Add button: Click the Add button, to add a new code. By default, Custom keyword is displayed besides 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 ie Standard, Non-Standard and Custom Codes.
Active ListBox: This listbox has 3 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 'All' value is selected from the List Box then it displays both Active and InActive CPT Codes in the search binocular. By default, 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 user tries to add a new Code then 'Custom' keyword is displayed. The Custom keyword changes to Non Std on Save if the added Code or User Name field does not contain 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 save button is clicked then 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 user has not entered data in User Name field but has entered the Code Description in Short Name or Full Name field then on save program will automatically save that description in the User Name field. If two different type of description is entered for Short Name and Full Name field respectively then on save 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 then on save system automatically adds the description mentioned in User Name field. If two different type of description is entered in User Name and Full Name field respectively then on save Full Name description is displayed on 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 CPT 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 user wants to add any other Category which has to be different from the Category present in the Category field then user can enter the Category in the User Category field. Also the added User Category can be seen in the binocular search of CPT code under Category Column.The maximum character 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 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', error message “130:- NOC Code without Comments” is displayed.This checkbox is not enabled for CUSTOM code.
Note:No alert message is displayed for 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 DMERC Claim is created. On CPT Master Screen if any CPT Code has DMERC checkbox checked and same DMERC Code is used on Assessment→CPT then DMERC Claim is created. There are few other conditions to create DMERC Claim.
Global Period (Days): Global Period functionality is basically for the users with the procedures that require follow up visits.A charge code is said to be in a global period if that non-chargeable more than once for a patient. The charge code can be defined in global period for a specific time period, this specific non-chargeable period of a charge code is known as 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 is 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 and when we create any further claims for this patient the autocreated global period patient alert is shown on creation of every new claim till the global period alert is over and will no longer visisble for that patient.
Codes: This button is enabled only when number of days is entered in Global Period field.
RVU:RVU stands for Relative Value Units. The units defined in this field are displayed in the Rvu column when CPT code selected from 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 Assessment Screen. User can’t enter value more than 1000 units, if entered then validation message as “RVU Can Not be Greater Than 1000” is displayed. Only numeric values are allowed to enter in this field. If alpha-numeric or alphabets or special character are added intentionally then 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 11 digit numeric value is added and saved.
Unit: Enter the value in Units field.
Quantity: Enter the value in the quantity field. This field is shown is disabled till any unit value is not selected from the dropdown list. The character limit of this field is 10 characters which includes 7 digits, decimal point and 2 digits i.e., 9999999.99. If user tries to add the 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 CPT Master screen for a charge is auto-populated on Claims Screen and Assessment Screen.
Example:Consider a case when Charge Code (99221) with Default Modifier 1P is added on CPT Master Screen. Now on Settings→Configuration→Specialty→Template, if user selects any Specialty Template and click on Add CPT/HCPC Code and if the same Charge Code I.e 99221 is added then Default Modifier which has been added on CPT Master Screen will not get displayed. While on the other hand if the that Charge Code (99221) is added on Assessment Screen or Claims Screen then Charge Code with Modifier will get 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 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 Claim is of 'UB04' type and 'UB04+Professional Claim' is created. Click Clear hyperlink to clear the selected Revenue code.
Applicable For Anesthesia: This field will be displayed only if the property prognocis.anesthesia.support is set to Y. If the property is set to 'N' then Anesthesia field will not be available on CPT Master Screen and also on I button of Claims Screen. Click the checkbox so that the charges become applicable for Anesthesia. When this checkbox is checked, Base Unit field and Time Units Not Applicable gets enabled .
Base Unit: Enter the base unit value in this field. When value is entered in Base Unit and the same charge code is used in Claim and time is entered in Anesthesia Start Time and Anesthesia End Time field present on I button of Claims Screen then on save of Claim it populates the Base Unit value defined in Master Screen and auto calculates the total charge fee.
Note: The maximum value supported in Base Unit field is 2 digit numeric value.
Time Units Not Applicable: This field is enabled only when 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 EMR Side
Parent Code: Parent Code contains the list of All Standard, Non Standard Code and Custom Codes which is associated to a specific Child Code
CrossOver
CO Code...:This field will be enabled only if the property billing.use.crossover is set to Y. If the property is set to N then CO Code... button will be disabled on CPT Master screen.
LCD...: By default, LCD button will not be displayed on CPT Master screen. To enable Local Coverage Determinations feature on Assessment or Claims screen is based on property use.local.coverage.determination.for. There are 4 values: For the users with no LCD feature, they can select 0 – DO NOT USE LCD ,For the users with Billing Module only, they can select 1 – CLAIMS , For the users with EMR Module only, they can select 2 – ASSESSMENT from the dropdown and For the users to use both EMR and Billing module, they can select 3 – BOTH ASSESSMENT AND CLAIMS. Warning Message content executed on Assessment and Claims screen should show applicable ICD codes list at the end or not is based on property lcd.show.valid.icd10.codes. If the property is ‘ON’ then at the end of LCD validation message user can see comma separated valid ICD10 codes which are present in imported data from Xls for LCD validations. If the property is ‘OFF’, then the user will only see the message configured for CPT or HCPC Code with Insurance AR Group combination in Xls but not the valid ICDs.
CCI Codes...: CCI stands for Correct Coding Initiative. When any charge code is added with selected codes on Selected CCI codes field then Modifier 51 is displayed if the Claim Filing Code of the Insurance is defined as Medicaid and Modifier 59 is displayed for all other Insurances will get added to that charge code automatically on Save of Claim. To display CCI edit warning message is based on property billing.cciedit.warning.If the Property is turned ON, then CCI Edit gives 'Warning' message on 'Ready to Send' and 'save' of a Claim. If the property is turned 'OFF', then '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 will disabled for Custom or Standard CPT Codes. Clicking this button user can define a required Standard, Non Standard and Custom CPT Codes. User also has the provision to define the Modifiers to the added Codes.
Active: By default, the checkbox is shown checked. User can uncheck the checkbox so that the Code is InActive list and hence can be seen in InActive List.
Action buttons
save button: Click on
save button to save the Code.
delete button:
Click on delete button to delete the Code.Note:User is not allowed to delete Standard Codes, if user tries to delete the Standard Code then error message ‘Cannot Delete. Standard Code.’ is displayed. Also if user tries to delete the Custom Codes or Non Standard Codes or Standard Codes which are used on Assessment or Claims Screen then error message ‘Cannot Delete. Used in Claims.’ is displayed.
reset button: Click on reset button to
reset the last saved changes.
Export button:
Click on Export button, csv gets downloaded. The CSV file contains list
of Charge Codes and Revenue of that Charge Code which can be exported.
Import button:
Click on Import button, user can attach a document to import. The allowed extensions to attach a document is
in CSV format.