Procedure codes are used within the healthcare industry to identify specific medical procedures or other services rendered to patients. These codes correspond with the HPCPS (Healthcare Common Procedure Coding System) and CPT (Current Procedural Terminology) code databases, the de-facto standards as published once per year by the American Medical Association. The Kareo PM application includes this database of standard codes which is updated every year. However, you can add your own procedure codes for things like no-show fees or miscellaneous fees (i.e. collection/court fees).
To add a new procedure code
- Click Settings>Codes>Find Procedures on the top menu.
Note: To avoid duplication, a best practice is to first search the database to see if the procedure code already exists in the system.
- If the procedure code is not in the system, click New at the bottom.
- Enter the information. See below.
- When finished, click Save.
- Procedure or Speed Code: Enter a 5-character (numbers and/or letters) procedure code or speed code. See Tips below. If applicable, see also the NDC Number field.
- Procedure Code (CPT): If a speed code was entered in the field above, enter the real 5-character procedure code in this field. See Tips below. Check the "Custom Code" box if applicable.
- Official Name: Enter the official name of the procedure; avoid abbreviating procedure names when possible.
- Local Name: Optional. If you want a more user-friendly name to appear on the encounter form, enter it in this field.
- TOS: Select the type of service (TOS) from the drop-down menu; these are industry classifications for various types of procedures.
- Default Units: Enter the default units for the procedure. This is especially useful when entering speed codes for drugs. For example, if a speed code is “HA60” (60 milligrams of a certain drug) and the fee schedule for the HA60 code is priced per milligram, then the default units would be 60.
- Procedure Code Category: Optional. Allows certain reports to be generated based on procedure categories. To link a procedure code to a procedure category, click Procedure Code Category and select the category from the list. See section New Procedure Category.
- Default Revenue Code: For UB-04 forms, select a code from the drop-down menu.
- Procedure is currently used: Checked by default. Uncheck only if you want to render a procedure code inactive.
Note: Once a procedure code has been marked inactive, the code cannot be used when entering new charges.
- Drug Information
- Drug Name: If this procedure is related to a specific drug, enter the drug name.
- NDC Number: If applicable, enter the National Drug Code (NDC). See Tips below.
Speed Code: In some cases, there are drugs that do not have their own procedure code but use a single generic code instead; for example, "99070" which means “SUPPLIES PROVIDED BY PHYSICIAN OVER & ABOVE THOSE INCLUDED IN THE SERVICE”. This is usually the case for drugs that have not had a J-code assigned to them. To distinguish generic procedure code records within Kareo PM, a speed code is used. This is an internal code that you would use to identify a particular drug. Some examples are: "HA60" or "HBR120" to mean 60 milliliters of one drug or 120 milliliters of another. To use a speed code, complete the following for the New Procedure Code:
- Enter a 5-character speed code (numbers and/or letters) of your choice in the Procedure or Speed Code field.
- Enter the real 5-character procedure code (like 99070) in the Billable Procedure Code field.
- Enter the NDC Number in the NDC Number field.
Note that what is entered in the Billing Procedure Code field will always override what is in the Procedure or Speed Code field. Therefore, whatever internal speed codes you wish to use will not affect the real procedure codes used to bill insurance companies.
NDC Number: In certain situations, like when billing for injections, a National Drug Code (NDC) must be provided. In some cases, drugs have their own special procedure codes (often known as J-codes). For example, Ampicillin uses the HCPCS code J0290 for doses up to 500mg; for greater doses, such as 1.5g, it uses code J0295. In some cases, these procedure codes are not enough on their own and the NDC number must also be provided. If the NDC number is provided, it will print on the CMS 1500 (HCFA) form. See also Converting NDCs from 10 digits to 11 digits.