Once you’ve created and saved a patient claim, you can start insuring your 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 an insurance policy (patient claim) 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 $50 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.
As a provider, you’ll need to add in the CPT and Diagnosis codes that apply to the patient’s visit. CPT & Diagnosis codes can be added to the Insurance Info section of the appointment by searching and selecting your desired codes.
This information can be entered from the practitioner Day view while charting by clicking on the appointment a second time, and opening the Insurance Info tab:
Here are the steps to adding CPT & Diagnosis codes:
- From the Practitioner Day View, double click the appointment to view the Appointment window (or click on an appointment from the Schedule view.)
- Scroll down to the Insurance Info section
- Search for the applicable CPT code in the “Add Billing Code” search bar
Let’s say in this example, we add a billing code with an assigned rate of $65. This will override the $50 treatment price, and Jane will bill the patient $65 instead.
💡Pro Tip: If you press the Space bar on your keyboard when adding in billing codes to a purchase, Jane will show you all of your favorite codes.
Once you have added in the CPT code(s), you can add in the diagnosis code(s) to each CPT code added to the visit.
💡Pro Tip: If you are going to be adding multiple billing codes to a visit, and each billing code needs to have the same list of diagnosis codes, then you can start by only adding one billing code and all of the diagnosis codes for the visit under that billing code. Once you’ve added all of the diagnosis codes to your first billing code, Jane will automatically add the diagnosis codes that were added to that first billing code to all subsequent billing codes that you add (phew, that was a mouthful).
Once the diagnosis 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 out Creating Superbills guide.
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:
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.