Add Button: Click the Add Button to add a new code. By default, the Custom keyword is displayed beside the Code field. The Custom keyword can be changed to Non-Std as per the code added.
Search: Click the Search icon to select the desired code from the list of all codes, i.e., Standard, Non-Standard, and Custom codes.
Active List Box: This list box has three values. They are Active, Inactive, and All. When 'Active' is selected, then only active CPT codes are displayed in the binocular search. Similarly, when 'Inactive' is selected from the list, then only inactive CPT codes are displayed in the binocular search. Also, when the 'All' value is selected from the List Box, it displays both active and inactive CPT codes in the search binocular. By default, the Active value is shown selected in the List Box.
*Code: This is a mandatory field and is applicable only when new codes are added. When a user tries to add a new code, the 'Custom' keyword is displayed. The Custom keyword changes to Non-Std on Save if the added code or User Name field does not contain a Standard Code or description. The maximum character limit for this field is 10 characters. Alphanumeric and special characters are supported in this field.
Note: Existing codes that are already imported cannot be changed. In such a case, one needs to delete the record and create a new one.
*User Name: This is a mandatory field to add a name to the code. This field is used to give the description for the added code, which can be seen in the Search section of the Name column. If data is added in the Code field and the Save button is clicked, then the error message 'Mandatory Field is not entered.' is displayed. The maximum character limit for this field is 50 characters. Alphanumeric and special characters are supported in this field.
Note: If, in any case, the user has not entered data in the User Name field but has entered the code description in the Short Name or Full Name field, then on Save, the program will automatically save that description in the User Name field. If two different types of descriptions are entered for the Short Name and Full Name fields, respectively, then on Save, the program considers the Short Name description.
Short Name: This field is used to add the description of the newly added CPT code. The maximum character limit for this field is 50 characters. Alphanumeric and special characters are supported in this field.
Note: If no description is entered in the Short Name and Full Name fields, then on Save, the system automatically adds the description mentioned in the User Name field. If two different types of descriptions are entered in the User Name and Full Name fields, respectively, then on Save, the Full Name description is displayed in the Search section.
Full Name: It is mandatory to specify at least one of the three names given for the disease. The User Name will be used to specify this CPT code in PrognoCIS.
Category: Enter the name of the category under which the CPT code is to be grouped. The maximum character limit for this field is 50 characters. Note: Alphanumeric and special characters are supported in this field.
User Category: If a user wants to add any other category, which has to be different from the category present in the Category field, then the user can enter the category in the User Category field. Also, the added User Category can be seen in the binocular search of the CPT code under the Category column. The maximum character limit supported for this field is 50 characters. Alphanumeric and special characters are supported in this field.
Procedure Code: This denotes that the procedure is performed. When this checkbox is checked for a CPT code, then those CPT codes will be displayed in the IP (Procedure Code) search present on the U button for Institutional Claims.
NOC: If this checkbox is checked for a code and if the same Charge Code is used on claims, then on 'Ready To Send' and 'Save', the error message "130:- NOC Code without Comments" is displayed. This checkbox is not enabled for Custom codes.
Note:No alert message is displayed for a Self-Pay claim or if the claim has insurance but all the Charge Codes must be 'Billed to Patient'..
DMERC:This checkbox is used when a DMERC claim is created. On the CPT Master screen, if any CPT code has the DMERC checkbox checked and the same DMERC code is used on Assessment → CPT, then a DMERC claim is created. There are a few other conditions to create a DMERC claim.
Global Period (Days): Global Period functionality is basically for users with procedures that require follow-up visits. A charge code is said to be in a global period if it is non-chargeable more than once for a patient. The charge code can be defined in a global period for a specific time period; this specific non-chargeable period of a charge code is known as the global period. When a claim is billed for a patient for the first time with the charge code defined in a global period, the claim and overall behavior are normal/usual. When the charge code is billed to the patient for the first time, a patient alert is auto-generated for this patient. Now, suppose we have a patient billed with the Global Period charge code; when we create any further claims for this patient, the auto-created global period patient alert is shown on the creation of every new claim until the global period alert is over and will no longer be visible for that patient.
Codes: This button is enabled only when a number of days is entered in the Global Period field.
RVU:RVU stands for Relative Value Units. The units defined in this field are displayed in the RVU column when a CPT code is selected from the search binocular. If any code has RVU units defined and the same code is used on Assessment, then the same units value are populated on Save of the Assessment screen. A user cannot enter a value greater than 1000 units; if entered, the validation message "RVU Can Not be Greater Than 1000" is displayed. Only numeric values are allowed in this field. If alphanumeric characters, alphabets, or special characters are added intentionally, then the error message "Invalid RVU." is displayed.
NDC: NDC stands for National Drug Codes. This identifies the labeler, product, and trade package size. This field is enabled when an 11-digit numeric value is added and saved.
Unit: Enter the value in the Units field.
Quantity: Enter the value in the Quantity field. This field is disabled until a unit value is selected from the dropdown list. The character limit of this field is 10 characters, which includes 7 digits, a decimal point, and 2 digits, i.e., 9999999.99. If a user tries to enter a value greater than 9999999.99 and clicks on the Save button, then the validation message 'Maximum quantity value cannot be greater than 9999999.99' is displayed.
Default Modifier: Select the CPT modifier from the Search icon. The selected Default Modifier on the CPT Master screen for a charge is auto-populated on the Claims screen and the Assessment screen.
Example: Consider a case when a Charge Code (99221) with Default Modifier 1P is added on the CPT Master screen. Now on Settings → Configuration → Specialty → Template, if a user selects any Specialty template and clicks on Add CPT/HCPCS Code and if the same Charge Code, i.e., 99221, is added, then the Default Modifier which has been added on the CPT Master screen will not be displayed. On the other hand, if that Charge Code (99221) is added on the Assessment screen or Claims screen, then the Charge Code with the modifier will be displayed.
Revenue Code: Select the revenue code to assign from the Search icon. Revenue codes are three-digit numbers used on hospital bills, indicating to the insurance company either the patient's place of treatment or the type of items received by the patient as part of his or her treatment. Revenue codes can be defined in Group Types Master (System - U5 - Revenue Codes). The selected revenue code is used when the claim is of the 'UB04' type and a 'UB04+Professional Claim' is created. Click the Clear hyperlink to clear the selected revenue code.
Applicable For Anesthesia: This field is displayed only if the property prognocis.anesthesia.support is set to Y. If the property is set to 'N', then the Anesthesia field will not be available on the CPT Master screen or on the I button of the Claims screen. Click the checkbox so that the charges become applicable for anesthesia. When this checkbox is checked, the Base Unit field and Time Units Not Applicable checkbox are enabled.
Base Unit: Enter the base unit value in this field. When a value is entered in the Base Unit field and the same charge code is used in a claim, and time is entered in the Anesthesia Start Time and Anesthesia End Time fields present on the I button of the Claims screen, then on Save of the claim, it populates the Base Unit value defined in the Master screen and auto-calculates the total charge fee.
Note: The maximum value supported in the Base Unit field is a two-digit numeric value.
Time Units Not Applicable: This field is enabled only when the Applicable For Anesthesia checkbox is checked.
Child Code: The Child Code can be added from Encounter → Assessment Screen → CPT Tab → IMO Search → Custom Tab from the EMR side
Parent Code: The Parent Code contains the list of all Standard, Non-Standard, and Custom codes associated with a specific Child Code
CrossOver
CO Code...:This field is enabled only if the property billing.use.crossover is set to Y. If the property is set to N, then the CO Code... button is disabled on the CPT Master screen.
LCD...: By default, the LCD button is not displayed on the CPT Master screen. To enable the Local Coverage Determinations feature on the Assessment or Claims screen is based on the property use.local.coverage.determination.for. There are four values: For users with no LCD feature, they can select 0 – DO NOT USE LCD; for users with the Billing Module only, they can select 1 – CLAIMS; for users with the EMR Module only, they can select 2 – ASSESSMENT from the dropdown; and for users who use both EMR and Billing modules, they can select 3 – BOTH ASSESSMENT AND CLAIMS. Whether the warning message content executed on the Assessment and Claims screens shows the applicable ICD codes list at the end is based on the property lcd.show.valid.icd10.codes. If the property is 'ON', then at the end of the LCD validation message, the user can see comma-separated valid ICD-10 codes which are present in the imported data from the XLS file for LCD validations. If the property is 'OFF', then the user will only see the message configured for the CPT or HCPCS code with the Insurance AR Group combination in the XLS file, but not the valid ICDs.
CCI Codes...: CCI stands for Correct Coding Initiative. When any charge code is added with selected codes in the Selected CCI Codes field, Modifier 51 is displayed if the Claim Filing Code of the insurance is defined as Medicaid; otherwise, Modifier 59 is displayed for all other insurances and is automatically added to that charge code on Save of the claim. Whether to display the CCI edit warning message is based on the property billing.cciedit.warning.If the property is turned ON, then CCI Edit gives a 'Warning' message on 'Ready to Send' and 'Save' of a claim. If the property is turned 'OFF', then an 'Error' message is displayed on 'Ready to Send' and 'Save' of a claim. By default, the property is 'ON'.
Billing Group: This button is enabled only for Non-Std CPT codes and is disabled for Custom or Standard CPT codes. By clicking this button, the user can define the required Standard, Non-Standard, and Custom CPT codes. The user also has the provision to define the modifiers for the added codes.
Active: By default, the checkbox is checked. The user can uncheck the checkbox so that the code is moved to the Inactive list and can be seen in the Inactive list.
Action Buttons
Save button: Click the
Save button to save the code.
Delete button:
Click the Delete button to delete the code.Note:The user is not allowed to delete Standard Codes. If a user tries to delete a Standard Code, the error message 'Cannot Delete. Standard Code.' is displayed. Also, if a user tries to delete Custom codes, Non-Standard codes, or Standard codes that are used on the Assessment or Claims screen, then the error message 'Cannot Delete. Used in Claims.' is displayed.
Reset button: Click the Reset button to
reset the last saved changes.
Export Button:
Click the Export Button to download the CSV file. The CSV file contains a list
of Charge Codes and the revenue of those Charge Codes that can be exported.
Import Button:
Click the Import Button to attach a document to import. The allowed file extension for attaching a document is
the CSV format.