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Service Codes - PM

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Maintain service codes.

  • A service code is used to track all billable and non-billable patient or provider activities (events). This value is also referred to as a charge code. These service codes define the client treatment, room and board charges, and staff only services.
  • Each service with a different fee must have a different service code.
  • Service codes may require that a provider (clinician or person providing the service) be identified when the code is used. 
  • If add-on codes are needed, they must be added first in order for them to be available to assign to the primary service codes.

Service Code

  1. Go to: Avatar PM > System Maintenance > System Definition > Service Code Maintenance > Service Codes
  2. In the Add New or Edit Existing field, select Add to add a new service code, or select Edit to edit an existing service code.

  • If adding a code, in the New Service Code field, enter the code.

  • If editing a code, in the Service Code field, enter the code and select a value from the Results list.

  1. In the Inactive Service Code field:

  • Select Yes to deactivate the service code. The service code will not be available in forms throughout Avatar.

  • Select No to render the service code active. This works for new service codes as well as existing, inactive service codes.

  1. In the Service Code Definition field, enter the service code description.

  2. In the Service Required By field:

  • Select Both if a staff member and a client are required for the service. For example, a therapy session (billable service).

  • Select Client Only if a client is required for the service. For example, a room and board service.

  • Select Provider if the service is a provider only service. For example, documentation completion, or a department meeting.

  1. In the Type Of Service field, select whether the service is for an individual or a group. 
    When a provider is associated to a service for a client, the system credits the provider with the amount of time spent with the client. When the provider treats a group of clients, the system needs the Service Type designation in order to credit the provider with the amount of time spent on client care. Without this designation, the system could possibly credit a provider with 600 minutes of clinical time for a 60-minute group session of 10 clients.

  • Select Individual for services provided for a single client.

  • Select Group for services provided for a group of clients.

  1. In the Type Of Fee field, select how the total charge will be calculated for the service.
    Fixed fees are static regardless of the number of units used. User-defined fees vary by the number of units used. A unit is determined by a user-specified number of minutes per unit. If a service has a linear progression of fee increases based on the duration of the service, a unit-based fee should be used. If the progression is not linear for multiple units of service, then multiple fixed fee service codes need to be defined. (The general rule for defining services is that each service code should be a fixed fee charge with its own independent fee.)
    Example:
    1. A therapy service has a charge of $15 for 30 minutes, $30 for 60 minutes, and $45 for 90 minutes, etc. This service should be a unit-based charge with a unit duration of 30 minutes and a fee of $15. The service has a linear progression of $15 for each 30-minute unit rendered to a client.
    2. A therapy service has a charge of $15 for 30 minutes, $20 for 60 minutes, and $30 for 90 minutes. This service should be defined as three separate Fixed Fee charges.

  • Choose Fixed Fee (Per Event) for a service fee that is charged a set amount each time the service is rendered. The service fee is not affected by the service duration.

  • Choose User Defined for a service that has a fee per unit of time. The service fee is dependent on the service duration.

  1. In the Fixed Fee Units field, enter the number of service units for a fixed fee service.

  2. In the Minutes Per Unit field, enter the number of minutes for one unit of service (user definition service). When the service time reaches the next service unit, the service fee is increased.

  3. In the Per-Diem Service Code field, select Yes to define the code as a per-diem service charge.

  4. Designate whether the service should be shown but not claimed on the 837I file.

  5. In the Unit Rounding Logic field, choose how user-defined service charges are calculated when the service time reaches the next service unit defined in the Designated Degree Of Rounding field.

  • Select No Rounding to increase the service charge by the next unit of time (Designated Degree Of Rounding field).

  • Select Round Any Portion Over Each Unit to increase the service charge when the service time is any amount greater than defined (Designated Degree Of Rounding field).

  • Select Round Over 1/2 Unit to increase the service charge when the service time is over one half the amount defined (Designated Degree Of Rounding field).

  • The following examples use a service with 60 minutes entered in the Minutes Per Unit field:

    • No Rounding Selected

    • Round Any Portion Over Each Unit Selected

    • Round Over 1/2 Unit Selected

  1. In the Designated Degree Of Rounding field calculate how the service fee increases when the service time is greater then a unit (user defined services).

  • Values

  • Examples

  • Service Code Rounding tables

  1. In the Group Code field, select the group code. Group codes are used to categorize service codes.

  2. In the Covered Charge Category field, select the covered charge category. This field works with the Benefit Plan form (Covered Charge Category field), and with various myAvatar forms.

  3. In the Is This Service A Procedure? field, select Yes to report this service an a procedure. This is used to identify procedures such as ECT services, and to record procedures for Meaningful Use data.

  4. In the Is This A Balance Forward Service Code? field, select Yes to carry outstanding balances from another application system to myAvatar PM when the facility goes “live.”

  5. In the Does This Code Have A Professional Component? field, select Yes to define the service as a professional charge, allowing the service to print on the following bills: HCFA-1500 paper and electronic, 837 Professional electronic.

  6. In the Other Service Code Category field, select the service code category. The other service code category works with the Roll-Up Services Definition form.

  7. In the Worklist Frequency field, select how often the service will be included in inpatient or residential worklists. If Other is selected, specify each day to be included in the Days of Inclusion field. All entries must be in the form of a number, from 1 to 31, with each entry separated by a comma. Or use the letter “L” to designate "the Last date of the month."

  8. In the Is This Service A Visit? field, select Yes to define the service as a visit; Select No to define the service as a service unit.

  • The number of available visits will be decreased when this service is rendered (set up in the Managed Care Authorizations form, Maximum Visits field).

  • The number of covered visits will be decreased when this service is rendered (Financial Eligibility forms, Maximum Covered Visits field).

  1. In the HCFA Type Of Service field, select the code to display in the HCFA Type of Service field on the HCFA bill.

ARRA Measures Reporting

  1. In the Include Service in ARRA Measures Numerator, select the services to be included in ARRA measures reporting.

  2. In the Exclude Service in ARRA Measures Numerator, select the services to be excluded from ARRA measures reporting.

  3. In the Include Service in ARRA Measures Denominator, select the services to be included in ARRA measures reporting.

  4. In the Exclude Service in ARRA Measures Denominator, select the services to be excluded from ARRA measures reporting.

  5. In the Include Service in Exclusionary Value for the following ARRA Measures, select the services to be included in exclusionary values for ARRA measures reporting.

Other Service Code Qualifications

  1. In the Procedure Type field, designate a service that is also a procedure as either a vaccine or a supply code.

  2. In the Service Code Category field, select whether this is a Primary, Add-On, or Interactive Complexity code.

    • Primary codes are the main code entered for a service and determine what add-on codes can also be billed.
      Add-on codes do not have to be entered for a primary service code.

    • Add-on codes are additional service codes 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).

    • The interactive complexity code is used when a user indicates that Interactive Complexity was present during a service.

  3. In the Service Code Type field, select the type of code.

    • If Other is selected, the Service Fee/Cross Reference Maintenance form will require a Duration Range to be entered.
      Note: When service codes are entered in the Client Charge Input forms for a Primary service code that is defined as Other and also has an add-on code selected, the system compares the values in the Duration (Minutes) field (Client Charge Input) to the Duration Range (Service Fee/Cross Reference Maintenance). If the Duration (Minutes) exceeds the Duration Range, the primary service will be set to the high end of the Duration Range, and the add-on code will file with the remainder of the time.

  4. In the Select Add-On Service Code field, select the specific add-on service code, if applicable.

  5. In the Select Interactive Complexity Service Code field, select the specific interactive complexity code, if applicable.

  6. In the Is This An Observation Code? field, select whether or not the code is used for observation.

  7. In the Is This A Pharmacy Service? field, select Yes to designate the service as a pharmacy service.

  8. In the NCPDP Unit of Measure field, select the default value to use, if the Unit of Measure is NOT provided by the pharmacy. (Used for NCPDP billing only.)
    This is only enabled for services where the field Is This A Pharmacy Service? is set to Yes.
    Note: This value can be defined by service code to be used in the NCPDP claim submission (field 600-28) when a value is not provided on an individual charge basis. The NCPDP Unit Of Measure value is usually included along with the charge information that is sent from the pharmacy system to myAvatar via an HL7 interface in segment ZP2 field 7 of the charge message.

  9. In the Secondary Activity field, select whether or not secondary activity messages should apply for this service. This is used by the Appointment Scheduling form Staff Check In Notification.

  10. In the Secondary Activity Message field, enter the message text.

  11. In the Is This A Family Service? field, select whether or not this service pertains to a family unit. Selecting Yes designates this service as a billable family service in the Progress Notes (Group and Individual) form and will notify the user if no group member has a billable family service code or if more than one client in the group has a billable family service code. These group validations will only occur for groups that have the Is this a Family? field set to Yes.

  12. In the Is This Service An Intervention? field, select whether or not the service qualifies as an intervention. This information is used for Meaningful Use.

  13. In the SNOMED Procedure field, enter the Hospital procedure SNOMED. This field appears when the IMO search is implemented. This is used for a procedure code SNOMED search for Meaningful Use CQM testing.

  14. In the Is This An ECT Service? field, select whether or not the service should receive an ECT adjustment during the contractual allowance process. This indication will also impact the 837 Institutional and paper UB92/UB04 bill generations by including this service in the procedure codes section of the bill with an ICD-9 indicator of 94.27.

  15. In the Service Type Code (270) field, select the type.
    Note: If a code defined with a HIPAA Transaction Version of Version 5010 is used on a 4010 submission, an error will be given on the error report.

  16. When finished, select Submit.

► Additional Sections

► Registry Settings
► See Also
► SQL Tables
  • SYSTEM.batchload_tx_accepted
  • SYSTEM.billing_tx_followup_tx
  • SYSTEM.billing_tx_master_table 
  • SYSTEM.billing_tx_xref_table