New Procedure Code

Follow these steps to add a new procedure code:

1. On the Settings menu, click Codes>New Procedure. This opens the New Procedure task.

Optionally, if you are adding more than one procedure code during the same work session, you can click Find Procedures to open the Find Procedure task (or browser); and then click the New button on the Task Button Bar of the browser to add a new procedure code. As you add new procedure codes to the system, the new codes will be added to the list area of the browser.

2. Enter the following information:

Procedure or Speed Code: Enter the procedure code; or enter the speed code, if one applies.

In certain situations, when billing for injections, users must provide a National Drug Code (NDC). In some cases, drugs have their own special procedure codes (often known as J-codes). For example, Ampicillin uses the HCPCS code J0290 for doses up to 500mg. For greater doses, it uses code J0295 to mean 1.5g of the drug. Sometimes these codes are enough on their own. At other times, however, users must provide an NDC number along with the procedure. So in the case of J0290, a user could add an NDC number to the record. If the number is provided, it will print on the CMS-1500 (HCFA) forms. The drug name is not currently used, but may be in the future if we need to change the CMS-1500 printing logic to print the name as well. (Note that we do not support electronic billing of NDC information).

In other cases, drugs do not have their own procedure codes, and use a single “generic” code like 99070 (which basically means “unspecified supplies and materials”). This is usually the case for drugs that have not had a J-code assigned to them. Since the procedure code is the same but the drugs are different, the user must provide an NDC number to explain to the insurance company what the actual drug was.

However, since our system only allows one record with a particular procedure code value (i.e. there can only be one 99070 in the system), a new concept of a “billing procedure code” has been added to the system, which allows the procedure code to instead be a “speed code”.

A speed code is essentially what the user would select or type in order to identify a particular drug. Some beta customers that we have had to build workarounds for in the past use speed codes like "HA60" or "HBR120" to mean 60 milliliters of one drug or 120 milliliters of another. In both of these cases there is a specific NDC, and the same actual procedure code (99070).

Thus, in the current system, a user can enter the real procedure code in the first field – this is the case for J-codes or any normal procedure code. However, if the user has to enter a drug that uses the same generic procedure code as other drugs, the user will enter a speed code of his or her choosing into the first field, and enter the real procedure code, like 99070, into the billing procedure code field. If a billing procedure code is specified, that is the code that will print.

Note that the billing procedure code will always override the normal procedure code, even for non-drug-related coding. Thus, it is actually useful if a billing company wishes to have a “mini-procedure-macro” where users type in something they remember, but the insurance companies are billed with real procedure codes.

Billable Procedure Code: Enter the billable procedure code only if a speed code was entered in the above field.
Official Name: Enter the official name of the procedure. Avoid abbreviating procedure names, if possible.
Local Name: Enter the local name given to the procedure.
TOS: Select the type of service (TOS) from the drop-down list. (The items listed are industry classifications for various types of procedures.)
Default Units: Enter the default units for the procedure. Note: As part of a recent change to the system, you now have the ability to add default units to a procedure. This is especially useful for drugs where a speed code, for example, might be “HA60” and mean 60 milligrams of a certain drug. If the fee schedule for the HA60 code is priced per milligram, then the default units has to be 60 in order to default to the right amount for that speed code. Note that the default units can be used for non-drug situations as well.

Procedure Category: If you wish to link a procedure code to a procedure category, click the Procedure Category button to open the Procedure Categories task (or browser), and then select the category from the list or procedure categories previously entered into the system.

Note: Linking a procedure code to a procedure category allows users on the system to generate certain reports based on procedure category. (For more information on setting up procedure categories, see Procedure Categories.)

Procedure is currently used: This checkbox is automatically checked when entering a new procedure code. However, if at any time in the future you wish to render a procedure code inactive, clear the checkbox.

Note: Once a procedure code has been marked inactive, the code cannot be used when entering new charges.

Drug Name: If this procedure is related to a specific drug, enter the drug name.
NDC Number: Enter the National Drug Code (NDC), if applicable.

3. Click Save on the Task Button Bar to save the new procedure code; or to exit without saving the new entry, click Cancel.