Add/Modify a Procedure Code (CPT®)
CPT® Codes (Current Procedural Terminology) is a uniform medical language that defines the Procedures or Services performed by a qualified healthcare professional. They are referred to in the System as CPT® or Procedure Codes.
Adding fees directly to the CPT® code will update your Default Fee Schedule (Libraries > Charge Fee Schedules > Fee ID 0 (zero)).
- Updating the Fee on the Procedure Code in the Procedure Code Library will update the corresponding Fees on the Default Fee Schedule, 0.
- Updating the Fees on the Default Fee Schedule, 0, will update the corresponding Procedure Code(s) in the Procedure Code Library.
Add Procedure (CPT®) Codes
Procedure Description Panel
- From Libraries on the left Sidebar menu, choose Procedure Codes.
- Select Add.
- CPT®: Use a System-delivered code or create your own quick code. This does not transmit on a claim.
- Submit CPT®: Enter the Procedure Code that will be submitted on a Claim.
- Type: CPT® Code is the default.
- Effective Date: Controls when this Procedure Code can be used. (This can be left blank)
- Expiration Date: The Procedure Code cannot be used after the date entered here. (This can be left blank)
- Description: Enter a Description for the Procedure Code.
- Abbreviation: Enter an Abbreviation for the Procedure Code.
- Patient-Facing Description: Enter the Description that you want the Patient to see, such as on a statement. (This can be left blank.)
Procedure Info Panel
- Billable:
- Yes: The CPT® will be submitted to any Responsible Party, such as, Insurance or WC.
- No: The CPT® will not be submitted to any party. This is for informational purposes only. Payments and Adjustments cannot be posted to this CPT.
- Patient Only: The CPT® is Patient Responsibility only and will never be submitted to the Patient's Insurance. This can be used for Medical Records or Products sold in the office.
- Taxable: Select if collecting taxes on the CPT®.
- Emergency: If selected, this Procedure will be billed as an emergency service on electronic Claims (ANSI 2400*LX1-09 as Y).
- Outside Lab: If selected, new fields appear for 'Purchased Service Cost' and 'Laboratory'. This data is output as required on both paper and electronic Claims. The Billing Provider NPI will output in the ANSI 2420B loop, if the amount in the 'Purchased Service Cost' field is greater than 0.00.
- Allow Future DOS: As a rule, Service Dates (DOS) cannot be future dates. If this option is selected, the system will allow a future DOS to be saved. This is usually used for DME where supplies have been provided for 30/60/90 days, and the last day is a future date.
- Fee: Enter a fee for the CPT®.
- Units/Procedure: Enter the number of Units for this CPT®.
- Revenue Code: Enter the Revenue Code used for Institutional Claims. Click this link to learn more about the Revenue Code Library.
- Revenue Only: When selected, only the Revenue Code will be submitted on an institutional claim; NOT the CPT® code.
- Report Group: The CPT® can be added to a Report Group for reporting purposes.
- TOS: Type of Service (This can be left blank.)
- POS: Place of Service on the Line Item level.
- This field can be left blank, and the POS will default from the Claim Level POS which is set on the Facility Setup or Reference Batch Facility.
- If you enter a POS here, it will override the Facility Setup when the Line Item Charge is entered.
- If all line items have the same POS, the Claim Level POS will change when the Charge screen is saved.
- Hold Claim (Days): Enter the number of days you want this CPT® code to be held before submitting. This is left blank most of the time.
- Modifiers: If this CPT® is always sent with a modifier, enter it here. In the example, the CPT® was entered as 9921425, and 25 was entered in the modifier field. If this CPT® is chosen when entering a charge, the 25 modifier will be added automatically to the charge.
Global Period Panel
If there is a Global Period associated with the Procedure, the Global Days can be added here. Multiple Global Periods can be added to account for the different Global Days per Payer. Learn More: Global Days
Edit/Delete Global Periods
Select the Edit icon to modify an existing Global Period.
Select the Delete icon to remove the existing Global Period.