Struggling with CPT Codes in OpenEMR? Here’s Your Guide to Workarounds

Medical billing is a process in health care that proves to be quite complicated. At times this involves determining the insurance coverage, claims filing and posting, and the final payment. An important aspect of this procedure is medical coding, CPT codes of which are particularly valuable.

For those practices that have adopted OpenEMR, an open-source electronic medical record system, the use of CPT codes can be quite frustrating. These codes are critical to submitting accurate bills, but they are rarely seamless to use – issues with entering codes correctly, and compatibility with other tools.

These challenges can be eliminated if OpenEMR is well managed in terms of CPT codes. Want to navigate the complexity associated with CPT Codes in OpenEMR? 

Read this guide as we have shared solutions to common issues associated with CPT codes as used in Open EMR and best practices that may be employed while managing the CPT codes of OpenEMR.

CPT Codes and Their Role in Medical Billing

CPT codes are known as the current procedural terminology codes. These codes are critically important for standardizing the medical services provided across the healthcare sector.

This makes the consistency as far as medical billing and documentation are concerned. CPT codes consist of codes that are published and updated each year by the AMA (American Medical Association) due to enhancements in scientific procedures and facilities.

New and updated codes in 2024 primarily add COVID-19 immunization codes into a single code and a new code for RSV immunizations.

Timely and accurate administration of CPT codes in the delivery of care results in effective billing, fewer rejected claims and improved overall patient care.

Related: The Definitive Resource for Understanding New Patient CPT Codes

Common Issues with CPT Codes in OpenEMR

OpenEMR often has many difficulties with the CPT codes. This can hinder the efficiency of medical billing. The Common issues with the CPT codes in OpenEMR include:

1. Difficulty in updating the CPT code set.

• CPT codes need to be updated in the OpenEMR system.
• This process itself can be complex due to frequent annual changes and new code introductions.
• Without timely updates, practices may use outdated CPT codes.
• This can lead to claim denials.
• Practices should regularly check for updates and integrate them into OpenEMR.

2. Problems with code validation and accuracy.

• Code validation issues in OpenEMR often arise from outdated or incorrectly entered CPT codes.
• Inaccurate codes can disrupt the billing process and delay reimbursements.
• Implementing strict validation protocols within OpenEMR and utilizing built-in code verification tools.
• This helps to ensure that the correct codes are used before claims are submitted.

3. Challenges with insurance claims submission.

• Insurance claims submissions can be challenging when CPT codes in OpenEMR don’t align with payer requirements.
• This misalignment often results in claim denials or delays.
• To overcome this, practices should ensure their CPT codes are up-to-date and cross-referenced with payer-specific guidelines.

Procedure to Adding CPT Codes in OpenEMR

Adding CPT codes in OpenEMR involves a few steps, from preparation to finding and editing existing codes. Below is a detailed guide to help you through the process.

1. Preparation

Before adding new CPT codes, it’s essential to gather some necessary data items that your practice may require. These include:

• Price Levels: The price for each price level of the code, which may vary depending on your practice.
• Code Type: The type of code you’re adding (e.g., CPT, HCPCS).
• Service Category: The category under which the service falls.

Having these items ready will streamline the process of adding codes.

2. Adding CPT Codes to the OpenEMR System

To add new codes to the system, follow these steps:

1. Navigate to Codes Section: From the main menu, go to Admin > Coding > Codes.

2. Access the Code Entry Screen: Once in the Codes section, use the controls at the top of the screen above the ‘Search’ controls. Here’s how you proceed:

1. Select the Code Type: Choose the appropriate type from the dropdown menu.
2. Enter the Code: Input the code you wish to add.
3. Add Modifiers: If the code has any modifiers, add them in the respective field.
4. Activate the Code: Ensure the ‘Active’ checkbox is selected, as most codes will need to be active.
5. Description: Enter a descriptive text for the code.
6. Service Category: Leave this unassigned for now; you will assign it later.
7. Diagnosis/Service Reporting: Indicate if the code will be used for Diagnosis, Service reporting, or both.
8. Fees: If your practice has multiple price levels, enter the dollar value for each one (e.g., ‘Standard,’ ‘Discount’).
9. Add the Code: Click the ‘[Add as New]’ link to add the code to the system.

To add another code, repeat the steps above.

3. Finding and Editing Existing Codes

If you need to find or edit an existing code, follow these steps:

1. Start the Search: In the lower half of the Codes screen:
   • Select the Code Type: Choose the type of code you’re searching for.
   • Enter the Code: Type in the entire or partial code and click ‘Search’.
   • Reporting Checkboxes: Choose to filter by Diagnosis Reporting codes, or both.
   • Active Checkbox: Select this if you only want to return active codes.

2. View Matched Entries: The search will return partial matches if you only entered part of the code. Matched codes will appear in the bottom section.

3. Edit the Code:
   • Click the ‘Edit’ link next to the code you want to modify. This will move the code and its data to the top editing area.
   • Make the necessary changes.
   • Click ‘[Update]’ to save the changes.

If you wish to delete the code instead, Click the ‘Delete’ link which is located right the ‘Edit’.

If these procedures are implemented, CPT codes can be well managed in regards to OpenEMR so that proper and updated codes can assist a practice.

Related: 8 Reasons Why CapMinds is the Best Partner for OpenEMR

Managing CPT Codes in OpenEMR (Step-By-Step Guide)

Managing CPT codes in OpenEMR is crucial. It helps to maintain accurate billing and smooth operation. Follow these steps to optimize your CPT code management:

1. Update the CPT Code Set Regularly

Ensure your OpenEMR system includes the latest CPT codes by downloading updates directly from official sources like the AMA. This helps prevent the use of outdated codes, reducing claim rejections.

2. Use Built-In Validation Tools

OpenEMR provides code validation tools to check the accuracy of CPT codes before claims submission. Regular use of these tools helps catch errors early, minimizing billing issues.

3. Customize Billing Workflows

Tailor OpenEMR’s billing workflows to match your practice’s specific needs, such as integrating payer-specific guidelines to reduce discrepancies.

4. Conduct Regular Audits

Schedule routine audits of your CPT code usage to identify and correct any inaccuracies or outdated information.

By adhering to these steps, practices can enhance their billing accuracy, streamline operations, and improve financial outcomes

Integrating Third-Party Tools for CPT Code Management

Integrating third-party tools with OpenEMR can significantly improve the management of CPT codes. This provides enhanced functionality and reduces the potential for errors. Here’s how to make the most of these tools:

1. Automated Updates

Third-party tools can automatically update your CPT code set, ensuring that you’re always using the most current codes without manual intervention.

2. Real-Time Validation

These tools often offer real-time validation features, checking CPT codes against payer rules and regulations before claim submission. This reduces the likelihood of claim denials due to coding errors.

3. Comprehensive Reporting

Third-party tools frequently include advanced reporting features that provide insights into your coding and billing practices. These reports can help identify trends, errors, and opportunities for improvement.

4. Seamless Integration

Ensure the selected tool integrates smoothly with OpenEMR, maintaining workflow continuity while adding advanced features.

Best Practices for CPT Code Management in OpenEMR

1. Regular updates and audits of CPT code sets.

Regularly updating and auditing CPT codes within OpenEMR ensures compliance with the latest medical billing standards. This practice helps: 

• Identify outdated or incorrect codes
• Reducing the risk of claim denials. 

Scheduled audits also allow for the detection of discrepancies, ensuring that all billing processes remain accurate and efficient​.

2. Training staff on accurate CPT coding and OpenEMR usage.

Ongoing staff training on CPT coding and OpenEMR usage is vital for maintaining billing accuracy. Properly trained staff are better equipped to handle coding updates and navigate OpenEMR efficiently, reducing the likelihood of errors. 

Regular training sessions also keep the team informed about the latest coding changes, enhancing overall practice performance.

3. Monitoring and reporting for continuous improvement.

Monitoring CPT code usage and generating regular reports in OpenEMR is essential for continuous improvement. These practices help identify coding errors, track billing performance, and provide insights for optimizing the billing process. Continuous monitoring ensures that the practice remains compliant and can adapt quickly to changes in coding standards.

4. OpenEMR’s customization options for better workflow efficiency.

Using features of OpenEMR customization can improve the CPT code usage and make the work more effective. Accounts receivable templates and billing flowcharts can be modified to the needs and requirements of the practice which eliminates errors with billing. These adaptations make it possible for the practice to deal with the specific issues arising out of its billing process.

CapMinds OpenEMR Customization and Integration Solution

Need assistance with OpenEMR for your healthcare practice? Trust CapMind’s expert OpenEMR customization and integration services. As a leading health tech company, we understand the unique challenges you face. 

Our tailored solutions ensure a seamless transition to OpenEMR, maximizing efficiency and minimal workflow disruption. Our Service includes:

• Customized setup to fit your specific needs
• A low-cost solution for your practice’s long-term future.
• Comprehensive staff training and ongoing tech support.
• Modern User Interface (UI) customization
• Integration with third-party tools and APIs

Don’t let outdated systems hold you back. Embrace the future of healthcare management with OpenEMR. Our experienced team will guide you every step of the way, from initial consultation to full implementation.

Contact CapMinds today for a free consultation and discover how OpenEMR can transform your healthcare delivery.