Code Table Descriptions
You cannot create codes in the code table listing, you can only modify the descriptions of existing codes or hide codes. If a code that your practice uses is missing, contact NextGen Healthcare Support.
The following table describes the available code tables.
| Code Table | Description |
|---|---|
| Allergy Criticality | Enables providers to select allergy criticality values in the Medication Allergies module. The values are High, Low, and Unable to Assess. The code table complies with Consolidated Clinical Document Architecture (CCDA R2.1). |
| Allergy Severity
The available codes are:
| Indicates severity of an allergy reaction. The code table is part of CCHIT certification and is the required subset to qualify the severity of an allergy in a Continuity of Care Document (CCD) document. The codes are codified to SNOMED severities. You cannot change the descriptions or create new allergy severity codes. After a severity is selected in the Allergy module of NextGen® Enterprise EHR, it can be used by interfaces (NextGen® Enterprise Rosetta Interface Messenger) and CCD generation. To comply with Consolidated Clinical Document Architecture (CCDA R2.1), the Allergy Severity code table has been updated to hide Fatal Mild to Moderate, and Moderate to Severe, values. |
| Bill Classification | Indicates the type of care being billed. It is the second digit in the Type of Bill data element that prints in FL 4 of the UB form. |
| City Type | Describes the type of station for a city. The descriptions for these codes are selections used in the City Type field in the Zip Codes master file. |
| Claim Types | Specifies the type of payer that the system uses for paper and electronic claims submission. Assign the claim type on the Process as Claim Type field on the System tab of the Payer Information window. When a claim type is assigned, an "X" prints in Item 1 of the HCFA 1500 to indicate the appropriate type. |
| Confidentiality The codes are:
| Indicates the confidentiality of the Continuity of Care Document (CCD) and how the information is shared. It is part of CCHIT certification and is required for document exchange within a Regional Health Information Organization (RHIO). NextGen® Enterprise Rosetta Interface Messenger uses the code for CCD generation. |
| Contact Method | Indicates the patient's preferred mode of contact to receive notifications. For example, alternate phone, cell phone, email, home phone, and other contact methods. |
| Current Gender The codes are:
| Indicates patient's current gender. This is selected for each patient on the Patient Information window. A patient's current gender may be the same or different from their birth sex. |
| Delay Reason Code | Indicates the reason the claim is delayed in reaching the carrier. Assign these codes on the Billing & Collections tab of the Encounter Maintenance window. |
| EDI Contact Method The codes are:
| Indicates how a patient wants to be contacted by EDI Services. These options display on the tab and the tab.
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| EDI Notification Preferences The codes are:
| Indicates how a patient wants to be contacted by EDI Services for balance reminders, appointment reminders, and recall plans. These options display on the tab and the tab.
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| Employment Statuses | Indicates whether the patient is employed. Assign the status on the Employment Maintenance window, which you can access from the Employer tab of the Patient Information window. The status prints in Item 8 of the HCFA 1500. |
| Ethnicity Category The codes are:
| Defines codes available for a patient's ethnicity. The code table is displayed in the Ethnicity Category Mapping master file. It is a part of the Meaningful Use Stage 3 requirements for identifying race population and ethnicity groups for patients. |
| Gender Identity The codes are:
| Defines regulatory responses to the question of gender identity. It is a part of the Meaningful Use Stage 3 requirements for identifying gender for patients. |
| Insurance Types | Identifies the type of insurer, such as Medicare, Medicaid, and other insurance types, for electronic claims. Assign insurance types on the Payer Information window.
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| Location Designation | Indicates the kind of services performed at a location. Location designations are used in the Locations master file. An interface that attempts to send a syndromic surveillance message uses the location from the visit and sends the code value of the location designation in the HL7 message. The default selections are Emergency Care, Medical Specialty, Primary Care, and Urgent Care. |
| Marital Statuses | Indicates a patient's marital situation. Assign marital status on the Demographics tab of the People/Patient Information window. The marital status prints in Item 8 of the HCFA 1500 and prints in FL 16 on the UB92 form. A marital status is not part of the 837 transaction and it is not used as a FL on the UB04. |
| Medicare Secondary Payers | Indicates that a payer is secondary to a primary Medicare payer. This code table uses record DA006 for electronic claim processing and must be edited for paper claims. You must select this code on the Insurance Maintenance window when you are adding Medicare as the secondary payer. If you select the Crossover check box on the Payer Information window, it prevents a secondary claim from being created whenever this payer is secondary to a primary Medicare payer. |
| Notification Preferences | Indicates the patient's preferred mode of contact to receive notifications from the practice. The practice can customize the notification preference at the practice level. |
| Occurrences | Describes the information that goes into the Date of Current field that prints in Item 14 of the HCFA 1500. Assign this information on the Encounter Maintenance window. Depending on the code selected, a state or onset date and time may be required. |
| Occurrence Codes | Provides information on institutional claims about occurrences that may impact how a claim is processed by the payer. Occurrence Codes are selected and dates are entered in the Encounter Maintenance window on theUBtab in the Occurrence Codes feild in NextGen® Enterprise PM. The codes and dates are then included in electronic 837I and paper UB04 claims. Occurrence Codes fill the 2300 HI01-12 BH Qualifier segment on electronic 837I claims, and FL 31 - 34 on paper UB04 claims. |
| Patient Discharge Status | Indicates the reason for a patient's discharge on institutional claims. A status can be selected in the Encounter Maintenance window on the General tab in the Discharge Status field in NextGen® Enterprise PM. The status is then included on electronic 837I and paper UB04 claims. Patient Discharge Status fills the 2300 CL103 segment on electronic 837I claims, and FL17 on paper UB04 claims. |
| Patient Status Designation The codes are:
| Indicates the patient status with the provider regarding immunization. The status is required for transmission to immunization registries and indicates whether the sending provider organization considers the patient as active. You can set the status on the Add/Modify Patient Information window on the Status tab. The status may be different between the sending and receiving systems. For example, a person may no longer be active with a provider organization, but may still be active in the public health jurisdiction, which has the Immunization Information System (IIS). The provider organization would indicate that the person is inactive in their system when a message is sent from them. The IIS would indicate that person as active in a message from the IIS. |
| Places of Service | Enables you to assign a place of service to service items in the SIM library and to locations in the Locations master file. By setting the Facility option for a place of service, you determine whether billing for a service is facility or non-facility. The place of service prints in Item 24b of the HCFA 1500. |
| Present on Admission Indicators The codes are:
| Designates whether a patient's diagnosis was present at the time of inpatient admission used on institutional claims. An indicator can be selected for a diagnosis code on the encounter Diagnosis Selection window in NextGen® Enterprise PM. The indicator is then included with the diagnosis code on electronic 837I and paper UB04 claims. Present on Admission Indicator follows the diagnosis code in the 2300 HI01-9 segment on electronic 837I claims, and FL 67 on paper UB04 claims. |
| PRO Procedures | PRO Procedure codes are assigned in NextGen® Enterprise PM on the Patient Insurance– Encounter window, which is accessed from the Encounters/Insurance tab on the Patient Chart. The code selected in NextGen® Enterprise PM prints in Item 24d of the HCFA 1500. PRO codes include CPT4, HCPCS, and modifiers. It is required for Medicare electronic claims processing in some states, including Florida. |
| Quadrants | Corresponds to the quadrant or area of the mouth for specific dental procedures on the Charge Posting window. The quadrant prints in box 25 on both the ADA 2012 form and the ADA 2006 form. |
| Qualified CDSMs | Enables providers to access and select the Appropriate Use Criteria (AUC) in the Order Module when placing order for advanced diagnostic imaging service for a Medicare beneficiary. The code table consists of a list of Clinical Decision Support Mechanisms (CDSMs) that NextGen Healthcare currently supports. National Decision Support Company CareSelect™ is the default CDSM for providers. Providers can access the AUC and record the score to meet the Centers for Medicare & Medicaid Services (CMS) criteria. |
| Race Category The codes are:
| Defines codes available for a patient's race. The code table is displayed in the Race Category Mapping master file. It is a part of the Meaningful Use Stage 3 requirements for identifying race population and ethnicity groups for patients. |
| Relationships | Indicates the patient's relationship to the insured individuals. Assign relationships on the Relationship Information, Contact Information, Insured Information, and Guarantor Information windows from the Patient Chart. Patient Relationship to Insured prints in Item 6 of the HCFA 1500 and in FL 59 on the UB92 and UB04 forms. When you modify a relationship code in the code table, the Claim Value field displays a read-only value. The billing process for all claim types uses the value assigned to each relationship code to fill the relationship code in 837I, 837P, and 837D claim types. |
| Rx Type The codes are:
| Indicates the medication type. It is a part of CCHIT certification and is the required subset to qualify the prescription type in a CCD document. After the code is entered in the Medication module of NextGen® Enterprise EHR, it can be used by interfaces (NextGen® Enterprise Rosetta Interface Messenger) and CCD generation. |
| Sexes | Assigns gender on the Patient Information, Relationship Information, Contact Information, Insured Information, and Guarantor Information windows from the Patient Chart. Gender prints in Item 3 (Patient), Item 11a (Insured), and Item 9b (Other Insured) of the HCFA 1500 and in FL 15 on the UB92 form and in FL 11 on the UB04 form. |
| Sexual Orientation The codes are:
| Defines the list of regulatory responses to the question of sexual orientation. It is a part of the Meaningful Use Stage 3 requirements for identifying sexual orientation for patients. |
| Signature Source | Identifies signature requirements for the release of information. Signature source displays in Item 31 of the HCFA 1500 and is based on a setting under 1500 in the Claim Printing Library. Assign signature source on the Payer Information window. |
| Source of Admission | Indicates the physician recommendations for admission. It prints in FL 20 on the UB92 form and in FL 15 on the UB04. |
| State | Indicates the state the patient resides in. |
| Student Status | Indicates whether the patient is a student and student status, such as full-time or part-time. An "X" prints in Item 8 of the HCFA 1500 to indicate the appropriate status. |
| Support Role Type | Indicates which support role a person has in relation to the patient. Support roles are individuals who can be associated with a patient just as patient family relationships can be associated with a patient. Examples of support roles are caregivers and emergency contacts. You can associate a person with a support role with a patient on the Relations/Role tab of the Patient Information window. |
| Surface | Corresponds to the surface on the tooth for specific dental procedures on the Charge Posting window. You can select one or more codes if the Allow multiple tooth surfaces check box is selected in Practice Preferences. The surface prints in box 28 on both the ADA 2012 form and the ADA 2006 form. |
| Test Results Qualifier | Displays in the Test Result list on the Charge Entry window when the Create Test Results MEA Segment check box is selected on the Other tab of the Service Items Library window. These codes are pre-populated and codes cannot be added or deleted from this list. |
| Time Zone | Corresponds to Time Zone designations within the U.S. The descriptions for these codes are selections used in the Time Zone field in the Zip Code master file. |
| Tooth | Corresponds to teeth for specific dental procedures on the Charge Posting window. When you select a Tooth, the Surface or Quadrant should also be selected when applicable. The tooth prints in box 27 on both the ADA 2012 form and the ADA 2006 form. |
| Type of Admission | Indicates the priority of a patient's admission. It prints in FL 19 of the UB92 form and in FL 14 on the UB04 form. |
| Type of Facility | Indicates the type of facility where the treatment took place and it is the first digit in the Type of Bill data element. It prints in FL 4 of the UB92 and UB04 forms. |
| Type of Service | Identifies the standard type of service rendered based on specific payer requirements for the type of claim form (paper or electronic). The code can be blank or alphanumeric. The Type of Service code or Alternate Type of Service code prints in Item 24c on the HCFA 1500.
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| UB Condition Codes | Provides information on the institutional claims about conditions that may impact how a claim is processed by the payer. Condition Codes are selected on tab in NextGen® Enterprise PM. The codes are then included on electronic 837I and paper UB04 claims. Condition Codes fill the 2300 HI01-12 BG Qualifier segment on electronic 837I claims, and FL 18 - 28 on paper UB04 claims. |
| Value Codes | Provides information on institutional claims about monetary amounts. Depending on the billing circumstance, the payer may require a specific value code and dollar amount on a claim in order to properly adjudicate and pay the claim. For example, the amount of a no-fault insurance payment made on behalf of a Medicare beneficiary and the amount to be applied to the patient's deductible by the provider. Value Codes are selected and dollar amounts entered on the tab in NextGen® Enterprise PM. The codes and amounts are then included on electronic 837I and paper UB04 claims. Value Codes and amounts fill the 2300 HI01-7 BE Qualifier segment on electronic 837I claims, and FL 39a - 41d on paper UB04 claims. |
| Veteran Status | Indicates whether the person or patient has been discharged from the military. The corresponding field displays in NextGen® Enterprise PM on the Patient/Person Information window in the UDS tab. This field is used for UDS reporting.
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