Local Anesthesia Billing Settings (View Only)

The insurance reporting category for the anesthesia billing settings.

The code set for the anesthesia billing required by the payer for reporting anesthesia services:

• ASA (CPT-4 anesthesia procedure codes 00100-01999)
• CPT Surgical Codes (CPT-4 surgery 10040-69990)

Note: Typically, payers request that anesthesia services be described using the ASA CPT-4 codes.

If anesthesia services are provided by a Certified Registered Nurse Anesthetist (CRNA) who is under the direction or supervision of a physician anesthesiologist, does the payer wish to receive an:

1. MD Only: A claim from the physician only as if he/she personally performed all of the anesthesia service.

Note: Payers who do not credential CRNAs will require MD only claims.

2. CRNA Only: A claim from the CRNA only as if he/she personally performed the service without the supervision or direction of a physician.
3. Split-Directing and Directed Provider Claims: The payer requests claims from both of the providers involved in the case.
   Medicare requires the anesthesia providers to submit two claims when both an MD and a CRNA and/or Anesthesiologist Assistant (AA) are involved.
   

If more than one provider is involved in a single anesthesia case, this setting determines which of the providers is listed as a directing or directed provider on the claim.

1. First — Selects the provider in attendance at the start of the anesthesia service
2. Last — Selects the provider in attendance at the end of the anesthesia service
3. Longest — Selects the provider with the greatest number of actual minutes in attendance during the anesthesia case

Determines the unit interval that is used to calculate the anesthesia time units reported on a the claim. This is the value reported on the claim to the payer; and not the time units value used to calculate the gross charge. Time unit values used to calculate the gross charge are determined based on the value saved in the 'Fee Schedule Increments' practice setting.

1. Actual Minutes — Reports actual minutes in attendance.
2. 10, 12, or 15 Minute Increments — Divides the actual minutes in attendance by the unit interval selected. For example, 60-minutes of anesthesia for a payer requiring 15-minute unit intervals is reported as 4 time units of anesthesia.

This setting manages situations where the units of time have been calculated and there are minutes left over:

1. Round to the nearest whole unit
2. Round to the next whole unit
3. Round down to the last whole unit

For example, time units are calculated in 15-minute increments: 115 divided by 15 minutes is 7 units, with 10 minutes left over. The remaining 10 minutes qualify to be billed as a complete unit. athenaOne would report the number eight (8) in the Units field reported on the claim.

Determines whether the payer acknowledges modifiers that indicate the concurrency level of the case. This code set of HCPCS modifiers is maintained by athenahealth on behalf of its clients. This set of modifiers is not recognized by all payers.

1. If Yes is selected, athenaOne assigns each claim one of the following level of direction or supervision modifiers:
   • AA — Anesthesia services performed personally by anesthesiologist
   • AD — Medically supervised by a physician for more than four concurrent procedures
   • QK — Medically directed by a physician: two, three, or four concurrent procedures
   • QX — CRNA with medical direction by a physician
   • QY — Medical direction of one certified registered nurse anesthetist (CRNA) by an anesthesiologist
   • QZ — CRNA without medical direction by a physician

2. If No is selected, level of direction or supervision modifiers are not assigned by athenaOne.

Indicates whether athenaOne should systematically create additional charges for the increased work associated with specific conditions. To enable systematic creation of these charges the athenahealth Staff Member sets the flag to Yes. Additional charges are then created for the following circumstances:

• If Yes is selected, athenaOne will create additional charges when a selection is made in the time sheet batch as follows:
• Extreme Age (<1, >70yo) — Separate line item billed using CPT code 99100
• Emergency — Separate line item billed using CPT code 99140.
• Use of Hypothermia (total body hypothermia) — Separate line item billed using CPT code 99116.
• Use of Hypotension — Separate line item billed using CPT code 99135.
• If No is selected, athenaOne will not create additional charges for the patient.
  Note: Charge entry behavior is not affected. The user should consistently identify whether or not extenuating circumstances are present and allow athenaOne to determine whether or not these services are billed to the IRC or insurance package.

Indicates the additional units to be charged if the physical status modifiers flag is set to yes or MD Only. Typically a practice will bill an additional 1—3 units for physical status modifiers P3—P5.

The 'P6' is used to describe anesthesia cases in which the patient is declared brain-dead and the patient's organs are being removed for donor purposes; however, additional units are almost never billed and/or reimbursed for the physical status modifier P6.

The date this setting was created, and the username of the person who created it.

The date this setting was last modified, and the username of the person who modified it.