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System Maintenance: Define CPT Codes

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You can manage defined CPT codes in myAvatar using the CPT Code Definition form. CPT codes are used for Professional services.

  1. Go to: Avatar MSO > System Maintenance > CPT Code Definition
  2. In the Add/Edit/Delete CPT Code field, select the action to perform:
    • If you choose to Add a new CPT code to the system, enter the new code number into the Code field.
      Once this form is filed, the code number cannot be edited.
    • If you choose to Edit an existing CPT code, search for and select the code in the CPT Service Code field.

  3. In the CPT Code Description field, enter the description.

  4. In the CPT Code Category field, select the category of the code.

    • A Primary Code is the main code entered for a service and determines what add-on codes can also be billed. Primary CPT codes do not require an add-on code.

    • An Add-On Code is additional CPT code that can be billed in addition to the primary code during a session (an add-on code cannot be billed as a stand-alone code and will be denied if the primary code is not also billed in the same claim.)

    • An Interactive Complexity code is used when Interactive Complexity was present during a service. There can only be one Interactive Complexity code entered per service. The Interactive Complexity code will be denied if the primary code is not billed in the same claim.

  5. In the CPT Code Type field, select the type for the code.

  6. If applicable, select the Interactive Complexity CPT Code from the drop-down list.

  7. If applicable, select whether or not there Is An Add-On Code Required For The Interactive Complexity To Be Approved.

  8. If add-on codes are required, click the Specify Add-On CPT Codes button. This opens the CPT Code Definition table.

    1. Click New Row.

    2. In the CPT Code field, enter the CPT code.

    3. In the Duration Range (Minutes) field, enter the duration in numeric form.

    4. If additional CPT Codes are necessary, repeat these substeps.

    5. Select Save. This returns you to the CPT Code Definition form.

Code Thresholds

  1. In the Maximum Units Per Day field, enter the maximum number of allowed units for the CPT code.

  2. In the Minimum Duration field, enter the CPT code minimum duration.

  3. In the Maximum Duration field, enter the CPT code maximum duration.

Additional Settings

  1. In the Effective Date field, enter the beginning date.

  2. In the Expiration Date field, enter the ending date.

  3. In the Limit License Type(s) Allowed field, select the license(s) that are approved to provide the procedure code.

    • Fields 13 through 15 will be used during adjudication to determine if the procedure code is valid.

  4. In the Bypass Third Party Coverage Not Found Rule field, select Yes to bypass the third party coverage verification during adjudication.

  5. In the Does This Service Count As A Visit field:

  • Select Yes if the service associated with the CPT code is a visit. The number of available visits is set up in the Plan Definition form.

  • Select No if the service associated with the CPT code is a unit of service.

  1. In the Procedure Code Group Definitions field, select procedure code group definitions.

  • Procedure code groups are setup in the Procedure Code Group Definition form.

  • The CPT code will be added to the procedure code group.
    If required, the CPT code can be removed from the procedure code group in this form, and in the Procedure Code Group Definition form.

  1. In the Place of Service field, select the treatment venues.

  2. Click File CPT Service Code.

Report

  • Click Display CPT Code(s) to generate a CPT code report that details the information entered in this form.

Delete a CPT Service Code

  1. In the Add/Edit/Delete CPT Code field, select Delete.

  2. In the CPT Service Code field, search for and select the CPT code.

  3. Click the File CPT Service Code button.

  4. You may receive a confirmation dialog indicating that deleting the CPT code will remove it from an authorization group or groupings. Select Yes to continue or select No to cancel the deletion.

► Additional Sections

► Registry Settings

► SQL Tables

  • SYSTEM.table_cpt_addon_codes
  • SYSTEM.table_cpt_service_codes

 

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