Billing Two Anesthesia Codes in the Event of Emergency C-Section

Help Guide for NextGen® Enterprise PM 8

Billing Time in Attendance

To accommodate the scenario where a payer recognizes only time in attendance with the patient or permits standard billing for time in attendance and decreased billing for time not spent in attendance, multiple service items should be utilized. One service item represents the actual time spent with the patient and the other represents time spent managing the case where the provider was not actually face to face with the patient. Example 1 A patient is in labor 7 ½ hours. The provider spends 30 minutes with the patient administering an epidural. The other 7 hours are spent managing the case but the provider is not actually with the patient. The provider bills anesthesia services at $100 per unit. The payer allows billing for face-to-face time in 15 minute units and billing for the additional time at a reduced rate of 60 minute units. SIM CPT4 FEE Represents face-to-face time: 01967FT 01967 $100 Represents non-face time that is billable: 01967NFTB 01967 $100 Note: The same CPT must be use

Help Guide for NextGen® Enterprise PM 8

Set Up SIM Options for OB Anesthesia Billing

To accommodate OB epidural billing needs, the Anesthesia Library > SIM Options tab includes a number of settings that may be helpful. Access File Maintenance. Select Libraries, and then Anesthesia. The Anesthesia Library List window opens. Double-click to open the desired library. The Anesthesia Library Maintenance window opens. In the Concurrency and Claim Rules section, do one of the following: To create a new rule, select the Open Menu button and select New. The Anesthesia Library Payer Maintenance window opens. For more information, see Set Up Concurrency and Claim Rules for Anesthesia Billing To modify an existing rule, select the row from the list, select the Open Menu button and select Open. The Anesthesia Library Payer Maintenance window opens. Select the SIM Options tab. In the Service Items Range Options section, do one of the following: To create a new SIM range, select the Open Menu button and select New. The SIM Range window opens. For more information, see Set Up SIM Opti

Help Guide for NextGen® Enterprise PM 8

Billing First Hour and Subsequent Hours Differently

In cases where the payer requires different unit calculations for the first and subsequent hours, the Minutes per Timespan option should be used in the Anesthesia Library > SIM Options tab. Example Anesthesia was administered from 1:00am to 4:00am. The payer allows billing for the first hour in 15 minute increments (4 units per hour). For subsequent hours, a reduced rate of 60 minute increments (1 unit per hour) is permitted. Anesthesia Library > SIM Options tab: The Minutes per Timespan option has been selected for the applicable code/code range and the Minutes Per Unit setting for the first time span is set to 15 minutes. Since 15 minute units are permitted for the first hour only and subsequent hours must be billed in 60 minute increments, the From time on the second line is set to 61 minutes. This automatically changes the Thru time on the previous line from 9999 to a value of 60. Charge Posting: The service item is entered and the time range defined (1:00am to 4:00am). The number

Help Guide for NextGen® Enterprise PM 8

Exempt from Concurrency

To address the billing scenario where pain management epidurals should not be counted against maximum concurrency allowances, the Exempt from Concurrency option on the Anesthesia Library > SIM Options tab can be used. If the check box is selected, the SIM or SIM range does not count against the provider’s concurrency settings. Example: SIM code 01967 has been flagged as Exempt from Concurrency. When this service is performed, it does not count against the maximum concurrency value. Parent topic: OB Epidural Billing

Help Guide for NextGen® Enterprise PM 8

Total Time Units Minimum/Maximum

Some payers may define minimum and/or maximum time unit values for anesthesia services. Example 1 Anesthesia administered from 1:00am to 1:30am. The payer has defined the minimum number of time units as 4. Anesthesia Library > SIM Options tab: A Minimum Time Unit value of 4 has been defined in the Anesthesia Library > SIM Options tab for the specified SIM /SIM range. Charge Posting: The service item is entered and the time range is defined (1:00am to 1:30am). The number of time units is calculated as 2 (30 minutes = Two 15 minute units). Note: In this example, the base units for the SIM code is set to 0 to clearly demonstrate that the Total Time Units Minimum setting affects time units only, and not total units. Anesthesia Concurrency Audit: Upon passing the Anesthesia Concurrency Audit process, the system updates the number of time units to 4 to meet the minimum units setting defined in the Anesthesia library. The price is updated accordingly. Example 2 Anesthesia administered from 1:

Help Guide for NextGen® Enterprise PM 8

Total Price Minimum/Maximum

Some payers may define minimum and/or maximum price values for anesthesia services. Example Anesthesia administered from 1:00pm to 8:00pm. The payer has defined the maximum price to be $2000.00. Anesthesia Library > SIM Options tab: A maximum price of $2000.00 has been defined in the Anesthesia Library > SIM Options tab for the specified SIM /SIM range. Charge Posting: The service item is entered and the time range is defined (1:00pm to 8:00pm). The number of units is calculated as 28 (420 minutes = 28 units of 15 minute each). The price is calculated as $2800.00 (28 units X $100 per unit). Anesthesia Concurrency Audit: Upon passing the Anesthesia Concurrency Audit process, the system updates the price to $2000.00 to meet the maximum price setting defined in the Anesthesia library. The number of units remains the same. Parent topic: OB Epidural Billing

Billing Two Anesthesia Codes in the Event of Emergency C-Section

Example

Recommendations

Billing Time in Attendance

Set Up SIM Options for OB Anesthesia Billing

Billing First Hour and Subsequent Hours Differently

Exempt from Concurrency

Total Time Units Minimum/Maximum

Total Price Minimum/Maximum

Billing Time in Attendance

Set Up SIM Options for OB Anesthesia Billing

Billing First Hour and Subsequent Hours Differently

Exempt from Concurrency

Total Time Units Minimum/Maximum

Total Price Minimum/Maximum