CPT4 Codes

NextGen® Enterprise EHR Help

Assign CPT4 Codes

CPT®4 codes are assigned using File Maintenance. Once assigned, they are then linked to the test and are used when a NextGen® Medical Necessity Check is requested. From File Maintenance > Master Files > EHR, select CPT4 Codes. Select Description. Enter a text description of the test and the search starts automatically. Select a test, and select OK. If the test does not have an assigned CPT®4 Code, enter the CPT®4 code for the selected test, and a Description. Enter the Type of Service and the Reimbursement code. Select OK to save the new value. Select OK to exit the Add CPT4 Code Information window. Link a CPT4 Code to a Specific Test You can use File Maintenance to map a CPT4 code to an order test. Parent topic: Medical Necessity Setup

NextGen® Enterprise EHR Help

Link a CPT4 Code to a Specific Test

Select File Maintenance > Master Files > Order Tests. The Order Tests List window opens. Double-click to select a specific test. The Modify Order Test Information window opens. Select the folder next to CPT4 Codes. The CPT4 Code Search window opens. Select the Description heading, and enter a description of the test in the Available field. Select the corresponding test and select the right arrow to link the CPT4 code to the test. To save this CPT4 code with this test, select OK . The CPT4 Code Search window closes. The added CPT4 codes appear in the Modify Order Test Information window. Select OK to exit the Modify Order Test Information window. Parent topic: Assign CPT4 Codes

Help Guide for NextGen® Enterprise PM 8

Add or Modify CPT4 Codes for Encounter Rate Billing

Encounter rate billing involves the insertion of an Encounter Rate (ER) code onto the patient's encounter. The ER code can then be included on the claim to the payer. The ER code must first be created as a CPT4 code. Example ER Codes may include the following: Medicare FQHC: G0466, G0467, G0468, G0469, G0470 Medicare RHC: 0521 Clinic Service Medicaid: 0529 Clinic Service Medicaid Texas: T1015 Clinic Service Medi-Cal: 01 Primary, 02 Secondary, 03 Dental, 04 Optometry To add or modify a CPT4 code for encounter rate 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. Add CPT4 Code Information In the Code field, enter the CPT4 code. This field is requ

Help Guide for NextGen® Enterprise PM 8

Multiple Surgery Discounting

If the payer is linked to a contract and the CPT® code is enabled for multiple procedure discounting, then the allowed amount is reduced. The discount is calculated in conjunction with the sequence of CPT®4 codes and the corresponding modifier percentage on the fee schedule. Important: Ensure that you have enabled Multiple Surgery for multiple procedure discount Ensure that the modifier reimbursement percentage for the sequence has been set When you want to apply multiple surgery discounts on the allowed amount, the following can be used as reference: In the File Maintenance contract library, you set the following: Facility and non-facility amounts for the CPT®4 codes in the Fee Schedule tab Sequence indicator and modifier percentage in the Modifier Reimbursement tab In NextGen® Enterprise PM's Estimate Patient Cost window, submit the CPT®4 code for cost estimation. The system fetches the fee that is scheduled for the CPT®4 code. Based on the sequence that the CPT®4 code has been enter

File Maintenance Help for NextGen® Enterprise 8

Sequence NextGen® Enterprise EHR and HL7 Charges Coming to NextGen Enterprise PM

Open Practice Preferences, and then select Charge Entry in the Preferences list. Under Charge Holding Tank Processing Order, do one of the following: To modify an existing row, select the row and then select the Menu . Select Open. Note: You can add more than one range to a row. Multiple ranges on one row allow the charges from those ranges to be processed at the same time. To add a new row, select the Menu and then select New. The CPT4 Code Ranges window opens. If you are modifying a row, the existing ranges are listed. Do one of the following: To modify an existing range, select the range and then select the Menu and select Open. To add a new range, select the Menu and select New. The CPT4 Code Range window opens with the CPT4 codes in the range. The CPT4 Code Range window opens with no CPT4 codes. Select the next to the CPT4 field. The CPT4 Code Search window opens. Find the code you want. In the Search Method section, select one of the following search methods: Code or Description.

Help Guide for NextGen® Enterprise PM 8

Setting Up Roll-Up Billing by CPT4 Code

Roll-Up Billing by CPT4 Code in NextGen® Enterprise PM involves the following setup in File Maintenance: Practice Preferences CPT4 Codes General and Payer tabs in Service Items library Payers Set Up Practice Preferences for Roll-Up Billing by CPT4 Code Set Up CPT4 Codes for Roll-Up Billing Set Up SIM Codes for Roll-Up Billing by CPT4 Code Set Up Payers for Roll-Up Billing by CPT4 Code Parent topic: Roll-Up Billing by CPT4 Code

CPT4 Codes

Recommendations

Assign CPT4 Codes

Link a CPT4 Code to a Specific Test

Add or Modify CPT4 Codes for Encounter Rate Billing

Multiple Surgery Discounting

Sequence NextGen® Enterprise EHR and HL7 Charges Coming to NextGen Enterprise PM

Setting Up Roll-Up Billing by CPT4 Code

Assign CPT4 Codes

Link a CPT4 Code to a Specific Test

Add or Modify CPT4 Codes for Encounter Rate Billing

Multiple Surgery Discounting

Sequence NextGen® Enterprise EHR and HL7 Charges Coming to NextGen Enterprise PM

Setting Up Roll-Up Billing by CPT4 Code