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Researching a CPT or HCPCS code

Working in the Toolkit you will often need more information about the CPT or HCPCS Code associated with a charge item. You may also want information on CPT or HCPCS Codes not currently in your CDM. Chargemaster Toolkit provides two resource locations for additional information. Active Code Book, invoked from the main menu, displays information on whatever charge item is selected at the time. The Active Info Window, displayed as a split screen in the active window, also provides information relevant to the selected code.

Options checklist

Locate specific detail about a CPT or HCPCS Code, including applicable revenue codes and modifiers, Payment Status Indicator, Payment Rate, etc.
Search on a description only to locate the CPT or HCPCS code.
Search for detail about a CPT or HCPCS Code that is not currently in the CDM.
Search CMS Program Transmittals and Local Coverage Determinations related to a particular CPT or HCPCS Code.
View competitors’ pricing information for a particular item.
View all the new CPT and HCPCS Codes for the current year.
Perform fee schedule analysis on multiple charge items.

Key information and lessons from the field:

Anytime you see the blue “i” icon displayed you can pull up detail about a particular CPT or HCPCS Code in the Active Code Book. Information about the selected code is displayed including code details, acceptable revenue codes and modifiers, a list of every charge item in your CDM that contains the selected Code, compliance issues associated with the Code, payment status indicators, fee schedule information and links to search LMRP, LCD and CMS program transmittals as well as Hospital and Physician CCI edit information. You will also find replacement CPT/HCPCS codes and applicable linked Codes that exist in your CDM.
When you do not know the appropriate CPT or HCPCS Code, you can do a description search, either on an existing item description or on any description you type into the tool. You can search by right clicking on a specific service description in the active window and choosing “search code book” or by clicking on the magnifying glass icon. When performing a typed in search it is important to limit your description to only include key words to limit the number of possible matches returned.
Herceptin 440mg Injection will deliver over a thousand possible matches because the Toolkit uses all of the words entered in the search. Removing the word Injection reduces the results to a few hundred. Herceptin alone will display two results. Using only key words when performing your search will create a more successful and accurate search of the codes you attempt to find.
The View menu option within the Active Code Book lists all new CPT and HCPCS codes for the past two years, their effective dates and identifies if each code is used in your CDM. Depending on the user’s permissions new codes can be added to the CDM through this tool.
By entering the CPT or HCPCS Code into the Active Code Book a user can pull up the code detail for any Code.
Information displayed in the Comparative Pricing Tool option in the Active Info Window is driven by both the CPT or HCPCS Code and the first two digits of the revenue code used with the charge item. Depending on the CPT/HCPCS and revenue code used by your selected competitors, you may or may not see pricing information.
When working in the Modifier Mismatch Tab and the Compliance Tab it is important to have the Active Info Window open so that the corresponding information can be reviewed. The Active Info Window can be opened or closed by selecting Active Info in the Tools menu.
When creating filters using the Fee Schedules in the Active Info Window it is important to remove the filter when you are finished. You will know there is an active Fee Schedule filter on because the Toolkit will place a funnel with a green check on the Fee Schedules Tab in the Active Info Window. If you don’t see all the records you expect in the Active Window, check if you have a filter turned on.

Researching a CPT or HCPCS code

Options checklist

Key information and lessons from the field:

Further Reading: