Configure Procedure and Diagnosis Billing in PCC EHR

Use the Billing Configuration tool to configure billing behaviors of procedures and diagnoses. You can also customize the Bill window (also called the Electronic Encounter Form).

Introduction: Configure Billing Behaviors in PCC EHR

As a clinician charts a visit, they add orders, procedures, and diagnoses to the chart note. Based on your configuration, PCC EHR automatically adds appropriate ICD-10 billing codes to the encounter.

Clinicians click the “Bill” button at any time to visit the Bill window. The Bill window is also called the “Electronic Encounter Form” or “EEF”, as before EHRs and EMRs some clinicians used a paper “Encounter Form” to select billing codes.

On the Bill window, the clinician (or later, a biller) can see what has been coded for an encounter so far, make changes, add additional billing codes, link procedures and diagnoses, and then approve the visit for billing. (Read Prepare an Encounter for Billing to learn more.)

You can use the Billing Configuration tool in PCC EHR to control all of these billing behaviors. For example, you can configure billing codes for orders, configure the mapping between diagnosis descriptions and ICD-10 billing codes, and adjust the default procedures (like 99213 and other visit codes) that appear on the screen. You can also set up “optional” codes for orders, and make use of other custom configuration options to streamline the PCC EHR workflow for your practice.

Here are some notes to keep in mind as you use the Billing Configuration tool:

  • Changes are For Future Visits, Not the Past: No matter what changes you make to your billing configuration and electronic encounter form, previous billed visits will not lose information. For example, you could remove procedures from the encounter form or alter the default procedure codes for orders, but old visit encounter forms will still display what was billed at the time.

  • User Access: Permission to use the Billing Configuration configuration tool is controlled in the User Administration tool. Contact your system administrator if you can not run the tool. To prevent over-writing each other’s work, the Encounter Form Editor can only be opened by a single user at a time.

  • ICD-9 and ICD-10 Compatible: Some of the examples below display ICD-9 and ICD-10 codes. All features of PCC EHR work with both ICD-9 and ICD-10. A few years after the ICD-10 transition, PCC removed ICD-9 as a configuration option, but your old ICD-9 charge records will still display in charge histories.

Configure the Procedure Billing Code Mapping for Each Order

When you chart a patient’s visit and create an order, procedure codes and diagnoses can be automatically added to the Bill window for the encounter. Use the first tab of the Billing Configuration tool to configure which billing codes your labs and other orders will trigger by default. You can also set optional, unselected procedures.

Why Do This?: When you indicate a diagnosis on a patient’s chart note, it appears on the Bill window for the encounter automatically. Your orders, labs, and medical procedures, however, may require multiple procedure billing codes, optional billing diagnosis codes, and other adjustments.

Follow this procedure to configure which procedure codes appear for each order:

Open the Billing Configuration Tool from the Configuration Menu

From anywhere in PCC EHR, click on the Configuration menu and select “Billing”.

Select the First Tab, “Order Mapping”

Click on the first tab, “Order Mapping” to view order mapping.

Find an Order or Order Type

Use the Search Filter to find an order or set of orders to edit.

Double-click on an order to edit the billing codes.

Note: You can create new labs in the Lab Configuration Tool. You can create new orders in the Component Builder in the PCC EHR Configuration Tool. The list of available immunizations comes from the Immunization and Disease table in the Table Editor (ted) in Partner, which in turn relies on the Procedures table. Contact PCC Support for help with order configuration or for help adding new combination vaccinations.

Add Procedure Billing Codes (and Optionally Diagnosis Codes)

Next, add one or more procedure billing codes. Optionally, you can also add a billing diagnosis code.

You can start typing in a field to search and then select from the pull-down menu. You can click the plus sign (+) to add additional codes. PCC EHR will not allow you to select a billing code that has expired (due to an ICD-10 code update, for example), but you can add codes that will be valid in the future.

Automatic Diagnosis Codes Should Be Rare: Clinicians enter diagnoses on a patient’s chart note. If you configure an order to automatically trigger a billing diagnosis, it will not appear on the chart note and will be difficult to track in the patient’s record. However, certain procedures, such as ear piercing or the Z23 immunization diagnoses (as shown above), do not need to appear on a chart note but are required for reimbursement from an insurance company.

Optional: Add “Optional” Codes

The “Pre-Select on Billing Screen” option will be selected by default when you add a code. That means that whenever the order is made, the code will appear on the electronic encounter form, pre-selected. If you deselect this option, then the codes will appear unselected on the electronic encounter form.

Use this feature when an order may or may not require a certain billing code. The clinician can then decide whether or not to send the billing code on-the-fly, while billing.

Optional: Continue to the Other Tabs to Configure Other Billing Options

After working on your orders, you may want to make revisions to diagnosis code mapping or to the diagnoses and procedures that will always appear on the encounter form. Click on the other tabs to review other billing settings.

See the procedures below for complete instructions.

Click “Save”

Click the Save button to save your work and close the Billing Configuration tool.

Test Your Changes

Next, create a visit for a test patient and order the order. Click “Bill” to see if the correct diagnosis and procedure billing codes appear.

Link Diagnoses to ICD-10 Billing Codes

When the clinician selects a diagnosis on a chart note, PCC EHR can automatically select an appropriate ICD-10 billing diagnosis and add it to the visit’s EEF for billing.

Use the Diagnosis Mapping tab in the Billing Configuration tool to specify which ICD-10 billing diagnoses will be added to the encounter form for each SNOMED description.

Use the Search Filter to find a diagnosis, and double-click on any description to make changes.

When you edit a diagnosis, you can adjust the corresponding ICD-10 billing codes. When a clinician selects the diagnosis on a patient’s chart, what ICD-10 code will appear on the claim?

PCC EHR will not allow you to select a billing code that has expired (due to an ICD-10 code update, for example), but you can add codes that will be valid in the future.

Assisted Mapping, Manual Mapping Options

When available, the Diagnosis Configuration tool will display an “assisted mapping” option. The assisted mapping option describes any patient details or coding conventions that will determine the code. It then lists all possible ICD-10 codes for the given diagnosis description.

PCC’s ICD-10 assisted mapping comes from the National Library of Medicine. Your practice can switch to a manual mapping code to suit your billing needs.

There may also be diagnoses with no available mapped ICD-10 code. When there is no assisted mapping option, you can use the manual mapping option to set the billing diagnoses.

You Can Also Change Codes Later, As You Bill: Regardless of the assisted mapping or manual mapping settings, your practice can change the billing code later, during use. Diagnosis Mapping sets the default code that appears when a clinician first selects a diagnosis.

Map Multiple, Optional ICD-10 Billing Codes to a Single Diagnosis

You can configure multiple ICD-10 mapping options for any SNOMED diagnosis description.

When your practice decides that a SNOMED diagnosis description needs a list of optional ICD-10 billing codes, add or edit the list of ICD-10s in the Manual mapping section.

You can select the “Preselect” checkbox for one or more ICD-10 codes. If set to “Preselect”, that ICD-10 code will be added to the visit automatically when the user selects the SNOMED diagnosis. Otherwise, it will be available through a drop-down menu.

For example, your practice may want a certain ICD-10 to be preselected automatically, but allow the clinician or biller to adjust it to one of several other options that are not preselected. You can use the ICD-10 manual mapping features to create a pick-list for the clinician.

Update Previous Work-Arounds: Before the PCC 7.3 (April 2016) update, your practice may have used different SNOMED-CT descriptions to indicate well visits, mapping them for with/without abnormal findings. You may also have created Electronic Encounter Form shortcuts for BMI reporting or made different mapping options available for recording prematurity. You can now use the multiple-mapping option to reconfigure your diagnoses and your billing screens to use the new, optional mapping features.

Add Selectable Procedures to the Bill Window (Electronic Encounter Form)

As you chart a patient’s visit, PCC EHR adds diagnoses and procedures to the Bill window (sometimes called the Electronic Encounter Form, or EEF.) The Bill window can also display your practice’s list of common visit procedures, such as E&M visit codes.

Follow the procedure below to use the Billing Configuration tool to modify the Procedures list and make it useful for your practice.

Open the Billing Configuration Tool from the Configuration Menu

From anywhere in PCC EHR, click on the Configuration menu and select “Billing”.

Select a Tab to Edit Procedures (or Diagnoses)

Click on one of the section tabs to edit either the Default Procedures or Default Diagnoses section of the encounter form.

Find an Item, or Type a Custom Heading Name

Use the search field at the top to find a procedure (or diagnosis). You can search by name or code.

If you wish to add a non-selectable heading, for organizing items on the encounter form into categories, enter your heading label in the second field.

Well Visits: You do not need to add each of the age-appropriate Well Child procedures to your encounter form. Add the “Well Child (Age Auto-Calculated)” entry instead, and PCC EHR will adjust the encounter form for each new visit.

Note: If you can’t find the procedure or diagnosis you are looking for, first double-check that you are working in the correct tab (Diagnoses, Procedures) of the Encounter Form Editor. Next, check the respective tables in the Partner Table Editor (ted). The encounter form can only display procedures and diagnoses found in the Partner tables.

Multiple Units or Special Procedures?: If you need to regularly order a special procedure or multiple unit procedure, you may be able to create a new entry in the Partner Table Editor (ted) to communicate your need to the Partner billing system. Some offices use such procedures to indicate the need for a follow-up visit, for example.

Click “Add”

Diagnoses: In order to keep a complete patient record, physicians should enter all diagnoses on the chart note. All charted diagnoses are automatically added to the electronic encounter form. It is possible to enter new diagnoses on the EEF, as a message to your checkout or billing staff, but those items will not become part of the patient’s medical record.

Click and Drag Your Items to Desired Locations

New items appear in the lower-left corner of the list. Click on the drag handle and move any item to a new location.

Two Columns: Note that there are two columns on the screen. You may click and drag items between the two columns.

Optional: Delete Items

Click on any item and then click “Delete” to remove it from the list. If you make a mistake or need to rewrite a heading, simply delete an item and add it again.

Click “Save” or “Save + Exit”

Click the Save button to save your work, or Save + Exit to save and close the Billing Configuration tool.

Add Default ICD-10 Diagnosis Codes to the Bill Window (Electronic Encounter Form)

You can also additional ICD-10 codes to your Electronic Encounter Form. These codes will appear, ready for selection, whenever you click “Bill” from a chart note.

Diagnoses should always be recorded on the chart note, accompanying other assessment notes. However, there are a few unusual billing situations where you may need to add an ICD-10 billing code to an encounter. For example:

  • Some PCMH programs ask for BMI percentile coding on claims. There are ICD-10 codes for BMI percentiles that are not described by SNOMED-CT. Your practice could add the BMI percentiles to the electronic encounter form for easy selection during any visit.
  • The ICD-10 codes for abnormal well visits do not have a set of clear 1-to-1 associations in SNOMED-CT.

You can use the Billing Configuration tool to add ICD-10 diagnoses to your billing screen.

As you add diagnosis codes, remember that these codes are for billing purposes only. They will not appear on the patient’s chart note or be part of a patient’s medical history or summary of care.

Example: Configure Immunization Orders to Trigger a Diagnosis and Billing Procedure Code

Use the Billing Configuration tool to configure each immunization order so that it triggers the appropriate billing codes for both the diagnosis and the procedure. The standard PCC installation includes this configuration, and PCC Support will be happy to help you adjust your configuration.

Your practice can use the Billing Configuration tool to configure your immunization orders.

Open each order and adjust billing diagnoses and procedures.

If you add the Z23 “Encounter for immunization” billing diagnosis code to all immunizations, and add the appropriate billing procedure codes as well, it will save time later for your billers.

You can also add additional, unselected codes to orders (as shown above) in order to make them available on the electronic encounter form whenever an order is placed.

Configure the Order that Procedures Appear on a Claim

While it is not part of the claim standard, some payers have rejected vaccine procedures if they appear on a claim before the well visit code. You may encounter other situations where a payer’s claim software denies procedures based on their order.

If a payer suggests you need to rearrange the order of procedures on claims (for example, to have the physical or other visit code appear before immunization codes), you can reply to the payer that they are not following the claim standard and should pay the claim as-is.

However, PCC can also adjust your configuration to have certain procedure codes always appear first on a claim.

First, identify all of your visit codes and the payers who have asked for this non-standard configuration. If possible, obtain documentation for the corresponding requirement(s). Contact PCC Support and ask them to add these codes to the claim generation configuration file for the insurance batches for the indicated payers. PCC Support will add your list of codes to the procedure order question for the relevant insurance batch. (Under-the-hood, this question reads: “In what order should procedures appear on the claim form; list procedure codes in order by priority:”) Then, when you process claims for that payer, those codes will appear first.

  • Last modified: October 14, 2021