01. To add a new Procedure Code, or edit an existing record, go to LISTS then PROCEDURE /PAYMENT/ADJ CODES.
02. The following are the different types of codes (and what they’re for) that can be entered here:
Procedure Charge – CPT codes representing services rendered billable to insurance.
Product Charge – Charges for products sold by the practice.
Inside Lab Charge – Charges for work done by a lab within the office.
Outside Lab Charge – Charges fo work done by a lab outside the office.
Global Surgical Procedure – Multiple charges made under the umbrella of a surgery. If you select this type, the Global Period X Days field appears.
Billing Charge – Charge applied to an account.
Tax – Tax Charges.
Comment – For making user defined comments. If you select this code type, the Amounts and Allowed Amounts tabs are hidden.
Insurance Payment – Payments made by an Insurance Carrier.
Cash Copayment – Patient/Guarantor payment for Co-Pay, made with cash.
Check Copayment – Patient/Guarantor payment for Co-Pay, made with check.
Credit Card Copayment – Patient/Guarantor payment for Co-Pay, made with credit card.
Cash Payment – Patient/Guarantor payment for charges, made with cash.
Check Payment – Patient/Guarantor payment for charges, made with check.
Credit Card Payment – Patient/Guarantor payment for charges, made with credit card.
Deductible – Patient/Guarantor payment for Deductible.
Adjustment – Credit or Debit to patient’s account.
Insurance Adjustment – Adjustment made by an Insurance Carrier.
Insurance Withhold Adjustment – An amount withheld by an Insurance Carrier. This amount must be adjusted against the patient’s account.
Insurance Take Back Adjustment – An amount taken-back by an Insurance Carrier. This amount must be adjusted against the patient’s account.
03. If you want to edit an existing record, highlight it then click EDIT. Otherwise click NEW to create a new entry. Also note, once codes have been added you can search by first selecting an option from the FIELD drop-down. The choices are TYPE, DESCRIPTION and CODE 1. Then enter a value in the SEARCH FOR field.
04. Starting at the top, enter a value in the CODE 1 field. If a Procedure Code is being entered, enter the 5-digit CPT code here. Note; the check-box to the right, INACTIVE, can be checked if an existing code is to no longer be used.
05. Next enter a DESCRIPTION.
06. Select a CODE TYPE. There is a table with explanations of the various choices on pages 24 and 25 of this guide.
07. The ACCOUNT CODE field is not required, but is available for your use. To use this field, enter a user-defined value, which would also be entered on other Procedure Codes that should be grouped on the Practice Analysis report.
08. The TYPE OF SERVICE field does not typically need to be filled out these days, but if needed you can search the help files for “Type of Service Codes (TOS)” which will give a listing of codes and what they’re used for.
09. Though not required, it is recommended you enter a PLACE OF SERVICE value on the Procedure Code as it will then default when the Procedure Code is used. You can search the help files for “Place of Service Codes” for a listing of codes and what they’re used for.
10. The ALTERNATE CODES 2 and 3 are for sending alternate values to various insurance carriers. For more information on this see Page 21, Item 10. Normally the same value entered in the CODE 1 field is also entered in these two fields automatically.
11. In the TIME TO DO PROCEDURE field you can enter the average time, in minutes, required to perform this procedure. It is not however required.
12. In regards to the SERVICE CLASSIFICATION field, the Medisoft Basic program only offers one choice (A), while the Medisoft Advanced and Medisoft Network Professional versions have eight choices (A-H). This is used in conjunction with the INSURANCE COVERAGE PERCENTS BY SERVICE CLASSIFICATION fields in the patient’s case.
13. The next two fields, DON’T BILL TO INSURANCE and ONLY BILL TO INSURANCE, can be populated with Insurance codes so that Procedures/Claims either don’t get billed to a particular insurance, or only get billed to a particular insurance.
14. If a particular DEFAULT MODIFER is normally used with a Procedure Code you can enter it/them in these fields. If no modifier is entered here, you can still enter one later when applying charges to a patient’s account.
15. If you bill UB-04 claims, you can enter the corresponding REVENUE CODE, otherwise leave this blank.
16. Enter a DEFAULT UNITS amount if you would like, otherwise this can be entered later, when applying charges to a patient’s account.
17. The next four fields are used when billing J or X codes for drug related services. If needed, enter the NATIONAL DRUG CODE, and NDC UNIT PRICE. Then select an NDC UNIT OF MEASUREMENT. Lastly enter CODE ID QUALIFIER which is typically N4. If not needed, leave these fields blank.
18. Use the PURCHASE SERVICE AMOUNT field to enter amounts you pay a lab or other vendor for technical and professional services they performed for you for the procedure, such as x-rays or labs.
19. Next place check-marks in any boxes that apply to the Procedure code being entered.
20. When you enter a code in the Code 1 field, the UB HCPCS RATE field is automatically populated with the same value and the HCPCS Code box is checked. If you need to enter a HCPCS rate instead of the HCPCS Code, uncheck the HCPCS Code field above. This field then changes to the UB HCPCS Rate field in which you can enter the rate amount.
21. Now click on the AMOUNTS tab.
22. While Medisoft Basic only allows for one charge amount per Procedure code, the Medisoft Advanced and Medisoft Network Professional versions allow for up to 26 different charge amounts. The charge amount that is used depends on what is set in the patient’s case, on the Account tab, in the PRICE CODE field. By default, “A” is used.
23. Enter the actual cost of the service or product in the COST OF SERVICE/PRODUCT field, if applicable.
24. In the MEDICARE ALLOWED AMOUNT field, enter the allowed amount for this procedure that is provided by Medicare. If you are not a Participating Medicare Provider, enter the Limiting Charge that is provided by Medicare. This field is used to calculate any automatic write-off of the difference between the standard charge and the allowed amount. If you don’t put anything in the Medicare Allowed Amount field, the first time an allowed amount is calculated for this procedure (in the Transaction Entry window), the value is added to this field.
25. Now click on the ALLOWED AMOUNTS tab.
26. Enter the (allowed) AMOUNT for the Procedure for each Insurance Carrier. If left blank this field may be populated once a payment is entered. Also place a check-mark in the UB NON-COVERED field if applicable.
27. Click SAVE when finished.