Research a Billing Code

The Research Code page lets you drill-down into more information when researching a specific billing code. You can use this page to select and view details for a specific procedure code table or a historical listing of associated procedure code tables in which the specified code might reside.

Note: This feature is limited to searching for the procedure code tables associated with the Reimbursement Terms portion of a selected service type within a specific contract profile.

The types of tables you can research are limited to those included in the Reimbursement Terms portion and can include the following:

Lookup Tables
DRG Weight Tables
Modifier Tables

Use this procedure to research a billing code.

Procedure

Access the Research Code page.
- Select Go To > Contract Research > Contract Profiles. The Contract Profile page opens.
- Select the contract name from the Profiles list. For more information about searching for a contract profile, refer to Select Contract Profile Research Criteria.
- Click Display Profile. The View Contract Profile page opens.
- Click Research Code in the Profile Actions section. The Research Code page opens.
Select one of the following options:
- Show Individual Tables – Returns the details for one procedure code table within the current profile that meets your selection criteria.
- Show All Tables – Returns a historical listing of all procedure code tables within the current profile that meet your selection criteria.
  Note: The selection that you make determines which fields are available as selection criteria.
Select a service type that contains the table(s) you want to view from the Service Type list.
Note: You can select any service type listed on the current profile.
Select the type of table you want to view from the Table Type list. You can select one of the following options:
- Procedure Lookup Tables
- DRG Weight Tables
- Modifier Tables
- Provider Specialty Percentage
Select the type of code you want to view from the Code Type list.
- This field is only available if you selected Procedure Lookup from the Table Type list.
Type the code you want to search for in the Code field.
- This is a required field.
Type a date in the Reference Date field or select a date from the calendar to limit your search to a specific reference date.
- This field is only available if you selected Show Individual Table above.
- When researching a code from the contract profile, this field defaults to the current date to locate the procedure code table with the most recent reference date.
- When researching a code from a specific claim, this field defaults to the billing date from the claim to locate the procedure code table used at the time of the reprice.
Type a date in the Admit Date field or select a date from the calendar to limit your search to a specific admit date.
- This field is only available if you selected Show Individual Table above.
- When researching a code from the contract profile, this field defaults to the current date to locate the procedure code table with the most recent reference date.
- When researching a code from a specific claim, this field defaults to the admit date from the claim to locate the procedure code table used at the time of the reprice.
Optionally, you can choose to disregard the status of table.
- Selecting the Disregard Active Status check box displays all tables, regardless of their status.
- Clearing the Disregard Active Status check box displays only those tables available for that profile.
- This check box is only available if you selected Show All Tables above.
Click Research Code. The details for the procedure code(s) that matched your search criteria appear.

Field Descriptions

The following table describes each of the fields on the Research Code page. The fields are listed in alphabetical order by section.

Field	Description
Selection Criteria
Admit Date	Determines which version of the lookup table was in effect for a specific claim date.
Code	Allows you to enter the specific procedure code you want to view.
Code Type	Allows you to select the type of code included in the Procedure Lookup table.
Disregard Active Status	Allows you to return all tables, regardless of their status. Click this check box to return all tables. Clear this check box to return only those tables in an active status.
Reference Date	Allows you to select the effective date to return for the lookup table you are searching for.
Service Type	Allows you to select the service type that contains the table you want to view. You can select any service type on the current contract profile.
Show All Tables	Returns a historical listing of all procedure code tables within the current profile that meet the search criteria.
Show Individual Tables	Returns the details for one procedure code within the current contract profile that meets the search criteria.
Table Type	Allows you to select the type of lookup table.
Contract Profile
Activation Date	The date the contract is available for processing.
Active Status	The status of the contract profile.
Contract Facility	The name of the facility with which the contract is held.
Contract Name	The name of the contract in the system (taken from the request form).
Effective Date	The effective date of the current contract rates.
Impl. Stage	The current implementation stage of the contract profile.
Impl. Status	The current implementation status of the contract profile.
Termination Date	The termination date of the contract, if any is present and the customer requested to include it.
Lookup Table
Activation Date	The date when the lookup table is available for use in claims processing (repricing).
Active Status	The status of the table.
Base Price	The price associated with the code.
Code Range From	The low value in a range of codes included in a table.
Code Range To	The high value in a range of codes included in a table.
Code Type	For procedure lookup tables, the type of code included in the table: REV CDM DRG CPT4 HCPC HIEC NDC HCPCPS ICD9 OTHER
Effective Date	The date when the lookup table is effective.
Impl. Stage	The current implementation stage of the table.
Impl. Status	The current implementation status of the table.
Location	The facility in which the table was created and is stored.
Modifier	The modifier that applies to the table.
No.	The sequential reference number of the item.
Override Details	Displays the amounts of any overrides associated with the procedure code in the service type.
Procedure Option	The method of reimbursement. The value is Normal for every method except anesthesia, which has several options.
Procedure Type	For procedure lookup tables, the type of procedure included in the table.
Rev Code	The revenue code.
Table Name	The name of the lookup table; the name is a link that opens the View Lookup Table page.
Termination Date	The date when the lookup table is terminated, or no longer effective.
Updated	The date, time and user information of when the lookup table was last updated.