Codes Section

The Codes section allows you to add, edit and find CPT, HCPCS and Revenue codes. You can manually set a default price for each code or create a custom Fee Schedule. You can also create Diagnosis codes, credit and debit Adjustments, Remittance remark and adjustment reason codes, ICD Procedure codes and Inventory codes. Within the Codes section, you can also configure your insurance Contracts.

The following help pages are supported by the current version of CollaborateMD. Please follow the curriculum outline to receive the proper training associated with this section.



Button Overview

Below you will find a description of the buttons located within the Codes section:
  • New CPT/HCPCS: Selecting this option will allow you to manually add a new CPT/HCPCS Code.
  • Show All: Selecting this option will show all CPT/HCPCS codes in your database.
  • Add From HCPCS List: Selecting this option will allow you to add codes from the master HCPCS list.
  • Add From CPT List: Selecting this option will allow you to add codes from the master CPT list. 

NOTE: The CPT codes are available from the AMA Master List. You must have a license to utilize this feature. The license costs $99 per username and is non-transferable. For instructions on How to purchase a CPT License please see the Services Help Page.

Billing & Procedure

Codes

New CPT/HCPCS Code
Follow the instructions below to manually add a new CPT/HCPCS Code:
  1. Go to the Codes section.
  2. Click on the Billing & Procedure tab.
  3. Click on the Codes tab.
  4. Select New CPT/HCPCS.
  5. Enter your code name in the Code field. Important: When creating a custom code, only the first five (5) digits will be sent on the claim forms. Any added extensions will not populate on claim forms. 
  6. Choose the code Type from the drop down.
    • Note: Selecting Retail will automatically set this charge to the status of Balance Due Patient when added to claims. 
  7. Enter the code Description.
  8. Enter your additional code information such as Defaults, Fee Schedules, Contracts, etc. 
  9. When you're done click on the Save button.
Add From HCPCS List
Follow the instructions below to add a code from the HCPCS List: 
  1. Go to the Codes section.
  2. Click on the Billing & Procedure tab.
  3. Click on the Codes tab.
  4. Select Add From HCPC List.
When the Master HCPC Selection Window opens, choose your search criteria:
  • Select Range to Display: If you know the range in which the codes are located, you can choose it from the drop down, or leave it set to All Codes to search for all codes in the database.
  • Enter Code to Search For: If you know the code you would like to add, you can enter it in this field.
  • Enter Keyword to Search For: If you are not completely sure of the exact code, but you know what is in the description, you can enter a keyword in this field.
  • Order Results By: Select the drop down to order results by description or code.
  1. Once you have entered your search criteria, select Search.
  2. Select the code(s) you wish to add by: 
    • Manually checking the box beside each code. 
    • To add more than one code at a time, hold down the Ctrl key on your keyboard and select the codes you wish to add. 
    • To add a consecutive list of codes, hold the Shift key on your keyboard, click the first code you wish to add and then select the last code you wish to add. All codes in between will be highlighted. 
  3. When you're done click on the Save button.
Add From CPT List
Adding a code from the CPT Master List will make that code available to all users within your account that have the appropriate permissions. Please note, only users that have the CPT License will be able to add codes from the CPT Master List. For more information on how to acquire a CPT license, Click Here

Follow the instructions below to add a code from the CPT Master List
  1. Go to the Codes section.
  2. Click on the Billing & Procedure tab.
  3. Click on the Codes tab.
  4. Select Add From CPT® List.
When the Master CPT® Selection Window opens, choose your search criteria:
    • Select Range to Display: If you know the range in which the codes are located, you can choose it from the drop down, or leave it set to All Codes to search for all codes in the database.
    • Enter Code to Search For: If you know the code you would like to add, you can enter it in this field.
    • Enter Keyword to Search For: If you are not completely sure of the exact code, but you know what is in the description, you can enter a keyword in this field.
    • Order Results By: Select the drop down to order results by description or code.
    1. Once you have entered your search criteria, select Search.
    2. Select the code(s) you wish to add by: 
      • Manually checking the box beside each code. 
      • To add more than one code at a time, hold down the Ctrl key on your keyboard and select the codes you wish to add. 
      • To add a consecutive list of codes, hold the Shift key on your keyboard, click the first code you wish to add and then select the last code you wish to add. All codes in between will be highlighted. 
    3. When you're done click on the Save button.
    Find / Edit Procedure Code
    Follow the instructions below to find a Code:
    1. Go to the Codes section.
    2. Click on the Billing & Procedure tab.
    3. Click on the Codes tab.
    4. Enter the code you are looking for in the Search bar or select Show All.
    5. Select the code you wish to edit. 
    6. When you're done click on the Save button
    Inactivate Procedure Code
    Follow the instructions below to inactivate a Code:
    1. Go to the Codes section.
    2. Click on the Billing & Procedure tab.
    3. Click on the Codes tab.
    4. Select Show All.
    5. Select the code you would like to inactivate. 
    6. Select the check box that says Inactive Code.
    7. When you're done click on the Save button.
    Reactivate Procedure Code
    Follow the instructions below to reactivate a Code:
    1. Go to the Codes section.
    2. Click on the Billing & Procedure tab.
    3. Click on the Codes tab.
    4. Select the check box that says Search inactive procedure codes.
    5. Select Show All.
    6. Select the code you would like to reactivate. 
    7. A pop-up will appear indicating “This CPT® code is currently inactive”. Click OK.

    8. Deselect the checkbox that says Inactive Code.
    9. When you're done click on the Save button.

    Defaults

    When adding or editing a code, you have the ability to set your default code options. Note: Any updates or changes to defaults will only apply to new claims going forward. Existing claims will not be updated.  
    • Default Price: Enter your default price for this code. The maximum value is 999,999.99. 
    • This an all inclusive code: Checking this box means this code covers all other procedures on the claim, therefore all other line items on the claim are set to PAID. 
    • Default Units: Enter the default units for this CPT code.
    • This code is a percentage of the claim total: Checking this box means the code should be calculated as a percentage of the claim total dollar amount. This will also remove the Default Price and Default Units fields, as well as add a Default Percent field, in which to specify to percentage of the total claim dollar amount this code represents.
    • Exclude this code from duplicate service check: Check this box to exclude this code from being validated when a duplicate service request is made when a claim is created.
    • Modifiers (Global): If this code has global default modifiers that should be billed with the code a majority of the time, enter them here manually or by clicking the magnifying glass and choosing from the listed options. 
    • Modifiers (Situational): To enter modifiers that should be billed with the code in certain situations, click the Create situational modifiers link to begin entering the modifiers and rules for when these modifiers should be used on the claim. Note: Scenario based modifiers can be set for Dates of service, Primary Payer, Facility, and Rendering Provider. Additionally, users can add an internal note within the Notes box. Once satisfied, click Save.
      1. If you do not wish to view the Situational Modifiers that have been added, click the Hide situational modifiers link. When collapsed, the system will display the number of available active modifier sets.
      2. M1-M4: Displays the selected modifiers for the set.
      3. Applies To: Displays the situational rules defined for when the selected modifiers will be used on claims.
      4. Notes: If internal notes have been added the clipboard icon will display in the Notes field. Hovering over the icon will display the actual note entered.
      5. Delete: Check this box if you wish to remove a defined situational modifier set.
      6. If multiple sets of situational modifiers exist for a single code, users can change the order of precedence by selecting the desired set and using the arrows to move to the correct priority location. This will ensure the correct modifiers are used in the event conflicting information is presented on a claim.
      7. Once the first set of situational modifiers has been added, users will need to select the Add more situational modifiers link to create additional situational based modifiers.
    • Place of Service: Enter the default Place of Service for this code manually or by clicking on the magnifying glass and choosing from the list of options. 
    • Type of Service: Enter the default Type of Service for this code manually by clicking on the magnifying class and choosing from the list of options. 
    • Rev Code: Enter the default Rev Code manually or by clicking on the magnifying glass and choosing from the list of options. 
    • CLIA Number: Enter your Clinical Laboratory Improvement Amendment number for this code if applicable. 
    • Drug Code: Enter the Drug code for this code if applicable. 
    • Drug Price: Enter your default Drug Price if applicable. 
    • Drug Unit: Enter the correct number and Type of Drug Unit, if applicable. 
    • Drug Code Format: Select the appropriate Drug Code Format from the drop down. 
    • Default Charge Status: If applicable, select the default charge status for this code. Note: The level of priority will always be the Default Charge Status and then payers Default Billing Status. This means, if a CPT code does NOT have a default charge status, we will use the Default Billing Status that is set on the payer, which is normally “Send to Payer via Clearinghouse” unless modified by a user.
    • Additional Description (*For Non-Specific Procedure Codes): Enter your additional description in this field 
    • Effective/Terminate Dates: If your code has Effective and Termination dates, you can enter the dates in manually or choose the dates from the interactive drop-down calendar.
    • Superbill: Enter your superbill defaults here: 
      • Print this code on Superbill: Selecting this option will have the code display on your superbill. 
      • Category: This option shows how you group the codes on the superbill. 
      • Description: Enter an abbreviated description 
    • Statements: 
      • Statement Description: Enter the description you would like to be displayed on the patient statements.

    Fee Schedules

    When adding or editing a code, you have the ability to set the fee schedule(s) for the code.
    • Select in the Price column next to the fee schedule you would like to update and populate the price for the code. 

    RVUs

    An RVU, or Relative Value Unit, is a metric designed to measure a physician's work activity in uniform units.
    • Year: Select the year in you would like to use to measure the physician's work activity.
    • Type: Select which type you would like to use: Options Include: Global, Professional, Technical and Discontinued.

    Medicare Allowables

    You can show the Medicare allowables for this code depending on the year.
    • Year: Select the year in you would like to use to show the Medicare Allowables. 
    • Type: Select which type you would like to use. Options Include: Global, Professional, Technical and Discontinued.

    Contracts

    This tab will show you all of the contracts in your system and the pricing of the code for the contract. You can edit the price by clicking on the Price field next to the contract and editing the amount. To exclude the code from a contract, simply click the Exclusion button next to the contract you wish to exclude.

    Notes

    You can add a note to a code by selecting the Notes tab. Enter your note up to 4000 characters. To edit or remove a note, simply delete what you no longer want to display.

    Add Alert

    Follow the instructions below to add an alert:
    1. Click the Alerts tab.
    2. Select Add Alert
    Begin entering the alert information:
    • Message: Enter the Alert message
    • Display Options: Select where you want the alert to appear. Clicking on the question mark next to each option will give you an explanation of each option.
      • Global Alert: Shows this alert anytime the CPT code is used.
      • Show Alert in Patient Section: Show this alert whenever a patient that has this CPT code as a default is opened OR this CPT is selected as a default on  a patients record.
      • Show Alert in Claim Section: This alert will show whenever this CPT is selected on a claim OR a claim is opened with this CPT on a line item. 
      • Show Alert in Appointment Scheduler: Show this alert whenever an appointment is added or opened in which the patient on the appointment has this CPT code as a default.
      • Show Alert in Payment Section: Show this alert whenever a payment is made on a line item involving this CPT.
    • Alert Date Range (Optional): Set a date range for how long you would like this alert to appear.
      • Alert Start Date: Enter or select the alert start date from the calendar.
      • Alert End Date: Enter or select the alert end date from the calendar.
    1. Once you're satisfied with your changes, click Save.

    Edit Alert 

    Follow the instructions below to edit an alert:
    1. Click the Alerts tab.
    2. Double click on the alert you wish to edit.
    3. When the Alert window opens, make the necessary changes and click Save.

    Delete Alert 

    Follow the instructions below to delete an alert.
    1. Click the Alerts tab.
    2. Check the Delete box next to the Alert you wish to delete or double click on the alert and check the box called Delete Alert.
    3. When you're done click on the Save button.

    Charge Panels

    Charge Panels, also known as bundling allow you to create a predefined group of two or more CPT codes that can be added to a claim as separate line items. Charge Panels are helpful because a physician may have performed one service as the result of doing another. The CollaborateMD Training and Support Departments are unable to instruct users what codes are allowed to be bundled or used in a Charge Panel, please contact the patients insurance company for more information on what codes are allowed to be bundled together. 

    Add Charge Panel 

    Follow the instructions below to add a new charge panel:
    1. Go to the Codes section.
    2. Click on the Billing & Procedure tab.
    3. Click on the Charge Panels tab.
    4. Click on the Add Panel button.
    5. Input a name for the new charge panel.
    6. In the Code field, enter a short code that can be used as a shortcut to enter this panel into a claim. All Charge Panels will begin with CP (Charge Panels). 
      • Limitations: Charge Panel "Codes" must be unique to the customer you're currently logged into. The Code field supports numbers OR letters after the "CP". 
    7. Choose what Type of claim the charge panel will be used for.
    8. Enter a Description. 
    9. Click on the magnifying glass in the Code column to select a CPT/HCPCS code to include on the charge panel.
    10. Configure the default selections for the code. Note: When using the code default modifiers and/or price, the system will not display the defaults as these can be set globally or for specific situations. Please refer to the Codes Defaults and Fee Schedules help pages for more information.
    11.  Repeat until you're satisfied with the Charge Panel you've created.
    12. Once you are done, click the Save button.

    Note: If you have set a default billing status for any code(s) on the charge panel, the status will still apply to that code when added to the charge panel. 

    Find/Edit Charge Panel

    Follow the instructions below to find a charge panel:

    1. Go to the Codes section.
    2. Click on the Billing & Procedure tab.
    3. Click on the Charge Panels tab.
    4. Enter the name or the charge panel in the Search bar or select Show All
      • Alternatively, you can also search for a charge panel by the CPT/HCPCS codes that are associated with it.
    5. Make the necessary changes, if applicable.
    6. Once you are done, click the Save button.