Once you have created a new insurance policy on a patient’s profile, you can start insuring that patient’s visit(s).
In this lesson we’ll cover the following CPT & Diagnosis code topics:
- Adding CPT & Diagnosis Codes to a Visit
- Re-booking Clients with the Same Insurance Info
- Adding Modifiers
- Changing a CPT Code
- Removing CPT & Diagnosis Codes
- Reordering Diagnosis Codes
- Adding CPT & Diagnosis Codes to a Paid Visit
If you have not done so already, please go through the US Insurance Set Up Steps first.
Preparing the Appointment for Claim Submission
In order to prepare an appointment invoice for EDI claim submission, the date of service will need to have at least one billing code and diagnosis code added, as well as the patient’s insurance policy added.
First up, let’s review how to add CPT/Diagnosis codes to a visit for insurance billing or superbill creation.
Let’s say Victoria books in for a visit at our Demo Clinic. When Victoria arrives at the office, a staff member will Arrive the visit in Jane.
Arriving the visit will generate an invoice for the default Treatment price, let’s say $60 in this case. You can ignore this invoice price for now, as any CPT fees will override this treatment price.
The provider has now treated Victoria and is ready to check her out.
There are two main ways to add CPT and Diagnosis codes to your appointment:
If you’re someone who needs to add these codes to your documentation, you’ll likely want to add Billing Codes to appointments via Chart Entries.
If you don’t need to include CPT and Diagnosis codes in your documentation, you can add your codes directly to the Appointment Panel.
Both of these can be done from the practitioner Day view. To open up the client’s chart, you can click on the appointment once. To open up the Appointment Panel, you can click on the appointment a second time or, if you’re in the Edit Billing Codes area of the chart, on the Manage Insurance Info button.
Adding CPT and Diagnosis codes from the chart:
Once you’ve opened up your client’s Chart Entry, you can click into any Note field and type the ‘#’ key before the CPT or Diagnosis code (either the name or letter/numbers associated with it). When you start typing, Jane will offer you a dropdown of potential codes to choose from, with your favorite codes at the top.
When you’ve added all your codes to the chart, you can scroll to the bottom of the entry and open the Edit Billing Codes section. From here, you can arrange your codes in the order you would like them to appear on your claim and then add them to the appointment by selecting all applicable codes and clicking Update Billing.
Check out our detailed guide on Adding Billing Codes to Charts for step-by-step instructions, videos, and some tips on how to save time (and headaches!). 💪
Adding CPT and Diagnosis codes to the Appointment Panel:
You can open up the Appointment Panel and scroll down to the Insurance Info section. In the Add Billing Code bar, you can search the codes you’d like to add.
🔥 Hot tip: If you press the Space bar first, Jane will show you all of your favorite codes!
Let’s take a closer look at how CPT and Diagnosis codes work in Jane:
You’ll remember that the base cost of Victoria’s Treatment is $60. If we then add a CPT code with an assigned rate of $100, this will override the $60 treatment price, and Jane will bill the patient $100 instead.
If you’re adding billing codes from a Chart Entry, you can add your CPT and Diagnosis codes in any order you’d like and rearrange them after. If you’re adding them to the Appointment Panel, you’ll need to enter your CPT code(s) before you can add the associated Diagnosis code(s).
💡Pro Tip for adding codes from the Appointment Panel: If you are going to be adding multiple CPT codes to a visit, and each CPT code needs to have the same list of Diagnosis codes, start by adding your first CPT code with all the Diagnosis codes under it. Now, when you add your next CPT code, Jane will automatically add all those Diagnosis codes for you!
Once all the necessary Billing codes have been added to the appointment, the provider can either generate a superbill if Victoria is a Cash patient or move on to add a claim to the visit if Victoria has coverage.
For more info on generating superbills in Jane, please have a look at our guide to Creating Superbills.
Need to book in a patient for a subsequent visit where all (or most) of the Insurance Info will be the same?
If so, you can copy that information over either at the time of booking or after the patient has booked in to save yourself some time. This applies for both cash and insurance patients!
We’ve got this handy guide that covers all the details: Re-booking Clients with the Same Insurance Info
Modifiers can be added right below the diagnosis area by just typing them in:
You’ll need to press the Enter button on your keyboard in order to save the modifier. You’ll see the little “X” next to the modifier if it has been attached to the billing code properly.
If you’ve added this modifier in the past, Jane will show it as an option that you can select from.
Here’s a quick example:
A quick reminder that you can set up Default and Insurer-specific Modifiers in your Settings!
If you need to add a different CPT code to a visit (i.e. maybe you were copying a previous visits codes), but you’d like to retain the associated diagnosis codes, click the drop-down arrow to the right-hand side of a CPT code.
Select the option to “Change Billing Code” to search for a new code:
To remove a CPT code, click the drop-down arrow to the right-hand side of the code and select “Remove Billing Code.”
To remove a Diagnosis code, click the “X” on the right of the code:
If you’d like to change the order of the codes, click the blue double-headed arrow next to the diagnosis codes.
From here you can drag and drop the diagnosis codes into the correct order.
If you need to add billing codes to a paid appointment, you’ll want to use the Allow Editing toggle to make the needed changes!
Start by clicking on an appointment to view the Appointment window, and scroll down to the Insurance Info section.
Toggle on Allow Editing:
With Allow Editing turned on, you can now click to add any needed billing code information.
Once you have added the billing codes and/or claim, Jane displays a button that allows you to Update Invoices.
When you click the Update Invoices button, behind the scenes, Jane is re-applying the client’s original payment. If there is a balance outstanding Jane will show that as the amount owing on the patient’s account. Or if the client’s original payment exceeds the amount of the regenerated invoice, Jane will generate a credit on the patient’s profile.
Way to go! Another lesson complete.
📘 Continue learning the insurance billing workflow in Start Billing 3 - Insuring the Visit.