Anesthesia Billing Document

Transcription

1 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 functionality i. For turning ON, set the property: prognocis.anesthesia.support to Y. ii. A Specialty Template named 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 NUMERIC Start Time 2 SCANESET Anesthesia NUMERIC End Time 3 SCANESDU Anesthesia Duration NUMERIC

2 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 Anesth Salivary Glands v. The test codes for 3 elements should be present in the 3 properties as shown below in figure:

3 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 Charge Code associated to Anesthesia Template: Settings>Configuration>CPT Master. Fig 3: CPT Master with Anesthesia CPT code associated with Base Units(5) vii. When anesthesia is applied to any patient, Anesthesia details can be entered from 2 places: a. Go to Encounter Specialty and select the template Anesthesia and fill the following: Anesthesia Start Time Anesthesia End Time Duration is not mandatory, or rather not required now as it automatically gets computed. The associated CPT code will get transferred to Assessment on Save.

4 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.

5 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. 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). Box 24G shows the Anesthesia Units for that charge code (8) and Gray Band of Charge code displays the Anesthesia Start Time and End Time in minutes.(start Time 1200 End Time 1245)

6 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.

7 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 Note: The above setting Anesthesia Minutes On CMS is applicable only for CMS1500 paper Insurance form. The EDI Claim will still continue to send minutes as shown in EDI snapshot above. Properties: 1) anesthesia.duration.testcode 2) anesthesia.endtime.testcode

8 3) anesthesia.starttime.testcode 4) prognocis.anesthesia.support Tags for Mapping of Tags in PrognoCIS Field Id Tags Remarks L120a BLD_SUPPLEMENTAL Prints Start and End time for Primary/Secondary L220a BLD_SUPPLEMENTAL Prints Start and End time for Primary/Secondary L320a BLD_SUPPLEMENTAL Prints Start and End time for Primary/Secondary L420a BLD_SUPPLEMENTAL Prints Start and End time for Primary/Secondary L520a BLD_SUPPLEMENTAL Prints Start and End time for Primary/Secondary L620a BLD_SUPPLEMENTAL Prints Start and End time for Primary/Secondary L117 BLD_UNITSORMIN PRI / L217 BLD_UNITSORMIN PRI / charge code in Primary charge code in Primary

9 L317 BLD_UNITSORMIN PRI / L417 BLD_UNITSORMIN PRI / L517 BLD_UNITSORMIN PRI / L617 BLD_UNITSORMIN PRI / charge code in Primary charge code in Secondary charge code in Secondary charge code in Secondary 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