Add PCS Codes

This rule will add the PCS code to the UB-04 form.  PCS codes are the procedural classification codes, different from the ICD-10 codes, used in inpatient and hospital settings.

Workflow

Let's review how to add the PCS code to the UB-04 form!

• 1. 1. Navigate to Management Center > Claim Rules.
        
        
     2. Click Create Claim Form  Rule.
        
     3. Select the Practice.
        
     4. Next, give the rule a name.
     5. Update the Claim Type to Institutional.
        
     6. Select Conditions to create criteria a claim should meet before the rule will apply.
        
     7. Next, click on the Behaviors dropdown.
     8. Select PCS Codes.
        
     9. Next, click Add.
        
     10. Update the box to reflect the PCS code you wish to be included.
         
     11. Select Add Procedure Code to add another PCS code to the claim.
         
     12. To create multiple behaviors, repeat steps 7-10.
     13. Click Save to complete the process.
          

Box Number(s)

• UB-04: Box 74 - Principal Procedure Code and Date
• CMS-1500: N/A

Helpful Hints

• If one of your conditions is payer-based, select Current Sequence Behavioral instead of the Primary Behavioral Payer. This will ensure the rule applies to secondary and tertiary claims when needed. 
• To read more about how to set claim rule conditions and order, see the Claim Rule: Setting Claim Rule Conditions article.
• To read more about how to set up a claim rule to be effective as of a certain date, see the Scheduled Change Sets article.