Anesthesia Cases
The anesthesia case is used to record and link data related to the patient's anesthesia service or procedure, so that all required information is available throughout the anesthesia billing workflow. There must be one anesthesia case for every patient surgery or procedure entered via the time sheet.
The Anesthesia Cases page allows you to record most, if not all, services, procedures, and incidental procedures provided by anesthesiologists during one patient's surgery or procedure. You can also record the data needed to submit a claim, such as diagnosis code, hospitalization dates, surgeon, referring provider, and so forth.
On the Main Menu, click Claims. Under CHARGE ENTRY, click Anesthesia Time Sheet Batches. On the Manage Anesthesia Time Sheet Batches page, click the view/edit link for a time sheet batch. On the Time Sheet Batch page, click view/edit for an existing anesthesia case, or click add new anesthesia case.
Your practice must have the Anesthesia Billing feature enabled, and you must have the Anesthesia: Time Sheet Edit role.
- Display the Manage Anesthesia Time Sheet Batches page: On the Main Menu, click Claims. Under CHARGE ENTRY, click Anesthesia Time Sheet Batches.
- Click the view/edit link for the time sheet batch where the patient's anesthesia services are recorded. The Time Sheet Batch page appears.
- Click add new anesthesia case. The Anesthesia Cases page appears.
Enter the anesthesia case information
- Patient ID —
- If the patient
is already registered in your practice, enter the patient ID number. You can also enter
a period to access the Find patient tool.
Note: The patient lookup tool available through the time sheet returns only patient ID numbers registered in the provider's provider group. Names that appear without an ID number are not registered in the provider's provider group. You must register the patient in the provider's provider group before you can select the patient. - If the patient
is new to your practice, enter a period to access the Find patient tool, then click register new patient to
display the Patient Registration
page. After you save the new registration information, click the return
to timesheet link in the Task
Bar.
The new patient information then appears in the time sheet row.
- If the patient
is already registered in your practice, enter the patient ID number. You can also enter
a period to access the Find patient tool.
- Procedure code — Enter the CPT surgical code in the CPT field, or enter a period to access the Procedure Lookup tool and select the code from the list. After the CPT code is entered, athenaOne returns the list of corresponding ASA codes in the ASA list.
- ASA — Select the corresponding ASA code. An asterisk indicates a
local mapping.
Note: You can create local CPT—ASA code mappings using the Local Anesthesia Code Mappings page. - Non-Anesthesia — Select this option if the service or procedure is not a time-based anesthesia service. If selected, this option tells athenaOne that start and stop times and ASA codes
are not needed.
Note: To add a non-anesthesia procedure to an anesthesia case, click Add Non-Anesthesia Procedure to this Case (below the Diagnoses field). Input fields appear for you to enter the procedure code, diagnosis codes, and unit for the non-anesthesia procedure. - Diagnoses — Enter the diagnosis codes used to support medical necessity. You
can type a period to search for the codes by entering an ICD-10 code, ICD-9 code, or SNOMED term.
- Service department — Select the location where services were rendered.
- Operating
room — Select the operating room where the service was rendered.
Note: This menu appears if you defined operating rooms in your practice via the Operating Rooms page. - Hospitalization dates — Enter the from and to dates of the patient's hospitalization in MM/DD/CCYY format.
- Referring provider — Click the Choose/view link to access the Referring Provider Lookup tool and select the provider from the directory of referring providers.
- Surgeon — Click the Choose/view link to access the Referring Provider Lookup tool and select the surgeon from the directory of referring providers.
- Anesthesia type — Select the type of anesthesia administered.
- Physical status — Select the physical status of the patient.
- Extenuating circumstances — Select any extenuating circumstances.
- Medical direction — Select "Incomplete" when fewer than seven of the direction requirements have been met. Otherwise, select "Complete." The meaning of the (default) option is determined by your practice settings.
- Adverse
events — Select any adverse events that occurred when
service was rendered.
Note: This field appears only if you created an adverse events code set via the Adverse Events page. - Post
operative complications — Select any post operative complications that apply to this anesthesia case.
Note: This field appears only if you created a post operative complications list for your practice via the Post Operative Complications page. - Case review — Select this option if you plan to include this anesthesia case in a future review or study.
- Notes — Enter any notes about this anesthesia case.
- Click Save to create the anesthesia case. The new case appears listed at the bottom of the page and in the list of anesthesia cases at the bottom of the Time Sheet Batch page.
After you create an anesthesia case, it appears listed in the Anesthesia Case menu on the Time Sheet page for every time sheet entry (i.e., every line item) with a matching patient ID and on every time sheet in the batch where the anesthesia case was created.
As you add entries to the time sheet, the Anesthesia Case menu is populated when you enter the patient ID in the Patient ID field.
For every time sheet entry, you must select an existing anesthesia case or add a new anesthesia case.
- Display the Manage Anesthesia Time Sheet Batches page: On the Main Menu, click Claims. Under CHARGE ENTRY, click Anesthesia Time Sheet Batches.
- Click the view/edit link for the time sheet batch where the patient's anesthesia services are recorded. The Time Sheet Batch page appears.
- Click add new anesthesia case. The Anesthesia Cases page appears.
Register the new patient
- Patient
ID — Enter a period to display the Find patient tool, then click register new patient.
The Patient Registration page appears in the Workspace, and a return to timesheet link appears in the Task Bar at left. - Enter the patient registration information and click Save at the bottom of the Patient Registration page.
- Click the return to timesheet link in the Task Bar to return to the anesthesia time sheet. The new patient appears in the second to last row of the time sheet.
- Anesthesia Case menu — Select [add new]. Additional fields appear.
Enter the anesthesia case information
- Procedure code — Enter the CPT surgical code in the CPT field, or enter a period to access the Procedure Lookup tool and select the code from the list. After the CPT code is entered, athenaOne returns the list of corresponding ASA codes in the ASA list.
- ASA — Select the corresponding ASA code. An asterisk indicates a
local mapping.
Note: You can create local CPT—ASA code mappings using the Local Anesthesia Code Mappings page. - Non-Anesthesia — Select this option if the service or procedure is not a time-based anesthesia service. If selected, this option tells athenaOne that start and stop times and ASA codes
are not needed.
Note: To add a non-anesthesia procedure to an anesthesia case, click Add Non-Anesthesia Procedure to this Case (below the Diagnoses field). Input fields appear for you to enter the procedure code, diagnosis codes, and unit for the non-anesthesia procedure. - Diagnoses — Enter the diagnosis codes used to support medical necessity. You can use the ICD-10 lookup tool to search by ICD-10 code, ICD-9 code, or SNOMED term.
- Service department — Select the location where services were rendered.
- Operating
room — Select the operating room where the service was rendered.
Note: This menu appears if you defined operating rooms in your practice via the Operating Rooms page. - Hospitalization dates — Enter the from and to dates of the patient's hospitalization in MM/DD/CCYY format.
- Referring provider — Click the Choose/view link to access the Referring Provider Lookup tool and select the provider from the directory of referring providers.
- Surgeon — Click the Choose/view link to access the Referring Provider Lookup tool and select the surgeon from the directory of referring providers.
- Anesthesia type — Select the type of anesthesia administered.
- Physical status — Select the physical status of the patient.
- Extenuating circumstances — Select any extenuating circumstances.
- Medical direction — Select "Incomplete" when fewer than seven of the direction requirements have been met. Otherwise, select "Complete." The meaning of the (default) option is determined by your practice settings.
- Adverse
events — Select any adverse events that occurred when
service was rendered.
Note: This field appears only if you created an adverse events code set via the Adverse Events page. - Post
operative complications — Select any post operative complications that apply to this anesthesia case.
Note: This field appears only if you created a post operative complications list for your practice via the Post Operative Complications page. - Case review — Select this option if you plan to include this anesthesia case in a future review or study.
- Notes — Enter any notes about this anesthesia case.
- Click Save to create the anesthesia case. The new case appears listed at the bottom of the page and in the list of anesthesia cases at the bottom of the Time Sheet Batch page.
For anesthesia time sheet batches that have a date of service on or after October 1, 2015, you must include ICD-10 codes in the Diagnoses fields on the Anesthesia Cases page. Use the ICD-10 lookup tool to search by ICD-10 code, ICD-9 code, or SNOMED term. Also, warning messages may appear for some time sheet entries, informing you of updates that you need to make to comply with ICD-10. Review these messages and make any changes necessary to add or update ICD-10 or ICD-9 codes.
For payers that are not prepared to accept ICD-10 codes, athenaOne converts ICD-10 to ICD-9 codes only when you
- Mark a time sheet batch as complete.
- Approve the ICD-10 to ICD-9 code mappings (see ICD-10 to ICD-9 Mapping).
After you approve the ICD-10 to ICD-9 mappings, ICD-10 codes are automatically downconverted to ICD-9 when you complete a time sheet batch for a payer that requires ICD-9 codes.
If you do not approve the ICD-10 to ICD-9 mappings before the ICD-10 transition date, you will not be able to enter ICD-9 codes in anesthesia time sheets or create claim batches that require ICD-9 codes. Instead, you will need to enter ICD-9 codes manually on the Charge Entry page.
Patient ID |
The patient ID number in the Patient
ID field. You can enter a period to access the Find patient tool. Note: The patient lookup tool available through the time sheet returns only patient ID numbers registered in the provider's provider group. Names that appear without an ID number are not registered in the provider's provider group. You must register the patient in the provider's provider group before you can select the patient. |
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Procedure code |
Enter the CPT surgical code in the CPT field (or enter a period to access the Procedure Lookup tool and select the code from the list). After the CPT code is entered, athenaOne returns the list of corresponding ASA codes in the ASA menu.
From the ASA menu, select the corresponding ASA code.
Select the Non-Anesthesia option if the service or procedure is not a time-based anesthesia service. If selected, this option tells athenaOne that start and stop times and ASA codes are not needed. |
---|---|
Diagnoses |
Enter the diagnosis codes used to support medical necessity. You can use the ICD-10 lookup tool to search by ICD-10 code, ICD-9 code, or SNOMED term. |
Service department |
Select the location where services were rendered. |
Operating room |
Select the operating room where services were rendered. This menu appears if you defined operating rooms in your practice via the Operating Rooms page. |
Hospitalization dates |
Enter the from and to dates of the patient's hospital stay. |
Referring provider |
Click the Choose/view link to access the Referring Provider Lookup tool and select the provider from the directory of referring providers. |
Surgeon |
Click the Choose/view link to access the Referring Provider Lookup tool and select the surgeon from the directory of referring providers. |
Anesthesia type |
Select the type of anesthesia. |
Physical status |
Select the patient's physical status. Note: You should indicate the patient's physical status when you enter anesthesia data, even though this data is not required.
Indicates the additional units to be charged if the physical status modifiers flag is set to yes or MD Only. Typically, a practice bills an additional 1—3 units for physical status modifiers P3—P5. P1 P2 P3 P4 P5 P6 — Patient is declared brain-dead and the patient's organs are being removed for donor purposes. Additional units are almost never billed or reimbursed for the physical status modifier P6. |
Extenuating circumstances |
Indicates any extenuating circumstances. Administered via the Anesthesia Billing Settings page. If an extenuating circumstance is selected, athenaOne creates additional charges as follows:
|
Medical direction |
Select "Incomplete" when fewer than seven of the direction requirements have been met.
*Medical direction is a covered service only if:
* From the HGSA Billing Guides
In athenaOne: When you create an anesthesia claim from a time sheet entry with incomplete medical direction, the following occurs:
Note: The QZ modifier is assigned only if the anesthesia settings would have required a split claim or CRNA claim, and the payer accepts a level of dir/supv (i.e., HCPCS) modifiers. Payers that have specified an MD-only claim without a level of direction/supervision modifiers would have only had a service created for the MD. |
Adverse events |
Select any adverse events that apply to this anesthesia case. Note: This field appears only if you created an adverse events code set via the Adverse Events page. |
Post operative complications |
Select any post operative complications that apply to this anesthesia case. Note: This field appears only if you created a post operative complications list used in your practice via the Post Operative Complications page. |
Case review |
Select this option if you plan to include this anesthesia case in a future review or study. |
Notes | Enter any notes about this anesthesia case. |