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Edit Procedure Code Window

Procedure code properties and default notes can be entered on the Edit Procedure Code window. To open, in the main menu, click Lists, Procedure Codes, then double click an existing code.

Below is a description of each option.

Time Pattern: Use the vertical slider on the left to set the procedure time allotment. By default, each square represents 10 minutes.  To change the default, see Setting the Time Increment. Slashes (/) indicate assistant time, X's indicate provider time.  Click on an X or / to toggle to the other. Procedure time is used to determine default appointment length. See Time Bars for more detail.

Proc Code: The code itself. It can be up to 15 digits long. All codes starting with D will be shortened to 5 characters before being included on a insurance claim.  For example, you can have two different codes for nitrous, with the difference being a letter that is added to the end of a standard D code. When sent to insurance, only the standard 5 digit code will be used.

Note: Once created, codes can't be changed or deleted. Instead move it in an obsolete category.

Alt Code: Associate an alternate code. Useful for some Medicaid plans like Dentical.  See Medicaid Insurance Plans.

Medical Code: Associate a medical code. The medical code must already exist. See Cross Coding Procedure Codes to Medical Codes. Cross coding only affects medical claims.  It does not affect what shows on Continuity of Care documents (CCDs).

Ins Subst Code: Associate an insurance substitution code and optionally set an Only if condition. The substitute code will be used to calculate estimates for procedure downgrades (when insurance reduces the allowed amount of a procedure). See Procedure Downgrades.

  • Posterior composites: Typically enter the amalgam code and set the condition to Molar.
  • Porcelain crowns: Typically enter the FGC code and set the condition to SecondMolar. If your office charges the same for both types of crowns this setting is not as important.

Description: Only non-ADA code descriptions can be edited.  Automatically update ADA code descriptions using Procedure Code Tools.

Abbreviation: Can be edited.

Layman's Term: Enter simpler language to describe the procedure. It will show as the procedure description in Treatment Plans, the Chart, and the Account module.

Base Units: Typically for Medical Insurance claims.  When calculating a procedure fee, the standard fee is increased based on the base unit, thereby increasing the billed fee. The base unit calculates the fee and time pattern using an additive process. 
Base Unit = 0 (standard fee)
Base Unit = 1 (standard fee + standard fee)
Base Unit = 2 (standard fee + standard fee + standard fee).

For example, the procedure code for Nitrous Oxide may have a time pattern of 15 minutes (base unit of 0) and a fee of $100. During the procedure, you may typically use Nitrous Oxide for a longer period of time.  Instead of adding the procedure to the chart multiple times, increase the base unit.

  • By setting the Base Unit to 1, the Time Pattern = 30 minutes and the Procedure Fee = $200
  • By setting the Base Unit to 2, the Time Pattern = 45 minutes and the Procedure Fee = $300
  • By setting the Base Unit to 3, the Time Pattern = 60 minutes and the Procedure Fee = $400

There is a checkbox on the Insurance Plan Edit window for "Claims show base units" which shows the base unit on the medical claim form.

Drug NDC: National Drug Code number.

Default Revenue Code: A 3-digit code sometimes used for institutional claims. It tells insurance where the patient was when they received insurance or the type of item they received. It will show as the default Revenue Code on the Procedure Info - Medical Tab.

Color Override: Override the default color for this procedure on the Graphical Tooth Chart. Usually colors are based on procedure status, such as Treatment Planned or Completed, not on individual procedure code. However in rare situations you may want a procedure code to always show in one color. For example, implants look better as always gray, instead of red, blue, or green. Click none to remove the override.

Do not usually bill to Ins: Determines the default setting of the 'Do Not Bill to Ins' checkbox on the Procedure Info - Financial Tab. Useful to identify procedures that are not usually sent to insurance (e.g. non-standard D codes, crown seats).

Is Hygiene procedure: Check this box to automatically assign the procedure to the hygiene provider when scheduling an appointment with two providers. See Edit Appointment for an explanation of Hygiene provider.

Is Prosthesis: Determines whether or not additional Prosthesis Replacement fields will show on the Procedure Info window. 

  • Checked: Prosthesis fields will show. Users must complete this information before sending the insurance claim.
  • Unchecked: Prosthesis fields will not show.

Is Radiology: Typically used for EHR to designate a procedure as an x-ray. If checked, this procedure will considered a radiology order for EHR purposes. See Enter and Approve CPOE Radiology Orders.

Assign to Prov: Assign a specific provider to this procedure. For example, create a procedure for selling mouthwash from the dental office, then assign the procedure to a dummy provider. This avoids inflated production numbers on real providers.  The provider selected here will be assigned to this procedure when it is created and when it is set complete.

Paint Type: Determines how the procedure will be drawn on the Graphical Tooth Chart.

  • Extraction: A large X when treatment-planned. Tooth is hidden when procedure is set complete.
  • Implant:  For any implant procedure code. It will frequently be a procedure you do in your own office, such as placing an abutment. To indicate a previously placed implant, assign this paint type to a surgical procedure with a status of EO. Before the implant graphic will show, the tooth must also be marked missing. Once an implant is showing, a crown can be entered. Crowns do not normally show on missing teeth, so entering an implant procedure first will be necessary in this case.
  • RCT: Root canal graphics. A vertical line shows on permanent teeth; will not show on Primary teeth (pulpectomies).
  • PostBU: A graphic that fills the pulp chamber. Also used for pulpotomies (vital pulp therapies) on primary teeth.  If you do lots of BUs that do not involve the pulp chamber, remove this paint type from the procedure code and use no paint type at all.  Then the graphics will make better sense on the chart.
  • FillingDark/Light:  Dark and light color options.
  • CrownDark/Light - Caps tooth.  Tooth must be visible (or there needs to be an implant).  Dark and light color options.
  • BridgeDark/Light - Looks like a crown, but shows on both visible and missing teeth.  Dark and light color options.
  • DentureDark/Light: Teeth should be marked missing or hidden.  Dark and light color options.  Similar to crown graphic.
  • Sealant: An "S".
  • Veneer:  A graphic (inverted T) on the front of the tooth.
  • Watch: A small "W" above or below the tooth.

Treatment Area: Determines the surface and tooth options available when charting the procedure (Procedure Info window).

  • Surf: Tooth and Surfaces
  • Tooth: Tooth only
  • Mouth: no extra options
  • Quad:  UR, UL, LR, LL
  • Sextant:  1 - 6
  • Arch:  U, L
  • Tooth Range: 1 - 32

Category: Select the category this procedure code will be grouped under.  Customize category options in Definitions, Proc Code Categories.

Default Fees: The global fees for this procedure code, for each Fee Schedule.  For more details, see Enter Procedure Code Fees.

  • Double click on a row to change a fee amount. 
  • To view or enter provider or clinic specific fees, click More next to View provider and clinic specific fees. Double click a row to change a fee amount.
  • To view a log of all fee changes for this procedure code, click Audit Trail.
  • Once fees are entered they are saved, even if you click Cancel on the Edit Procedure Code window.

Default Note: This is the default Procedure Note that will automatically copy to the patient's chart when the procedure is Set Complete. Notes can include anything that normally goes into your chart notes.

Auto Note: Click Auto Note to insert an Auto Note in the default note text [[AutoNoteName]]. Once a procedure is set complete, reopening the Procedure Info window will trigger auto note prompts. Once responses are entered, the entire note will be copied into the Notes area. Note: Prompts will only be triggered if the preference for 'Procedures Prompt for Auto Note' in Chart Module Preferences is checked.

Incomplete Notes: To remind staff to enter specific information in the note, use two quotes "" in the note without anything in between (Example: Due Date ""). Staff must then enter information between the quotes once the procedure is completed (Procedure Info window). If they do not, a red Incomplete Note warning will appear above the note. Completed procedures with incomplete notes show on the Incomplete Procedure Notes Report.
Examples of where you could use quotes are composite shade, crown shade, denture shade, due date, blood pressure, nitrous levels, etc.

Notes and Times for Specific Providers: Lists provider-specific default notes and/or time allotments for the procedure. To create a new note:

  1. Click Add Note.

  1. Highlight the provider.
  2. On the left, select the procedure's time pattern for this provider, if different.
  3. Change the provider's default procedure note, if different.
  4. Click OK to save.

Provider-specific notes can be deleted without disturbing patient data.

Default Claim Note: Enter a note that will automatically copy to the Claim Note field when a claim is created that includes this procedure. See Edit Claim - General Tab.

 

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