Procedure Code Replacement

Important: This tool is in development and does not currently support all procedure code replacements by Electronic Payer ID. WebPT Billing runs procedure code replacement rules by Payer ID in a background process each night. At this time, these rules are not able to be manipulated. See a list of procedure code replacements by Electronic Payer ID here.

If you have a CPT code that you do not want billed or that you want replaced with a different procedure code, the Procedure Code Replacement tool allows you to create those overrides by Payer or Insurance Class. For example, Medicare will not accept CPT code 97014, but they will accept code G0283. Using the Procedure Code Replacement tool, you can create an override rule that tells the system to replace code 97014 with code G0283 for any claims billed to Medicare. 

CREATE A NEW PROCEDURE CODE REPLACEMENT

  1. Navigate to the Charges menu and select Procedure Code Replacements
  2. Any established Procedure Code Replacement rules will display. Use the checkboxes at the top of the page to filter results by Inactive, Expired, or Future rules. When WebPT builds your account, common rules will be pre-loaded. These rules are denoted by SYSTEM in the Last Update User column. However, you can edit or deactivate any rules to suit your business needs.Troubleshooting Tip: Use the filter tool in the Original Procedure Code column to troubleshoot if any rules are in place that impact why a code is not billing appropriately.
  3. To create a new rule, click the New button in the top right corner.
  4. Complete the information on the Procedure Code Replacement card. In this example, we create a rule for CPT code 97010. Many clinics like to charge for hot/cold packs using code 97010, but most don’t bother billing these claims because it’s rarely reimbursed. In this case, we can set the code 97010 to be replaced with NONE.
    1. Setting Name: Enter the name of the rule and/or the insurance to identify the rule. 
    2. Original Procedure Code: Enter the original procedure code you wish to replace. Note: The procedure code must be active in order to search for and replace it. 
    3. Replacement Code: Enter the new code that you want to replace the original procedure code.  Note: A procedure code of NONE would enter an NC modifier to the charge line in WebPT Billing.
    4. Effective Date Range: Enter the effective dates for the rule. You can backdate the Start Date for the rule, but it will only apply to charges posted from the current date forward. Leaving the End Date blank will apply the rule indefinitely.
    5. Qualifying Criteria: Use the drop-down to select how the rule applies. Note: Choosing Excluded Insurance Class would mean that this rule applies to all insurance classes except the ones you select. 
    6. Status: Select Active or Inactive from the drop-down. 
    7. Payer/Insurance Class/Excluded Insurance Class: This is a dynamic search bar based on the Qualifying Criteria you choose above. Use the Search bar to enter a description or scroll through the options listed below to make your selection(s).
  5. Click Save to create the rule. 

EDIT A PROCEDURE CODE REPLACEMENT

  1. From the Procedure Code Replacements page, click the line of the rule you wish to edit.
  2. Make any adjustments to the rule. Select Inactive from the Status drop-down to deactivate the rule, if applicable. Be sure to click Save to apply your edits.
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