Anesthesia Billing Document

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Anesthesia Billing Document

If Anesthesia is Applicable for the Clinic (property: prognocis.anesthesia.support), user can mark selected codes Applicable for Anesthesia and also define the Base Units. In such a case, if the Anesthesia Start and End Time and Duration is also entered, when the Code crosses over from Assessment to Billing, the system computes the Time Units (Time Duration / 15) adds Base Units and sets these as Units on the Claim generated.

Steps for using Anesthesia Billing functionality

i. For turning ‘ON’ Anesthesia Billing, set the property: prognocis.anesthesia.support to ‘Y’. ii. A Specialty Template named ‘Anesthesia Billing’ will be present in the set-up:

Settings>Configuration>Specialty. If it is inactive, please make it active. This template will have a System assigned: ‘Anesthesia’

iii. The 3 new elements displayed in table below with NUMERIC result type will be present to the above system:

Table 1: Elements Anesthesia Start Time, End Time and Duration

Sr. No. Code Name Result

Type 1 SCANESST Anesthesia Start Time NUMERIC 2 SCANESET Anesthesia End Time NUMERIC 3 SCANESDU Anesthesia Duration NUMERIC

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User Quick Guide – v2b9/Billing

Anesthesia Billing

Figure 1: Anesthesia Template in Speciality

Fig 1: Anesthesia Template in Speciality

iv. Please make sure to associate the appropriate Charge code to the Anesthesia template, (alongwith modifier if required).

Ex: CPT code 00100 “Anesth Salivary Glands”

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Fig 2: Properties with associated test codes for Anesthesia Duration, End Time and Start Time vi. Check the checkbox “Applicable for Anesthesia” and Associate appropriate “Base Units” to the

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User Quick Guide – v2b9/Billing

Anesthesia Billing

b. Directly on Claim from I button.

viii. If entered from EMR side, on Claim creation, the system does following calculation for the Anesthesia Charge code Units:

Anesthesia Billable Units (8) = Time Units (3) + Base Units (5) where,

Time Units = Anesthesia Duration / 15 (Ex: 45/15=3) and

Base Units = Units associated to Anesthesia Code on CPT/HCPC master (Ex: 5 for 00100).

Fig 4: Claim created with Anesthesia Charge Code with proper (for Ex. 8 ) Billable units

ClaimsEdit; Claims Screen on ‘I’ button displays Anesthesia Start Time, End Time and Duration as shown in figure 5 below if entered from EMR side.

b. If not entered in speciality template on EMR side, the Start Time and End Time can be entered directly on I button below and the Duration in minutes will be automatically calculated.

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Fig 5: “i“ button on Claim Screen shows the Anesthesia Start Time, End Time and Duration

Note: The Units added/transferred from Anesthesia template along with Anesthesia Code on Assessment screen in EMR will not be considered for Anesthesia Billing.

Note 2: If Anesthesia Duration is more than the multiples of 15, then Time Units considered are more by 1 unit.

Ex: If Anesthesia Duration = 46 min, the Time Units = 46/15 = 3.06 (which is more than 3). Therefore instead of 3, the Time Units will be considered as (3 + 1) = 4.

This is how the Anesthesia Units and Minutes are displayed on CMS 1500 for associated Charge code (00100).

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User Quick Guide – v2b9/Billing

Anesthesia Billing

Fig 6a: Anesthesia Units

Fig 6b: Anesthesia Minutes

This is how the EDI Claims send the Anesthesia Time:

Note: EDI Claims always send Anesthesia Minutes only. Anesthesia Units are never sent.

Fig 7a: Loop 2300 Segment NTE shows anesthesia Start and End time.

Fig 7b: Loop 2400 Segment SV1 shows duration in Minutes.

ix. Settings  Configuration  Masters  Insurance  Extra Info Tab shows checkbox “Anesthesia Minutes on CMS” checked. This checkbox when checked prints Minutes instead of Units in column 24G on a CMS 1500 form. Some insurances like Medicare does not approve claims if Units are sent. They only want Minutes.

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Fig 8: Ins Master >Extra Info button shows Anesthesia Minutes on CMS.

x. Settings  Configuration  Masters  Insurance  Extra Info Tab shows checkbox “Anesthesia Minutes on CMS” checked.

Figure 9: 24G on CMS 1500 prints Anesthesia Minutes instead of Units when “Anesthesia Minutes On CMS” checkbox is checked on Insurance Master

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User Quick Guide – v2b9/Billing

Anesthesia Billing

3) anesthesia.starttime.testcode 4) prognocis.anesthesia.support

Tags for Anesthesia Billing

Mapping of Anesthesia Billing Tags in PrognoCIS

Field Id Tags Remarks

L120a BLD_SUPPLEMENTAL

Prints Start and End time for

Primary/Secondary Insurance.

Prints Start and End time for

Primary/Secondary Insurance.

Prints Start and End time for

Primary/Secondary Insurance.

Prints Start and End time for

Primary/Secondary Insurance.

Prints Start and End time for

Primary/Secondary Insurance.

Prints Start and End time for

Primary/Secondary Insurance.

L117 BLD_UNITSORMIN__PRI /

BLD_UNITSORMIN__SEC

Prints actual duration for each

charge code in Primary

Insurance.

BLD_UNITSORMIN__SEC

Prints actual duration for each

charge code in Primary

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Insurance.

BLD_UNITSORMIN__SEC

Prints actual duration for each

charge code in Primary

Insurance.

BLD_UNITSORMIN__SEC

Prints actual duration for each

charge code in Secondary

Insurance.

BLD_UNITSORMIN__SEC

Prints actual duration for each

charge code in Secondary

Insurance.

BLD_UNITSORMIN__SEC

Prints actual duration for each

charge code in Secondary

Insurance.

Document Details

Created by: Malvika Tarnekar Created dt: April, 2011 Updated by: Yogesh Bhavsar

Last upd dt: Aug, 2012 (Latest changes related to Min or how info now gets sent is not updated) Verified By: Malvika Tarnekar

Version Introduced In: (Included V2B3 version) Document Version: Anesthesia_15_1.0