We have a case where we need to only allow a handful of CPT codes to be billed to a particular program. The program reimburses for those codes only. We’ve built the program as an insurance because we send them the 1500 form for claims.
I am trying to figure out a way to prevent any other codes from being put on the progress note. I thought I could use the Valid Insurance/CPT/ICD Combinations to set this up. I have set up my rule, created an encounter on a test patient that should trigger the rule and clicked done. No alert appears to warn the provider that there are problems. I’ve read several posts on here that sound like it did do this. I’m guessing that I am missing something.
I have selected the insurance company in the “select insurance” section.
I have added the CPT Codes that are valid in the “cpt codes” section.
I have added the ICD Codes that are most often used on these encounters in the “icd codes” section.
I cannot find any documentation in ecw’s knowledge base to verify that I am setting this up properly. I know sometimes my logical mind doesn’t process the same as ecw.
I tried using the Invalid Insurance/CPT/ICD Combinations for one of the CPTs that I don’t want to check my logic. That alert appears as expected when clicking the done button on the progress note. This would work except there are only 14 cpts that I do want so trying to eliminate all the others would be a maintenance nightmare.