Manually Submitting CPT II Codes for Claims-Based Reporting

NextGen® Adaptive Content Engine Help Enterprise 8

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 latest CPT code set. For more information about downloading the latest CPT code set, go to NextGen Healthcare Success Community, and download the latest CPT4 Utility Guide forNextGen®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 configurati

NextGen® Adaptive Content Engine Help Enterprise 8

Submitting CPT II Codes Automatically

You can select the automating submission method after completing the configuration steps. The CPT II code automatic submission functionality facilitates claim-based quality measure reporting by automatically assigning and submitting CPT II codes. Selected HEDIS measures are mapped to the CPT II code system on the Coded Results Mapping template. Practices can configure additional measures. When the CPT II code automation functionality is enabled, documentation that meets the criteria setup on the Coded Results Mapping template automatically assigns a CPT II code when the template that contains the configured field is saved. You can either send the CPT II code directly to the Superbill without assigning a diagnosis, or you can send it to the Finalize template where a provider assigns the diagnosis before submitting to the Superbill. Note: You must report any measure excluded from claims-based reporting on the Exception/Measures template. The auto-submission methods are: Automatic: activa

NextGen® Adaptive Content Engine Help Enterprise 8

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 latest 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

Submitting Procedure Coded Measures

You can select and submit a procedure code to satisfy a claims-based measure. The Procedure Coded Measures panel on the Exceptions/Measures template displays a grid with configurable Quality measures (identified by QID) and HEDIS measures from the Provider CQM Maintenance template and Claims Based Reporting Setup panel. Measures that are excluded from claims-based reporting must be reported on the Exception/Measures template. You can submit exceptions for claims-based measures in the Procedure Coded Measures panel. The measures that display modifiers in the Modifier column are exceptions. Procedure Coded Measures Submit CPT II Procedure Codes and Measure Exceptions You can manually submit CPT II procedure codes and the measure exceptions in the Procedure Coded Measures panel on the Exceptions/Measures template. Submit Claims Based Correction Report You can generate the claims-based billing correction report to submit the new CPT II codes for manual billing. Parent topic: Viewing Except

NextGen® Adaptive Content Engine Help Enterprise 8

Reporting CPT II Procedure Codes

Quality Program measures for the Merit-Based Incentive Payment System (MIPS) are reported using CPT II codes for both registry- and claims-based reporting. The system is delivered with a defined set of measures and code mappings, including HEDIS measures, so that you can immediately submit the specific CPT codes. In addition, you can add measures and code mappings, as needed to meet new reporting requirements. Beginning with 5.9.2020.1, NextGen® Adaptive Content Engine contains the following mapped CPT II codes for auto-submission: 0500F, 0501F, 0502F, 0503F, 1111F, 1123F, 1124F, 1125F, 1126F, 1157F, 1158F, 1159F, 1170F, 3044F, 3046F, 3048F, 3049F, 3050F, 3051F, 3052F, 3060F, 3061F, 3062F, 3074F, 3075F, 3077F, 3078F, 3079F, and 3080F. CAUTION: The information recorded in this document is accurate as of this release. You must confirm the valid codes each release per year as they may be updated. Coded results mapping provides the following configurable options to facilitate claim-based r

NextGen® Adaptive Content Engine Help Enterprise 8

Submit CPT II Procedure Codes and Measure Exceptions

You can manually submit CPT II procedure codes and the measure exceptions in the Procedure Coded Measures panel on the Exceptions/Measures template. To open the Exceptions/Measures template, do one of the following: From the navigation bar, select Exceptions/Measures. From the Finalize template, expand the CPT II Claims Based Reporting panel, and select the Exceptions/Measures link. Select the Exceptions/Measures link on templates. Expand the Procedure Coded Measures panel. Procedure Coded Measures Select a measure from the grid.The fields below the grid are filled accordingly and the I accept responsibility to provide supporting documentation check box is selected. Note: Measures that have modifiers indicate the measure is an exception. If you want to exclude a measure from claims-based reporting, select and submit the exception measure.You must assign providers to the measures on the Provider CQM Maintenance template for the measures to be displayed on the Exceptions/Measures templat

Manually Submitting CPT II Codes for Claims-Based Reporting

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Configuring Settings for CPT II Claims Based Reporting

Submitting CPT II Codes Automatically

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Submitting Procedure Coded Measures

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Submit CPT II Procedure Codes and Measure Exceptions

Configuring Settings for CPT II Claims Based Reporting

Submitting CPT II Codes Automatically

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Submit CPT II Procedure Codes and Measure Exceptions