Site of Service: Using the Setting Lookup

You can use the Setting Lookup feature during a medical review (or independently of a review) to determine the appropriate setting for a procedure when a full medical review is not required, but a setting decision is still needed. The code library includes both CPT® codes addressed in the InterQual Procedures Criteria and codes not addressed in the criteria.

  • From the left side navigation menu (), select Setting Lookup.

  • Enter a 5-digit CPT code or procedure description and click Find.

    If you searched on a description, multiple codes may be returned.

  • Click the code for which you want to see the setting data.

    The data insights information appears.

  • Optionally, copy the information using the copy button (Image of copy button).
  • Click the close button (X) to close the Setting Lookup dialog.
  • If appropriate, paste the information you copied into a comment in an in-progress review. The information pasted into a comment will appear on the Review Summary.