Our client needs to submit cpt-4 codes for the unlisted procedures and services (like 97039, 97139, 97799). Use of these codes will require sending with the claim the specific information about the service they are providing. In 837P ver. 5010 there must be a Procedure Description present (Loop 2400, SV101-7).
OfficeAlly manual says that: “if the CPT is a non‐specific procedure code and a Procedure Description (SV101‐7) is not present, we will use the Line Item Note to populate the Procedure Description. If a Line Item Note is not present, the system will use the Box 19 note to populate the Procedure Description. “
My question is how can we enter this description? I opened Encounter -> Administration -> Misc Billing Options HCFA but could not find Box 19. No ‘Line Item Note’ either.
Item 24D - Enter the procedures, services, or supplies using the CMS Healthcare Common Procedure Coding System (HCPCS) code… Enter the specific procedure code without a narrative description. However, when reporting an “unlisted procedure code” or a “not otherwise classified” (NOC) code, include a narrative description in item 19 if a coherent description can be given within the confines of that box. Otherwise, an attachment shall be submitted with the claim.
Page 5 of NUCC Crosswalk, Box 19 = Loop 2300 Segment NTE or PWK.
Box 19 will need to be added to /openemr/interface/patient_file/encounter/load_form.php?formname=misc_billing_options & to openemr/library/gen_x12_837.inc.php.
It probably will require a phone conversation with Office Ally to facilitate these submissions.
Stephen’s suggestion is better because no new coding is required & a specific note can be assigned to a specific charge.
On CMS 1500 the shaded area above the Procedure Code is finite & not expandable, about 6 characters. There are times when a problematic claim must be resubmitted with paper.
A third option is to use “Additional Notes” which has copious space for characters. Did not test the results in the corresponding CMS 1500.
Which way to proceed is largely dependent on how fastidious the local Medicare carrier is.
Thank you both for this valuable info. It worked out fine with OfficeAlly. Before that our claims were rejected. We’ll see what the insurance payer is going to say but I hope it’ll work also.