NextGen Knowledge Center

Anesthesia Units to Follow Primary Claim

The Anesthesia Units to Follow Primary Claim option in Practice Preferences > Claims controls whether secondary and tertiary claims are submitted with the same total anesthesia units that are submitted on primary claims.

When this check box is selected, the total anesthesia units calculated for the primary payer are used on claims for all COBs.

When this check box is not selected, the total anesthesia units may be different on claims for each COB based on payer-level settings.

The total anesthesia units for a charge are normally recalculated when a claim is created for each payer on the encounter; primary, secondary and tertiary. The following calculation is used:

[Base Units + Time Units + Modifier Units = Total Units]

Base Units are defined for the SIM code in the Services Items library and are not payer specific. Therefore, base units are the same for all payers.

Time Units are calculated based on the Anesthesia Minutes Per Unit and Anesthesia Rounding Method defined for each payer in the Payers master file. Because these are payer-level settings, time units may be different for each payer.

Modifier Units are defined in the Claim Modifiers library. Because each payer may have a different library attached, modifier units may be different for each payer.

For example:
  • SIM code 12345 is defined with Base Units = 3.
  • Medicare is setup with Anesthesia Minutes Per Unit = 15, Anesthesia Rounding Method = Round Down at 7 Up at 8, and Claim Modifier P4 = 2 units.
  • BCBS is setup with Anesthesia Minutes Per Unit = 30, Anesthesia Rounding Method = Exact Units to the First Decimal, and Claim Modifier P4 = 1 unit.
Using the above example setup where Medicare is primary and BCBS is secondary on an encounter, and the total time entered on an anesthesia charge is 67 minutes, the total units are calculated as follows for each payer:
  • Medicare: 3 Base Units + 4 Time Units + 2 Modifier Units = 9 Total Units
  • BCBS: 3 Base Units + 2.2 Time Units + 1 Modifier Unit = 6.2 Total Units

The total units on the primary and secondary claims is determined by the Anesthesia Units to Follow Primary Claim setting.

If the check box is not selected, then:
  • Primary Claim: Total Units = 9
  • Secondary Claim: Total Units = 6.2
If the check box is selected, then:
  • Primary Claim: Total Units = 9
  • Secondary Claim: Total Units = 9