Validating Places of Service with CPT Codes

We are able to verify that the right place of service is chosen based on the CPT code.For example, a 99262 is a Hosp Consult, so it should not be done in the office.

We have built a table of CPT codes and valid Place codes.The charge entry program and the Insurance Edit Program will report any occurrences of bad place codes.

/u/Zybex/cyber/run/validplc.crd

;  validplc.crd
99200-99215=01,09,  ,  ,  ,  ,  ,  ,  ,  ,  ; E&M codes office visits
99217-99239=02,  ,  ,  ,  ,  ,  ,  ,  ,  ,  ; Hosp Visits
99241-99245=01,06,07,04,05,09,10,  ,  ,  ,  ;    Consults
99251-99255=02,04,  ,  ,  ,  ,  ,  ,  ,  ,  ;  Hospital Consults
99261-99263=02,03,04                        ;  Hosp
99281-99288=07                              ;
99291-99292=02                              ;
99295-99298=02                              ;
99300-99320=03,04,  ,  ,  ,  ,  ,  ,  ,  ,  ;    Nursing Home Visits
99321-99333=10                              ;  Long Term Care
99341-99350=06                              ;  Home Visits
99354-99355=01                              ; Prolonged Office Visit
99356-99357=02                              ; Prolonged In Pt.
99358-99359=01,02,05,04                     ; Prolonged w/o contact
99360-99360=02,04,05,07                     ; Phys. standby svcs
99361-99373=01,02,04,05,07                  ; Phys Phone COnsult
99374-99375=03,04,06                        ; Home health Supervision
99377-99378=08                              ; Hospice Care superviosn
99379-99380=03                              ; Nursing Fax Supervision
99381-99397=01,09                           ; Preventive Visits
99401-99429=01,02,03,05,09                  ; Prev Counseling
99431-99431=02                              ; Newborn care in hosp
99432-99432=01,07,09                        ; Newborn Care, not hosp.
99435-99435=02,05                           ; Newborn discharge hosp
99436-99440=02,05,07                        ; Attendance Birth
99450-99455=01,09                           ; Disability exam

SWITCH TO PLACE CODE
1 =11,  ,      ; Office,  Outpatient 
2 =21           ; In Patient Hosp.
3 =32,  ,  ,  ; Nursing Home
4 =31           ; SNF
5 =22           ; outpatient
6 =12           ; Home
7 =23           ; ER
8 =34           ; Hospice
9 =71           ; Clinic
10=33          ; Long term Care
 

 

 

 

This feature is available in CyberMed Release 9.5 or later.

 

CSR Setup:  validplc.crd must be in the Run PPN.

Insedt.run  Ver 9.4(112)

Multoi.run  Ver 9.4(140)