Case / Procedures & Provider Time Tab

Procedure Table

The table contains a list of all procedures added to the case.

Type of Serv

Display Only

(Pulled from added/updated Procedure)

Yes

The type of service provided. When the CPT code is any of the following, this value will be as indicated:

• 00100-01999 Anesthesia

• 99100-99140 Anesthesia

• 10021-69990 Surgery

• 70010-79999 Diagnostic Radiology

• 80048-89356 Diagnostic Laboratory

• 90281-99099 Medical Care

• 99141-99199 Medical Care

• 99201-99499 Medical Care

Code

Display Only

(Pulled from added/updated Procedure)

Yes

The procedure that was performed on the case. If the procedure can be mapped to an anesthesia code, the ASA column contains that anesthesia code. If procedure in the Code column is an anesthesia procedure, the ASA column contains that procedure code.

ASA

Display Only

(Pulled from added/updated Procedure)

No

The corresponding anesthesia code of the procedure.

• If the procedure in the Code column cannot be mapped to an anesthesia code, this column is blank.

• If the procedure in the Code column can be mapped to an anesthesia code, the ASA column contains that anesthesia procedure code.

• If the procedure in the Code column is an anesthesia procedure, the ASA column contains that procedure code.

• If more than one anesthesia code can be mapped to a CPT code, a list of possible anesthesia codes are listed.

Description

Read-only

Yes

The description of the procedure. This column contains information only and is updated when a procedure is selected in the Code column.

Modifiers

Display Only

(Pulled from added/updated Procedure)

No

The two-character code used to describe the services associated with a procedure. A procedure can have up to four modifiers.

Diagnosis Codes

Display Only

(Pulled from added/updated Procedure)

Yes

The diagnosis codes of the procedure. Each diagnosis code is represented in the priority of the relating diagnosis codes for the procedure. Diagnosis codes are ranked according to the primary diagnosis (1), secondary diagnosis (2), etc.

Qty

Display Only

(Pulled from added/updated Procedure)

Yes

The number of units for the service being rendered, for example, the number of treatments. For an anesthesia procedure, this value is 1.

NDC

Display Only

(Pulled from added/updated Procedure)

No

The National Drug Code of the drug administered by injection, as indicated by the J-Code procedure.

Provider

Display Only

(Pulled from added/updated Procedure)

No

The name of the provider who performed the general procedure on the case.

For an anesthesia procedure, this column is blank.

Provider ID is required when the case includes a Directed CRNA.

Place of Serv

Display Only

(Pulled from added/updated Procedure)

Yes

The designated place of service for the facility.

DOS

Display Only

(Pulled from added/updated Procedure)

Yes

The date of service for the procedure. For anesthesia procedures, this column will be updated from the provider time after it has been recorded in the Anesthesia Case Provider Time section.

The DOS column contains the actual date the service began. For anesthesia procedures that span more than one day, the DOS is calculated based on the date and end time recorded for the provider in Anesthesia Case Provider Time and will be reported in the 837 at the service line level.

Fee

Read-only

(Calculated based on the Billing Fee Schedule)

Yes

The dollar amount for the service fee of the procedure calculated by the billing fee schedule.

• For general procedures, this column contains the calculated dollar amount that will be billed for the procedure.

• For anesthesia procedures, this column contains the calculated amount for that procedure unless there is another anesthesia procedure that has a greater fee amount. In this case, dashes are displayed in the Fee column for the procedures with the lesser values.

• For anesthesia procedures with an add-on code, this column contains the fee for that add-on, regardless of whether that fee is less than another anesthesia procedure on the case.

Procedure Details Section

This area provides information about the currently selected procedure in the procedure list.

Code

Display Only

(pulled from the Billing Fee Schedule)

Yes

The procedure code of the currently selected procedure in the procedure list.

PSUs

Display Only

(pulled from the Billing Fee Schedule)

No

The Physical Status Units (PSUs) for the currently selected anesthesia procedure in the procedure list. If a different physical status modifier is selected on the procedure, this value will be updated, which might cause fees to be recalculated. For a general procedure, dashes will be displayed for this value.

Base Units

Display Only

(pulled from the Billing Fee Schedule)

Yes

The standard base units on the currently selected procedure in the procedure list. If the procedure has an override value on the base unit, that value will also be displayed. Override values will appear in red. Dashes indicate that an override is not present.

Billing Fee

Read-only

(calculated from the Billing Fee Schedule and Anesthesia Provider Time)

Yes

The dollar amount calculated from the billing fee schedule for the currently selected procedure in the procedure list. This value is dynamic and will be updated as changes to the procedures are applied. For example, the Physical Status modifier is changed on an anesthesia procedure. If an override has been applied, the dollar amount of the override will be displayed in red. If an override has not been applied, dashes will be displayed.

Expected Fee

Read-only

(calculated from the Expected Fee Schedule and Anesthesia Provider Time)

Yes

The reimbursement amount expected from the payer or plan for the currently selected procedure in the procedure list. 

CMS Status

Read-only

(pulled from CMS)

No

The value assigned by CMS for the currently selected procedure code. 

The values that can be displayed include:

• Active Code

• Bundled Code

• Carriers price the code

• Deleted Codes

• Excluded from Physician Fee Schedule by regulation

• Deleted / Discontinued Codes

• Not Valid for Medicare Purposes

• Deleted Modifier

• Not Valid for Medicare Purposes

• Anesthesia services

• Measurement Code - Reporting only

• Noncovered Services

• Bundled/Excluded Codes

• Restricted Coverage

• Injections

Billing Fee Schedule

Drop Down

Yes

The current billing fee schedule used for calculating procedure fees. The field is a drop down which allows users to override the default fee schedule, as necessary. Fee schedules available from the drop down are only those that are active and affiliated with the current practice.

Expected Fee Schedule

Display Only

(pulled from the Insurance assigned to case)

Drop Down

The expected fee schedule used for calculating the expected fee amount.

The default fee schedule can be overridden by selecting another fee schedule from the drop down list.

Case Fee Summary Section

This area provides information about the provider time on the anesthesia procedure. The information is updated as the provider time is completed.

Minutes

Read-only

(calculated from the Anesthesia Provider Time)

No

A breakdown of the total minutes tied to the procedure split between Directing and Directed. The maximum number of minutes allowed for the procedure is defined in the fee schedule.

Uncapped Minutes

Read-only

(calculated from the Anesthesia Provider Time)

No

The Uncapped Minutes fields are populated with the true minutes required for the procedure, including those minutes above the capped amount, as defined in the fee schedule.

Billed Time Units

Read-only

(calculated from the Anesthesia Provider Time)

Yes

The billed units for all procedures on the case split between Calculated, Override, and Add-On Override units.

Add-On Minutes

Read-only

(calculated from the Anesthesia Provider Time)

No

A breakdown of the total minutes tied to an ancillary procedure split between Directing and Directed.

Uncapped Add-On Minutes

Read-only

(calculated from the Anesthesia Provider Time)

No

The Uncapped Add-On Minutes fields are populated with the true minutes required for an ancillary procedure, including those minutes above the capped amount, as defined in the fee schedule.

Expected Time Units

Read-only

(calculated from the Anesthesia Provider Time)

Yes

The units expected to be paid for all procedures on the case split between Calculated, Override, and Add-On Override units.

Bill Amount

Read-only

(calculated from the Billing Fee Schedule and Anesthesia Provider Time)

Yes

The amount that was billed for total charges for each procedure. It should match the Billing Fee.

Expected

Read-only

(calculated from the Expected Fee Schedule and Anesthesia Provider Time)

No

The expected amount of payment from the responsible party for the amount billed, which is determined by the expected fee schedule configured at the practice configuration.

Total Billed Units

Read-only

(calculated from the Billing Fee Schedule)

Yes

The total of all base + time + physical status units.

Anesthesia Case Provider Time Section

Provider Role

Display Only

(pulled from Provider Type field on Add Provider Time window)

Yes

The role the provider performed while administering anesthesia: Directing, Directed, or Observing.

Provider Name

Display Only

(pulled from Provider field on Add Provider Time window)

Yes

The last, first, and title of the provider who performed the anesthesia procedure specified.

Start Time

Display Only

(pulled from Start Time field on Add Provider Time window)

Yes

The date and time the provider started the anesthesia procedure as specified.

End Time

Display Only

(pulled from End Time field on Add Provider Time window)

Yes

The date and time the provider ended the anesthesia procedure as specified.

Exclude

Display Only

(pulled from checkbox on Add Provider Time window)

No

To exclude the time segment from concurrency checking, the Exclude from Concurrency Checking checkbox is selected in the Add Provider Time window when adding time. If selected, the Exclude column is checked.

This differs from the Exclude from Concurrency Checking option to the right of the table, which excludes the entire case from concurrency checking validation.

Anesthesia Method

Drop Down

Yes

The method used to administer the anesthesia. The options include::

• CSE - Combined Spinal Epidural

• EPI - Epidural       

• GEN - General      

• LOC - Local Anesthesia      

• MAC - Monitored Anesthesia Care      

• G8 - MAC for Deep Complex or Markedly Invasive Procedure     

• G9 - MAC for Patient with History of Severe Cardiopulmonary Condition     

• REG - Regional      

• SPI - Spinal 

• TIA - Total Intravenous Anesthesia     

• UNK - Unknown

Add-On Begin Time

Calendar Date and Time

(mm/dd/yyyy hh:mm)

No

The time at which the transition from a primary procedure to a secondary procedure occurred on the case, if applicable. For example, suppose the primary procedure started as anesthesia for a vaginal delivery, but then evolved into a secondary procedure as anesthesia for a C-section. In this case, you would enter the start time of the secondary procedure, which is the anesthesia related to the C-section.  

The Add-On Begin Time option is only available when procedures 01968 and 01969 are entered in the procedure details table. The primary procedure and the add-on procedure must be entered in the procedure details table. In addition, both the primary procedure and the add-on procedure must be included in the current billing fee schedule.

If either 01968 or 01969 procedure (anesthesia add-on procedure) is included in the procedure details table, the add-on begin time is required. By default, this information is blank.

Physical Status

Drop Down

Yes

The billing unit value added to an anesthesia procedure to indicate the complexity of the procedure regarding the physical status of the patient. The billing unit values are used to calculate anesthesia fees. The supported physical status modifiers are P1 through P6. This information is required if the procedure is an anesthesia procedure. By default, this option is blank. Select a value from P1 to P6 for the physical condition of the patient.

The following table contains the description of each modifier according to the American Society of Anesthesiologists (ASA) ranking of patient physical status: