# How the Fee Sheet Works?

**URL:** <https://community.open-emr.org/t/how-the-fee-sheet-works/1661>\
**Category:** Management and Administration\
**Created:** [November 15, 2011, 4:12am UTC](https://community.open-emr.org/t/how-the-fee-sheet-works/1661 "2011-11-15T04:12:29Z")\
**Posts on this page:** 6\
**Page:** 1

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**Author:** ![system](https://discourse-uploads-openemr.s3.dualstack.us-east-1.amazonaws.com/original/2X/b/bb9e4e8ae2ea7faac2e952fd9e38a3ce03aac403.png) [@system](https://community.open-emr.org/u/system)\
**Post date:** [November 15, 2011, 4:12am UTC](https://community.open-emr.org/t/how-the-fee-sheet-works/1661/1 "2011-11-15T04:12:29Z")

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**[harrisonr](https://sourceforge.net/u/harrisonr/)** wrote on [Tuesday, November 15, 2011](https://sourceforge.net/p/openemr/discussion/202505/thread/adda2dfb/#0dc8):

What is the business logic surrounding the Fee Sheet?&nbsp; It’s role in the encounter process?&nbsp; If if contains already approved diagnoses and procedures, why is there a “justification” check box?&nbsp; Why is there a “New Patient” and&nbsp; “Established Patient” on the Fee Sheet screen, what difference does this make?&nbsp; So many moving parts, can’t seem to discern the logic from a user perspective.&nbsp; A worked example showing how the various data elements work together with the Fee Sheet List would be most helpful.&nbsp;

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**Author:** ![system](https://discourse-uploads-openemr.s3.dualstack.us-east-1.amazonaws.com/original/2X/b/bb9e4e8ae2ea7faac2e952fd9e38a3ce03aac403.png) [@system](https://community.open-emr.org/u/system)\
**Post date:** [November 15, 2011, 6:02am UTC](https://community.open-emr.org/t/how-the-fee-sheet-works/1661/2 "2011-11-15T06:02:51Z")

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**[bradymiller](https://sourceforge.net/u/bradymiller/)** wrote on [Tuesday, November 15, 2011](https://sourceforge.net/p/openemr/discussion/202505/thread/adda2dfb/#0428):

Hi,

I think this may be covered in the following tutorial video:  
[http://www.open-emr.org/wiki/index.php/OpenEMR\_4.1\_Users\_Guide#Documenting\_a\_visit.2Fencounter](http://www.open-emr.org/wiki/index.php/OpenEMR_4.1_Users_Guide#Documenting_a_visit.2Fencounter)

-brady

> **[OpenEMR](https://www.open-emr.org)**
>
> The world's leading open-source electronic medical record and practice management software.

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**Author:** ![system](https://discourse-uploads-openemr.s3.dualstack.us-east-1.amazonaws.com/original/2X/b/bb9e4e8ae2ea7faac2e952fd9e38a3ce03aac403.png) [@system](https://community.open-emr.org/u/system)\
**Post date:** [November 15, 2011, 6:04am UTC](https://community.open-emr.org/t/how-the-fee-sheet-works/1661/3 "2011-11-15T06:04:09Z")

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**[bradymiller](https://sourceforge.net/u/bradymiller/)** wrote on [Tuesday, November 15, 2011](https://sourceforge.net/p/openemr/discussion/202505/thread/adda2dfb/#eef6):

Also briefly overviewed here in the User Manual:  
[http://www.open-emr.org/wiki/index.php/New\_Encounters\_%26\_Coding\_4.1](http://www.open-emr.org/wiki/index.php/New_Encounters_%26_Coding_4.1)

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**Author:** ![system](https://discourse-uploads-openemr.s3.dualstack.us-east-1.amazonaws.com/original/2X/b/bb9e4e8ae2ea7faac2e952fd9e38a3ce03aac403.png) [@system](https://community.open-emr.org/u/system)\
**Post date:** [November 16, 2011, 3:02pm UTC](https://community.open-emr.org/t/how-the-fee-sheet-works/1661/4 "2011-11-16T15:02:41Z")

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**[kevmccor](https://sourceforge.net/u/kevmccor/)** wrote on [Wednesday, November 16, 2011](https://sourceforge.net/p/openemr/discussion/202505/thread/adda2dfb/#6298):

Typically the fee sheet is accessed from the encounter summary in the bottom frame, with the patient demographics in the top frame.&nbsp;&nbsp; If usefully configured, the CPT and HCPCS that your practice uses are in the appropriate fee sheet dropdown lists and, when selected, are added to the billing detail.&nbsp; Usually ICD-9 codes are entered from the search buttons (it is helpful to know the codes beforehand).&nbsp; CPT and HCPCS procedures are “justified” by associating an ICD-9 diagnosis with the justify button, which adds codes as they are sequentially selected.&nbsp; The ICD-9 codes that are used should also appear in the top frame patient demographics Medical Problems list, which can be seen in detail by clicking the “edit” button.&nbsp; The Fee Sheet frame also lets one enter the copay and the rendering provider.&nbsp; The Fee Sheet frame is the heart of the billing process, but information from the encounter summary (dates, facility,&nbsp; etc.) and any miscellaneous billing options also comprise the information collected for generating claims.

Reference:  
[http://www.cms.gov/manuals/downloads/clm104c26.pdf](http://www.cms.gov/manuals/downloads/clm104c26.pdf)&nbsp; for Medicare CMS-1500  
[http://www.trailblazerhealth.com/Publications/Job%20Aid/Crosswalkto1500ClaimForm.pdf](http://www.trailblazerhealth.com/Publications/Job%20Aid/Crosswalkto1500ClaimForm.pdf)

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**Author:** ![system](https://discourse-uploads-openemr.s3.dualstack.us-east-1.amazonaws.com/original/2X/b/bb9e4e8ae2ea7faac2e952fd9e38a3ce03aac403.png) [@system](https://community.open-emr.org/u/system)\
**Post date:** [November 16, 2011, 8:15pm UTC](https://community.open-emr.org/t/how-the-fee-sheet-works/1661/5 "2011-11-16T20:15:07Z")

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**[gutiersa](https://sourceforge.net/u/gutiersa/)** wrote on [Wednesday, November 16, 2011](https://sourceforge.net/p/openemr/discussion/202505/thread/adda2dfb/#bf50):

with out justifying each procedure code, the claim will go with no diagnosis and will be denied.  
Justification is actually nice.

for example if u do&nbsp; well care visist, say 99385, or 99395,&nbsp; but u also find that the patient’s blood pressure is high (ie a problem in addition to your preventive care) the cpt4 code for the problem would be 99202, 99212, 99203 or 99213 depending on the visit’s circumstances;&nbsp; there has to be a diagnosis for the well care visit as well as the elevated bp.&nbsp; otherwise one of the codes&nbsp; may not get&nbsp; reimbursed. Also would need mod 25

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**Author:** ![system](https://discourse-uploads-openemr.s3.dualstack.us-east-1.amazonaws.com/original/2X/b/bb9e4e8ae2ea7faac2e952fd9e38a3ce03aac403.png) [@system](https://community.open-emr.org/u/system)\
**Post date:** [November 16, 2011, 8:16pm UTC](https://community.open-emr.org/t/how-the-fee-sheet-works/1661/6 "2011-11-16T20:16:57Z")

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**anonymous** wrote on [Wednesday, November 16, 2011](https://sourceforge.net/p/openemr/discussion/202505/thread/adda2dfb/#e1ad):

The fee sheet is for internal use in the billing department. It is a homegrown made-up dollar value for services rendered. If the clinic charge is marked in the fee sheet as $50 for a service and the insurance normally pays $60 for this service, the clinic will be paid for what it charged ($50). So, the clinic just lost $10 in the transaction. If the clinic charges $75, the full amount is $60 is accepted and the $15 is written off. Safe to say that the fee sheet is calculated to go above the highest known payment from their list of payors.  
Clinicians look at the service code and are, normally, not concerned about the nuances of the amount value of the service.  
A “new patient” is someone who will need a new EMR, initial evaluation from the clinician, and so the services will be extensive.  
An “established patient” is someone who is known to the practice and whose medical history is current for the past 2 yrs. If 2 yrs has lapsed from the last clinic visit, this patient is identified as a “new patient”. Very important to the clinic to have a system to identify this, for billing and quality care monitoring.