On September 20th of 2020, PCC updated the SNOMED-CT diagnostic terms and the ICD-10 diagnosis billing codes on your practice’s system.

PCC regularly updates your system’s ICD-10, LOINC, SNOMED-CT, NDC, RVU, VIS, and other standardized lists so you won’t encounter challenges when you chart, order a lab, interface with a care provider, or bill for a visit. (Your practice’s local system automatically updates your practice’s procedure code validation, as well.)

In PCC EHR, clinicians enter diagnoses using SNOMED, which maps to ICD-10 billing codes for claims. We updated both of these codesets in order to provide you with the most up-to-date diagnostic language in the chart, and to support the 2021 edition of ICD-10, which takes effect for dates of service after 2020-10-01.

Read the sections below to learn about the updates, educational opportunities, and diagnosis codes and descriptions of particular interest to pediatricians.

Use 2021 ICD-10 Diagnosis Billing Codes, Including New COVID-Related Codes

The 2021 ICD-10 update includes new sections for COVID-19-related infections and vaping-related disorders. You can review the complete, updated guidelines in the CDC’s ICD-10-CM Official Guidelines for Coding and Reporting.

The new codes and guidelines take effect for dates of service starting on 10/1/2020. You can learn about the updates that are of most interest to pediatric practices by attending PCC Web labs held by Jan Blanchard (CPC, CPEDC). Missed a web lab? You can watch a recorded session as well.

In addition to COVID-19 and vaping-related guidelines and codes, Jan notes that the 2021 ICD-10 update includes more specificity for substance abuse codes, several adjustments to influenza coding, and new codes for reflux, headaches/face pain, and more. In the “curiosities” bucket, the update includes “Pedestrian on electric scooter and standing micro-mobility pedestrian conveyance (hoverboard, segway)” added to V00-V06.

Chart Diagnoses Mapped to Deprecated ICD-10 Billing Codes: Were there any 2021 code changes for items that your practice frequently bills? You can review your system configuration using the snomedmap report. While there were no major disruptions in the 2021 ICD-10 update, it’s always worth taking a look at your code mapping reports to head off any billing challenges.

Use the Latest SNOMED Diagnoses, Including New COVID-Related Descriptions

The SNOMED-CT update includes thousands of new descriptions for diagnoses, allergies, therapies, and procedures. It also updates thousands of text descriptions for diagnoses and their mapped ICD-10 billing codes. You can review information about the update on the National Library of Medicine website.

Review Your COVID-19 SNOMED to ICD-10 Mapping: As codesets continue to change in response to COVID-19, PCC recommends you review the diagnoses you use to chart and bill for COVID-19 issues. For example, this update includes a new recommended mapping of the Exposure to SARS-CoV-2 SNOMED description to the Z20.828 ICD-10 code. This mapping was not included by default in the previous SNOMED standard. You can double-check your practice’s diagnosis billing configuration in the Billing Configuration tool.

New COVID-19-Related Diagnosis Descriptions

The update includes 22 new diagnoses for the use of identifying when an issue is related to COVID-19. For example, there are new descriptions for otitis media and several new descriptions for respiratory distress and infections, pneumonia, bronchitis, and similar. For a complete guide to COVID-19-related descriptions, you can read the COVID-19 section of the SNOMED-CT International Release Notes.

New Favorites Available in Diagnosis Quick Search

The update adds 2043 diagnosis descriptions to your system. PCC added 245 of them to the “Favorites” quick search feature of all diagnosis fields in PCC EHR.

In preparation for the update, PCC’s certified coder, Jan Blanchard, assembled a list of 245 new SNOMED-CT descriptions of interest to pediatricians. The update added these diagnoses to your practice’s default Favorites list for quick searching, unless your practice has specifically requested otherwise.

What is a diagnosis 'Favorites' list?: As you type or search in any diagnosis field, PCC EHR automatically searches a customizable list of Favorites. Use the Diagnosis Configuration tool to adjust your practice’s list of Favorites. You can also right-click on any diagnosis field in PCC EHR to search your system’s full SNOMED-CT diagnosis library.

You can review the list of 245 new Favorite descriptions. Attend PCC’s monthly coding weblabs to learn more about the new descriptions and other coding topics.

Deprecated SNOMED Diagnosis Descriptions

The Fall 2020 SNOMED-CT update removes or replaces many codes common to pediatric practices. Your practice may want to take special note of them.

Here are the top 25 codes from PCC’s pediatric practices that have been removed from the SNOMED-CT diagnosis library in 2020. When these codes appeared for selection on a chart note protocol, PCC added a replacement if available. For other diagnoses, your providers can usually find new appropriate descriptions with a search, but you may want to plan ahead.

SNOMED Codes Mapped to ICD-10 for Billing

The SNOMED-CT update includes new mappings to ICD-10 billing codes. Many previous mappings have been updated.

You may wish to review billing configuration for your diagnoses. You can open the Billing Configuration tool to configure which ICD-10 diagnoses are mapped to each SNOMED-CT description in PCC EHR. You can also use the snomedmap report tool to examine your practice’s diagnoses that may need updating.

Watch a Video: Watch Clinical Document Exchange: The Initiator Role to learn how to configure your PCC system to submit requests and retrieve clinical documents.

Initiate a Query for Patient Records

If a new patient transfers to your practice, or if you know that an existing patient has received care at another healthcare facility, you can request and retrieve their records on demand within PCC EHR.

Open the patient’s chart and navigate to the History component. Click on “Find Clinical Documents”.

If the patient has default organizations configured, PCC EHR immediately begins querying them for records.

If the patient does not have default organizations configured, or you want to query organizations which are not part of the patient’s defaults, click the triangle beside the Healthcare Organizations to Query header.

The triangle reveals a list of healthcare organizations that your office has historically queried for the patient. Check marks appear beside the patient’s default organizations.

To query an organization that is on the patient’s list but is not a default, check the box beside it and click the “Find Patient” button.

If you want to query an organization that is not on the patient’s list, search for it by name or address and add it to the patient’s list.

Search Results Only Show Organizations You Can Query: Search results include healthcare organizations that both match your search terms and have adopted the Carequality interoperability framework.

After you add the new organization to the patient’s list, click the “Find Patient” button.

The “Find Patient” button initiates a query to all of the selected organizations for patients whose name, date of birth, and sex match yours. Each organization returns patient match results in its own table.

Patient Not Found: If an organization does not have any records that match your patient’s demographic criteria, the query will return a message that says “Patient Not Found”. If the request times out, you will receive a message that says “No response, please try again later.”

Select your patient from the query results, then click “Find Documents”.

Found documents display in a table beneath the organization and patient they are associated with.

You can filter the list of found documents by date. You can also expand the results to include previously retrieved documents, deprecated documents, and documents are of an unsupported file type.

Deprecated Documents and Unsupported File Types: Deprecated documents are flagged by the source organization for being out of date. Unsupported file types are documents that cannot be retrieved and imported into PCC EHR due to their file format.

If you want to run the query again, click the “Refresh” button in the top-right corner of the results table. The time stamp in the top-right corner of each table shows the last time a query was performed.

Query Results Remain Visible All Day: Clinical document queries persist on the Find Clinical Documents screen until 11:59 p.m. and can be seen and refreshed by all users who have query permissions. After midnight, the Find Clinical Documents screen clears its queries, leaving a blank slate for users who access it the next day.

View and Manage Retrieved Documents

Once you have determined that there is a document for your patient at a queried healthcare organization, you will need to import it in order to view its contents and save it to PCC EHR.

Click the “Retrieve” button beside the document you wish to import. If there are multiple documents and you want to import all of them, you can click the “Retrieve All” button beneath the table.

Wrong Patient? Try Again: If you realize at this point that you have requested documents for the wrong patient, you can cancel your search by clicking the “Back to Patient Match” button beneath the table.

Once you retrieve documents, the “Retrieve” button is replaced by “View” and “Reconcile” buttons. The “View” button appears for all document types. The “Reconcile” button only appears for CCDA documents.

You can open a retrieved document by clicking the “View” button.

Once open in a Document Viewer window, you can see the document’s contents and other information about it, such as its title and source, the date it was last modified, and the name of the document category under which it is saved in the patient’s chart in PCC EHR. Retrieved documents are always saved into the Retrieved Documents category when you first import them.

Click the “Edit” button to modify the document’s title, re-assign it to a different category, attach it to a visit, send it to a provider for signing, share it to the patient portal, attach it to a portal message, annotate it, or create messaging tasks from it.

You can remove the document from the patient’s chart by clicking the “Remove Document” button.

Removed Documents Get Deleted Altogether from PCC EHR: Unlike other kinds of documents in PCC EHR which return to the Import Documents screen when you remove them from the patient’s chart, clinical documents retrieved from other healthcare organizations are deleted from your PCC system altogether when you click the “Remove Document” button. Documents deleted in error can usually be retrieved anew from the source organization, as long as the source organization has not deleted them.

You can find and edit retrieved documents anytime in the Documents section of the patient’s chart.

Reconcile Retrieved Documents

You can import Problems, Medication Allergies, and Medications from retrieved documents into your patient’s chart in PCC EHR.

If you already have a retrieved document open in a Document Viewer window, click the “Reconcile” button to review and import its data.

You can also begin reconciling a document from the Find Clinical Documents screen within the History section of the patient’s chart, provided the document was retrieved the same day you are reconciling its contents.

The reconciliation window compares the Problems, Medication Allergies, and Medications in the retrieved document to those already in your patient’s chart. You can select which items, if any, you wish to import from the retrieved document.

Once you have selected all of the items you wish to import, click the “Next” button.

Review your changes. If you notice duplicate or outdated information in the preview, click “Edit” to make corrections.

The corrections you make in this window will be reflected in the patient’s chart once you complete the reconciliation.

When you have finished making corrections, click “Done” to exit the editor. Then, click “Save” to finish reconciling the retrieved document.

The patient’s Problem List, PCC eRx Allergies, and Medication History in PCC EHR will reflect the choices you made while reconciling the retrieved document.

Reconciled documents include a “Last Reconciled” date and user stamp.

You can reconcile documents as many times as you need. The “Last Reconciled” date and user stamp updates each time a document is reconciled.

Manage Default Healthcare Organizations

You can set up default healthcare organizations for just one patient and for all patients at your practice.

Set Up Default Organizations for One Patient

You can manage a patient’s default healthcare organizations within the Find Clinical Documents section of their chart in PCC EHR.

On the Find Clinical Documents screen, click the triangle beside the Healthcare Organizations to Query header.

The triangle reveals organizations which have historically been queried for this patient.

Place a check mark beside organizations that should be queried by default for the patient, and uncheck those that should not.

You can add more organizations to the list using the “add another healthcare organization” search field.

As soon as you place a check mark beside an organization, it is considered a default for this patient. Default organizations are automatically queried when users open the Find Clinical Documents section of the patient’s chart.

Set Up Default Organizations for All Patients

If your practice frequently request records from a local hospital or urgent care clinic, and that organization has adopted the Carequality interoperability framework, you can set it up as a default healthcare organization to query for all of your patients.

Click on the PCC EHR Configuration menu and select “Clinical Document Exchange”.

Use the search field to find a healthcare organization that you regularly request patient records from.

The search results include healthcare organizations that both match your search terms and have adopted the Carequality interoperability framework. Select an organization from the search results to add it to the list of healthcare organizations that should be queried by default for all patients.

Repeat this process for as many organizations as you want to query by default for all patients. Click “Save” to save the configuration and close the window.

If an organization is no longer active with the Carequality network, an Inactive icon (red triangle with exclamation point) appears beside it in the Clinical Document Exchange configuration window.

Inactive organizations are automatically hidden from patient charts, but they remain in the Clinical Document Exchange configuration list until you manually remove them by clicking the “x”.

Note: Sometimes organizations are marked inactive in the Carequality directory as the result of a name change or a change in ownership. Search for the new name of the organization to re-add it to your list of default organizations to query.

User Permissions

Allow Users to Retrieve Clinical Documents

Users require special permissions in order to query other healthcare organizations for patients’ clinical documents. Permissions are assigned on a per-user basis in PCC EHR.

Open User Administration from the Tools menu in PCC EHR.

Select a user from the list and click the “Edit” button.

Under the “Clinical Document Exchange” header, check the box labeled “This user is allowed to query for clinical documents.”

Select a role for the user. The list of roles is defined by the Carequality interoperability framework and cannot be modified. Each user at your practice may only be assigned one role. Role assignment is required.

Once you have assigned permissions and a role to the user, click the “Save” button.

Repeat this process for all users at your practice who need to be able to query other healthcare organizations for patients’ clinical documents.

Users with Clinical Document Exchange permissions are able to see the “Find Clinical Documents” button within the History section of patient charts. The “Find Clinical Documents” button is hidden from users who do not have Clinical Document Exchange permissions.

Allow Users to Manage Practice-Wide Clinical Document Exchange Settings

Some users at your practice will require special permissions in order to manage your practice’s default healthcare organizations to query. These permissions are assigned on a per-role basis in PCC EHR.

Open User Administration from the Tools menu in PCC EHR.

Click the “Roles” tab at the top of the window.

Select an existing role and click the “Edit Role” button.

Check the box for “Clinical Document Exchange Configuration”, then click “Save”.

If you would rather create a new role to manage Clinical Document Exchange Configuration permissions, click “Add Role” instead of editing an existing one.

Name the role, check “Clinical Document Exchange Configuration”, then click the “Save” button.

Assign the new role to relevant users in PCC EHR.

Users with Clinical Document Exchange Configuration permissions are able to manage your practice’s default healthcare organizations to query.

Close User Administration when you have finished assigning permissions. The new permissions will take effect the next time users log in to PCC EHR.

Pediatric practices around the country can continue to see patients, provide great care, and thrive as businesses during and following the COVID-19 pandemic.

PCC worked with practice managers and managing providers to develop this library of recommendations.

Recall Patients

PCC recommends that all practices launch a patient recall initiative. During the initial months of the COVID-19 pandemic, many practices experienced lower visit volume. Children’s developmental needs and other health concerns (diabetes, asthma, depression, and more) did not slow down, and this created an unmet need.

Consider contacting all families who have visited your practice in the past three years and schedule them for telemedicine or in-person appointments. Get your patients caught up on well visits, screenings, shots, and chronic problem and care plan management. As you provide much needed care, you will also be maintaining your practice’s relationships and your ability to help your community.

Read Why and How Pediatric Practices Should Launch a Recall Initiative Today to learn more.

Adjust How You Schedule Patients

When PCC spoke with pediatric practices, they shared changes they’ve made to patient scheduling during the COVID-19 era.

Implement the PCC EHR Appointment Book

The Appointment Book has built in Telemedicine features and can be configured with visit templates to help your schedulers. The close integration between the Appointment Book and the patient’s chart record make everything easier, from connecting to patients, to charting, to billing.

If your practice is not using the PCC EHR Appointment Book, PCC Support can help you get started.

Maximize Portal Communication

Contact your families and make sure they all have patient portal access. This will allow their initial contact with your practice to be asynchronous, which means your staff and clinicians can followup on questions and concerns whenever they are available.

By improving this initial point of contact, you can more efficiently triage issues and schedule appointments as needed.

Implement Appointment Requests in the Patient Portal

Your practice can create a patient portal template for appointment requests. Then, when the family wants an appointment, they can pick “Appointment Request” when they create a portal message.

With an Appointment Request template, you can encourage families to provide the information you need to schedule them.

Read Configure Your Patient Portal Message Templates to learn more.

Update How You Handle Scheduling Phone Calls

When your practice schedules an appointment, what do you review and communicate to the family?

Develop a quick script that informs the family what to expect when they visit your practice, and confirm demographic, insurance, and other information when you schedule. For example, if your practice requires masks, no longer uses your waiting room, or performs a phone-based checkin prior to the appointment, set that expectation when you schedule.

If your practice is implementing practice-wide credit card on file for all families, you can collect that information when you schedule. See below for more tips on CCOF implementation.

Adjust When You Schedule, Your Scheduling Blocks, and More

Review when your practice schedules different visit types, and make adjustments that balance what your families need with your practice’s enhanced safety protocols and other changes.

• Well Visits in the Morning: Some pediatric practices have implemented a “Well Visits in the Morning” schedule. That means all well visits are seen in exam rooms, normal cleaning takes place in between visits, sick visits happen in the afternoon, and the once-a-day more comprehensive cleaning happens after the office has closed.

• Sick vs. Well Locations: Another pediatric practice has two locations, and they have changed one to a “sick only” location and one to a “well visit only” location.

• Change Blocks, Stop Using Blocks: Some practices report that in 2020 they “threw out the visit template”, reworked their blocks based on daily trends, or no longer use visit blocks at all.

The above ideas may or may not suit your practice’s goals, but you might make other changes to how you schedule. In the COVID-19 era, pediatric practices need to stay agile as they tweak and adjust schedule blocks, hours, open time slots, and family expectations. As your community and culture rapidly changes in response to COVID-19, patient appointment needs will change too.

Proactively Schedule Followups and Recurring Appointments

When a followup appointment is appropriate, consider scheduling it at the same time as you schedule the initial visit, or during the initial visit. Rather than waiting the weeks or months before you contact a family to schedule, make the appointments when you have the family’s attention.

If your practice normally only schedules out six months, consider expanding that to 13 months so you can schedule annual well visits at the preceding visit.

Ask: “Could This Be a Telemedicine Encounter?”

Many practices schedule telemedicine encounters for sick visits and followup visits. Some are trying out partial well visits over telemedicine as well.

See the Telemedicine section below for ideas on expanding your practice’s telemedicine services.

Improve Your Practice’s Pre-Visit Steps

What does your practice do in advance of each appointment? During the COVID-19 era, you can examine your process and make changes that will make the visit itself easier and more efficient.

Your process might include:

• Expand When and How You Check Eligibility: Especially if you are increasing telemedicine visits or offering new services, you should review eligibility for all encounters in advance. You can do that with PCC’s built in eligibility tools. Practices report that payers do not respond to eligibility requests until 5 days previous, and anecdotally some Medicaid payers only provide day-of or day-before eligibility information. Regardless, it’s important to check eligibility as employment status, insurance payer rules, and state rules about visit types are rapidly changing.

• Implement Pre-Visit Questionnaires in the Patient Portal and/or With CHADIS: Since clinician in-person time now has additional constraints and challenges, you may want to implement or expand your pre-visit screenings or questionnaires. You can design your own questionnaires in the patient portal’s templates tool, or you could sign up for CHADIS or a similar service. PCC is working to enhance CHADIS functionality, and a partial CHADIS integration is in pilot test now. As you expand your pre-visit questionnaire use, keep in mind that you will need to adjust your workflow so the front desk or a nurse can send the families these materials or links.

• Collect Copays in Advance: In order to make in-person and telemedicine encounters as smooth and “touchless” as possible, your practice can implement a policy of collecting copays in advance of an appointment. Since account balances and payments can be done through the patient portal, families will have transparency and can see their credit if the visit ends up not requiring a copay, for example.

Change How You Checkin and See Patients

When it’s time for the encounter, what changes will your practice make to accommodate the additional challenges of COVID-19? This section includes recommendations we heard from pediatric practices across the country.

Eliminate or Reduce Use of Your Waiting Room

Some practices have closed their waiting rooms or greatly reduced any time spent in them. They tell families:

1. Wait In Your Car: Your practice can instruct families to wait in their car until the time of their appointment.

2. Call When You Arrive: When a family pulls in, they can call your front desk to checkin. You can verify insurance, demographics, and collect the copay over the phone.

3. We Will Text You When Your Exam Room is Ready: PCC’s built-in text feature means your staff can quickly select an appointment and text the family when their room is ready.

As they make these transitions in their offices, some practices are changing their long term plans for their layout. For example, could you transition your waiting room into multiple exam rooms or office space?

Virtualize Your Checkin and Precheckin Processes

By using the patient portal, texting, and the phone, some practices have eliminated all parts of the in-person patient checkin.

To facilitate encounter management, some practices create a new Visit Status in PCC EHR, such as “Precheck”, so that everyone can understand when a family has completed their demographic updates, paid their copay, and are ready for the doctor.

At The Door: Take Temperature, Provide PPE

When a family enters the building, a practice can greet them at or near the entrance. They can use this opportunity to take temperatures and to review PPE guidelines for the practice.

If a patient or family member is not wearing a mask, a practice can optionally provide masks for them to wear.

Consider Car Visits and Shot Tents

PCC heard from practices that now see their patients right in their cars.

Instead of an exam room, the clinician visits the patient in the parking lot of the pediatric practice.

When an immunization or other medical procedure is needed, they can use a “shot tent” or station set up for that purpose.

Plan for Flu and Immunization Clinics

If your practice performs annual flu clinics, where you bring in patients en masse for their flu immunization, you can make adjustments to your usual procedures and do the same in 2020 and beyond.

Similarly, if you implement Telemedicine well visits (some practices are trying), you may have a backlog of kids who need to come in for immunizations. When COVID-19 vaccines are developed, pediatric practices may be an important part of distribution and administration.

Practices can work now to improve their “immunization-only” visit workflow and how they might run clinics while maintaining enhanced safety protocols.

Read More Here: Run a Pediatric Drive-Up Flu Shot Clinic

Implement and Expand Your Telemedicine Services

Telemedicine encounters can provide effective care without physical contact. During the COVID-19 era, practices across the country have expanded their use of phone, portal messages, and video telemedicine encounters. When a practice schedules a sick visit or a followup visit, they can stop to ask the both the family and themselves, “Could we do this as a telemedicine encounter?” The answer is often “Yes!”

You can learn how to use PCC EHR’s tools for these encounters here:

• Schedule, Chart, and Bill for a Telemedicine Encounter (Video, Article)
• Bill For Phone Calls and Portal Message Encounters (Video, Article)

Read below for an overview of tips and recommendations we heard from pediatric practices.

Schedule for Telemedicine Appointments

When you schedule a telemedicine encounter:

• Actually Schedule Telemedicine Encounters: A telemedicine encounter is not just a phone call that you decide to bill for later. Schedule your Telemedicine encounters. Adjust your schedule’s visit reasons, blocks, and more to make telemedicine a real part of your practice’s offerings that you will bill insurance for.

• Use the PCC EHR Appointment Book: When you schedule a telemedicine encounter in the Appointment Book, a telemedicine icon appears with the encounter for all users, additional fields are available for telemedicine connection information, and PCC EHR can optionally designate a telemedicine billing place of service based on your configuration.

• Perform Precheckin When You Schedule: As with any encounter in the COVID-19 era, it is important to review and update information as soon as you can, to make the actual encounter run smoothly. Update patient information, verify insurance, and collect credit card information for the copay when you schedule.

• Set Expectations: When you schedule a telemedicine encounter for a family, tell them exactly what to expect. For example, when will the practice call them for pre-visit questions? How will they receive telemedicine connection information? Let them know during scheduling.

Perform “Precheckin” Calls Before a Telemedicine Encounter

On the day of a telemedicine encounter, or the day before, your practice can call the family. At some practices, this call is made by the MA or nurse. During that call, they:

• Update Patient and Family Information: Verify demographics, insurance, and other details.

• Collect Money: Collect copays and payments for any outstanding balances. Since billing and collection for telemedicine visits are rapidly changing, some practices have made it their policy to always collect the copay ahead of time and issue a refund later once the EOB arrives.

• Tell Them How to Connect: Provide technical instructions on how to connect to the encounter. The caller can provide the telemedicine link verbally, and also send a portal message or followup text message with the URL, using PCC’s direct text message feature.

• Update Visit Status: When the precheck phone call is complete, the practice updates the Visit Status for the appointment so the practice can see it has been completed and the patient is ready for the telemedicine encounter.

Adjust Encounter Workflow, Charting, and Billing for Telemedicine

You can make changes to your workflow and PCC EHR configuration to help telemedicine encounters be successful.

For example, create additional Visit Reasons, Visit Statuses, and custom chart note protocols that include tools for recording information during a telemedicine encounter.

If some parts of a visit must be done separately, you must decide how you will chart and bill for the two different parts.

To help chart a telemedicine protocol, create one or more telemedicine protocols for your clinicians.

Get Paid and Maintain Practice Revenue

This section collects recommendations and tips for pediatric billing and collections during the COVID-19 era.

Here are some general recommendations:

• Consider Billing For Other Encounter Types: Prior to 2020, you may not have billed for phone consultations or portal messages. Many practices now do, and PCC has a guide which can help.

• Adjust Your Electronic Encounter Form: After a clinician is finished with an encounter, they click “Bill” to review diagnoses and procedures and select a visit code. You can customize your practice’s electronic encounter form to include phone consultations and telemedicine-related procedures to make it easier to bill for services.

• Update Your Chart Note Protocols and Orders: When you click on a procedure or other order on a chart note, PCC EHR can automatically add the appropriate CPTs to your encounter form. Review your lab, radiology, referral, and other orders so that they appear by default on appropriate chart notes and will automatically queue up the correct codes for billing.

Streamline Personal Payment Collection

Across the country, pediatric practices are finding ways to make personal payment of copays and outstanding balances as quick and “touchless” as possible.

• Implement Portal Payments: Families can pay their copay and outstanding balances in the patient portal. Read Get Started with Portal Payments to learn more. Once you’re set up, work with your schedulers and staff so that they can prompt families to use this service.

• Implement Credit Card on File (CCOF) for All Families: Your practice can use a third-party service to securely store credit card information, and incorporate CCOF into your practice’s billing policies. When you use portal payments, credit card information is similarly stored by a third party, but by expanding CCOF to all families for other billing needs, you can streamline payment and avoid problems at the time of service. Ask your bank and your merchant services for information about CCOF service. If you are doing portal payments with PCC, you have an existing contract with BluePay, a company which also offers CCOF for other billing needs. You can use a CCOF account flag and clinical alerts in PCC EHR to both drive adoption (by checking if a family has CCOF yet) and inform staff. You can then also create a custom report for the current week’s appointments showing who has CCOF and who still needs it set up.

• Collect Copays In Advance: As mentioned above, many practices have begun collecting copays during a pre-visit checkin call. For some encounter types, it may not be clear if a copay is needed. A practice can collect the copay for every visit and issue a refund later when the EOB arrives.

Get Paid By Your Insurance and Medicaid Payers

Are your insurance and medicaid payers paying you for Telemedicine visits in parity with your in-person sick visits? According to regulations in some areas, they should be. You can research this and other topics at the COVID-19 section of your Practice Vitals Dashboard.

For common coding topics during the COVID-19 era, read Code and Bill for a COVID-19 Related Encounter, or take a look at PCC’s quick COVID-19 Coding Guide.

As insurance companies learn to respond properly to changing circumstances, your practice may need to be extra vigilant as you review claim rejections and underpayments and resubmit.

Is Billing Place of Service Still an Issue for Telemedicine?

Early on in the COVID-19 era, some practices encountered challenges with the billing place of service used on claims.

Insurance payers have mostly improved how they handle this. PCC has seen good response in many states to telemedicine billing and other encounter changes that practices have needed to make.

However, just in case, your practice should know about the capabilities in PCC EHR:

• Set Default Telemedicine Places of Service: Your practice can set default telemedicine billing places of service per scheduling location.

• Select Billing Place of Service When You Post: Your billers can select or change an encounter’s billing place of service when they post charges.

• Change Billing Place of Service for Previously Posted Charges: If needed, your biller can even update the billing place of service for charges after they have been posted.

Apply for a CARES Grant and Other Available Support

Pediatric practice across the country have participated in the federal government’s CARES program, which includes grants and money for small business loans. As the COVID-19 pandemic continues, every practice should stay abreast of these opportunities, and PCC will help keep you informed.

• PCC’s Guide to Applying for CARES Medicaid Relief Fund

For UC 2020, PCC is running a chat feature to keep users connected as we attend remote sessions. Presenters and instructors will use the chat as a way to field questions and facilitate discussion, and it can also be used to talk and connect with other session attendees.

The chat will be live for the duration of our virtual UC, and you can access it outside of session hours. For more details about UC 2020, and a session schedule and links, visit the UC 2020 page on pcc.com.

Sign up for UC Chat

Use the link you received from PCC Marketing to reach the registration page.

Enter your email address, and select a username and password. The chat tool will then send you a verification email.

When you receive the verification email, simply click on the Verify Email button to complete the process.

Now you’re ready to log in!

Logging in to UC Chat

Follow the link from PCC’s UC2020 page, or manually enter the URL for chat in your browser: https://uc2020.pcc.com/uc2020

Enter your email and password to log in to UC Chat.

How to Use UC Chat

On the right is the main message window, and on the left you can select from different channels, or message threads.

Discussion Channels

There are two main channels:

• UC Lobby: This is for general chat and conversation. Talk and connect with other Virtual UC attendees.
• Live Session: This channel is for questions and discussion about UC sessions as they are happening. During sessions, this channel will be moderated and monitored by a PCC staff member, and is where you can ask presenters questions.

Other Channels

There are other channels that provide opportunity to connect directly with other practices who are similar in size and scope. To add them to your ribbon, Click on “More…”




There are channels specific to different sizes of practices, as well as a channel specifically for start up practices. Join one or more of these channels if you want.

There are also channels here for virtual vendors. If you would like to connect directly with one of the vendors, you can do so here.

Direct Messages

If you want to chat with one or more people directly, you can do so by sending a direct message. First, click on the plus next to Direct Messages.




Find and select the person or people you want to message, and then click the “Go” button.




You can now begin messaging these people. Your recent direct messages will appear in the ribbon on the left for easy navigation.

Preferences and Settings

You can change your username, notification settings, avatar, and other details in the Account Settings menu.





The first screen here, “General Settings” gives you options to change your user name and email. You can fill out the “Position” field to let people know more about who you are; it can be helpful to include your position and the name of your practice. You can also add a profile picture here.

Notifications

You can also change your Notification preferences in Account Settings, under the “Notifications” tab.

Use PCC EHR’s Snap Text to enter commonly used words, phrases, or longer texts with just a few keystrokes.

To watch a video about Snap Text in PCC EHR, click here.

Each user can customize their own personal Snap Text and your office can set practice-wide entries for all users.

Set User Permissions

Creating and managing the practice-wide Snap Text list is accessible via the User Administration tool. To add permission to user role, open the User Administration tool and visit the Roles tab, select a role, and check the Snap Text Configuration box.

Open the User Administration tool and visit the Roles tab, select a role, and check the Snap Text Configuration box.

For a more detailed guide to setting up roles and configuring user permissions, read Set User Roles for Permissions and Security.

Create Snap Texts

Open My Account within PCC EHR’s File menu and select the Snap Text tab.

Each user is listed in the drop down menu on the upper right. By default your PCC EHR account is selected.

Here, you’ll find two columns, one for the typed text and one for the expanded text.

To add a new Snap Text, click “Add.” Enter the typed text in the first field, and the full, expanded, text in the second. The short text should be a few characters long, and the expanded text can be as long as you need.

Typed text can be any combination of characters. It is case sensitive, so the expanded text will only be triggered if the letter case matches. That also means that “ABC” and “abc” can both be used to trigger different expanded texts.

Avoid Common Words, Use a Prefix Character: Whatever short codes you enter will be automatically replaced by the expanded text. Avoid using real words that might be used in a different context. Consider using a special character prefix before your code. For example, “.adhd” to expand to “Attention Deficit Hyperactivity Disorder” while still leaving “adhd” available to be used without being expanded.

Click Save, and you’ll be returned to the Snap Text tab, where you can add another or Save and Exit.

The Practice Defaults list, managed by users with permission, as described above, are available to all users automatically. If a user creates a Snap Text in their own list that matches a practice default typed text, the user’s snap text will take precedence over the practice default for that user.

Copy And Edit Snap Texts

Each user can view, but not edit, the snap texts of other users.

When reviewing another user’s entries, any user can copy entries to their own list by using the copy button at the bottom of the tab.

Any of your own snap texts, even those copied from other users, can be edited by selecting it from your list, and clicking the edit button. Simply change the text, or if it’s no longer needed, click the delete button to delete it from your list.

To find and edit or copy specific texts, use the Search Filter to find all texts, both typed and expanded, containing a word or phrase.

Using Snap Texts

Type any of your short typed texts into a PCC EHR text field, and the expanded text will automatically replace the short text when you type a space, or in the case of multi-line text fields, enter or return. After text is expanded, you can use ctrl.+z or select “Undo” from the Edit menu, to remove the expanded text and return to the short typed text.

Alternately, instead of memorizing and typing your short texts, you can open a list of your Snap Texts by typing Ctrl+Shift+. or, on a Mac, command+Shift+..

You can also right-click or control-click and select “Insert Snap Text” to open the list of snap texts. Select one, or begin typing to search both the short and expanded text columns.

You can use the Lab Configuration tool to create and track lab orders for COVID-19 tests. Your PCC EHR system includes codes and descriptions for SARS-CoV-2, including the newer 95209-3 SARS-CoV+SARS-CoV-2 Ag test.

Watch a Video: Watch a video walk-through of creating a COVID-19 lab order.

CMS Guide to Becoming Certified for Lab Testing: On 2020-09-25, CMS released new tools for laboratories seeking Clinical Laboratory Improvement Amendments (CLIA) certification to test for coronavirus disease 2019 (COVID-19).

Procedure Code Guidance: The procedure codes discussed in this article are intended only as examples. You should consult the AMA’s current CPT Coding Guide and work with your insurance payers to verify what codes you should report on claims. Your practice updates and maintains your billable procedure list, codes, and prices in the Procedures table in the Tables configuration tool on your PCC system.

Open Lab Configuration

Open the Lab Configuration window from PCC EHR’s Configuration menu.

Add a New Lab and Configure Details

Click into the Lab Orders tab, and click the “Add Lab Order” button to create a new lab.

Enter the lab’s name, default lab facility, and other details.

Set Default Lab Behaviors

Next, review and edit the settings and default behaviors for this lab order.

• Specimen Collection: If you wish to record specimen collection information for this lab order, click “Enable recording of Specimen Collection user, date, and time”.

• Appear on Patient Reports and My Kid's Chart: If you wish this lab to be visible by default on patient reports, including the Patient Visit Summary and My Kid’s Chart (the patient portal), select “‘Include on Patient Reports’ will be selected when this order is issued”. Clinicians can determine whether or not a lab order is visible at any time for any order by selecting the check box on the specific order for a patient.

• Refusal and Contraindication: If a lab order can be refused or contraindicated, select the appropriate options to enable those checkboxes on the order.

Add COVID-19 Lab Tests for Third-Party Vendors

If your practice receives results for this lab order electronically from LabCorp or Quest you can add their specific lab test to this lab order. Both LabCorp and Quest have provided lab codes for COVID-19 tests. Enter those into the E-lab Vendor Order Mapping:

• Labcorp COVID-19 Test: 139900
• Quest SARS-CoV-2 RNA, Qual Real-Time Test: 39433

PCC EHR will be able to correctly associate and track the lab results with the order in the patient’s record. For more information about e-labs, read the Import E-lab Test Results article.

Optional: Add Specific LOINC Lab Tests for Manual Results

Type a LOINC code or test name in the “Tests to Include” section to add a LOINC test’s fields for manual entry to your lab order.

For example, you could add the 95209-3 SARS-CoV+SARS-CoV-2 Ag test.

Click “Save”

Click Save to save your lab order changes.

Configure Billing

Open Billing from the Configuration menu. Search for your new lab order, select it, and click “Edit”.

If you’re collecting and preparing the specimen for analysis by an outside laboratory, enter the specimen collection procedure, 99000 Handling and/or conveyance of specimen for transfer from the office to a laboratory, in the CPT Billing Procedure field. Additional procedures can be linked by clicking the plus button to add a new line. Click save and the selected procedures will be included in the visit’s bill.

Depending on whether or not your practice is actually performing a lab, you might add one or more of the following procedures to the lab order:

• 87426 Infectious agent antigen detection by immunoassay technique
• 87635 Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), amplified probe technique
• 86328 Immunoassay for infectious agent antibody(ies), qualitative or semiquantitative, single step method (eg, reagent strip); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19])
• G2023 Specimen collection for severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), any specimen source.

  Note: This code is for use by independent labs, not private offices.

• U0002 2019-ncov coronavirus, sars-cov-2/2019-ncov (covid-19), any technique, multiple types or subtypes (includes all targets), non-cdc

For more information, read Code and Bill for a COVID-19 Related Encounter.

Optional: Add Labs to Protocols

You can order any lab from the Labs component, which is already available on most of your chart protocols. Specific labs can be added to each protocol- if you’re creating a visit type just for these tests, use the PCC EHR Configuration Tool to add the labto your chart note protocols. Contact PCC Support for assistance.

Test Your New Lab Order

Create a sample visit for a test patient and order your new COVID-19 lab. You should see appropriate tests inside the order, and if you added the Specimen Collection (or other CPT), it should appear on the Electronic Encounter Form.

For additional help setting up your labs or adding them to your protocols, please contact PCC Support.

How does a pediatric practice code and bill for COVID-19 related encounters? Read below to learn about the SNOMED-CT, ICD-10, and CPT codes available for tests, diagnoses, and more. PCC Support can help you customize your chart note protocols, diagnoses, orders, and billing tools.

New Codes On Your System: Throughout 2020 and into 2021, PCC regularly updated your system to add vendor lab identifiers, SNOMED-CT descriptions, ICD-10 codes, and LOINC codes to help with COVID-19-related orders, charting and billing. Contact PCC Support if you have any questions or can’t find the code you need.

Procedure Code Guidance: The procedure codes discussed in this article are intended only as examples. You should consult the AMA’s current CPT Coding Guide and work with your insurance payers to verify what codes you should report on claims. Your practice updates and maintains your billable procedure list, codes, and prices in the Procedures table in the Tables configuration tool on your PCC system.

Code for Exposure or Other COVID-19 Related Symptoms

How do you code for exposure to COVID-19? What other diagnoses are used for a COVID-19 encounter, and how might you map those to SNOMED descriptions for use on a chart note?

Exposure

When you diagnose exposure to COVID-19, you can use:

• Z20.822 Contact with and (suspected) exposure to COVID-19
  • SNOMED-CT Mapping Option: Exposure to SARS-CoV-2 (alternate title: Exposure to 2019 novel coronavirus)

History, Associated Symptoms, and More

What other ICD-10 billing codes, and corresponding SNOMED descriptions, are available for COVID-19 related encounters?

• B97.21 SARS-associated coronavirus as the cause of diseases classified elsewhere
  • SNOMED-CT Mapping Option(s): Suspected disease caused by severe acute respiratory coronavirus
• Z86.16 Personal history of COVID-19
  • SNOMED-CT Mapping Option(s): H/O: viral illness, H/O: infectious disease
• Z86.19 Personal history of other infectious and parasitic diseases
  • SNOMED-CT Mapping Option(s): History of disease caused by Severe acute respiratory syndrome coronavirus
• Z03.89 Encounter for observation for other suspected diseases and conditions ruled out
  • SNOMED-CT Mapping Option(s): Disease caused by Severe acute respiratory syndrome coronavirus 2 absent
• M35.81 Multisystem inflammatory syndrome (MIS)
  • SNOMED-CT Mapping Option(s): Acute organ dysfunction due to systemic inflammatory response syndrome, Systemic inflammatory response syndrome, Systemic inflammatory response syndrome associated with organ dysfunction, Systemic inflammatory response syndrome without organ dysfunction
• M35.89 Other specified systemic involvement of connective tissue
  • SNOMED-CT Mapping Option(s): Disorder of connective tissue co-occurrent and due to systemic disease
• J12.82 Pneumonia due to coronavirus disease 2019
  • SNOMED-CT Mapping Option(s): (pneumonia diagnosis descriptions)

You might also use other diagnoses for common signs and symptoms:

• R051-R059 Cough
• R06.02 Shortness of breath
• R50.9 Fever, unspecified

Code for a Screening Encounter?: In December of 2020, the WHO added another related ICD-10: Encounter for screening for COVID-19 (Z11.52). During the COVID-19 pandemic, a screening encounter code is generally not appropriate. For encounters for COVID-19 testing, including preoperative testing, code instead as exposure to COVID-19.

Adjust Your PCC EHR Chart Note Protocols to Display COVID-19 Related Diagnoses

To make them easier to select, you can use the Protocol Configuration tool to add diagnoses directly to your practice’s chart note protocols.

When clinicians select a SNOMED diagnosis description, the mapped ICD-10 billing code appears on the Bill screen.

Many codes include pre-defined mapping. Use the Billing Configuration tool to adjust the mapping of SNOMED-CT descriptions to ICD-10 codes. Possible SNOMED to ICD-10 mappings are listed in the section above with each billing code.

Order and Code for COVID-19 Lab Tests

During an encounter, you may decide to order a COVID-19 test. When you order a COVID-19 test, your practice might collect the specimen and relay the test to a lab vendor for processing. Increasingly, pediatric practices are also completing tests in-house.

In PCC EHR, when you click “Order” next to a lab order, the appropriate LOINC will be part of the order, appropriate diagnoses and procedures can be queued up for billing, and optionally the lab test information can automatically be added to the chart note for incoming electronic results.

Set Up Your COVID-19 Lab Test Orders: You can learn how to create a COVID-19 lab test order on your system, add it to chart note protocols, and configure billing behavior by reading: Create a COVID-19 Test Lab Order. For additional details about Lab Configuration in PCC EHR, you can read Lab Configuration.

Billing Codes for COVID-19 Tests and Orders

When you gather the specimen for a COVID-19 test, you can bill:

• 99000: Handling and/or conveyance of specimen for transfer from the office to a laboratory

Depending on your lab configuration, and whether or not you perform the test in-house, you may use additional procedures for a COVID-19 test:

• 87635: Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), amplified probe technique
• 87426: Infectious agent antigen detection by immunoassay technique
• 86328: Immunoassay for infectious agent antibody(ies), qualitative or semiquantitative, single step method (eg, reagent strip); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19])
• U0002: 2019-ncov coronavirus, sars-cov-2/2019-ncov (covid-19), any technique, multiple types or subtypes (includes all targets), non-cdc
• G2023: Specimen collection for severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), any specimen source. Note: This code is for use by independent labs, not private offices.

In PCC EHR, you can map your orders directly to the procedures you bill so they will automatically appear on your electronic encounter form automatically.

E-Lab Configuration Identifiers

You can configure lab orders so results will be sent back to your practice electronically, if your lab vendor supports e-lab integration.

Labcorp and Quest have provided the following vendor-specific identifiers, which PCC added to all practice systems:

• Labcorp COVID-19 Test: 139900
• Quest SARS-CoV-2 RNA, Qual Real-Time Test: 39433

Code and Bill a COVID-19 Diagnosis

During an in-person or telemedicine visit for a patient with a COVID-19 diagnosis, you would code both the COVID-19 diagnosis and related conditions.

When you indicate a COVID-19 diagnosis with a SNOMED description, use:

• 840539006 Disease caused by 2019-nCoV: This diagnosis has alternate, searchable names of “Disease caused by 2019 novel coronavirus” and “Disease caused by Wuhan coronavirus”.

In PCC EHR, you can select this diagnosis on a chart note and/or add it to a patient’s Problem List.

For all encounters that occured after April 1st, 2020, use this code when you bill for a visit with a patient with a positive COVID-19 diagnosis:

• U07.1 COVID-19

This code was added to all PCC systems with a 2020-03-23 update. By default in PCC EHR, when you select the SNOMED COVID-19 description, the ICD-10 COVID-19 code will appear:

For services rendered prior to the April 1st effective date of U07.1 COVID-19, the CDC recommends you chart and code for the conditions of Pneumonia, Bronchitis, Lower Respiratory Infection, Respiratory Infection NOS, and ARDS, and then adding B97.29 Other coronavirus as the cause of diseases classified elsewhere. Before the specific COVID-19 ICD-10 diagnosis code is in effect, use the less specific B97.29 secondary to the manifestation code to indicate the patient has COVID-19.

Details May Change: The above scenarios and COVID-19 codes are new and payer response may vary. PCC keeps an up-to-date handout with COVID-19 coding and billing recommendations here: 2020 COVID-19 Coding Guide. We will update that PDF and this article as the situation changes and we learn more.

Use Other Procedure CPTs for COVID-19 Related Visits

In addition to the codes mentioned above, here are some other CPT codes you might use in relation to a COVID-19 related encounter.

Code for Telemedicine, Phone Calls, Portal, Email and Other Remote Services: What CPT visit code should your practice use for a video telemedicine encounter, a telephone call, a portal message consultation, or other remote service? PCC is maintaining a COVID-19 Coding Guide with descriptions of appropriate codes for different circumstances. You can also read PCC’s Schedule, Chart, Code, and Bill for Telemedicine Encounters.

Bill for COVID-19 Risk Counseling

Your practice may talk with a patient or parent at length about COVID-19 risk. You could use:

• 99401: Preventive medicine counseling and/or risk factor reduction intervention(s) provided to an individual (separate procedure) approximately 15 minutes
• 99402: …approximately 30 minutes
• 99403: …approximately 45 minutes
• 99404: …approximately 60 minutes

You may use these codes for COVID-19 risk reduction and prevention counseling. You can add these codes onto a claim with other office visit codes, or they can stand alone.

Are These Codes Okay for Telemedicine?: Although these codes do not appear in Appendix P of the CPT manual, which lists telehealth or telemedicine codes, many states are currently mandating that all services, including the 99401-99403 codes, be billable in a telemedicine encounter.

Add-On CPTs for Urgent and Unusual Circumstances

If an emergency appointment disrupts your office’s schedule, such as the sudden arrival of a patient with Acute Respiratory Distress, you can use this additional code on the claim:

• 99058: Service(s) provided on an emergency basis in the office, which disrupts other scheduled office services, in addition to basic service

If you have to leave the office for an emergency visit that disrupts your schedule:

• 99060: Service(s) provided on an emergency basis, out of the office, which disrupts other scheduled office services, in addition to basic service

If you leave the office for an encounter at the request of the patient or family, you might add:

• 99056: Service(s) typically provided in the office, provided out of the office at request of patient, in addition to basic service

We're Seeing Kids in the Parking Lot. Is That a 99056?: If the patient or family makes a special request for you to come out to the parking lot to perform a visit, you may add this code. If your practice sees patients in your parking lot as your general office policy during the COVID-19 epidemic, this code may not apply.

Vaccine, Administration, and Counseling Codes

Payment for administration of COVID-19 vaccine varies among payers and states. You should consult your CPT resource for guidance, and speak with your payers.

Guide to COVID-19 Vaccines in PCC EHR: Read COVID-19 Vaccines: Plan, Configure, Order, Administer, and Track to learn about the MVX, CDX, NDC, and CPT codes needed for COVID-19 vaccine encounters.

How to code for COVID-19 vaccine-related encounters has continued to evolve and change during 2021. For example, in June of 2021, North Carolina Medicaid changed their payment policy for CPT 99401 (Preventative medicine counseling and/or risk factor reduction intervention) to allow for an additional 15 minutes to counsel about the benefits of receiving COVID-19 vaccine. They require a CR modifier on the code. When this change occurred, PCC reached out to North Carolina clients.

If you learn of similar updates to policy, please reach out to PCC and/or PCC Community to share!

When you update a patient’s demographics, you can select from your practice’s list of races and ethnicities and enter any language from the full CDC OMB lists. You can have up to three races, ethnicities, and languages listed on a patient’s chart.

PCC EHR includes a default list of races and ethnicities, but your practice can optionally add any race or ethnicity from the full CDC OMB lists.

For convenience, you can search the list below to see if what you need is available in the CDC standards used in PCC EHR. Contact PCC Support to have any of the races or ethnicities below added to your practice’s drop-down lists. All languages are always available in PCC EHR.

Races

Default List

• American Indian or Alaska Native
• Asian
• Black or African American
• Native Hawaiian or Other Pacific Islander
• White
• Other Race
• Prefers not to answer

Other Available Races in PCC EHR

Ethnicities

Default List

• Hispanic or Latino
• Not Hispanic or Latino
• Prefers not to answer

Other Available Ethnicities in PCC EHR

Languages

Default List

All languages defined in the CDC OMB list are always available in PCC EHR.

Languages in PCC EHR