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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 is used to calculate downgraded estimates for procedures (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).

  • Checked: Box will be checked by default.
  • Unchecked: Box will be unchecked by default.

Is Hygiene procedure: See Edit Appointment for an explanation of Hygiene provider.

  • Checked: This procedure will be automatically assigned to the hygiene provider when scheduling an appointment with two providers.
  • Unchecked: This procedure will be assigned normally.

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.

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.

Bypass Global Lock Date: Determines whether or not this procedure will be affected by the Global Lock Date (if turned on).

  • Checked: If this procedure has a $0 fee, it will not be limited by the global lock date, meaning it can be deleted or backdated. You can also add a new procedure and backdate it prior to the lock date, or backdate an existing procedure's procedure date to before the lock date. This can be useful for providers who add non-clinical procedures as reminders then later remove them.
  • Unchecked: Global lock dates apply to this procedure as normal.

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: 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.

Notes
There are several types of default notes that can be associated with a procedure. Each is designated with a tab:

  • Completed Note: A default Procedure Note that automatically copies to the Procedure Info window, Notes field when the procedure is Set Complete.
  • TP'd Note: The default Procedure Note that automatically copies to the Procedure Info window, Notes field when the procedure has a status of treatment planned.
  • Default Claim Note: A default note that automatically copies to the Claim Note field when a claim or Preauthorization is created that includes this procedure. See Edit Claim - General Tab.

Hints:
Incomplete Notes: Use two quotes "" to remind staff to enter specific information in a note (Example: Due Date ""). If the information is not completed, a red 'Incomplete Note' warning will appear above the note. To view a list of completed procedures with incomplete notes, see Incomplete Procedure Notes Report. Other examples: composite shade, crown shade, denture shade, due date, blood pressure, nitrous levels, etc.

Auto Notes: To insert an Auto Note template in a Completed or TP'd Note, click Auto Note. If 'Procedures Prompt for Auto Note' in Chart Module Preferences is checked, opening the Procedure Info window will trigger any auto note prompts.

Notes and Times for Specific Providers: When specific provider's have different completed or TP'd notes and/or time allotments, create a provider specific 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.

 

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