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Billing Codes (article)

Summary:

Billing codes are used to describe diagnoses and treatments, determine costs and reimbursements, and relate one disease or drug to another. In PIMSY, billing codes are used to document service as well as administrative duties and non-billable time keeping.

Columns:

Code – CPT Code

Active – If checked, the code is active in your system

Description – the description of the code

Type – The type of code it is:

CPT General = Most codes fall into this code type and are available to be assigned as the primary service performed when documenting a service note.

CPT Add On = Codes which are only available as an additional service.

E/M = Evaluation/Management codes are a primary service used by physicians and nurse practitioners in med management.  

UB04 Add On = Revenue codes for institutional billing.

HCPCS = Also known as “H” codes, these are the third type of primary service code.

Rev Code – For institutional billing, put the Rev Code here that goes with the CPT code.

Auth Group – This allows a group of codes to decrement as a group, rather than individually, when a payer source authorizes as such.

Billable – Means someone is paying for the service, whether it’s self-pay, insurance, or a funding source.

Unmanaged – When checked, the system will no longer decrement the code. This allows for unlimited units within the time frame specified on the auth.

Add to New Clients – When checked, the billing code and its default units will be added to every new client when they are entered into the system.

It is important to remember that an authorization may need to be specific to a payer source when it is added to the client. Therefore, it may not be a good idea to use this function on billable codes

Default units – The number of units that a code will have added by default.

PTO Codes – Create your own code for staff to use for vacation or sick time. PIMSY payroll will track those codes on the user as they take days off, as long as it’s added to the SAL.

Default Taxonomy # - Most insurance companies don’t use this anymore but it would be the company’s default taxonomy number. If you put it here, it will go over to all users. However, with the 5010 billing for electronic billing, companies required the billing taxonomy number along with the user’s individual taxonomy number, so now it goes on the Administration set up and individual user’s rates tab.

Default package numberPlease skip this column as it is not used.

Color – This is one of four ways that appointments on the SAL Calendar can be color coded in order to see at a glance what type of appointment a person has by the color on the Calendar. Color coding by Billing Code is the most popular option. The second way of doing this is to change the system setting (-295) to color code by users, so a different color is set for every user. The third way is to color code by location, and the fourth is to color code according to the room the appointment is scheduled for.

Default Unit Alert Level – When the remaining units on an authorization decrement to a predetermined level, PIMSY will send alerts to tell staff that it is time to request a new auth. This can be set up through the system and profile settings.

Default expiration Alert Lead Time in Days – Similar as above, but will alert to X number of days before the authorization expires.

Allow Multiple Notes per Day – PIMSY has a system setting that will restrict a user from using the same code on the same client during the same day. When checked, this will override the system setting.

Excluded From Billing Service Calc.disregard this column for now, it is for PIMSY use only.

Note Template (paste-in) – Using MS Word to create a double spaced outline, templates can be attached to a note based on the CPT code. When a user choses a billing code in a note, there is a small leaf beside the code which will populate the template into the note or give the user an outline of what to document for that particular code.

Code Setup Columns

You can have multiple billing rates over time just add to the list to have different rates. For example, next year you charge higher rates so you will need to adjust your billing codes.

Start Date – it is recommended that the start date is put back at least six months from starting with PIMSY. To do this, click on the month, enter the month you want to use with the arrow key on your computer. Arrow over to the right to put it in the day and arrow over again to the right to enter the year.

End Date – Do the same thing as above to enter the end date, however, set it to expire very far out (ex. 2050).

Default Billing Rate/Unit – Set this at the highest amount to be billed for this code. There are other places in the system that can be set for different billing rates. Example: They can be done under insurance for different contracts or even different providers may charge higher then another.

Expected Amount/Unit – If you only bill one insurance company and know what the contracted rate is, this is where you can store it and keep a record of it. However remember if you bill multiple insurance with different rates this should remain blank.

Auth Decrement Action – This is how the units will decrement from the client’s insurance authorizations. The most common is 1 unit/note, if something different is used then you need to make sure the default billing rate matches how you want to bill per unit.

Billing Units Calc. - This is if you bill differently than the authorization decrements. If you bill the same then nothing needs to be done here.

Maximum Note Duration in Min – This is where to set the maximum number of minutes that you can bill for.

Active –Check this box so the item is active.

Instructions

Click on Financial from the top menu bar. Then select Billing Codes (first option under Financial). The Billing Code tab lists every code that can be documented on in your system. This includes all billing codes as well as administrative codes. A few codes come pre-entered in PIMSY. However, these should be modified and added to in order to meet your agency needs.

Adding New Codes

Select the blank line at the bottom of the top screen.

Type your code in the Code column, check Active, give the code a description, select a Type from the drop-down menu and complete any other information needed for this code. Be sure to click Save at the top left of the screen.

Scroll down and click on the row that includes the newly created code. This highlights the entire row in blue. On the bottom portion of the screen, add in the start and end dates as well as the other applicable data. Click SAVE when complete. A minimum of the start date, end date, and decrement action must be set in order for a billing code to be usable in the system.

One other thing to cover on the page is the Assign Defaults to Clients. This is found in the upper right corner. If you click this, it will assign all the codes that have default units set up to all active clients. Normally this is something that should NOT be done as it can create duplicates of the same code on the same client. We strongly recommend our clients NOT click on Assign to All. Clients should check with us first as this could cause serious issues if not done correctly.

Please call (877-334-8512 ext 3) or email Support (support@pimsyemr.com) if you have any questions.

Use Case:

ABC Therapeutic Group has decided to add a non-billable administrative code called Travel in order to pay a mileage rate on approved travel. They set their code up as follows:

                Code = 611

                Active = √

                Description = Travel

                Type = CPT General

                Unmanaged = √

                Default Units = 1

                Start Date = 01/01/2015

                End Date = 12/31/2055

                Auth. Decrement Action = 1 Unit / Note

                Active = √

 

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