Lookup
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Enter the Procedure Lookup value
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CPT Code
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Enter the CPT Code if the procedure is a CPT
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HCPCS Code
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Enter the HCPCS Code if the procedure is a HCPCS
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Name
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Enter the Procedure Description
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Hash to Total
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Enter the number to be used on the Visit Worksheet/Journal for the Hash Total for balancing purposes. This must be at least 5 characters in length. This is typically the same as the CPT code, but it could be a drug code such as J2300. If it has an alpha prefix such as J2300, the system will total the number only and ignore the alpha prefix. Alternatively, a drug code could be entered as 02300 instead of J2300, however it must be at least 5 characters to total properly on the Visit Worksheet/Journal.
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Brief Name
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Enter the Procedure Abbreviated Description
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User Name
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Enter a User-Defined Description if desired
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Begin Date
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Enter the effective date of the procedure
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End Date
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Enter the expiration date of the procedure
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Category
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Enter/Select the category for this procedure for reporting purposes. MedSuite provides a standard set that is available with the Procedure File.
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Type
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Enter/Select the procedure type for this procedure for reporting purposes
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Sub-Type
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Enter/Select the procedure sub-type for this procedure for reporting purposes
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File Insurance
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Select the default insurance filing option for this procedure if it should override the Plan Setup. Options include:
| • | File Claim - to file the claim according to Plan setup (paper or electronic). However, if this procedure has an override set up in a Fee Schedule to file to Paper or Do Not File, it will override this setting on the Procedure and the Plan. |
| • | File Claim - Paper Only - to override the Plan setup and always force a claim to file to paper; to not allow it to be sent electronically. However, if this procedure has an override set up in a Fee Schedule of Do Not File, it will override this setting on the Procedure and the Plan. |
| • | Do not File Claim - to override the Plan setup so that no claim is created at all. |
| • | If the field is left BLANK, the claim will be filed according to the Plan setup, or the Fee Schedule if an override of File to Paper or Do Not File is specified there. |
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HCFA Box 24G
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Select the default HCFA Box 24G options for the procedure if it should override the Plan Setup. Options include:
| • | If the field is left BLANK, the claim will be filed according to the setup on the HCFA tab of the Plan setup, or the Fee Schedule if an override is specified there. |
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Excluded From Concurrency
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Indicates if this procedure is excluded from concurrency processing. If selected to be excluded, it will not be counted in overlaps on other cases, and will not be updated by concurrency (i.e. the modifier nor the medical direction will be modified on the case with this procedure). If this option is un-checked on this procedure in this screen, but is checked on this procedure in a Fee Schedule, the flag in the Fee Schedule will override a blank flag here.
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Do Not Update in Concurrency
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Indicates if the procedure is included in concurrency processing for the purposes of calculating the "overlap" of other cases, but the case that this procedure is on will not be updated by concurrency. If this option is un-checked on this procedure in this screen, but is checked on this procedure in a Fee Schedule, the flag in the Fee Schedule will override a blank flag here.
This is done sometimes on OB C-Section Cases where the carrier wants no concurrent case modifier, but the case should be included with all other concurrent cases for the purposes of calculating the number of overlapping cases. Performing the concurrency update would put a modifier on the case and excluding it from concurrency altogether would affect the concurrent case count of other cases.
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Bill Zero $ Charge
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Indicates if the procedure will force the billing of zero dollar fees even if the File Zero Fee Charges on Claims on the Practice Claims Tab normally excludes these charges from claims.
This is a feature of PQRI processing where "Pay for Performance" procedures need to be billed.
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Medical Direction Overrides
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Indicates the Medical Direction Override that should be used when a procedure is Primary on a case with a Secondary Procedure. This is specifically designed for epidural to C-section procedures when the epidural procedure code is excluded from concurrency. The Medical Direction Override will place the Medical Direction selected here on the epidural ONLY when it is entered with a secondary procedure. If the override is left blank the system will put the concurrency modifier of the secondary procedure (C-section not excluded from concurrency) on both the primary epidural and secondary C-section.
NOTE: If the Z-Medical Direction is keyed in Visit Entry on the Anesthesia Tab the system will honor the Z-Medical Direction and ignore the Medical Direction Override set on the procedure code.
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Service Type
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Allows override of service type specified in Visit Type Maintenance for specific procedures
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Age Min
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Enter the minimum permitted age for this procedure which will be compared to the patient are in charge entry
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Age Max
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Enter the maximum permitted age for this procedure which will be compared to the patient are in charge entry
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Sex Specific
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Select the sex if the procedure is sex-specific
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Maternity
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Indicate if the procedure is a maternity code.
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Unlisted
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Indicate if the procedure is unlisted (ends with "99")
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Starred
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Indicate if the procedure is "starred"
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