Overview
This article will instruct you on the basic setup of a professional code.
Add Professional Codes
- Click on the Codes Module.
- Click Add.
- The Add Codes Window will open.
- The Add Codes Window will open.
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Number: Enter the CPT or HCPC number.
- This number must be five characters.
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Modifier: Enter one to four modifiers
- When entering modifiers, use caps with a space in between each modifier (AA BB CC DD).
- They will appear on the claim in the order you enter them here.
- The modifiers UA and HN can be automated based on payer and do not need to be added here.
- Name: The name field does NOT travel on the claim; therefore, you should name your codes based on the accepted terminology of your clinical staff. This will help staff in choosing the correct code. If they call a 90791 a DA, or an Assessment, or an Intake – then we strongly recommend using the same terminology here.
- Description: This field is optional
- Click on the Billing tab.
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Allow override of time/units ratio:
- If you always bill 1 unit regardless or time spent with client, choose Always 1 Unit.
- If there is a time ratio, choose No- Use fixed time/unit ration above and enter the ratio above:
- Example: If 1 hour = 1 unit, enter 1 Hours and 0 Minutes per unit
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Label (optional): Enter a label, such as Always 1 unit or 1 hour - 1 unit.
- This label will serve as a helpful note to providers (as to the proper ratio) when choosing this code.
- It does not affect the calculation of the ratio itself.
- Claim Type: Select Professional (837P/1500).
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Billable: Select Yes if this code will be billed to a third party, county, or even a self-pay payer.
- A billable code is a code that will be billed to a payer. You can also create non-billable codes to record certain services or track staff time.
- Group Active: Select Yes if a code can be used for documenting group services.
- Place of Service: If this code is always billed with the same place of service, you can choose it here from the drop-down.
- Click Save.
IMPORTANT: Please leave all other fields at their default.