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Procedure Codes 

Procedure codes can be maintained, edited and accessed via the Procedure Codes list. 

In the Main Menu, click Lists, Procedure Codes, or press Ctrl+Shift+F.

Search: There are three search options: 

  • By Abbrev:  Search the entire procedure code list for a specific abbreviation.
  • By Descript: Search for entered text in all description text in the selected category(s).
  • By Code: Search for a specific code in the selected category(s).

Categories: Click on a category to only show procedures within the category.  To see all codes, click All, or select every category (press Ctrl while clicking).

  • Edit Categories:  Jump to Definitions, Proc Code Categories where you can add, edit, rearrange and hide categories. Must have the Setup Permission.
  • Show Hidden:  Check this box to show categories marked hidden; uncheck it to hide those categories. Click default to set the default Show Hidden setting.

Procedure Codes: These buttons are only visible to users with the Setup Permission.

  • Import/Export: Import or export procedure codes to an XML format. Note that it is a violation of the copyright to share ADA procedure codes with another office.  But many other types of codes can be imported and exported.  Only the codes currently showing in the grid are exported.  This gives you the option to just export a few codes rather than all codes.  This is useful in Foreign Countries.
  • Tools: Launch Procedure Code Tools to automatically update procedure codes (e.g. remove temporary codes (T), add missing D or N codes, reset defaults). Important: Run this tool when you update to the full version of Open Dental from the Trial version as it will remove T codes and update CDT codes.
  • New: Add a Procedure Code. Useful for Foreign Countries who do not use ADA codes or when adding a non-ADA code.

Procedures Grid:  The procedures that show depend on the highlighted Category. 

  • To edit a procedure, double click anywhere in the row, except in a fee column. See Edit Procedure Code.
  • You can view, edit, and compare fees in up to three Fee Schedules, each represented by a Fee column (Fee 1, Fee 2, Fee 3). The fees that show in each column depend on the fee schedule criteria selected on the right.

Starting in version 15.3, a fee schedule's global fees can be overridden by provider and/or clinic. To enable this feature, the fee schedule must have the 'Use Global Fees' box unchecked. See Fees by Provider or Clinic below. Global vs versus provider and/or clinic fees are color-coded. Colors can be customized in Definitions, Fee Colors. The default colors are as follows:

  • Black: The fee is the default (global) fee of the fee schedule.
  • Orange: The fee is clinic specific.
  • Green: The fee is provider specific.
  • Blue: The fee is specific to a provider and clinic.

Fee Sched and Fee Tools: These buttons are only visible to users with the Setup Permission.

  • Fee Scheds: Jump to Fee Schedule Setup.
  • Fee Tools:  Access tools available for fee schedules, such as copying, importing/exporting fees, increasing fees by a percentage, and global fee updates.  See Fee Schedule Tools.

Fees by Provider and/or Clinic
Within a fee schedule, you can enter procedure fees that are provider and/or clinic specific. This will reduce the number of fee schedules you need, yet allow you to customize a single fee schedule for multiple providers/clinics. Open Dental will automatically assign the correct fee based on the fee schedule and the treating provider/clinic.

Examples (also see Scenaries below):

  • For PPO plans that have different fee tiers by provider (e.g. preferred vs premium) or clinic, create a single fee schedule then specify provider and/or clinic procedure fees in the procedure code list.
  • For UCR fees that are provider or clinic specific, create a standard UCR fee schedule, then specify provider and/or clinic specific procedure fees in the procedure code list.

General Steps:

  1. Under Compare Fee Schedules, select the criteria for a fee column. As you select criteria, the fees in the column will change to reflect the current fee entered for the fee schedule, clinic, and/or provider.
    • Fee Schedule: Click the dropdown or [...] to select a fee schedule.
      - If the selected fee schedule is set to 'Use Global Fees', the Clinic and Provider options will be disabled.
      - If the option is unchecked for the selected fee schedule, the Clinic and Provider options will be enabled and provider/clinic specific fees can be entered.
    • Clinic: Click the drop down or [...] to specify a clinic or leave blank.
    • Provider: Click the drop down or [...] to specify a provider or leave blank.
  2. Click in the correct Fee cell, then enter the fee.

Scenarios
#1: For PPOInsPlan1, Dr. Jones, Dr. Smith, and Dr. Wilson have different fees.
Solution:

  1. Create one fee schedule (normal) for PPOInsPlan1.
  2. In the Procedure Code List, adjust the fees for each provider:
    • For Fee 1, 2, and 3, select the PPOInsPlan1 fee schedule.
    • For Fee 1, select Dr. Jones as the provider.
    • For Fee 2, select Dr. Smith as the provider.
    • For Fee 3, select Dr. Wilson as the provider.
    • Under Procedures, click in each cell and change the fees for each provider as needed.
  3. For each patient's insurance plan, select the PPO InsPlan1 fee schedule. The fees will automatically adjust based on treating provider.

#2: Clinic A, B, and C have different standard UCR fees.
Solution:

  1. Create one fee schedule (normal) for Standard Fees.
  2. In the Procedure Code List, adjust the fees for each clinic:
    • For Fee 1, 2, and 3, select the Standard Fees fee schedule.
    • For Fee 1, select Clinic A.
    • For Fee 2, select Clinic B.
    • For Fee 3, select Clinic C.
    • Under Procedures, click in each cell and change the fees as needed.
  3. Assign the Standard Fees schedule as needed. The fees will automatically adjust based on treating clinic.

#3: Dr. Jane and Dr. George have different standard UCR fees. Dr. George's works in two clinics (A and B), and his standard fees are different depending on the clinic.
Solution:

  1. Create one fee schedule (normal) for Standard Fees.
  2. In the Procedure Code List, adjust the fees:
    • For Fee 1, 2, and 3, select the Standard Fees fee schedule.
    • For Fee 1, select Dr. Jane as the Provider.
    • For Fee 2, select Clinic A and Dr. George.
    • For Fee 3, select Clinic B and Dr. George.
    • Under Procedures, click in each cell and change the fees as needed.
  3. Assign the Standard Fees schedule as needed. The fees will automatically adjust based on clinic and treating provider.

 

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