Procedure Entry Function

• Procedure Entry Lead-in Screens
  
• Procedure Entry Screen Top Section
  
• Procedure Entry Screen Bottom Section
  
• Action Column Functions
  
• Entering Negative Charges
  
• Procedure Entry Functions
  
• Special Procedure Codes
  
• Procedure Entry Summary Screen

• Batch Number: The Batch Number screen displays if your practice has selected to use batch numbers for posting procedures. For information on using batches, see Transaction Batch Control.
  
  Data Field Information
  
  If you type a non-existing batch number a message displays asking if you want to create a batch.
  
  If you select Yes to create a new batch, the Procedure Entry Function create a batch screen displays. For information on creating a batch, see Create a Batch.
  
  If you selected an existing batch number, the detailed information for that batch number displays. The fields are informational only and cannot be changed. Running Totals for the currently posted charges, payments, and adjustments display.
  
  
• Superbill Number - the Superbill Number screen will display if your practice has selected the Post from Superbill Number field in the CGM webPRACTICE Default Values function. You can only post from a Superbill Number if your practice uses the Print Superbills function in Scheduling.
  
  Data Field Information
  

  Prompt	Response	Req	Len
  Superbill #	Type the applicable superbill number. If you type a superbill number that is invalid or one that CGM webPRACTICE cannot identify, a No Superbill Number found, manual entry required message displays and the patient look-up screen displays so you can proceed. The superbill number you typed in then defaults in the Superbill # field on the Procedure Entry detail screen.		10

  
  When you use superbill numbers to post procedures it eliminates several data entry keystrokes and reduces the chances of selecting the wrong patient. When the superbill is printed, CGM webPRACTICE stores the patient name and account number, any case selected, and the doctor and location codes scheduled for the appointment and automatically defaults this information in the fields in the top section of procedure entry.
  
  
• Patient Look-up - If your practice does not post using superbill numbers, you will be required to select the patient account you want to post procedures to using the standard Patient Look-up function.
  
  
• Unposted Procedures If the selected patient has any procedures that were previously stored, the unposted procedures screen will display all the stored procedures for this patient.
  
  You can either select the stored charges for a date listed or click New Procedure in the Action Column to enter a new procedure. If you did not select any of the stored procedures they will remain stored.
  
  You can select the stored charges for a date by clicking anywhere in the row containing the procedures. All the information for the stored charges will automatically populate into the procedure entry screen. Since these charges are not yet posted, the accounting date is set to the date the charges were entered and Stored. From here you may edit any fields, click Save to post the procedures, click Cancel, which will return the procedures to a stored status; or click Delete, which will delete the stored information. If you click Save a prompt will be displayed asking you to confirm the accounting date or select a different one.
  
  
• Accounting Date - After the patient or superbill number has been selected, you will be asked to enter the accounting date.
  
  Data Field Information
  

  Prompt	Response	Req	Len
  Accounting Date	Type the Accounting date or click the calendar icon to select a date. If you are using Batch numbers, this field will be the date stored for the Batch you will not be allowed to change it. If you are not using a batch, the default date displayed will be the current system date or the accounting date of the last procedure entered, which may be changed if necessary.		10

  
  All procedures are entered into CGM webPRACTICE with an accounting date. The accounting date determines the aging of the procedures and which month's productivity statistics will be affected. As you are posting procedures you will also be able to indicate the actual dates of service, which could be different from the accounting date. This can be helpful if, for example, a procedure does not get entered into CGM webPRACTICE until a later date (such as, hospital visits). You could use the date it was entered into CGM webPRACTICE as the accounting date, which would determine the aging for the procedure.

• If there is a diagnosis code(s) in the CPT®/DX Linking Table that exists for the procedure code entered and the diagnosis code(s) has been entered in the top portion of the screen, the diagnosis pointer(s) for the diagnosis code(s) will be inserted.
• If the procedure code has a Default Diagnosis entered in the Procedure Code Table, the diagnosis code will be inserted in the top portion of the screen and the appropriate diagnosis pointer will be inserted for the procedure line item.

• If diagnosis codes have been entered in the top portion of the screen, up to four diagnosis pointers will be inserted for the procedure line item, in the same order they were entered in the top portion of the screen.

• In the simplest form, each procedure code has a Normal Price defined in the Procedure Code Table. If no other circumstances affect the Normal Price in the Procedure Code Table, that is the amount that will be defaulted in the Charge field.
  
• The Procedure Code Table also allows up to five other "normal" rates to be entered. These other rates (referred to as Rate Schedules in the Procedure Code Table) must be used if more than one doctor exists in the practice but each doctor does not charge the same amount for each procedure. If that is the case, each doctor would be assigned to a specific Rate Schedule. It is through the Rate Schedule in the Procedure Code Table that each doctor's normal price for each procedure is defined. If the performing doctor is assigned to a Rate Schedule, and no other circumstances affect the normal price for that doctor, that is the amount that will be shown in the Charge field. If no amount exists in that doctor's Rate Schedule for the procedure performed, the amount that would be defaulted is the Normal Price for that procedure.
  
• For various reasons the need may exist to bill certain groups of patients with amounts other than the normal fees (i.e., Medicare patients, industrial patients, etc.). CGM webPRACTICE allows you to maintain separate sets of fees for billing these certain groups of patients. These fees are referred to as the alternate fees and they are maintained in the Fee Schedule Tables. If the patient currently being billed is assigned to one of these Fee schedules, the alternate fee amount contained in that Fee Schedule for that procedure will default in the Charge field. If no alternate fee existed in the Fee Schedule for that procedure, the amount that would be defaulted in the Charge field is the amount contained in the Procedure Code Table. In addition to having a normal alternate fee in the Fee Schedules you may also have alternate fees for the doctor's different Rate Schedules (if they also differ). If a patient is assigned to a Fee Schedule and the performing doctor is assigned to a Rate Schedule, the alternate fee contained in the Fee Schedule for that doctor's Rate Schedule is the amount that would be defaulted. If the doctor does not have an alternate fee defined in the Fee Schedule for the procedure performed, the amount that will be defaulted during procedure entry is the amount defined as being the normal alternate fee for that procedure. If a normal alternate fee is also not defined the Rate Schedule amount from the Procedure Code Table will be the default in the Charge field.

• Procedure Grouping - On the bottom portion of the screen you will notice a drop down box labeled Grouping. This list box contains all the Procedure Grouping codes created for your practice. Click the arrow on the list box to display the available grouping codes.
  
  If you select a grouping, all procedures contained in that grouping will automatically be displayed on your screen. This is extremely helpful when codes have to be bundled or for combinations of codes that are often billed out together.
  
  Action Column Functions
  The Action column contains functions for Store,  History, Auth, Add a Case, Check Codes, and CGM webCODER Website which allow you to perform functions usually associated with procedure entry without having to exit this screen.
  
  
• Store
  With the Store function you can temporarily store the procedures you have entered for the patient.
  
  
• History
  With the History function, you have immediate access to the patient's transaction history in a variety of formats.  If you have questions while entering charges, this allows you to hop out of procedure entry, review the patient's history in detail, and upon exiting the review function, come right back to the procedure entry screen to resume entering charges.
  
  
• Add a Case
  With the Add a Case function you can add a case to patient's account without having to exit Procedure Entry.
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• Check Codes
  With the Check Codes function you can check the accuracy of the codes prior to saving the procedures..
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• CGM webCODER WebSite
  You can access the CGM webCODER Website directly from within Procedure Entry.

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  Auth
  The Auth button allows you instant access to the patient's authorization record. If the patient has current or unused authorizations, the word Auth will blue (if the authorization contains either a Number of Visits or a Termination Date). If the patient's primary insurance carrier requires an authorization for visits, a check mark will be next to the word Auth. This eliminates costly denials caused by not having an authorization when needed by the patient's primary insurance carrier. When you click on the Auth button, all authorizations for the patient will be displayed. Click on the authorization that corresponds to the charge being entered, or click on the Add a New Auth button. See, Maintaining Authorizations for complete information on entering authorizations. After you have selected the correct authorization, the authorization number will automatically populate the description field in the charge entry screen. The CPT code will be populated with the code 'AUTH'. You can also manually enter a CPT code of AUTH and the actual authorization number in the description field. This will display correctly on insurance forms but will NOT be saved in the patient's authorization record.
  
  When you post an AUTH procedure code, the remaining number of authorizations is reduced based on the number of units entered in the Mlt field on the AUTH procedure code, regardless of how many units are in the Mlt field on the associated procedure. For example, if you enter Proc 99213 with Mlt 1 and Proc AUTH with Mlt 2, the remaining number of visits for this authorization number will be reduced by 2. But, if for example you enter Proc 95117 with Mlt 3 and Proc AUTH with Mlt 1, the remaining number of visits for this authorization number will be reduced by 1.
  
  NOTE: If you forget to enter the AUTH procedure code and have to go back into Change Patient Data and use the Post AUTH Action from the Transaction History screen, you have to select the procedure code that you want the AUTH tied to. The authorization is then automatically created with the number of units that were originally posted with the procedure code. Therefore, if you need to change the number of units on this AUTH, you need to go to Edit an Encounter for the AUTH and change the number in the Multiplier field.
  
  
  Special Procedure Codes
  There are several special procedure codes in CGM webPRACTICE that will automatically perform extra functionality to save you keystrokes, data entry time, or provide all the necessary information for filing insurance claims.
  
  NOTE: You must add each of these procedure codes to the Procedure Code Table. Type the codes in the Procedure Code field exactly as indicated. In the Type of Service field, select the Medical Care option. In the Bill to Insurance field, select the Yes option. In the Normal Price $ field, type 0.00.
  
  NOTE: If you are filing or refiling a claim with a special procedure code, you must refile all of the procedures along with the special procedure code to ensure that the special procedure code is linked to a valid procedure and billed correctly.
  
• Admission and Discharge Dates - If you are posting inpatient hospital charges, an admission date is required for all electronic formats.
  
  Since CGM webPRACTICE already knows based on your location code if you are posting hospital charges, once you click Save to post your charges, you will be prompted to enter the admission date.
  
  If this is a brand new hospitalization, you will have an Admission date prompt and a Discharge date prompt. The admission date is the only date that is required for electronic claims. If you do not have access to the admission date at this point, you may Cancel out and enter the admission date later. If you don't enter this information, your claim will be kicked out as an exception when creating your electronic claim file. If this patient has had a prior admission date entered, but no discharge date entered, CGM webPRACTICE will display the original admission date, a prompt for discharge date, and another prompt for both admission and discharge date. If this is a new admission date, leave the original admission date intact and put the new admission date in the second slot. If this is the same admission date as the admission date defaulted, just click on Save to accept that admission date.
  
  Anesthesia - Each anesthesia code should be entered into the procedure code table with a Type of Service of 7, which indicates anesthesia. The procedure code TIME should also be entered into the Procedure Code Table. When you enter an anesthesia procedure code, the anesthesia screen will display so you can enter the Start Time, End Time, modifiers, and surgery code.
  
  By filling in the Start Time and End Time, CGM webPRACTICE will automatically calculate the units and the dollar value. The time must be entered precisely as HH:MM followed by an 'A' for am or a 'P' for pm. The entry of modifiers and the surgery code is optional. If a surgery code is entered, it will go across as a note on the claim.
  
  If you clicked Save, you will notice a new line with a procedure code of TIME and your start time and end time inserted in the description field. The multiplier field will be the number of units CGM webPRACTICE calculated from your time entry, plus the number of base units for this procedure. The amount will be the number of units multiplied by the price per base unit for this doctor. The TIME information will print on the insurance form directly above the anesthesia procedure code with a '7' qualifier in front of it. If you had entered a surgery code, another line item under TIME will be displayed. The CPT code would be NOTE and the description would be the surgery code entered. The Surgery Code/NOTE information will print on the insurance form directly above the anesthesia procedure code with a 'ZZ' qualifier in front of it.
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• THRU - The Procedure Code THRU, or its equivalent, is used to capture the 'through date' for procedures that have multiple Dates of Service.
  
  When entering the procedures for a patient, use the first date of the procedure for the service date, enter the code for the procedure, the modifier(s) if necessary, diagnosis codes, assignment status, multiplier, and the amount. The very next entry should have the last date of the procedure as the service date, THRU for the procedure code and 0.00 for the dollar amount. It does not matter what is entered in the other fields, as they will be ignored when an insurance claim is created.
  
  When an insurance claim is created, if it finds a THRU code it will take the service date of that procedure and put it in the claim as the 'through date' for the previous procedure. It is therefore important to be sure the THRU code immediately follows the procedure it relates to in the patient's file. It is also important to remember when re-filing insurance to also re-file the THRU procedure code, if it exists.
  
  
• DLS - The Procedure Code DLS (Date Last Seen) pulls the date based on whatever you entered as the Date of Service. You do not need to type anything in the Description field.
  
  
• NOTE - The Procedure Code NOTE, or its equivalent, is used to capture free text notes that are specific to a particular procedure code. Type 'NOTE' in the Proc field on the transaction line below the procedure code that it pertains to. Type the text of the note in the Description field and make sure there is a 0.00 charge in the Chg Amt field.
  
  When an insurance claim is printed, the descriptions from any NOTE procedure codes print above the corresponding procedure code line item in Box 24a on the HCFA. A 'ZZ' qualifier prints in front of the note. You can use multiple NOTE codes for a lengthy note, but what prints is limited by the space on the HCFA.
  
  
• NOTE19 - The Procedure Code NOTE19, or its equivalent, is used to capture a free text note for the entire claim. Type 'NOTE19' in the Proc field on the transaction line. Type the text of the note in the Description field and make sure there is a 0.00 charge in the Chg Amt field. The text prints in Box 19 on the HCFA (or its electronic claim equivalent). The length of the printed note is limited by the space on the HCFA.
  
  
• PS - Purchased Services - The Procedure Code PS, or its equivalent, is used to capture purchased service information that may be required on the claim. When a provider contracts with another provider or vendor to perform the technical component of a diagnostic test, such as laboratory tests, the procedure code PS can be used to capture the required information.
  • You must set up a PS procedure code in the Procedure Code Table:
    • Select the Medical Care option in the Type of Servce field.
    • Select the Yes option in the Bill to Insurance field.
    • Select the Outside Lab check box.
    • Set the price at 0.00.
  • You must set up a Referral Source Code to identify the outside providers or vendors that you contract with.
    • Type a valid Tax ID or NPI Number.
  • When posting procedures, the Purchased Service information must go in the line directly below the CPT that is the Purchased Service.
    • In the Proc field, type PS.
    • In the Description field, type the Referral Source Code of the vendor that the services were purchased from, a backslash, and the dollar amount of the services (including the cents after the decimal point). For example, if services are purchased from Allied Pathology (which is Referral Source Code AP) the Description would be AP/150.00.
    • Leave the Chg Amt field at 0.00.
  • If the Create Insurance File function finds a PS transaction, the necessary associated loops and segments are created and sent on the electronic claim.
  • NOTE: If you are using purchased services, check with your insurance carrier for their specific requirements before using this function.
  • NOTE: You can only send one purchased servce per paper claim. If you need to report Purchased Service information on paper claims, contact CGM webPRACTICE customer service.
  
  
• ADM and DIS - Even though CGM webPRACTICE will automatically prompt for admission and discharge dates when posting hospital charges, you can also manually enter them after the fact by using the Procedure Codes ADM for admit and DIS for discharge. The actual date of admission or discharge should be entered as the date of service. By entering either of these procedure codes CGM webPRACTICE will insert the dates in box 18 on the HCFA form. If the carrier is an electronic carrier, these dates will also be inserted into the appropriate records in the electronic format.
  
  As with the previous examples, the dollar amount on an ADM or DIS procedure code should be 0.00. When an insurance claim is created, CGM webPRACTICE will take the service date from the ADM and DIS procedures and store them in the appropriate places. Make sure the same doctor, location, accounting date, and service date are used as the hospital charges they are associated with.
  
  
• TIME - Even though CGM webPRACTICE will automatically prompt you for anesthesia begin time and end time when you enter an anesthesia code, you can also manually enter the information after the fact. This might be the case if you clicked on Cancel when the original start time/end time screen displayed, or if your type of service code was not set to 7 for anesthesia prior to clicking Save, to invoke the special start time/end time screen. You need to make sure you use the same doctor, location, accounting date, and service date as the original anesthesia code. The CPT code you need to use is TIME. The beginning and ending time must be entered in the description field precisely as HH:MM-HH:MM. The TIME information will print on the insurance form directly above the anesthesia procedure code with a '7' qualifier in front of it. If you also want to include a surgery code, enter the procedure code NOTE on the next line and in the description field, enter the CPT of the surgery. Remember, by entering your anesthesia time this way, the amount billed for the anesthesia code will NOT be calculated for you. The Surgery Code/NOTE information will print on the insurance form directly above the anesthesia procedure code with a 'ZZ' qualifier in front of it .
  
  
• EPO - The EPO procedure code, is used to report information required by some carriers for the administration of Erythropoietin to adhere to the Erythropoietin Drug Policy (EPO). Type EPO in the Proc field on the transaction line below the procedure code that it pertains to. Type any required text in the Description field and make sure there is a 0.00 charge in the Chg Amt field.
  
  When an insurance claim is printed, the EPO information will print above the procedure code line item. The EPO does not require a qualifier, so there will be two blank spaces in front of the EPO information.

• Payment - Post a payment (see Payment Entry). The ability to post a payment immediately after entering a charge works well when posting from superbills that have corresponding copayments attached. After you post the payment, you will be returned to this screen for additional options.
• Adjustment - Post an adjustment (see Adjustment Entry).
  
• Recall - Enter a patient recall record (see Adding Recalls). If the doctor makes a notation on the superbill that he wants to see the patient in six months, for example, you can immediately put that in as a recall.
  
• Insurance - Print an Insurance form. This function will immediately print an insurance form or put the transactions into the electronic submission file. If you want the balances moved immediately into insurance balance, this works well. (See Print Insurance Forms for details.)
  
• Walk-out - Walk out Statement. This function will print a walk-out statement (or receipt) for the patient, for the charges just entered. This works well if you are posting the charges as the patient is checking out. (See Walk out Statement.)
  
• DMS Record - Enter a DMS record (See Patient Change, DMS Records). This comes in useful for certain specialties that have specific specialty screens that hold additional information that is needed for electronic filing. Or it could be used as a means to update the HIPAA information screen.
  
• More - More Procedures. This allows you to enter more procedures for the same patient that were possibly performed by a different doctor in the practice or at a different location (therefore requiring a change to the information entered in the top section of the screen). If the More button is selected, to indicate more procedures must be entered for this same patient, the top level of the screen will be redisplayed with the original responses that were entered. You will be allowed to edit any of the responses that were not for display only which includes: case, doctor code, location code, ticket number, diagnosis codes and referral source. Once you have made your edits, you can fill the bottom portion of the screen as explained in the section above.