The Procedures Module

Procedures Module

This module has many important sections. These are:

Finding records
List View
Creating a record
Fee Schedules
Procedure-DX Matching
Procedure Bundling
HA0 Record (narrative)
Deleting records

The data entry screen for the Procedures Module is below for entering procedures or products. There is a slightly different screen for entering prescription medications sold with The Dispenser™ and contact lenses sold if you are an eye care practice.

Finding a record
More than likely this module comes loaded with the procedure codes you need. To find one click Find. This will put you in find mode so that you can search using using any field.

If you are looking for one specific code just enter it in the Code field.
If you are looking for a range of codes, say all the E&M codes, enter "..." between the codes you want, such as "99201...99215". This will find all records between and including these code. The result of this search is below.
If you want to search on any other fields, such as UPIN or one of fee schedule amounts put search data in those fields, too. You can search using as many fields as you like!
When you have entered your search request press the enter key on the keypad (or maybe next to the space bar on some keyboards.)

List View
Above is the list view that occurred after finding all the E&M codes, 99201 to 99215. There are many things you can do on this layout.

To view a specific record click on its Description.
To sort the list click on the underlined header a column such as Description or Code.
To print this list click Print. If you want to change the Fee Schedules that will print (4 out of 15 will print) use the up and down arrows above these columns to select which fee schedule will print.
The Rep column tells you if this procedure will be used for reports about referring doctors, such as how many 99243's each referrring doctor sent you.
The List column tells you if this procedure will be in your personal "pick list" used in the Billing Module to select procedures while on the charges screen.
The Omit button eliminates that record from the list view only so that when you print it will not appear. This button does not delete the record!!!

Creating a New Record
To create a new record click the New button. On the left is the standard dialog to enter your new procedure code. If your system is for vision care or its you have The Dispenser™ a slightly different dialog appears for you to select which "Record Type" of procedure to create. If the code you entered is NOT unique you will get another dialog.

The Fields

Code is for the unique procedure code
Description should be a short description of the procedure. This prints on the patients statement but only the code is sent with claims.
TOS 1 is the usual type of service for this procedure. TOS 2-3 are needed there may be other codes used by non-standard insurances, such as Medicaid. In the Insurances Module you tell the system to use TOS1,2 or 3 for that insurance.
Modifier is for the default modifier that is always used with this procedure. Modifier 2 is for informational purposes only.
POS contains up to 8 Place Of Service codes where this procedure CAN be performed. The office is the default POS code (11). You do not want to be accidentally bill for a nursing home visit (POS = 32) when you actually saw the patient in the office (POS = 11). You won’t get paid! default.
SKU is the barcode scan of the product. If you have a value in this field, than the SKU is used to look-up information about this procedure in Billing! Printing barcodes is a future feature of this database.
UPIN determines if a UPIN must be associated with a claim in order to get payment from Medicare. Any diagnostic or surgical procedure you perform should be associated with a UPIN.
Update determines if this procedure will automatically update the Last Visit date in a patient’s record. The default is not Yes and this field is not an option on the Drug or Contact Lens screens. You do not want to update this field if the patient is just purchasing a product and not getting examined!
Auto Letter is used in conjunction with the Letters module. When this field is checked, and this procedure is used on an invoice, a blank letter is started automatically in the Letters module referencing the patient, the invoice's diagnoses, and the Consulting doctor listed on the invoice.
Report selects this procedure or product to appear on your referral reports.
In Days PO enter the number of days the post operative period is for this “surgical” procedure. The number of days entered will be added to the procedure date (when a charge is created using this procedure) and the calculated date placed in the PostOp Ends field which can be found on the Billing Info screen of the patient’s record. In Approx Time enter the time in minutes this procedure usually needs for an appointment. Your List determines which of the 7000+ procedures in this database will appear in the pick list used in Billing when you select a procedure code. The RVU is the relative value unit for this procedure.

Fee Schedules
There are 15 Fee Schedules available for each procedure. By using different fee schedules, and making sure that A(1) is for the patient’s charge, you will be able to have both patient and insurance charges on the same invoice. You will be able to select which fee schedule to use for each charge you create for an invoice. The fee schedules in PracticeMaker® are below. At the minimum enter your fee into the A and P fee schedules.

A(1) is set aside for “self-pay”.
H(2) is for HMO plans
M(3) is for Medicare
P(4) for private carriers.
11 other fee schedules are available.
The Fee Def field tells the software which fee schedule you are likely going to use with this code. If you put a patient charge on an insurance claim you will get beeped unless this field has the default fee schedule of “A” in it!

NOTE: Charges with Fee Schedule “A” will NOT be printed on a HCFA form or included with any electronic claims transmission! This completely segregates patient from insurance charges on the same invoice!

An invoice’s default Fee Schedule is calculated as follows:

If the Doctor has a fee schedule selected in his/her Providers database record this will be use

Otherwise, the Fee Schedule assigned to the primary carrier for that claim will be used.

When an invoice is re-assigned to another insurance or to the patient this fee schedule does not change!

Procedure-Dx Matching
In order to bill for certain procedures the proper diagnosis must be associated with that procedure on an insurance claim. By entering these associations you may prevent claim rejection by making sure the procedure is linked to a diagnosis that supports it being performed. To view this screen click the Proc-Dx Matching tab.

[click here to enlarge the above image]

The example above is for the procedure code 92083 (visual field). You can have as many diagnoses in the list on the left as needed. To add a diagnosis enter the entire code (including the decimal point) followed by a <return> to separate entries. You can use the automated system by entering in Dx Grouping the first three digits of the coding group (like "365" above) and then all diagnoses in that group appear. You can then click the arrow <--- icon to add that diagnosis. This list is freely editable if you make a mistake.

Procedure Bundling
This screen is not as elegant as the one above because it is informational only. As yet there is no activate checking of the entries. Simply enter the 5 digit procedure code that is consider coincident with the current one.

HA0 Record (narrative information)
The HAO record is a short narrative explanation of an unusual procedure you do. The example below would not really be used as it is a standard procedure. However, if you always want an explanation to be sent electronically than you can enter up to 281 characters to transmit electronically.

Keep in mind two things before you enter anything...

Use of this field causes the claim to be handled as if it were a paper claim and you will not get paid as fast.
In the new HIPAA transaction set (ANSI X12 837) the field is only 80 characters long

Deleting Records
To delete one record at a time click the Del button on the button bar. If your access privileges do not allow you to delete you need to enter the delete or admin password.

Once you get the delete dialog, confirm that you want to delete this records.

Deleting Many records at once
Often you may want to delete many records, such as after importing duplicate records by mistake. This process entails first flagging records that will be deleted later and then selection the Delete Flagged function available on the List View only.