Lesson 3 • Prescriber and Pharmacy Identifier Codes

Explains the identifier systems used to represent prescribers and dispensing pharmacies on claims. Accurate identifiers are required for claim acceptance and fraud prevention.

Lesson 4 • Drug Quantity and Days Supply Coding

Covers rules for coding dispensed quantity and days supply accurately. Errors in these fields are a leading cause of claim rejections and audits.

Lesson 1 • Physician-Administered Drug Code Selection

Covers the procedure code system used to report drugs administered in clinical settings. Distinguishes medical-benefit drug coding from pharmacy-benefit coding.

Lesson 2 • Specialty Drug and Biosimilar Coding

Addresses the unique coding challenges of specialty biologics and biosimilar products. Covers interchangeability designations and their impact on code selection.

Lesson 3 • Dosage Calculation for Medical Claims

Teaches how to convert prescribed doses into billable units for medical claims. Accurate unit calculation prevents underbilling and overpayment recovery.

Lesson 1 • Formulary Structure and Tier Coding

Explains how formulary tiers are coded and how tier placement affects patient cost-sharing. Connects tier codes to plan design and drug access decisions.

Lesson 2 • Rebate and Contract Coding Basics

Introduces the coding elements used in manufacturer rebate contracts and reporting. Links rebate codes to formulary placement and financial reconciliation.

Lesson 3 • Formulary File Formats and Submission

Teaches the standard file formats used to submit formulary data to regulators and partners. Ensures coders can build and validate compliant formulary data files.

Lesson 4 • Drug Pricing Benchmarks and Codes

Introduces the pricing benchmarks used to calculate drug reimbursement and patient cost. Teaches how pricing codes flow through claims and remittance data.

Lesson 1 • Regulatory Safety Submission Standards

Covers the electronic submission formats and message standards for safety reports. Ensures coders can produce submissions that meet global regulatory expectations.

Lesson 2 • Signal Detection and Aggregate Coding

Teaches how coded safety data is aggregated to detect emerging drug safety signals. Demonstrates how coding quality directly affects signal detection accuracy.

Lesson 3 • Adverse Event Terminology and Classification

Introduces the medical terminology dictionary used globally for adverse event coding. Establishes the hierarchical structure coders navigate to select preferred terms.

Lesson 1 • Claims Data Analysis for Error Detection

Applies data analysis techniques to identify coding errors and anomalies in claims data. Builds analytical skills that translate directly to audit findings.

Lesson 2 • Compliance Program Integration

Embeds coding compliance into a broader organizational compliance program. Prepares senior coders to advise on policy, training, and governance structures.

Lesson 3 • Coding Audit Methodology and Planning

Establishes a structured approach to planning and scoping pharmaceutical coding audits. Connects audit design to risk areas identified in prior chapters.

Lesson 4 • Fraud, Waste, and Abuse Indicators

Identifies coding patterns associated with fraud, waste, and abuse in drug billing. Equips coders to flag suspicious patterns for investigation.