Maintaining CPT Codes

Maintaining CPT codes increases the accuracy of patient prescriptions, patient invoices, insurance claims, and various reports. If you choose to participate in the EHR Incentive Program or the Physician Quality Reporting System (PQRS), ensure that all your procedure codes are up-to-date and mapped correctly before you begin participating in these programs.

You must set up and map CPT codes for all products and services that your company bills to insurance carriers. If you bill noncovered items to any insurance carrier, you must set up and map CPT codes for all products and services offered by your company. For more information on configuring the Bill Non-Covered Items setting for insurance carriers and plans, see the following topics:

This section explains how to maintain and map the procedure and modifier codes recorded on patient prescriptions and orders and displayed on insurance claims and the CMS 1500 form.

For multitenant environments, the following setup can be performed only by administrators of the parent company and is required only for the parent company. The parent company setup applies to all companies.

Topics include the following:

There is one CPT code for frames: V2020.
  1. In AcuityLogic Admin, click Insurance and select CPT Maintenance.

    The CPT Maintenance window opens.

  2. Select CPT Codes from the Maintenance Type drop-down list.
  3. To filter the CPT codes, type a CPT code in the CPT Code field, click the Filter button, and select one of the following:
    • No Filter: Clear a previous filter and display all results.
    • Contains: The results contain the text you typed in the field.
    • Starts With: The results start with the text you typed in the field.
    • Equal To: The results are the exact match of the text you typed in the field.

    The results that meet your search criteria display.

  4. To add a new CPT code, click Add CPT Codes.

    OR

    To modify an existing CPT code, click the Edit link next to the CPT code you want to modify.

  5. Type the CPT code in the CPT Code field.
  6. Type the description of the CPT code in the Description field.
  7. Select the Active check box to activate the CPT code.
  8. If applicable, in the Non Billable column, select the Non Billable check box.
    Unknown CPT codes can cause disruptions to calculation processes when benefits are computed for VSP and non-VSP orders. Unknown CPT codes can cause claims to go on hold or be rejected.

    Identify CPT codes for medically unnecessary services, fees, or items as Non Billable to prevent disruptions to calculation processes and claim rejections.
  9. Click Insert to add a new CPT code.

    OR

    Click Update to update an existing CPT code.

  1. In AcuityLogic Admin, click Insurance and select CPT Maintenance.

    The CPT Maintenance window opens.

  2. Select Modifier Codes from the Maintenance Type drop-down list.
  3. To filter the modifier codes, type a modifier code in the Modifier Codes field, click the Filter button, and select one of the following:
    • No Filter: Clear a previous filter and display all results.
    • Contains: The results contain the text you typed in the field.
    • Starts With: The results start with the text you typed in the field.
    • Equal To: The results are the exact match of the text you typed in the field.

    The results that meet your search criteria display.

  4. To add a new modifier code, click Add Modifier Codes.

    OR

    To modify an existing modifier code, click the Edit link next to the modifier code you want to modify.

  5. Type the modifier code in the CPT Code field.
  6. Type the description of the modifier code in the Description field.
  7. Select the Active check box to activate the modifier code.
  8. Click Insert to add a new modifier code.

    OR

    Click Update to update an existing modifier code.

There is one CPT code for frames: V2020.
  1. In AcuityLogic Admin, click Insurance and select CPT Maintenance.

    The CPT Maintenance window opens.

  2. Select CPT Item Code Mapping from the Maintenance Type drop-down list.
  3. To filter the codes, type text in the Item Type, Item Group Name, Item Name, Procedure Code, or Modifier Code field, click the Filter button for each, and select one of the following for each:
    • No Filter: Clear a previous filter and display all results.
    • Contains: The results contain the text you typed in the field.
    • Starts With: The results start with the text you typed in the field.
    • Equal To: The results are the exact match of the text you typed in the field.

    The results that meet your search criteria display.

  4. To add a mapping, click Add CPT Code Item Mapping.

    OR

    To modify an existing mapping, click the Edit link next to the mapping you want to modify.

  5. Type the modifier code in the CPT Code field.
  6. Select an item type from the Item Type drop-down list.
  7. Select an item group name from the Item Group Name drop-down list.
  8. Select an item name from the Item Name drop-down list.
  9. Select a procedure code from the Procedure Code drop-down list.
  10. Select a modifier code from the Modifier Code drop-down list, if needed.
  11. Click Insert to add a new mapping.

    OR

    Click Update to update an existing mapping.

Related Topics