Overview
Billing codes are used to describe treatments and procedures, as well as to determine costs, insurance reimbursements, and relationships between conditions or medications. In PIMSY, billing codes serve multiple purposes: they are used to document billable clinical services, as well as administrative tasks and non-billable timekeeping, ensuring comprehensive and accurate tracking across all aspects of client care and staff activity.
Required Permissions and Prerequisites
- This is in reference to our Desktop application
- Please assign the Create, Modify, View, and Delete permissions for the following rule(s):
- Billing Code
- Billing Code Prices
- Financial Main View (Menu)
Step-by-Step Instructions
Step 1: Navigating to Billing Codes
From the top navigation menu, go to:
Financial > Billing Codes
The Billing Code screen displays a complete list of all codes that can be documented within your system. This includes both clinical billing codes and administrative codes. While PIMSY comes with a few pre-entered codes, it is important to review and modify these codes as needed to align with your specific workflow, services, and documentation requirements.
Step 2: How to Add New Codes
In the top half of the screen, select the empty row at the bottom of the list and enter the info for each column:
Code - CPT/HCPCS Code- this is how the code will go out on claims
Active - If checked, the code is active in your system
Description - The Description of the code
Type - Type of Code, this tells the system where to display the code. For example, CPT General, HCPCS and E/M Codes can be scheduled. Add on types do not allow you to schedule. as they must be used in conjunction with a valid CPT or HCPCS 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 - Determines if monetary value is associated with services with this code.
User Tile Category - The associated user profile relevant to that code
Unmanage - When checked, the system will no longer decrement the code. This allows for unlimited units within the time frame specified on the authorization
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
Default Units - The number of units that a code will have added by default
PTO Code - Create your own code for staff to use for vacation or sick time. PIMSY payroll will track those codes on the user as the user accrues PTO, and deduct it accordingly when it's used.
Default Taxonomy # - If you have a taxonomy code that needs to go out in box 24J of the HCFA form, you may put the taxonomy code here (otherwise, the claims will pull the rendering taxonomy code from the individual users' setup.)
Default Package # - Please skip this column as it is not used
Default Unit Alert Level - When the remaining units on an authorization drop 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.
Once all relevant information has been entered, be sure to click Save.
Step 3: Assigning Rates and Decrements
To finalize setup for a newly created billing code, click on the row containing the code you've just created. This will highlight the entire row in blue, indicating it is selected.
In the bottom portion of the screen, enter the Start Date, End Date, the rate that should be charged per unit, and how the units should be calculated. For example, regular Outpatient Therapy codes should be given the decrement action of 1 unit per note.
If you have community based services that are billed in 15 minute increments, you would want to select that decrement action. Once all applicable fields are completed, click Save above the bottom portion. This stamps that information to the billing code selected at the top.
*Note: At minimum, the Start Date, End Date, and Decrement Action must be entered for the billing code to be active and usable within the system.