Use the following procedure to set up a claim modifier for Anesthesia SIM codes:
Open File Maintenance.
Select Libraries, and then select Claims Modifiers.
The Claims Modifiers List window opens.
To add a claim modifier, select Open Menu , and then select New.
The Add Claim Modifiers window opens.
Enter a value in the Claim Modifiers Library field.
Select Open Menu , and then select New.
The Add/Modify Claim Modifiers window opens.
In Modifier, enter a two-character anesthesia modifier. This field is required and cannot be modified after the modifier is saved.
P1 - Normal healthy patient
P2 - Patient with mild systemic disease
P3 - Patient with severe systemic disease
P4 - Patient with severe systemic disease that is a constant threat to life
P5 - Patient who is not expected to survive without the procedure
P6 - Declared brain-dead patient whose organs are being removed for donor purposes
In Effective Date, enter a start date for the modifier.
Note: The date defaults to 01/01/1900 for modifiers that were created prior to version 5.9.3.
In Expiration Date, enter an end date for the modifier.
Note: The date defaults to 01/01/2099 for modifiers that were created prior to version 5.9.3.
In Modifier Change for Claims, select one of the following options to add or remove the modifier on claims. The modifier is added or removed when the claim is created during the billing process in NextGen® Enterprise PM.
<none>: Leave this field blank to include the modifier on the claim for charges that were entered with the modifier.
Add if <Credential>: Select this option to add the modifier to the claim for charges with a specific ICD code that are rendered by providers with a specific Credential on the Modify Provider Information window > Credentialing tab.
When selected, the Credential field and ICD Selection section become enabled.
In the Credential field, select the appropriate credentials for the modifier.
In the ICD Selection section, select the appropriate ICD codes for the modifier from the Available section on the left and then select the right arrow to move the ICD codes to the Included section on the right.
Note: The modifier is added to the claim only if the provider's credential is in effect (not expired) for the date of service on the charge.
Add if <Department> on SIM: Select this option to add the modifier to the claim for charges with a SIM code assigned to a specific Department on the Service Item Library Maintenance window > General tab.
When selected, the Departments field becomes enabled. Select the appropriate departments for the modifier.
Add if <Encounter in a Series>: Select this option to add the modifier to the claim for charges on encounters that fall within a specific series range. For example, entering a range of 1 to 3 adds the modifier to claims for the first three encounters in a series.
When selected, the Encounter in a Series fields become enabled. Enter the appropriate encounter from/to range for the modifier.
Add if <ICD> on Charge: Select this option to add the modifier to the claim for charges with a specific ICD code.
When selected, the ICD Selection section becomes enabled. Select the appropriate ICD codes for the modifier from the Available section on the left and then select the right arrow button to move the ICD codes to the Included section on the right.
Add if <Primary Credential> and <Other Credential>: Select this option to add the modifier to the claim for charges with a specific ICD code that are rendered by providers with a specific Primary Credential and other Credential on the Credentialing tab of the Modify Provider Information window.
When selected, the Provider Primary Credential field, Provider Other Credential field and ICD Selection section become enabled.
In the Provider Primary Credential field, select the appropriate credential for the modifier.
In the Provider Other Credential field, select the appropriate credential for the modifier.
In the ICD Selection section, select the appropriate ICD codes for the modifier from the Available section on the left and then select the right arrow button to move the ICD codes to the Included section on the right.
Note: The modifier is added to the claim only if the provider's primary credential and other credential are both in effect (not expired) for the date of service on the charge.
Add if <Program>: Select this option to add the modifier to the claims for charges on encounters with a specific Program on the General tab of the Encounter Maintenance window.
When selected, the Program field becomes enabled. Select the appropriate programs for the modifier.
Add if <Provider Type>: Select this option to add the modifier to the claim for charges that are rendered by providers with a specific Provider Type on thePractice tab of the Modify Provider Information window.
When selected, the Provider Type field becomes enabled. Select the appropriate provider types for the modifier.
Add if <Specialty> is Rendering: Select this option to add the modifier to the claim for charges that are rendered by providers with a specific Specialty on the Practice tab of the Modify Provider Information window.
When selected, the Specialties field becomes enabled. Select the appropriate specialties for the modifier.
Remove: Select this option to remove the modifier from the claim for charges that were entered with the modifier.
In the SIM Type field, select Anesthesia to indicate the modifier applies to SIM codes with Anesthesia SIM selected in the SIM Type field in the Service Items library. This field is required.
In the Unit Value field, enter the number of units to be added during charge posting when the modifier is entered on an anesthesia charge, if applicable.
[Base Units + Time Units + Modifier Units = Total Anesthesia Units]
For example, the following Physical Status modifiers might be setup as follows:
P1 = 0 units
P2 = 0 units
P3 = 1 unit
P4 = 2 units
P5 = 3 units
P6 = 0 units
In the Anesthesia Concurrency Functionality section, select one of the following:
Billing (default): Select this button to do the following:
The modifier is applied during the billing process that creates the claim for the encounter.
The modifier is added to the claim only, not the charge.
Total units are not updated on the charge or the claim.
Applies to all payers on the encounter; primary, secondary, and tertiary.
Concurrency Charges: Select this button to do the following:
The modifier is applied during the Anesthesia Concurrency Audit process that converts the encounter from In Progress to Unbilled status.
The modifier is added to the charge, and therefore appears on the claim.
Total units are updated on the charge, and therefore appear on the claim.
Applies only to the primary payer on the encounter, not secondary or tertiary.
Both: Select this button to do the following:
The modifier is applied during the billing process or the Anesthesia Concurrency Audit process.
The modifier is added to both the charge and the claim.
Total units are updated on both the charge and the claim.
Applies to all payers on the encounter; primary, secondary, and tertiary.
Do one of the following:
To add SIM codes for the modifier, search and select the codes from the Available section on the left, and then select the right arrow to move the codes to the Included section on the right.
To remove SIM codes from the modifier, select the codes from the Included section on the right, and then select left arrow to move the codes to the Available section on the left.
