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Procedure Code Replacement

The Procedure Code Replacement tool allows you to create overrides by Payer or Insurance Class for CPT codes that you do not wish to be billed or you want to be replaced with a different procedure code. 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. 

Important: When a charge flows in from the EMR, the original procedure code will appear. However, the Procedure Code Replacement tool modifies the procedure code when the process runs in the evening and will update to the new code before the claim is sent to the clearinghouse.

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 required information on the Procedure Code Replacement card. 
    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. Status: Select Active or Inactive from the drop-down. 
    6. Payer/Insurance Class/Excluded Insurance Class: This is a dynamic search bar, enter a description or scroll through the options listed 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 rule you wish to edit.
  2. Make any adjustments needed to the rule. To deactivate the rule, select Inactive from the Status drop-down. Be sure to click Save to apply your edits.
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