Maintain Procedure Codes

With the Maintain Procedure Codes function you can review information for a specific code, add new codes to the table, change the information for existing codes, print the table, and inactivate or reactivate a code.

You can maintain up to five Equivalent procedure codes to be used for different insurance carriers. For more information, see Equivalent Codes.

Upon accessing this function, the Maintain Procedure Codes screen displays containing blank data fields.


 
Data Field Information
Prompt Response Req Len
Procedure Code Type the code you want or click the magnifying glass to search the table. This code cannot begin with a zero.   10
Procedure Description Type a description of the procedure code. This description prints on patient statements unless you type a Remark during Procedure Entry, which overrides this field. 45
Brief Description Type a brief description of the procedure code. This description displays on the patient's Transaction History screen, unless you type a Remark during Procedure Entry, which overrides this field. 22
Type of Service Type the code you want or select from the Type of Service list. 3
Bill to Insurance Select the option to indicate if this procedure should be billed to insurance. If 'Yes', this procedure will be submitted on any applicable insurance claims. If 'No', this procedure will not be submitted on any insurance claims. If 'Paper', this procedure will always print to a paper claim and will never be submitted electronically. 1
Accept Assignment If you want to always accept assignment for this procedure code, select this check box. There are other fields within CGM webPRACTICE that can override this accept assignment setting. For additional information see the Accept Assignment Protocol help section under Introduction, System Processes.   1
Take Home Supply If this code is considered a take home supply, select this check box.   1
Medicare Lab Reimbursement % Type the percentage amount that Medicare will reimburse for this procedure code.   1
ADA Code If this code is an ADA code for a dental procedure, select this check box.   1
Outside Lab If this code is for a procedure that is considered outside lab, select this check box.   1
Immunization Code If this procedure code is an immunization code, select this check box.   1
Mammography Code If the mammography certificate number needs to be sent on claims for this procedure code, select this check box.   1
Requires NDC If this procedure requires a National Drug Code (NDC), select this check box.   1
Include 0.00 Procedure on Claim If you post a zero dollar amount for this procedure code and want to include the procedure on the insurance claim, select this check box.   1
NDC Code If you selected the Requires NDC check box, type the NDC code for this procedure.
 
The format for entering the NDC data is: NDC/Unit of Measure/Quantity of Medication. Unit of Measure: GR=Gram, ME=Milligram, ML=Milliliter, UN=Unit
Example: 00703680101/ML/150
 

 
Notes:
  • An NDC Attachment will automatically be created for this procedure code when it is entered in Procedure Entry.
  • If the Quantity of Medication is not entered, the Quantity field in the NDC Attachment will automatically populate with a "1".

 

Proper billing of an NDC requires an 11-digit number in a 5-4-2 format. Converting NDC codes from a 10-digit to an 11-digit format requires a strategically placed zero, dependent upon the 10-digit format. The following table shows common 10-digit NDC formats indicated on packaging and the associated conversion to an 11-digit format, using the proper placement of a zero. The additional “0” is in a bold font and underlined in the following examples:

 

 

   26
Normal Price $ Informational Only - Use the Maintain Procedure Code Prices function to add or edit the price.   10
Facility Price $ Informational Only - Use the Maintain Procedure Code Prices function to add or edit the price.   10
# of Base Units If this code is an Anesthesia procedure code, type the number of base units.   10
Post-Op Days Type the number of post-op days assigned to this procedure code if the value is different than the number stored in the CGM webPRACTICE Integration Options.   2
Default Diagnosis Type the code you want to default during procedure entry or click the magnifying glass to search the table.   10
<Carrier> Procedure Code Type the Equivalent code you want to use on insurance claims for this insurance carrier. If only one of the carriers requires an equivalent code, you still need to type the appropriate equivalent code in each equivalent carrier field. For more information see the Equivalent Code help section under Introduction, System Processes.   10
<Carrier> Procedure Code Type the Equivalent code you want to use on insurance claims for this insurance carrier. If only one of the carriers requires an equivalent code, you still need to type the appropriate equivalent code in each equivalent carrier field. For more information see the Equivalent Code help section under Introduction, System Processes.   10
<Carrier> Procedure Code Type the Equivalent code you want to use on insurance claims for this insurance carrier. If only one of the carriers requires an equivalent code, you still need to type the appropriate equivalent code in each equivalent carrier field. For more information see the Equivalent Code help section under Introduction, System Processes.   10
<Carrier> Procedure Code Type the Equivalent code you want to use on insurance claims for this insurance carrier. If only one of the carriers requires an equivalent code, you still need to type the appropriate equivalent code in each equivalent carrier field. For more information see the Equivalent Code help section under Introduction, System Processes.   10
<Carrier> Procedure Code Type the Equivalent code you want to use on insurance claims for this insurance carrier. If only one of the carriers requires an equivalent code, you still need to type the appropriate equivalent code in each equivalent carrier field. For more information see the Equivalent Code help section under Introduction, System Processes.   10
Rate Schedule A $ through E $  Informational Only - Use the Maintain Procedure Code Prices function to add or edit the price.   10
Facility Rate A $ through E $ Informational Only - Use the Maintain Procedure Code Prices function to add or edit the price.   10
CGM webMOBILE Category If your practice uses CGM webMOBILE, select the applicable category for this procedure code. Procedure codes can be grouped by Category when they are displayed on the hand-held device.   10
Revenue Code If this procedure is performed at a Facility, type the applicable Revenue Code for the UB claim.   4
UDS Suppress Community Health Centers only - If this code should not be considered as an encounter, select this check box.   1
Principal Procedure Code If this procedure is performed at a Facility and the UB claim requires a Principal Procedure Code, type the applicable code.   10
Nominal Fee $ Informational Only - Use the Maintain Procedure Code Prices function to add or edit the fee.   10
Cost $ Informational Only - Use the Maintain Procedure Code Prices function to add or edit the fee.   10

After you Save the code, the information refreshes on the screen.

Inactive Codes - If you select a code that has been inactivated, the existing information displays for the code but the data fields will be unavailable and you cannot make any changes. Reactivate will be the only active function in the Action Column. You must reactivate the code before you can change any of the data stored for the code.

If you are the System Manager, you should limit access to the Maintain function to select staff members. You should also provide guidelines (customized to your practice) to these staff members for entering table data in a consistent manner. This should protect the integrity of your table information.

Use the Action Column functions to edit or create codes. To create new codes or edit existing codes in the table, a user must have the Allow Table Update check box selected in Maintain Users under System, User Management, and be given the appropriate security level. For additional information about security levels, see the Function Security Menu under System, User Management. For setting up user codes, see Maintain Users. If the Maintain function is accessed and the user is not authorized to 'Allow Table Update', the New, Inactivate, Reactivate, and Save functions in the Action Column will be unavailable. These functions will appear dimmed on the screen and the user will only be allowed to Review codes. If the user does not have the appropriate security level to access the Maintain function, codes can also be reviewed using the Review a Procedure Code function.

Action Column Functions
The Action Column functions are provided so you can perform multiple functions quickly and efficiently from within the Maintain function.

Select - Displays a new screen with blank data fields so you can select another code.

New - Displays a new screen with blank data fields so you can enter the information for a new code.

Next - Displays the next code in the table. If you are viewing the last code in the table and click Next, you are returned to the main Tables menu. If you make changes to the table and click Next, the changes will not be saved. You must click Save to save the changes before proceeding to the next table item.

Previous - Displays the previous code in the table. If you are viewing the first code in the table and click Previous, you are returned to the main Tables menu. If you make changes to the table and click Previous, the changes will not be saved. You must click Save to save the changes before proceeding to the previous table item.

Print - You can print all or part of the contents of the table. For additional information on printing, see Print the Procedure Code Table.

Inactivate - Immediately inactivates any active code currently displayed on the screen. When you inactivate a code in the table, it is not actually removed from the table but is assigned an inactive status. Information must be retained about the inactivated code for any data that was previously entered with that code. After a code has been inactivated you cannot use it for any data entry operation. An entry will be logged in the Changes to Table category in the System Log under System, File Maintenance, Look-Up Functions.

Reactivate - Immediately reactivates any inactive code currently displayed on the screen and allows it to be used in data entry again.