Procedure Code

Procedure code settings, behaviors, defaults, and more can be edited to meet the needs of the practice.

In Procedure Codes, double-click an existing code.

Procedure Code Settings

Time Pattern: Use the vertical slider on the left to set the procedure time allotment. By default, each square represents 10 minutes. To change the default, see Time Increments in Appointment View Setup. Slash (/) indicates assistant time, X indicates provider time. Click X or / to toggle to the other. Procedure time is used to determine default appointment length. See Time Bars for more details.

Proc Code: The code itself. It can be up to 15 digits long. All codes starting with D are shortened to 5 characters before being included on an insurance claim. For example, the office can have two different codes for nitrous, with the difference being a letter that is added to the end of a standard D code. When sent to insurance, only the standard 5 digit code is used.

Note: Once created, a code can't be changed or deleted. Instead move it to an obsolete category.


Alt Code: Associate an alternate code. Useful for some Medicaid plans like Denti-Cal. See Medicaid or Flat Co-Pay Insurance Plan.

Medical Code: Associate a medical code. The medical code must already exist. See Cross Code. Cross coding only affects medical claims. It does not affect what shows on an EHR CCD (summary of care).

Ins. Subst Code: Associate an insurance substitution code and optionally set an Only if condition. The substitute code is used to calculate downgraded estimates for procedures (when insurance reduces the allowed amount of a procedure). See Estimate Downgrades.

Description: Only non-ADA code descriptions can be edited. Automatically update ADA code descriptions using Procedure Code Tools.

Abbreviation: Can be edited. This is what appears on an appointment in the Appointments Module when Procs or ProcsColored are added to an Appointment View. Limited to 50 characters

Layman's Term: Enter simpler language to describe the procedure. It shows as the procedure description in Treatment Plans, the Chart Module, and the Account Module.

Base Units: Typically for Medical Insurance claims. When calculating a procedure fee, the standard fee is increased based on the base unit, thereby increasing the billed fee. The base unit calculates the fee and time pattern using an additive process. Base Unit = 0 (standard fee) Base Unit = 1 (standard fee + standard fee) Base Unit = 2 (standard fee + standard fee + standard fee).

For example, the procedure code for Nitrous Oxide may have a time pattern of 15 minutes (base unit of 0) and a fee of $100. During the procedure, the office may typically use Nitrous Oxide for a longer period of time. Instead of adding the procedure to the chart multiple times, increase the base unit.

There is a checkbox on the Insurance Plan for Claims show base units which shows the base unit on the medical claim form.

Drug NDC: National Drug Code number.

Default Revenue Code: A 3-digit code sometimes used for institutional claims. It tells insurance where the patient was when they received insurance or the type of item they received. It shows as the default Revenue Code on the Procedure - Medical Tab.

Color Override: Override the default color for this procedure on the Graphical Tooth Chart. Usually colors are based on procedure status, such as Treatment Planned or Completed, not on individual procedure code. However in rare situations the office may want a procedure code to always show in one color. For example, implants look better as always gray, instead of red, blue, or green. Click None to remove the override.

Procedure Code Settings (Continued)

Do not usually bill to Ins: Determines the default setting of the Do Not Bill to Ins checkbox on the Procedure - Financial Tab when charting a new procedure. Useful to identify procedures that are not usually sent to insurance (e.g., non-standard D codes, crown seats).

InsPlans Overrides: Override the default Do not usually bill to Ins setting for the procedure code on an insurance plan level. See Insurance Plans Overrides

Is Hygiene procedure: See Edit Appointment for an explanation of Hygiene provider.

Note: To immediately reassign the procedure to the hygienist for appointments already scheduled, see Update Provs on Future Appts in Operatories.

Is Prosthesis: Determines whether or not additional Prosthesis Replacement fields show on the Procedure Info window.

Is Radiology: Typically used for EHR to designate a procedure as an x-ray.

Auto Tax: Determines whether or not Sales Tax is applied to this procedure.

Assign to Prov: Assign a specific provider to this procedure. For example, create a procedure for selling mouthwash from the dental office, then assign the procedure to a dummy provider. This avoids inflated production numbers on real providers. The provider selected here is assigned to this procedure when it is created and when it is set complete.

Bypass Global Lock Date: Determines whether or not this procedure is affected by the Global Lock Date (if turned on).

ICD-10s (up to 4): Add up to four ICD-10 codes to automatically add to the Procedure - Medical Tab when charted.

Paint Types

Paint Type: Determines how the procedure is drawn on the Graphical Tooth Chart.

Treatment Area

Treatment Area: Determines the treatment area options available when charting the procedure (Procedure) and sending on claims.

Category

Category: The category under which this procedure code is grouped. Customize category options in Definitions: Proc Code Categories.

Default Fees

At the upper right are fees for this procedure code for each Fee Schedule.

Double-click on a row to change a fee amount in the fee schedule.

Additional Buttons

More: Click to view all fees, including provider and/or clinic-specific fees.

Audit Trail: All changes made to procedure fees are tracked in the audit trail. Click to view all Fee Changes.

Notes

Completed Note: Default procedure note that automatically copies to the Procedure Info window, Notes field when the procedure is set complete.

TP'd Note: The default Procedure Note that automatically copies to the Procedure Info window, Notes field when a procedure is Treatment Planned. Does not work with procedures charted using the Make Recall button.

Note: Use two quotes "" to remind staff to enter specific information in a note (e.g., Due Date ""). If the information is not completed, a red Incomplete Note warning appears above the note. To view a list of completed procedures with incomplete notes, see Incomplete Procedure Notes Report. Other examples: composite shade, crown shade, denture shade, due date, blood pressure, nitrous levels, etc.

Auto Note: Insert an Auto Note template in a Completed or TP'd Note. If the Procedures Prompt for Auto Note preference is enabled, opening the Procedure Info window triggers any auto note prompts.

Default Claim Note: A default note that automatically copies to the Claim Note field when a claim or preauthorization is created that includes this procedure. See Edit Claim - General Tab.

Notes and Times for Specific Providers: When specific providers have different completed or TP'd notes and/or time allotments, create a provider specific note.

  1. Click Add Note.
  2. Highlight the provider.
  3. On the left, select the procedure's time pattern for this provider, if different.
  4. Change the provider's default procedure note, if different.
  5. Click OK to save.

Provider-specific notes can be deleted without affecting existing patient chart notes.

Note: Right-Click any note text box for additional options.