Add or Edit Schedule Data in a Procedure Lookup Table

1. Access the Edit Schedule page.
   • Select Go To > Contract Loading > Lookup Table Management. The Lookup Table Management page opens.
   • Select Procedure Lookup for the Table Type.
   • Select Checked out by me for the Check Out Status, and then click Refresh View. A list of available tables appears.
   • Click a link in the Table Name field of a table that is checked out to you. The Edit Lookup Table page opens.
   • Click the Edit Schedule link. The Edit Schedule page opens. 
2. To add a schedule entry to the table:
   • Type or select the values in each field as needed:
     • Code From
     • Code To (Not available for Code Type ICD10)
     • Code Type
     • Rev. Code or TOS
     • Modifiers – You should enter the modifiers in the order they are expected on the claim. For more information, refer to Modifier Matching Logic.
     • Base Price
     • Procedure Option
   • Click Add.
3. To edit a schedule entry in the table:
   • Click the Edit link for the schedule entry to populate the fields on the Edit Schedule page.
   • Type or select the values in each field as needed.
   • Click Update.
4. To delete a schedule entry in the table:
   • Click the Edit link for the schedule entry to populate the fields on the Edit Schedule page.
   • Click Delete.
5. To add or edit the ICD10 Cluster data:
   • You must select ICD10 Cluster as the Code Type.
   • The Code To and Code From fields are disabled.
6. Optionally, you may perform one of the following functions:
   • Click Clear to delete the data you entered and return each field to its default value.
   • Click Edit, and then click Delete to delete an entry.
   • Click the procedure code or modifier link to view more information:
     • Click the link to view basic information about the code.
     • KnowledgeSource subscribers can log in to KnowledgeSource to view detailed information about the code.

     Note: You must be a KnowledgeSource subscriber to view ICD-10 code information.

Reimbursement rates based on specific code + modifier + modifier combinations can be selected and used in pricing. You should enter the modifiers in the order they are expected on the claim. The following matching criteria apply:

1. If the procedure modifier combination on claim line item is an exact match to the procedure code and modifiers (in the correct order) in the lookup table, that combination is priced on the fee schedule.
   • Code/Combination on Claim: E0776RRCG
   • Lookup Table

Code	Modifier	Modifier 2	Modifier 3	Modifier 4	Modifier 5	Base Price
E0776						100.00
E0776	CG					101.00
E0776	RR	CG				105.00
E0776	RR					105.00
E0776	CG	RR				110.00

2. If it is not an exact match, then the logic uses the first modifier for a match with lookup table.
   • Code/Combination on Claim: E0776RRCG
   • Lookup Table

Code	Modifier	Modifier 2	Modifier 3	Modifier 4	Modifier 5	Base Price
E0776						100.00
E0776	CG					101.00
E0776	RR	KX				105.00
E0776	RR					105.00
E0776	CG	RR				110.00

3. If the first modifier does not match to a modifier on the fee schedule, then the logic looks for pricing modifiers (TC, 26) anywhere in the modifier combination and matches them to the fee schedule if applicable.
   • Code/Combination on Claim: 71234RT26
   • Lookup Table

Code	Modifier	Modifier 2	Modifier 3	Modifier 4	Modifier 5	Base Price
71234						100.00
71234	26					101.00
71234	52					105.00
71234	26	RT				100.00
71234	26	LT				100.00

The pricing modifier logic is currently limited to look for TC and 26. Other pricing modifiers may be added in the future.

Note: We also understand that it is not possible for a code to have both professional and technical component (26 and TC) modifiers on a single claim line item.

4. If none of the above exists, then the reimbursement should be the default or global reimbursement (the code listed without a modifier).
   • Code/Combination on Claim: E0776RRCG
   • Lookup Table

Code	Modifier	Modifier 2	Modifier 3	Modifier 4	Modifier 5	Base Price
EO776						100.00
EO776	CG					101.00
EO776	RR	KX				105.00
EO776	RR	KE				105.00
EO776	CG	RR				110.00

The following table describes the fields on the Edit Schedule page for Procedure Lookup tables.

Field	Description
Base Price	Price associated with the code
Code From	The low value in a range of codes
Code To	The high value in a range of codes Note: The Code To field does not display for ICD-10 codes.
Code Type	The type of code included in the lookup table. Note: Code ranges are not compatible with a code type of ICD10 or Other.
ICD10 Cluster	The ICD10 cluster that corresponds the first ICD9 code in the range. Note: This maps the ICD-9 codes in a contract to clusters in ICD-10.
Modifier – Modifier 5	The modifier values associated with the code range. Up to five modifiers are allowed for procedure lookup tables. Reimbursement rates based on specific code + modifier + modifier combinations can be selected and used in pricing. You should enter the modifiers in the order they are expected on the claim. For more information, refer to Modifier Matching Logic.
Procedure Option	Type of procedure
Rev. Code or TOS	Revenue Code or Type of Service code to apply )
Updated	Date, time and user information of when the lookup table was last updated

• Lookup Table Management displays the Lookup Table Management page. For more information, refer to Manage Lookup Tables .
• Edit Lookup Table displays the Edit Lookup Table page. For more information, refer to Edit a Lookup Table.
• Import Schedule displays the Import Lookup Table Schedule page. For more information, refer to Add or Edit Schedule Data in a Table.
• Edit Schedule by Range displays the Edit Schedule by Range page. For more information, refer to Edit Schedule by Range.