Equivalent Codes

CGM webPRACTICE enters the Equivalent Code field names when your database is set up. The field names entered are the ones most commonly used, but you can change them in CGM webPRACTICE Integration Options.

Equivalent Insurance Name #1 = HCFA: This is a generic code to be used for all insurance carriers or situations that do not require a specific equivalent code. You can change the name of this field, but this field has specific programming tied to it and cannot represent a specific insurance company. The name should always represent the broadest, most general category encompassing all claims.
Equivalent Insurance Name #2 = MEDICARE: You can change this field name, if necessary, to represent another insurance carrier that you may have equivalent codes for.
Equivalent Insurance Name #3 = BCBS: You can change this field name, if necessary, to represent another insurance carrier that you may have equivalent codes for.
Equivalent Insurance Name #4 and #5 = Unassigned: These fields are left unassigned and you can add insurance carrier names if necessary.

You can use Equivalent Codes for a variety of reasons. For example, you would use the HCFA (general) equivalent code fields for Practice-Specific Codes if your practice uses particular codes for ease of posting, tracking, or reporting but still needs the correct billing code to go on the insurance claims. In this case you would enter the correct billing code in the HCFA Equivalent Code field in the appropriate table. For example, you could have a separate practice-specific Type of Service code for each radiology service (X-Ray, MRI, Ultrasound). All of these should normally be billed with the standard Radiology Type of Service code of 4. So, in the Type of Service Table you would create an MRI Type of Service Code and type 4 in the HCFA Type of Service field, so on all of the procedure codes that have that MRI Type of Service attached CGM webPRACTICE places that correct Type of Service code of 4 on all of your electronic and paper claims. But, when you run your reports by Type of Service, you can see the detail under each of your radiology categories rather than them just being condensed together under the Radiology (4) Type of Service.

You would use the four remaining carrier-specific equivalent fields for Insurance-Required Equivalent Codes where a particular insurance company requires codes that are different from the standard billing codes dictated by the Centers for Medicare and Medicaid Services (CMS). For example, CMS's CPT code for Venipuncture is 36415, but you may have an insurance carrier that uses their own internal list of codes and they may define 'Venipuncture' as 'G0001'. So in the Procedure Code Table for 36415, you would type G0001 in the MEDICARE Procedure Code field.

Complete the following steps to set up equivalent codes in your system where needed:

Verify the Equivalent Codes in CGM webPRACTICE Integration Options.
- The first three Equivalent Insurance Name #_ fields should display HCFA, MEDICARE and BCBS. You can edit these as necessary as described above.
- The Equivalent Insurance Names that are designated here reflect as the field names of the equivalent code fields in the Diagnosis Code Table, Location Code Table, Procedure Code Table, Type of Service Table and also in the Equivalent Ins. Code field in the Insurance Carrier Table.
Attach the Equivalent Insurance Names to the Carriers in Maintain Insurance Carriers.
- The Equivalent Ins. Code field is a CGM webPRACTICE required field. If you use equivalent codes for this carrier, select the corresponding Equivalent Code category from the list. For example, if you have a Medicare equivalent insurance carrier name because all of the Medicare programs require a specific equivalent type of service code, you need to link the Medicare equivalent name to all of your Medicare carriers by selecting Medicare in the Equivalent Ins. Code field. If you do not use equivalent codes for this carrier, select the HCFA (or the generic) category from the list. What you select here controls which equivalent codes, if any, are submitted on your claims.
Enter the Equivalent Codes in the Tables
- The equivalent code field names that you defined in CGM webPRACTICE Integration Options reflect as the equivalent code field titles.
- Type the equivalent code in the appropriate field(s) for each code and carrier that requires an equivalent code.
- NOTE: If you enter any equivalent codes in any of the tables, CGM webPRACTICE pulls the codes onto the claims in a specific way: If you enter a carrier-specific equivalent code, that code is pulled onto the claim. But, if the carrier-specific equivalent field is blank, then whatever is in the HCFA equivalent field pulls onto the claim. If both the carrier-specific and the HCFA equivalent fields are blank, the standard code pulls onto the claim.

Diagnosis Code Table
Location Code Table
Procedure Code Table
Type of Service Table

Procedure Entry

When you enter charges in the Procedure Entry Function, enter the standard codes. If the tables and codes are set up properly, when the claim is printed or sent electronically, CGM webPRACTICE pulls the correct equivalent codes onto the claim. Only the standard codes reflect in the patient's transaction history; the equivalent codes do not display anywhere except for on the claim.