Alternate CPT4 Code

File Maintenance Help for NextGen® Enterprise 8

CPT4 Roll Up

A CPT4 roll up combines the total charges for SIMs using the same CPT4 code into a single charge. If you enter an alternate CPT4 code for a SIM designated to perform CPT4 roll up, the application combines the charges with the alternate CPT4 code. To combine the total charges from SIMs using different CPT4 codes, each SIM included in the roll up must be mapped to the same alternate CPT4 code. You can perform line item roll-ups in the following instances: The separate line item charges are totaled. The quantity of line item charges are "rolled up" to become a single charge. CPT4 roll up is used primarily by CHC (Community Health Clinic) clients. The CPT roll up takes multiple line items that are flagged and have the same CPT code or alternate CPT code and rolls them up into a single line item and changes the quantity to one – the total sum of the charges appears on the line item. Activate a CPT4 Roll Up Parent topic: Payer Tab - SIM Library

File Maintenance Help for NextGen® Enterprise 8

Set Up an Alternate CPT4 Code

Open a Service Item library. From the Search list on the left, select a service item and then select the Payer tab. Select the applicable main payer from the drop-down list. Enter the Alternate Payer Alternate CPT4 code in the Alt Payer CPT4 column. Note: If there is an alternate payer attached to a main payer in the Payer Master and there are Alternate Payer Alternate CPT4 codes that need to be used on the alternate payer claim, then enter the Alternate Payer Alternate CPT4 code in the Alt Payer CPT4 field for the selected service item and payer that the alternate payer is attached to. Only when the location and service items on the encounter match the location and services set up on the Alternate Payer tab of the Add/Modify Payer Information window for the main payer will Alternate Payer Alternate CPT4 codes populate to the alternate payer claim. Parent topic: Alternate CPT4 Code

File Maintenance Help for NextGen® Enterprise 8

Adding a New UB92 Service Item

Field Description Payer Select a payer that requires an alternate CPT4 code for the service item. This payer name prints in box 50 of the UB form. If you need to set multiple payers, fill out the information for the first payer, then select a new payer. The fields clear, but the first payer's information is saved. Note: After a payer has been saved on the Payer tab, you cannot remove that payer if, for example, the payer is no longer valid. Instead, you must expire the payer by changing the expiration date in the Exp field. Eff Enter the date that the alternate code becomes effective. Exp Enter the date that the alternate code for the payer ends. Form Select either the HCFA 1500 or UB form. For more information on adding UB information, refer to the next section. Alt CPT4 Enter the alternate CPT4 code to be used. This must be a valid CPT4 code. If an alternate code is assigned, the Service Item displays on the charge window, but the ALT code prints on the claim. Alt Payer CPT4 Enter th

NextGen® Enterprise EHR Help

Verify the CPT4 Code in the Service Item Library

Prior to selecting and ordering Immunizations, verify the CPT4® in the SIM Library. Select File Maintenance > Libraries > Service Items. The Service Items List window opens. Double-click the default Service Item Library for your practice. Note: The default Service Item Library is indicated by a green color check mark under the Practice Default column. Enter the CPT4® code in the Search field. If the code exists, it appears in CPT4 Code. To verify if your alternate Medicare Billing code exists, enter the Q code in the Search field. Note: If the CPT4® code or Q code does not exist, you must set up the Service Item Library. For more information about setting up the Service Item Library, go to the NextGen Healthcare Success Community and download the latest System Administrator Guide for NextGen Enterprise. Parent topic: Using Advanced Service Item Library Mode

Help Guide for NextGen® Enterprise PM 8

Set Up CPT4 Codes for Roll-Up Billing

Verify that the appropriate CPT4 codes exist that are needed on UB claims in Field Locator 44 for the roll-up payer. The CPT4 codes are linked to SIM codes as the Alternate CPT4 in the SIM library. To set up a CPT4 code for roll-up billing, do the following: Access File Maintenance. Select System Master Files, then PM, and then CPT4 Codes. The CPT4 Code Search window opens. Do one of the following: To add a CPT4 code, select Open Menu and select New. To modify a CPT4 code, search for the code, then select the code from the list, and then select Open Menu and select Open. The Add/Modify CPT4 Code Information window opens. In the Code field, enter the CPT4 code. This field is required. In the Description field, enter a descriptive name for the code. This field is required. In the Type of Service field, select Medical Care. To save changes and close the window, select OK. Add CPT4 Code Information Parent topic: Setting Up Roll-Up Billing by CPT4 Code

File Maintenance Help for NextGen® Enterprise 8

Set Up an Alternate Type of Service Codes Library

From the File Maintenance window, select Libraries > Type of Service. Select open menu button , and then select New. Enter the name of the new library in the Service Name field. Select open menu button , and then select New. The Add Type of Service Alternate window opens. In the Type of Service list, select the applicable standard Type of Service. The Code field is automatically populated with the standard code and the field is disabled and cannot be changed. Enter the applicable Alternate Type of Service code for: paper claims in the Alt Paper field. electronic claims in the Alt Electronic field. Note: When entering alternate type of service codes for paper or electronic claim types, you must fill in both of these fields. For example, if a payer requires an alternate type of service code for paper claims, but they want the standard type of service code for electronic claims, then you must enter the alternate code in the ALT Paper field and the standard code in the ALT Electronic field

Alternate CPT4 Code

Recommendations

CPT4 Roll Up

Set Up an Alternate CPT4 Code

Adding a New UB92 Service Item

Verify the CPT4 Code in the Service Item Library

Set Up CPT4 Codes for Roll-Up Billing

Set Up an Alternate Type of Service Codes Library

CPT4 Roll Up

Set Up an Alternate CPT4 Code

Adding a New UB92 Service Item

Verify the CPT4 Code in the Service Item Library

Set Up CPT4 Codes for Roll-Up Billing

Set Up an Alternate Type of Service Codes Library