Configuring Automated Code Entry

Increase your organization’s revenue using Automated Code Entry. This feature ensures that all appropriate services are billed for each patient visit, reducing the amount of lost revenue due to missed billing opportunities. Charges for technical services, or modifiers or diagnoses that can increase reimbursement for services or assist with avoiding coding errors, are posted automatically, based on client-defined criteria. For example:

• Charges for technical components should often accompany the charges for professional services that are entered by providers. Automated Code Entry can automatically add charges for the technical components, along with the appropriate modifiers and quantities, to the professional service charges entered by providers.
  • Provider enters: 99214 Office/outpatient visit, est lev 1 - Automated Code Entry adds two new charges: S9441T - Technical Charge, Nurse EducationA7003T - Technical Charge, Injection, Nebulizer given by Nurse- Providers may forget to add the appropriate modifier or diagnosis, or to adjust the quantity on the charges for professional services that they enter. Automated Code Entry can automatically add the modifiers or diagnoses, or adjust the quantities of the professional service charges.
  • Provider enters: 93888 Intracranial Study - Automated Code Entry adds a modifier to the intracranial study charge: 26 Professional Component - Provider enters: 90662 Flu Vacc Prsv Free Inc Antig - Automated Code Entry adds a diagnosis for the flu vaccine charge: V04.81/Z23 Flu Vaccine This chapter reviews how to configure and implement Automated Code Entry. For instructions on daily usage and management of this feature, please refer to Managing Charge Transactions with Auto-Added Codes.

To implement Automated Code Entry, an administrator maps the charge codes entered by providers (referred to as the master codes) to the charge, modifier, or diagnosis codes that you want to add or adjust automatically (referred to as the auto-added codes). After a user submits a completed or draft transaction that contains a mapped master code, the auto-added codes are automatically posted on the same transaction. All completed transactions with auto-added codes are sent to the Holding Bin, where they must be reviewed for any possible corrections prior to final billing. Charge codes that have been automatically entered using this method appear in displays with this indicator: (A).

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Availability of Automated Code Entry on Web versus Handheld Platforms

Once configured, the Automated Code Entry feature is available on all platforms: web, Apple, and Android. Charges entered on any platform are evaluated, and then codes are auto-added based on the client-defined criteria.

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Using Automated Code Entry with Other Charge Capture Features

Automated Code Entry can be used in conjunction with the following features:

• Batch Charge Entry. If a user enters a master code on the Batch Charge Entry screen and then submits it for multiple patients, the appropriate auto-added charges, modifiers, and/or diagnoses are automatically added to each patient’s charge transaction in the batch. See Configuring Batch Charge Entry.
• Charge Data Master (CDM). If a charge is auto-added by Automated Code Entry, and that charge is mapped in the CDM, and the transaction meets all of the criteria for applying CDM codes, then the appropriate CDM codes are retrieved. See Implementing a Charge Data Master (CDM).
• Hold for Review. The Automated Code Entry feature can be used in conjunction with the Hold for Review feature. If a user enters a master code and then submits the transaction as held for review, the appropriate auto-added charges, modifiers, and/or diagnoses are still automatically added to the (held for review) charge transaction. See Configuring the Hold for Review Workflow.
• RVU Management. If a user enters a master code that also has an RVU associated with it, and then submits the transaction, the appropriate auto-added charges, modifiers, and/or diagnoses are automatically added to the charge transaction. In addition, the charges are saved with the RVU values, and if appropriate, the charge codes are auto-sorted based on RVU, the RVU values are multiplied, and a modifier is added. See Configuring RVU Management.
• Selection of NDC Codes. Any charges that are entered manually that would normally require the user to complete the NDC code and Quantity fields, will continue to do so. Any charges that are auto-added by Automated Code Entry that would normally require the user to complete the NDC code and Quantity fields are assigned a “Missing/invalid NDC code or quantity” error, since the charges are added behind the scenes and user does not have the opportunity to complete the NDC fields. See Configuring the Selection of NDC Codes During Charge Capture. Automated Code Entry cannot be used in conjunction with the following features:
• Custom Charge Capture Screens. Please note that this feature differs from the Custom Charge Capture Screens feature. Automated Code Entry automatically adds CPT codes, modifiers, or diagnoses to charge transactions every time that a user enters a transaction that contains a specific combination of a CPT code, Service Site, and Billing Area. There is no user intervention and the user may not even be aware that additional codes are being added, since they are added behind the scenes after they submit the transaction. With Custom Charge Capture Screens, CPT codes are added to the transaction only when the user chooses to respond to one or more questions (or in some cases, the responses are pre-selected for the user). The user can see the CPT codes that were added, and can modify them prior to submitting the charge transaction. Commure Pro recommends that you use only one of these features; do not implement both at the same time. See Configuring Custom Charge Capture Screens.
• PQRS. When the PQRS feature is implemented, each time a provider submits a charge transaction, it is evaluated to determine if it fits the quality reporting criteria, and if so, the provider is then prompted to answer a series of clinical metrics questions. Any charges, modifiers, and/or diagnoses that are entered manually that would normally trigger the questions, will continue to do so. Any charges that are auto-added by Automated Code Entry are not evaluated for quality reporting and will not trigger a form (even if they would normally meet the criteria). See Configuring PQRS/MIPS.

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Steps for Configuring Automated Code Entry

The steps for configuring Automated Code Entry are listed in the table below. Each of these steps requires changes to configuration of settings that are found on the Admin tab.

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Creating New Charge Codes

Any charge code that is defined in the Commure Pro master list of charge codes can be used with the Automated Code Entry feature. When billing for technical components, some organizations prefer to use “special” or “dummy” charge codes that are unique to their organization and its billing process. If necessary, you can add these charge codes to the master list of charge codes so that they can be utilized with Automated Code Entry. You can add codes to the master list of charge codes via the following setting: Admin - Institution - Charge Capture - Update Charges/Modifiers When adding the special/dummy charge codes to the master list of charge codes, you can enable the Exclude Flag for them, if you do not want users to be able to search for and select them manually (see Determining Usage of Charge Codes).

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Determining Usage of Charge Codes

When configuring Automated Code Entry, you might create “special” or “dummy” codes specifically for billing technical components. If desired, you can restrict access to those codes so that they are used only for automated entry, using the Exclude Flag (as described in Creating New Charge Codes). Restricting access prevents providers or other users from accidentally selecting them when they are entering their daily charges for professional services. The following settings control each user’s ability to find and select excluded codes, as well as their ability to copy the codes forward when copying charge transactions that include them: Admin - User - Charge Capture - Hide Excluded Diagnoses/Charges from Search Results Admin - User - Charge Capture - Exclude Flagged Diagnoses/Charges on Copied Transactions

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Configuring User Settings for Automated Code Entry

There are several user settings that apply to Automated Code Entry. All of the settings described below affect all platforms (web, Android, and Apple). The first user setting affects the visibility of auto-added codes. Once a charge transaction has been submitted and charges, modifiers, or diagnoses have been added to the transaction by the Automated Code Entry feature, those codes may or may not be visible for viewing:

• The auto-added modifiers and diagnoses are always visible to all users. (Please note that the diagnoses are added to the patient’s Existing List, just like any other diagnosis that is used on a charge transaction.)
• The auto-added charges may be visible or not, based on the setting below. In general, if you allow a user to view the auto-added charges based on this setting, then they may be able to edit them as well (as long as they fall within the basic parameters relating to editing charges, such as the transaction’s charge status and the time frame allowed for edits). Admin - User - Charge Capture - Show Auto-Added Charges to User You can also determine whether auto-added codes are copied forward when a user copies a transaction that has auto-added charges, modifiers, or diagnoses. When copying such a transaction, the following items are copied or not copied:
• The original master charges that were manually entered are always copied.
• The auto-added charges (and any associated modifiers) are never copied. However, once the new transaction is completed and submitted by the user, if it still meets the criteria of the mapping table, the auto-added codes will be applied at that time.
• The manually entered or auto-added modifiers (when applied to the manually entered master charge) may be copied, based on the setting below. Admin - User - Charge Capture - Copy Modifiers on Copied Transactions
• The manually entered or auto-added diagnoses may be copied, based on the setting below: Admin - User - Charge Capture - Copy Diagnoses on Copied Transactions And finally, when a user creates a new transaction, you can determine whether any manually entered or auto-added diagnoses from previous transactions should be copied forward to the new transaction, based on this setting:

Admin - User - Charge Capture - Copy Diagnoses on New Transactions

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Mapping Master Codes to Auto-Added Codes

The most important step in configuring Automated Code Entry is to map master charge codes to auto-added charge, modifier, and diagnosis codes using the following option: Admin - Institution - Charge Capture - Auto-Added Code Entry This option consists of a mapping table that is organized by Service Site and Billing Area. In this option, you are describing the circumstances under which a charge transaction should be modified. First you define a specific combination of a master charge code (the charge a provider selects to describe the professional component), a service site, and a billing area that should generate an auto-added charge. Next, you specify which additional charge codes, modifiers, or diagnoses should be added to the charge transaction whenever that particular combination is used by the provider capturing charges. When a user submits a transaction that contains a mapped combination, the auto-added code(s) are then automatically added to the charge transaction. Auto-added codes are added to both completed and draft charge transactions. Information can be entered into the mapping table in two ways:

• Enter it manually, code by code, in the mapping table (see Manually Entering Mapping Information).
• Create a CSV file containing the necessary information, and load the information from the CSV file into the mapping table (see Importing or Exporting Mapping Information). Each row in the table consists of a combination of a master code, service site, and billing area that has the following information mapped to it:
• one auto-added charge code (optional, the charge code must exist in the master list of charge codes)

• one or more modifiers (optional, the modifier code must exist in the master list of modifier codes)
• one or more diagnosis codes (optional, the diagnosis code must exist in the IMO database or in the Diagnosis Nomenclature Vocabulary)
• a quantity (required) If you are setting up an extensive automated code entry table, with many auto-added charge, modifier, or diagnosis codes for the same master code, you should evaluate whether it is necessary to increase the maximum number of charges allowed per transaction, modifiers allowed per charge, or diagnoses allowed per transaction. The maximums can be increased via these settings:

Admin - User - Charge Capture - Set Max # CPTs per Transaction or Charge Macro Admin - User - Charge Capture - Set Max # Modifiers per CPT Admin - Department - Charge Capture - Max # Diagnoses Allowed per Transaction

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Viewing or Printing Mapping Information

You can view mapping information that you or another administrator have previously entered by using the filter options at the top of the Auto Added Charge Codes screen. Once the mappings are displayed, you can print them.

1. Click the Admin tab, followed by the Institution tab.
2. Select Charge Capture from the Edit Settings drop-down list.
3. Click the Edit link next to Auto-Added Code Entry. The Auto Added Charge Codes screen is displayed. This screen is always blank when first accessed. The criteria fields are located at the top of the screen.
4. Enter information in the criteria fields that describes the codes you want to see. You do not have to fill out all of the fields; you can fill out none, one, or more.
   • Service Site: Select a specific Service Site, or select -All Services Sites-. Only mappings for master codes that have the selected service site are displayed.
   • Billing Area: Select a specific Billing Area, or select -All Billing Areas-. Only mappings for master codes that have the selected billing area are displayed.
   • Master Code: enter a charge code for a master code (for example, a code for a professional service). This is a code for which additional charges should be automatically added.
   • Include “All” when filtering by a Site or Billing Area checkbox: If you enter a value in the Service Site or Billing Area fields, the search results would normally only return those master codes that have mappings for that specific service site or billing area. However, if you check this box, then the search results will also return master codes that have a mapping of -All Service Sties- or -All Billing Areas-, respectively.
5. Click the Search button. All master codes that match the criteria you entered are displayed. If you entered no criteria at all, then all master codes that have ever been mapped are displayed.

Click the Clear Criteria button to clear all of the currently selected criteria and start over.

6. (Optional) Click the Print button to print the mappings that are currently displayed.

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Manually Entering Mapping Information

You can manually enter mapping information on a code by code basis. If you do not have many mappings, or if you just want to add a few new mappings, this is the easiest method. However, if you have a large amount of master codes that need to be mapped to auto-added codes, you may find it easier to import them from a CSV file (see Importing or Exporting Mapping Information). To manually enter mapping information, follow these steps:

1. Click the Admin tab, followed by the Institution tab.
2. Select Charge Capture from the Edit Settings drop-down list.
3. Click the Edit link next to Auto-Added Code Entry. The Auto Added Charge Codes screen is displayed.
4. (Optional) Enter information in the criteria fields that is inclusive of the mappings you are about to create and then click the Search button. If any results appear, verify that the mappings you were planning to create have not already been entered. See Viewing or Printing Mapping Information for instructions on using the criteria fields.
5. Click the Add button at the bottom of the screen. The Create a New Auto Added Charge Code Definition dialog appears.
6. Enter information that describes when a particular combination of service site, billing area, and master code should generate an auto-added charge or an adjustment to the modifier/quantity:
   • Service Site: Select a specific Service Site, or select -All Services Sites-.
     • If you select a specific site, automatic additions or adjustments are made only when the Master Code is used in combination with that service site.
     • If you select -All Service Sites-, automatic additions or adjustments are made when the Master Code is used in combination with any service site.
   • Billing Area: Select a specific Billing Area, or select -All Billing Areas-.
     • If you select a specific area, automatic additions or adjustments are made only when the Master Code is used in combination with that billing area.
     • If you select -All Billing Areas-, automatic additions or adjustments are made when the Master Code is used in combination with any billing area.
   • Master Code (required): Enter the charge code for the master code. This is a charge code (for example, the professional service), that when posted by a user, should generate an automatically-entered charge, modifier, diagnosis, or quantity adjustment.
     • Auto-Added Modifier: Click this link to select one or more modifiers. This is a modifier that should be automatically added and associated with the master code when a user saves a transaction containing the Master Code. If you leave this field blank, no modifiers are auto-added.
   • Auto Added Code: Enter zero or one charge code. This is a charge code that should be automatically added (for example, the technical component) when a user saves a transaction containing the Master Code. If you leave this field blank, no charge code is added when a user saves a charge transaction containing the Master Code.
     • Auto-Added Modifier: Click this link to select one or more modifiers. This is a modifier that should be automatically added and associated with the auto-added code when a user saves a transaction containing the Master Code. If you leave this field blank, no modifiers are auto-added.
   • Quantity: Enter a quantity between 1 and 5 (see also Match Quantity of Master Code, which overrides this field).
     • If you did not enter a charge code in the Auto Added Code field, then the Master Code will use the value that you enter here in the Quantity field. Please note that this will override the quantity entered for the Master Code by the provider when they initially entered the charge transaction. You might enter a value here when, for example, you want to automatically adjust the quantity of the master code.
     • If you entered a charge code in the Auto Added Code field, the auto-added code will use the value that you enter here in the Quantity field, and the Master Code will use the quantity entered by the provider.
   • Match Quantity of Master Code: Check this box if you want the quantity of the Master Code or the Auto Added Code to match the quantity of the master code entered by the provider on the charge transaction. When you check this box, it overrides the Quantity field above, and clears any value that you might have entered into that field. This checkbox is enabled only when you have entered a value any of these fields: the Auto-Added Diagnoses field, the Auto-Added Modifier field associated with the Master Code, or the Auto Added Code field.
     • If you entered a value in the Auto-Added Diagnoses field or Auto-Added Modifier field associated with the Master Code, but did not enter a charge code in the Auto Added Code field, then the master code will use the quantity entered by the provider for the Master Code. You might check this box when, for example, you want to auto-add a diagnosis or modifier to the master code, but you don’t want to change the quantity entered by the provider for that code.
     • If you entered a charge code in the Auto Added Code field, the auto-added code will use the same quantity entered by the provider for the Master Code. For example, if the provider saves a transaction containing the Master Code with a quantity of 3, then when the auto-added code is generated, it also will have a quantity of 3.
   • Auto-Added Diagnoses: Enter zero, one, or more diagnosis codes. These are diagnosis codes that should be automatically added when a user saves a transaction containing the Master Code. These diagnoses will be applied to both the master code and the auto-added code (if you specified one). You may search for diagnoses using either the ICD-9 code, the ICD-10 code, or a text description.
     • Copy Diagnoses to all CPTs on Transaction: Check this box if you want the diagnoses you selected in the Auto-Added Diagnoses field to be copied to all charge codes on the transaction, including any other auto-added charge codes, or any charge codes that the provider may have manually entered.
     • If you left the Auto-Added Diagnoses field blank, this checkbox is disabled.
   • Copy Physician Entered Modifiers to all Auto-Added Codes: Check this box if you want the same modifiers the provider associated with the manually entered master charge to also be associated with the auto-added charge.
     • If you entered a charge code in the Auto Added Code field, and you check this box, then any modifiers the provider associated with the Master Code will be added to the transaction and associated with the auto-added code.
     • If you left the Auto Added Code field blank, this checkbox is disabled.
7. Click Save to save this mapping, or click Cancel to exit the dialog without saving. When you click Save, the results area of the screen is refreshed, and all mappings meeting the currently selected criteria are displayed.

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Importing or Exporting Mapping Information

Instead of manually entering the mapping information code by code (see Manually Entering Mapping Information), you can create a Comma Separated Values (CSV) file containing the mapping information, and then import it into Commure Pro. Conversely, you can export the current mapping information stored in Commure Pro to a CSV file and then use the resulting file for whatever purpose you might need. Keep in mind that any charge, modifier, or diagnosis code (master or auto-added) that you want to import into the Auto-Added Code Entry mapping table must be a valid code in the IMO database or in the Commure Pro master lists of charge codes, modifier codes, or diagnosis codes, which are managed via the settings below: Admin - Institution - Charge Capture - Update Charges/Modifiers Admin - Institution - Problem List - Nomenclature Vocabularies This option does not load codes into the Commure Pro system; it only imports the mapping of master codes to auto-added codes. In addition, please note if you import a mapping file that contains mappings that are identical to ones that already exist in the system, duplicate entries are created. To ensure that you do not inadvertently create duplicate mappings, you may want to delete all existing mappings first, and then import a new, complete set of mappings. When importing, each CSV file should include the columns listed below, and must use the exact column headings described here. Then create a separate row in the CSV file for each mapping of a master code to an auto-added code. Each row describes the master code, its usage in combination with Service Sites and Billing Areas, and the code that should be auto-added (the charge, the modifier, the diagnosis, or the quantity). When exporting, the resulting CSV file contains the same columns described here. To import mappings from a CSV file into the Automated Code Entry option, follow these steps:

1. Click the Admin tab, followed by the Institution tab.
2. Select Charge Capture from the Edit Settings drop-down list.
3. Click the Edit link next to Auto-Added Code Entry. The Auto Added Charge Codes screen is displayed.
4. Click the Import File button at the top of the screen. The Import Auto Added Charge Codes dialog box is displayed.
5. Click the Browse button, locate the CSV file, and select it.
6. Click the Import button on the Import Auto Added Charge Codes dialog. The mappings from the CSV file are imported into Commure Pro. You can adjust the filter settings at the top of the screen and click Search to view the mappings that you imported.

Follow the steps below to export mappings from Commure Pro to a CSV file. All exported CSV files are automatically compressed into a zip archive file (.zip) to conserve space.

1. Click the Admin tab, and then the Institution tab.
2. Select Charge Capture from the Edit Settings drop-down list.
3. Click the Edit link next to Auto-Added Code Entry. The Auto Added Charge Codes screen is displayed.
4. Determine whether you want to export all mappings, or only a subset.
   • To export all mappings, click the Export File button at the top of the screen.
   • To export only a subset, use the criteria fields at the top of the screen to describe them, and then click Search. Click on each of the mappings that you want to export (the rows turn orange). Click the Export Selected button at the bottom of the screen. A Commure Pro File Download—Web Page Dialog box with the following message is displayed: “Please click here to begin the download. The file could take several minutes to generate.”
5. Click here in the message dialog. A File Download dialog appears.
6. Determine whether you want to open the archive file now, or save it.
   • To open the file immediately: click the Open button.
   • To save the file: click the Save button, and then select a location to save the file.
7. Click the Close button on the Commure Pro File Download—Web Page Dialog box.

When working with CSV files in Microsoft Excel, keep in mind that Excel strips leading zeros from CPT codes unless the column format is defined as Text. When creating a CSV file from scratch, select the MasterCode and AddedCode columns and then make these selections:Home tab > Format > Format Cells > Number tab > Text. When working with a CSV file that was exported from Commure Pro, follow these steps to avoid stripping the zeros:

1. Start Excel with no document selected.
2. Click the Data tab.
3. In the Get External Data section, click From Text.
4. Browse to your file, select it, and click the Import button.
5. Choose the file type: Delimited. Click Next
6. Choose the delimiter: Comma. Click Next.
7. In the Data Preview, click on the MasterCode column to select it, and then click the Text radio button at the top.
8. Repeat Step 7 for the AddedCode Column.
9. Click Finish.
10. Where prompted about where you want to put the data, just accept the default and click OK.
11. Make your changes to the file, and be sure to save as .CSV format.

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Editing or Deleting Mapping Information

You can manually edit or delete mapping information that was previously entered.

1. Click the Admin tab, followed by the Institution tab.
2. Select Charge Capture from the Edit Settings drop-down list.
3. Click the Edit link next to Auto-Added Code Entry. The Auto Added Charge Codes screen is displayed.
4. Enter information in the filter fields that identifies the particular master code(s) that you want to change or delete, and the click Search. Or, you can leave the filter criteria fields blank and then click Search, to see all previously entered mappings.
5. Click one or more rows to select them. You can also use the Select All or Select None buttons to select the rows you want.
6. Take any of these actions:
   • If you selected only one row, the Edit button is enabled. Click the Edit button to open the Edit this Auto Added Charge Code Definition dialog. Make your changes, and then click Save.
   • Click the Trashcan icon at the beginning of a row to delete just one row. When asked to confirm the deletion, click Yes.
   • Click the Delete button to delete all of the currently selected rows. When asked to confirm the deletion, click Yes. The results area of the screen is refreshed to show your change.