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: Active, Inactive, and All. When 'Active' is selected, then only active HCPCS codes are displayed in the binocular search. Similarly, when 'Inactive' is selected from the list, then only inactive HCPCS codes are displayed in the binocular search. Also, when the 'All' value is selected from the list box, then it displays both active and inactive HCPCS 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 automatically saves that description in the User Name field. If two different types of descriptions are entered in 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 HCPCS 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 HCPCS code in PrognoCIS.
User Category: If a user wants to add any other category that 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 HCPCS code under the Category column. The maximum number of characters supported for this field is 50. Alphanumeric and special characters are supported in this field.
RVU:RVU stands for Relative Value Units. The units defined in this field are displayed in the RVU column when an HCPCS code is selected from the search binocular. If any code has RVU units defined and the same code is used on an Assessment, then the same unit values 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, alphabetic, or special characters are added intentionally, then the error message "Invalid RVU." is displayed.
NDC Code: 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 shown as 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 add 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 modifier from the Search icon. The selected Default Modifier on the HCPCS 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 HCPCS Master screen. Now, on Settings → Configuration → Specialty → Template, if a user selects any Specialty Template and clicks on Add HCPCS/HCPCS Code, and if the same Charge Code (i.e., 99221) is added, then the Default Modifier that has been added on the HCPCS Master screen will not be displayed. While, on the other hand, if that Charge Code (99221) is added on the Assessment screen or the 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 a 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 will be 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 HCPCS Master screen and also on the Claims 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 2-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 → HCPCS 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
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 a Custom code.
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 HCPCS Master screen, if any HCPCS code has the DMERC checkbox checked and the same DMERC code is used on Assessment → HCPCS, then a DMERC claim is created. There are a few other conditions to create a DMERC claim.
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 the CO Code... button will be disabled on the HCPCS Master screen.
LCD...: By default, the LCD button will be shown disabled on the HCPCS 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 4 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. The warning message to be displayed on the Assessment and Claims screens is dependent on the property icd.show.valid.icd10.codes.
CCI Codes...: CCI stands for Correct Coding Initiative. When any charge code is added with selected codes on the 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 which will be added to that charge code automatically on Save of the claim. 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'.
Active: By default, the checkbox is shown checked. A user can uncheck the checkbox so that the code is in the Inactive list and hence can be seen in the Inactive list.
Action Buttons
Save Button: Click on the
Save button to save the code.
Delete Button:
Click on the Delete button to delete the code.Note:A user is not allowed to delete Standard codes; if a user tries to delete a Standard code, then 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 on the Reset button to
reset the last saved changes.
Export Button:
Click on the Export button, and a CSV file will be downloaded. The CSV file contains a list
of Charge Codes and the revenue of that Charge Code, which can be exported.
Import Button:
Click on the Import button; the user can attach a document to import. The allowed extension for attaching a document is
the CSV format.