Anesthesia Service Information

Field	Description
Type of Anesthesia	You can select one of the following options to identify the method of anesthesia administered: <none> QS – Monitored Anesthesia Care (MAC) 8: G8 – MAC for complicated or invasive surg 9: G9 – MAC for severe cardio-pulmonary cond General Anesthesia Epidural Anesthesia Spinal Anesthesia Note: Selection of QS, G8, or G9 fills the modifier in position 2 for the anesthesia charges. All other modifiers are for case documentation purposes.
Physical Status	The physical status modifier is a two-character code that indicates the general health of the patient. The first character is a letter P, and the second character is a single digit from 1-6. This selection overwrites any manually entered physical status modifier for the patient. You can choose one of the following options to enter the modifier in position 3 for the anesthesia charge: <none> 1: P1 - A normal healthy patient 2: P2 - A patient with mild systemic disease 3: P3 - A patient with severe systemic disease 4: P4 - A patient with severe systemic disease that is a constant threat to life 5: P5 - A moribund patient who is not expected to survive without the operation 6: P6 - A declared brain-dead patient whose organs are being removed for donor purposes
Medical Direction	Overrides the automatic calculation performed by the concurrency audit for medical direction. You must leave this field blank or select None. The following reasons are responsible for an encounter failure marked in red. The level of concurrency selected is different from what the audit would calculate. The Exempt from Concurrency check box is not selected. Encounter will pass the concurrency audit and override the automatic selection of medical direction calculated by the system if you select the Exempt from Concurrency check box and you select the following options: Personally performed by physician 1 case: Medical direction of 1 case Direction: Medical direction by a physician Supervision: Medical supervision CRNA service without medical direction Medically necessary
Present at Induction	Indicates that the Medical Doctor of Anesthesiology is present at the initial administration of the anesthesia and when the anesthesia begins to take effect.
Exempt from Concurrency	You can select this check box to do the following: Exclude the providers on the encounter from being included in the concurrency calculation. Shows the message Manually exempt from Concurrency on the Concurrency Audit Report for the encounter.

Help Guide for NextGen® Enterprise PM 8

Anesthesia Service Information Window

This procedure enables you to document information about the case and potentially add modifiers for the type of anesthesia, physical status of the patient, and medical direction. If your selection results in a modifier being added to a charge, then the modifier is applied to all anesthesia charges on the encounter. You can also add additional procedures to the encounter from this window. To add modifiers to all anesthesia services on an encounter, do the following: On the Charge Posting window, enter and Save an Anesthesia charge. Select the Anesthesia Service Information button on the charge posting toolbar. The Anesthesia Service Information window opens. Use the following table to select and apply modifiers to an encounter and then select OK. Field Description Type of Anesthesia Select one of the following options to identify the method of anesthesia administered: <none> QS – Monitored Anesthesia Care (MAC) 8: G8 – MAC for complicated or invasive surg 9: G9 – MAC for severe cardio-p

Help Guide for NextGen® Enterprise PM 8

Set Up Claim Modifiers for Anesthesia Billing

Use the following procedure to set up a claim modifier for Anesthesia SIM codes: Access the Add/Modify Claim Modifiers window. In the Modifier field, enter a two-character anesthesia modifier. This field is required and cannot be modified after the modifier is saved. For example: 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 the Effective Date field, enter a start date for the modifier. This field is required. Note: The date defaults to 01/01/1900 for modifiers that were created prior to version 5.9.3. In the Expiration Date field, enter an end date for the modifier. This field is required. Note: The date defaults to 01/01/2099 for modifiers that were created prior to version 5.9.3. In the Modifier

File Maintenance Help for NextGen® Enterprise 8

Set Up Claim Modifiers for Anesthesia Billing

Use the following procedure to set up a claim modifier for Anesthesia SIM codes: Access the Add/Modify Claim Modifiers window. In the Modifier field, enter a two-character anesthesia modifier. This field is required and cannot be modified after the modifier is saved. For example: 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 the Effective Date field, enter a start date for the modifier. This field is required. Note: The date defaults to 01/01/1900 for modifiers that were created prior to version 5.9.3. In the Expiration Date field, enter an end date for the modifier. This field is required. Note: The date defaults to 01/01/2099 for modifiers that were created prior to version 5.9.3. In the Modifier

File Maintenance Help for NextGen® Enterprise 8

Medical Direction Field Descriptions

In the Medical Direction of 1 Case, Medical Direction of 2-4 Cases, and Medical Direction of 5+ Cases sections, if a modifier is assigned to either the CRNA or the Medical Director but not both, then split billing does not occur. Split billing occurs when a modifier is assigned to both the Medical Director and the CRNA. Field Description Concurrency Modifiers: Personally performed by a Physician Enter a two-character modifier indicating the anesthesiologist performed the case alone. For example, AA. CRNA performing without medical direction Enter a two-character modifier indicating the CRNA performed the case alone without medical direction by an anesthesiologist. For example, QZ. Medical Direction of 1 Case: Medical Director Enter a two-character modifier indicating the anesthesiologist provided medical direction for one CRNA case. For example, QY. CRNA Enter a two-character modifier indicating the CRNA performed a case with medical direction by an anesthesiologist. For example, QX. M

Help Guide for NextGen® Enterprise PM 8

Medical Direction Field Descriptions

In the Medical Direction of 1 Case, Medical Direction of 2-4 Cases, and Medical Direction of 5+ Cases sections, if a modifier is assigned to either the CRNA or the Medical Director but not both, then split billing does not occur. Split billing occurs when a modifier is assigned to both the Medical Director and the CRNA. Field Description Concurrency Modifiers: Personally performed by a Physician Enter a two-character modifier indicating the anesthesiologist performed the case alone. For example, AA. CRNA performing without medical direction Enter a two-character modifier indicating the CRNA performed the case alone without medical direction by an anesthesiologist. For example, QZ. Medical Direction of 1 Case: Medical Director Enter a two-character modifier indicating the anesthesiologist provided medical direction for one CRNA case. For example, QY. CRNA Enter a two-character modifier indicating the CRNA performed a case with medical direction by an anesthesiologist. For example, QX. M

Help Guide for NextGen® Enterprise PM 8

Concurrency Audit Report Messages

Each charge line may have one or more messages on the report. The color coding identifies the status of the encounter after the Anesthesia Concurrency Audit process is run. The encounter statuses are: Green: Indicates the encounter passed the audit. Blue: Indicates a warning message and the encounter should be reviewed. Red: Indicates the encounter failed the audit. The following table lists the error messages, the status of the encounter, and the reason the Anesthesia Concurrency Audit process generated the message. Message Status Occurs when... Encounter successfully passed audit Pass (Green) There are no errors based on the Anesthesia Library rules. Encounter manually exempt from concurrency Warning (Blue) The Exempt from Concurrency check box was selected on the Charge Posting > Anesthesia Services Information window. May occur with an error message with a status of red. This indicates the encounter has concurrency errors, but it passed due to a manual exemption. Medical Direction

Anesthesia Service Information

Recommendations

Anesthesia Service Information Window

Set Up Claim Modifiers for Anesthesia Billing

Set Up Claim Modifiers for Anesthesia Billing

Medical Direction Field Descriptions

Medical Direction Field Descriptions

Concurrency Audit Report Messages

Anesthesia Service Information Window

Set Up Claim Modifiers for Anesthesia Billing

Set Up Claim Modifiers for Anesthesia Billing

Medical Direction Field Descriptions

Medical Direction Field Descriptions

Concurrency Audit Report Messages