Exempt from Concurrency

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

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

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

In the case where a vaginal delivery is planned but an emergency C-Section is necessary, additional set up is not required. The system permits the use of multiple anesthesia SIMs on a single claim. Note: Be advised that this is the only time where it is acceptable to report more than one anesthesia code on a claim. The system is coded using the assumption that clients are aware of billing rules and that billing for multiple anesthesia codes for the same case is typically not permitted. Example The patient was seen by the anesthesiologist from 1:00am to 1:30am for an epidural then the case managed from 1:31am to 3:00am. At 3:00am, it was determined an emergency C-section was needed. The payer permits billing for both face time and non-face time. Charge Posting: SIM 01967FT entered for time in attendance. SIM 01967NFTB entered for time spent on managing the case. SIM 01968 entered for the emergency C-section. Electronic Claim: Both line items are reported on the electronic claim. Paper C

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

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

OB Epidural Billing

The American Society of Anesthesiologists Relative Value Guide lists the following methods as examples to determine professional charges for billing labor anesthesia services: Base units plus time reporting in minutes (insertion through delivery) subject to a reasonable cap. Base units plus one unit per hour for neuraxial anesthesia service management plus direct patient contact time, commonly referred to as Face Time. Incremental time-based fees (e.g. 0<2 hrs, 2-6 hrs, >6 hrs) Single or flat fee Since practices determine their own method for billing OB anesthesia services, NextGen® Enterprise PM can accommodate commonly used and known methods of billing OB anesthesia services. These include: Pain Management epidurals should not be counted against maximum concurrency. Billing for labor cases that changed from a planned vaginal delivery to an emergency C-section. This is the only time billing two anesthesia codes on a claim is permitted. Some payers recognize only time in attendance wit

Exempt from Concurrency

Recommendations

Set Up SIM Options for OB Anesthesia Billing

Total Time Units Minimum/Maximum

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

Total Price Minimum/Maximum

Billing Time in Attendance

OB Epidural Billing

Set Up SIM Options for OB Anesthesia Billing

Total Time Units Minimum/Maximum

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

Total Price Minimum/Maximum

Billing Time in Attendance

OB Epidural Billing