Submitting CPT® II Codes Automatically

NextGen® Adaptive Content Engine Help Enterprise 8.3.1

Manually Submitting CPT® II Codes for Claims-Based Reporting

You can configure codes and their descriptions for an encounter, and select the CPT II code for a patient for a specific encounter. To use the manual submission option, you must set up the codes and exclusion modifiers, and then assign the measure to the provider on the Provider CQM Maintenance template. Note: To exclude a measure from claims-based reporting, you must use the Exceptions/Measures template to report the exception. Additionally, you must configure the Claim Edit Library. When CPT II codes are configured, providers can select and submit the necessary codes using the Procedure Coded Measures panel on the Exceptions/Measures template. The defined quality measures for providers, patients, and encounters are displayed in the grid in the Procedure Coded Measures panel. Configuring Claim Edits for CPT II Claims-Based Reporting You must configure the claim edits from the Claims Edit Library for CPT II codes. Parent topic: Reporting CPT II Procedure Codes See also Configuring Sett

NextGen® Adaptive Content Engine Help Enterprise 8.3.1

Submitting CPT® II Codes Semi-Automatically with Diagnosis

You can to configure additional options to semi-automatically submit the CPT II codes to Superbill. In addition to the configuration in the “Common Configuration for CPT II Claims Based Reporting” section, you must enable the automatic functionality in the Practice Configuration template. When configured for semi-automatic submission of CPT II codes and patient documentation meets the criteria that is mapped for a measure on the Coded Results Mapping template, the CPT II code is automatically assigned and submitted to the CPT Claims Based Measure Reporting panel on the Finalize template. A provider assigns a diagnosis code to the CPT II code on the Finalize template. You need to report measure exceptions on the Exceptions/Measures template for the CPT II code semi-automatic submission functionality to work. Enable Semi-Automatic Submission of CPT II Codes You can send the configured CPT II codes to CPT II Claims Based Measure Reporting on the Finalize template. Parent topic: Submitting

NextGen® Adaptive Content Engine Help Enterprise 8.3.1

Configuring Claim Edits for CPT® II Claims-Based Reporting

You must configure the claim edits from the Claims Edit Library for CPT II codes. For payers who require a diagnosis code on the CPT II code, you must activate one of the following claim edits in the Claim Edits Library in NextGen® Enterprise PM: 91-Charge Primary Diagnosis 117-CPT4(S) required specific Diagnosis Code(s) For more information about Claim Edit Library, go to NextGen Healthcare Success Community, and download the Claims Guide for NextGen® Enterprise PM. Submitting Procedure Coded Measures You can select and submit a procedure code to satisfy a claims-based measure. Parent topic: Manually Submitting CPT II Codes for Claims-Based Reporting

NextGen® Adaptive Content Engine Help Enterprise 8.3.1

Submitting CPT® II Codes Automatically without Diagnosis

You can to configure additional options to automatically submit the CPT® II codes to Superbill. In addition to the CPT II configuration in the “Common Configuration for CPT II Claims Based Reporting” section, you also need to configure the following areas to automatically submit the CPT II codes without the diagnosis option: Claim Edit Library Practice Configuration When configured to automatically submit the CPT II codes, the codes are automatically assigned and submitted to Superbill for a patient documentation that meets the criteria mapped for a measure on the Coded Results Mapping template. The claim edits activated during the configuration select all claims without a diagnosis. The diagnosis can be added later in NextGen® Enterprise PM. You need to report measure exceptions on the Exceptions/Measures template for the CPT II code auto-submission functionality to work. Enable Automatic Submission of CPT II Codes You can automatically submit CPT® II codes to the Superbill and Proced

NextGen® Adaptive Content Engine Help Enterprise 8.3.1

Configuring Settings for CPT® II Claims Based Reporting

You can enable the CPT II reporting feature by configuring a set of prerequisites. You must complete the following common configurations to enable CPT II code claims-based reporting. Download the CPT code set. For more information about downloading the CPT code set, go to NextGen Healthcare Success Community, and download the CPT4 Utility Guide for NextGen® Enterprise. Configure each CPT II code in Service Item Library Maintenance to enable the submission of a $0 charge claim. Review the mapping or add additional measures on the Coded Results Mapping template. Configure and assign measures to providers on the Provider CQM Maintenance template. Configure CPT II codes for claims-based reporting in Service Item Library. After you complete the required configurations, you must complete the configurations specific to the CPT II code submission option (manual or automated) that your practice uses. See the corresponding section in this document for the remaining configuration steps for the CP

NextGen® Adaptive Content Engine Help Enterprise 8.3.1

Viewing Exceptions and Measures

You can manage exceptions and view measure details on the Exceptions/Measures template. You can open the Exceptions/Measures template from the navigation bar or from the CPT II Claims Based Reporting panel on the Finalize template. You can view the following types of exceptions and measures on the Exception/Measures template: Registry-based measures Procedure coded measures Custom data mapping Exception/Measures For information on how to address specific measures, go to NextGen Healthcare Success Community, and download the guides for NextGen® HQM. Viewing Registry-Based Measures You can view the status and explanation of a selected registry-based measure on the top section of the Exceptions/Measures template. Submitting Procedure Coded Measures You can select and submit a procedure code to satisfy a claims-based measure. Reporting Through Custom Data Mapping You can use the Custom Data Mapping panel for reporting. When you update NextGen® Enterprise EHR, data recorded on the Custom Da

Submitting CPT® II Codes Automatically

Recommendations

Manually Submitting CPT® II Codes for Claims-Based Reporting

Submitting CPT® II Codes Semi-Automatically with Diagnosis

Configuring Claim Edits for CPT® II Claims-Based Reporting

Submitting CPT® II Codes Automatically without Diagnosis

Configuring Settings for CPT® II Claims Based Reporting

Viewing Exceptions and Measures

Submitting CPT® II Codes Automatically

Manually Submitting CPT® II Codes for Claims-Based Reporting

Submitting CPT® II Codes Semi-Automatically with Diagnosis

Configuring Claim Edits for CPT® II Claims-Based Reporting

Submitting CPT® II Codes Automatically without Diagnosis

Configuring Settings for CPT® II Claims Based Reporting

Viewing Exceptions and Measures