CPT®/Procedure Codes
To add or edit a CPT Code, select the lists menu then select CPT Codes.
|
CMS Form Information |
Field |
|
CPT Code |
Box 24D |
|
Charge |
Box 24F |
|
Type of Service |
n/a |
|
NDC (National Drug Code) |
Box 24D (shaded) |
For each CPT code, you can define up to 10 different pay scales. With each pay scale, you can also have an automatic modifier added when you use the code. The pay scale that is used is determined by the Payer that has been assigned to the claim. To set the pay scale for a payer, see the Standard Charge section in the Payer Setup screen.
You can also assign a modifier directly to the CPT code. For example, you can create a code called 9921501, 9921502, 9921503. When the claim is created, the first five digits of the code will appear on Box 24D, and the last two digits will appear in the first modifier box of Box 24D.
Unless you are creating a code identifying Anesthesia, always leave the Base Units field at 0. For Anesthesia, enter the number of 15 minute Base Units to apply to this code. Click here for more information about Anesthesia.
Each CPT code must be unique. Multiple codes of the same name are not allowed. If, for your circumstance, you need to create two or more codes that have the same name but possibly carry a different description and/or charge when sent to different payers, you can create a code with the same name but follow it with a colon and then a single digit to differentiate it from another code of the same name. For example,
· 99215
· 99215:1
· 99215:2
· 99215:3
All these codes will show ‘99215’ on the claim form.
Show description in box 24 of claim form
Check this box if you want the option to include the description of this procedure on the claim form. The description will print in the shaded area of box 24. When this box is checked, the Create Claim screen will include on additional option to show or not show the description on the claim form.
Type of Service
Type of service is no longer transmitted to the claim form. However there are a few internal uses of this field.
X - Disables the showing of this CPT code on the claim.
9 - Type of service for counseling or professional services. When type of service 9 is used, box 32B and box 33B will use the secondary payer identification number. This rule will take precedence over any other rules for box 32b and box 33b.
* The type of service can be added when creating claims. Entering the type of service in the CPT code screen will automatically insert the TOS code when the CPT is used. The TOS code can still be added or deleted prior to recoding the claim.
Activity Code is no longer used.
Phase Level Modifiers
When patient phase level modifiers are enabled, the CPT screen will allow up to 4 different modifiers to be added to the claim when the code is used. The modifier used is dependent upon the phase of the patient. Up to 4 patient phases can be set. Each phase corresponds to the 4 phase level modifiers.
Each phase modifier can include up to 4 modifiers. Separate each modifier with a colon. For example,
25:HG:UA:PJ
To enable the phase level modifiers, you need to set the option in the HCFA preferences screen. If the option is not turned on, then the phase level modifiers will not be viewable on this screen.
National Drug Code
If applicable, enter the NDC associated with this procedure. To include the NDC on the claim form, click the box ‘Include with Claim’. The NDC will appear in the shaded area of Box 24D (directly above the CPT code).
Last Update: 02/20/2008
CPT® is a registered trademark of the American Medical Association.