Note: This feature supports the submission of medical insurance claims for customers using the Medical Billing module. For more information, see Sensei Cloud Medical Billing.
Sensei Cloud comes populated with the ICD-10-CM medical diagnosis code set that you can use when documenting a patient's condition. These codes are included on the CMS 1500 Claim Form (box 21).
When ICD-10 codes have been defined for procedures, they are added to any subsequent claim details when an insurance claim (medical or dental) is produced.
This feature is enabled by default, but you can disable it if your practice does not use medical diagnosis codes. If prompting is enabled, the Diagnosis Codes dialog is automatically displayed whenever you add procedures to an appointment card, treatment plan, or ledger.
Note: Click Cancel if you do not want to add a code when prompted.
You can add or manage diagnosis codes for each procedure during these clinical workflows:
- Managing a scheduled appointment from the Hard Tissue Chart
(Patient > Clinical > Hard Tissue Chart > Today’s Appointment)
- Managing a scheduled appointment from the Clinical Chart (EMR)
(Patient > Clinical > Clinical Chart (EMR) > Manage Appointment)
- Managing a treatment plan from the Hard Tissue Chart
(Patient > Clinical > Hard Tissue Chart > Planning Mode > Pencil icon)
- Managing a treatment plan from the Treatment Plan window
(Patient > Treatment Plans > [select plan] > Pencil icon)
- Posting a charge from the patient's ledger
(Patient > Financials > Ledger > [click New Charge])
When ICD-10 codes are enabled, a column is added to the interface where procedures are managed.
- Click Add to select up to four codes for a procedure.
- After a code is saved, you can click Edit to add or remove codes from the procedure.
- Type at least three characters into the Search field to select a code.
- Review diagnosis codes as part of the procedure details in the Patient Ledger or Treatment Plan.
Including Diagnosis Codes on Dental Claims
Offices are able to map diagnosis codes to procedure codes, print diagnosis codes on a dental claim form, as well as submit diagnosis codes electronically on a dental claim form.
When posting new charges, you are prompted to add diagnosis codes each time that you add a procedure code (if diagnosis codes are enabled for your practice).
You can select up to four diagnosis codes to map to each procedure. Each claim form can also have a maximum of four diagnosis codes, and if a fifth code is added, the claim is split into two separate claim forms.
For example: If four diagnosis codes are added to the first procedure code (e.g. D0120), and then an additional diagnosis code (that is different than the four codes mapped to D0120) is added to another procedure (e.g. D2740), then the system creates two claim forms.
The first claim includes the first procedure code, D0120, and the four diagnosis codes that are mapped to it. The second claim includes the second procedure code, D2740, and the diagnosis codes that are mapped to it.
Note: In the preceding example, the K316 diagnosis code that was mapped to the second procedure (D2740) is the cause of the claim being split into two separate claim forms.
You can also view or modify diagnosis code mapping on CDT codes after posting:
- From the Patient tab, select Insurance > Claims Management.
- Select a claim, and then click Edit ICD10 Codes. The Define ICD10 Diagnosis Codes window is displayed.
- Remove diagnosis codes by clicking the x next to the code, or type new codes into the ICD-10 Code field to add them.
- Click Save.
Managing Diagnosis (ICD-10-CM) Codes for Your Practice
You can enable or disable the prompt setting, or disable the feature if your practice does not use medical codes. To manage diagnosis codes, select Administration tab > Practice Settings > Diagnosis Codes.
- For Prompt Settings, select Yes or No.
If Yes, users are automatically prompted to add diagnosis codes during the relevant workflows.
- To disable the feature, select Disable Diagnosis Codes.
Disabling this setting prevents team members from recording diagnosis codes; controls are removed from the clinical interface. Any existing diagnosis code data will remain part of the patient's clinical history.
Note: You cannot add, edit, or remove codes from the system.