Editing Procedure Codes

Default procedure code properties, Procedure Notes, and fees can be edited in the Procedure Code list.This is where you would enter a new code as well.

In the Main Menu, click Lists, Procedure Codes, then double click on an existing code.

Time Pattern: Use the vertical slider on the left to set the procedure time allotment.  Each square represents 10 minutes.  Slashes (/) indicate assistant time, X's indicate Provider time.  Click on an X or / to toggle to the other.  Procedure time is used to determine default Appointment length.

Proc Code:  The code cannot be edited and can be up to 15 digits long. All codes starting with D will be shortened to 5 characters before being included on a insurance Claim.  For example, you can have two different codes for nitrous, with the difference being a letter that is added to the end of a standard D code. When sent to insurance, only the standard 5 digit code will be used.  To add a new code, see Adding a New Procedure Code.  Codes can't be deleted; instead move it in an obsolete Category. 

Description:  ADA code descriptions cannot be edited.  Non-ADA code descriptions can be edited.   

Alt Code:  This is useful for some Medicaid plans like Dentical.  See Insurance Plan Types under Medicaid.

Medical Code:  If there is a corresponding Medical code, enter it. We recommend creating a Medical Code category in Definitions, Proc Code Categories, and assign all medical codes to that category.

• Cross Coding: First, set up the medical code using a CPT code instead of a dental code.  Do not enter a Medical Code when setting up the medical code. Then, enter an entirely separate dental code, and put the previously entered CPT code into the medical code box to link the two.
• Medical Code only: In this case, there is no dental code, only a CPT code.  So the Medical Code and Proc Code will be the same.

Ins Subst Code: Sometimes insurance companies reduce the allowed amount of a procedure. Put the substituted code in the box, and optionally set the "Only if" condition.

• Posterior composites: Typically reduced to the corresponding amalgam coverage. Enter the amalgam code. Since this is usually only done if the composite was performed on a molar, set the condition to Molar.
• Porcelain crowns: Typically reduced to full gold crown coverage. Enter the FGC code. Since this is usually only done if the crown is on a second molar, set the condition to SecondMolar. Many offices charge the same for both types of crowns, so this setting is not as important as the posterior composite setting.

Abbreviation:  Shows in the Appointment.  Can be edited.

Layman's Term:  If desired, enter simpler language to describe the procedure.  This entry will show as the description in Treatment Plans.

Base Units:  Typically for Medical Insurance claims.  When calculating a procedure fee, the standard fee is increased based on the base unit, thereby increasing the billed fee. The base unit calculates the fee and time pattern using an additive process. 
Base Unit = 0 (standard fee)
Base Unit = 1 (standard fee standard fee)
Base Unit = 2 (standard fee standard fee standard fee).

For example, the procedure code for Nitrous Oxide may have a time pattern of 15 minutes (base unit of 0) and a fee of $100. During the procedure, you may typically use Nitrous Oxide for a longer period of time.  Instead of adding the procedure to the chart multiple times, increase the base unit.
- By setting the Base Unit to 1, the Time Pattern = 30 minutes and the Procedure Fee = $200
- By setting the Base Unit to 2, the Time Pattern = 45 minutes and the Procedure Fee = $300
- By setting the Base Unit to 3, the Time Pattern = 60 minutes and the Procedure Fee = $400

There is a checkbox on the Insurance Plan Edit window for "Claims show base units" which shows the base unit on the medical claim form.

Drug NDC: National Drug Code number.

Default Revenue Code:  A 3-digit code sometimes used for institutional Claims. It tells insurance where the patient was when they received insurance, or the type of item they received. This default code will show on the Procedure Edit window, Medical tab.

Color Override:  Override the color for this procedure on the Graphical Tooth Chart in the Chart module. Usually colors are based on procedure status, such as Treatment Planned or Completed.  Colors are not usually set for individual procedure codes.  But in rare situations you may want a procedure code to always show in one color. For example, implants look better as always gray, instead of red, blue, or green. Click none to remove the override. Procedure status colors are set in Definitions, Chart Graphics Color.

Do not usually bill to Ins: For codes that shouldn't get billed to insurance, or non-standard D Codes. E.g. crown seats.

Is Hygiene procedure:  Automatically assign the procedure to the hygiene Provider when Scheduling an Appointment with two providers. See Edit Appointment for an explanation of Hygiene provider.

Is Prosthesis:  If checked, additional Prosthesis Replacement fields will show on the Procedure Edit window.  Users must complete this information before sending the insurance Claim.

Assign to Prov: Assign a specific provider to this procedure.  For example, create a procedure for selling mouthwash from the dental office, then assign the procedure to a dummy provider. This avoids inflated production numbers on real providers.  The provider selected here will be assigned to this procedure when it is created and when it is set complete.

Default Notes:  See Default Notes below. 

Paint Type: Determines how the procedure will be drawn on the Graphical Tooth Chart.

• Extraction: A large X when treatment-planned.  Tooth is hidden when procedure is set complete.
• Implant:  For any implant procedure code.  It will frequently be a procedure you do in your own office, such as placing an abutment. To indicate a previously placed implant, assign this paint type to a surgical procedure with a status of EO. Before the implant graphic will show, the tooth must also be marked missing. Once an implant is showing, a crown can be entered. Crowns do not normally show on missing teeth, so entering an implant procedure first will be necessary in this case.
• RCT: Root canal graphics. A vertical line shows on permanent teeth; will not show on Primary teeth (pulpectomies).
• PostBU: A graphic that fills the pulp chamber. Also used for pulpotomies (vital pulp therapies) on primary teeth.
• FillingDark/Light:  Dark and light color options.
• CrownDark/Light - Caps tooth.  Tooth must be visible (or there needs to be an implant).  Dark and light color options.
• BridgeDark/Light - Looks like a crown, but shows on both visible and missing teeth.  Dark and light color options.
• DentureDark/Light: Teeth should be marked missing or hidden.  Dark and light color options.  Similar to crown graphic.
• Sealant: An "S".
• Veneer:  A graphic (inverted T) on the front of the tooth.
• Watch: A small "W" above or below the tooth.

Treatment Area:  The treatment area will determine the surface and tooth options available when entering the Procedure.
- Surf: Tooth and Surfaces
- Tooth: Tooth only
- Mouth: no extra options
- Quad:  UR, UL, LR, LL
- Sextant:  1 - 6
- Arch:  U, L
- Tooth Range: 1 - 32

Category:  The category this procedure code will be organized under.  Customize category options in Definitions, Proc Code Categories.

Fees:  The fees for this procedure code, for each Fee Schedule.  Double click on a row to enter the fee amount.  Once fees are entered they are saved, even if you click Cancel on the Edit Procedure Code window. 

Audit Trail: View a log of all fee changes for this procedure code.

Default Notes, Incomplete Notes, and Specific Providers
Default notes are Procedure Notes that automatically copy to the patient's chart when the procedure is Set Complete. Notes can include anything that normally goes into your chart notes.

There is a special functionality built into procedure notes to remind staff to enter information. Anywhere in the note, enter two quotes without anything between them. Example: Due Date ""  When clinical staff Edit the Procedure note at time of treatment, they must enter information between the quotes. If they do not, the procedure note is considered incomplete. A red Incomplete Note warning will appear above the note.  If the procedure is set complete with an incomplete note, it will show on the Incomplete Procedure Notes Report. Examples of where you could use quotes are: composite shade, crown shade, denture shade, due date, blood pressure, nitrous levels, etc.

Specific Providers:  Frequently different Providers prefer different default notes and time allotments for each procedure. To add provider-specific notes, click Add Note:

Select a provider, set the time pattern, and enter the note. These notes can be deleted without disturbing patient data.