Checkout - Claim: Billing Tab

 

Usually, procedure codes are populated based on the mappings set up on the Order Type & Procedure Template Mapping page.

• If no mapping exists for an order type, athenaOne uses the procedure code corresponding to its order type group (as configured on the Fee Schedules page), provided that a single procedure code is mapped to the order type group.
• If more than one procedure code is mapped to the order type group, the field remains blank. When you click in it, athenaOne displays a list of the available procedure codes in your fee schedule.

 

 

The Claim: Billing tab Services section validates your code selection and alerts you to coding violations and order status issues.

• Valid Procedure — Ensures that the procedure code itself is valid per AMA CPT.
• Procedure Fees — Ensures that the procedure code and fee-affecting modifier have been set up in the fee schedule.
  Note: If a procedure code appeared in a fee schedule that is expired or deleted and does not appear in the current fee schedule, the description from the expired or deleted fee schedule is referenced, and the code is not validated against the current fee schedule.
• Valid Diagnosis — Ensures that the diagnosis code is valid per ICD10CM.
• Order Status — Prevents you from creating charges for orders that have not been performed.

Critical warnings prevent you from clicking the Bill? checkbox. You cannot create charges for items with a critical warning.

 

Non-critical warnings do not prevent you from creating a charge from the line item.

 

The Bill? checkbox is automatically checked after you enter all the information needed to create a charge, and there are no errors.

Note: If there are diagnosis codes in the Encounter:

• Procedure codes generate on the Billing tab in the CPT II Codes section with diagnosis codes
• If there is at least one diagnosis code, the Bill? box gets marked automatically
• You can still edit the fields if you want to use different diagnosis codes or do not want CPT II procedure codes billed

 

 

An item may be listed under the Miscellaneous heading if:

• You add charges manually that do not belong to another service category.
• A procedure code is flagged as miscellaneous in your fee schedule (on the Procedure Fees page). The list of miscellaneous services is administered on the Procedure Fees page, using a field called Miscellaneous billing section. Select the Show in miscellaneous billing section option to add the procedure code to the Claim Billing Tab under Add Service.

The provider can also add services that were performed during the visit using the Add Service field at the bottom of the list of services.

 

 

E&M Codes

"E&M" refers to visit and consultation services furnished by a physician. The Billing tab always includes a section for an E&M service, although you are not required to bill for this type of service. The provider must enter or select a CPT code. For more information, see E&M Coder Section.

 

Orders

Orders are the items that you requested using the patient's Assessment / Plan section. Orders include labs, imaging tests, DME, and items classified as other orders. Medications are displayed only if you administered or dispensed them.

Note: Orders for medications do not appear on the Claim: Billing tab.

 

Make sure to bill only for those services for which you are certified.

 

Lab orders referred to a clinical provider that is not affiliated with your practice are displayed with the name of the vendor. When you enter a lab order, placeholder lines appear in the billing tab for specimen handling and venipuncture charges.

Note: Fees for handling and venipuncture services must exist in the fee schedule in order for them to appear in the list of billable items.

 

Vaccine orders cause placeholder vaccine administration lines to appear in the billing tab. As with specimen handling and venipuncture charges, only the vaccine administration charges that appear in your fee schedule are displayed on the Billing tab.

 

Imaging orders appear on the Billing tab if the receiver is set up as a department clinical provider in your practice; the order is marked as a point-of-care test; or the receiver's compendium is managed by your practice. The receiver name for the in-house imaging order is displayed with an "(Internal)" label.

To link a facility's compendium to a practice, add the clinical provider to the Clinical Provider Mapping page, and then configure the practice to manage the facility's compendium on the Compendium Management page.

 

Procedures

Procedures are those items documented in the encounter's Procedure Documentation section.

 

 

CPT Category II codes track patient care. These codes are used by payers to facilitate performance measurement only. Category II codes are not required, but your organization may receive additional reimbursements when claims are coded with accurate CPT Category II codes.

 

You may see the following CPT Category II codes on the Billing tab if they're also included in the fee schedule and if information from the encounter or patient chart relates to a supported code.

Note: For information about actions that providers can complete to generate these codes, see Satisfying CPT Category II Codes on the Success Community.

• 1034F — Current tobacco smoker
• 1035F — Current smokeless tobacco user
• 1036F — Current tobacco non-user
• 1090F — Presence or absence of urinary incontinence assessed
• 1125F — Pain severity quantified; pain present
• 1126F — Pain severity quantified; no pain present
• 1159F — Medication list documented in the medical record (1159F appears on the Billing tab every time 1160F appears)
• 1160F — Review of all medications by a prescribing practitioner or clinical pharmacist (such as prescriptions, OTCs, herbal therapies and supplements) documented in the medical record
• 1170F — Functional status assessed
• 3008F — Body Mass Index (BMI), documented
• 3074F — Most recent systolic blood pressure < 130 mm Hg (based on lowest blood pressure reading from this encounter)
• 3075F — Most recent systolic blood pressure 130-139 mm Hg (based on lowest blood pressure reading from this encounter)
• 3077F — Most recent systolic blood pressure >= 140 mm Hg (based on lowest blood pressure reading from this encounter)
• 3078F — Most recent diastolic blood pressure < 80 mm Hg (based on lowest blood pressure reading from this encounter)
• 3079F — Most recent diastolic blood pressure 80-89 mm Hg (based on lowest blood pressure reading from this encounter)
• 3080F — Diastolic >= 90 mm Hg (based on lowest blood pressure reading from this encounter)
• 3288F — Falls risk assessment documented
• 3725F — Screening for depression performed

 

Tip: Hover over the image to see an expanded view

 

Note: If you exit the Billing tab without saving, athenaOne regenerates the CPT Category II codes when you reopen the tab. However, after you save the Billing tab, athenaOne does not regenerate additional CPT Category II codes when you reopen the tab.

1. After you complete the Assessment/Plan step of the Exam stage, click Next to proceed to the Sign-off stage.
   The Sign-off Summary appears in the center pane, and the Exam stage navigation bar changes to highlight Sign-off.
2. Click the Billing tab on the right side of the screen.
3. Review each code in the CPTII Codes section.
   Note: Before you save the Billing tab, the text above each CPT II code begins with "Code is generated based on..." After you save the Billing tab, the text above the CPT II codes changes to indicate that you can no longer edit the code:
   
4. Edit the CPT Category II codes if needed.
5. Enter the code's modifier if needed.
6. Edit the number of units if needed (the number of units defaults to 1).
7. Click Apply all ICD-10 codes to apply all diagnosis codes recorded during the Exam stage to each CPT Category II code. Otherwise, enter the ICD-10 codes manually.
   Important: Each CPT Category II code that you bill must have a corresponding ICD-10 code; some payers require specific ICD-10 codes for some CPT Category II codes. If you don't enter the ICD-10 code on the Billing tab, it must be entered on the Charge Entry page.
8. Notice that all the boxes in the Bill? column are checked to bill all the CPT Category II codes at once. Otherwise, check the box in the Bill? column to select individual codes to bill.
   
9. Click Save, Save & Mark Reviewed, or Save & Enter Charges.