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 used in order for the charge lines to roll up on a claim.
tab:
- SIM 01967FT is set to 15 minutes per unit.
- SIM 01967NFTB is set to 60 minutes per unit.
Charge Posting:
- Time in Attendance
SIM
01967FT is entered with a start time of 10:00am and a stop time of 10:30am (30 minutes). Since 01967FT is set up with 15 minute units, the system calculates 2 units at $100.00 each for a price of $200.00.
- Time Managing Care (not in attendance)
SIM
01967NFTB is entered with a start time of 10:31am and a stop time of 5:30pm (7 hours). Since 01967NFTB is set up with 60 minute units, the system calculates 7 units at $100.00 each for a price of $700.00.
Electronic Claim:
The two items roll up to a single line with a total fee of
$900.00 and
449 minutes.
Paper Claim:
The
Claim Print library in this example is set to report anesthesia time as HMM (hours followed by minutes).
The two items roll up to a single line with a total fee of
$900.00. The units field populates as
729 where 7 is the total number of hours and 29 is the total number of minutes.
Example 2
Same scenario as Example 1 but in this case, the payer does not allow billing for the time spent on managing care. Only face-to-face time is billable.
| | SIM | CPT4 | FEE |
|---|
| Represents face-to-face time: | 01967FT | 01967 | $100 |
| Represents non-face time that is billable: | 01967NFTB | 01967 | $0 |
Note: To accurately track time and anesthesia concurrency, it is recommended that clients enter both the face-to-face and non-face time services in charge entry.
tab:
- SIM 01967FT is set to 15 minutes per unit.
- SIM 01967NFT is set to 999 minutes per unit.
Electronic Claim:
Only the billable face-to-face time is included on the claim with a total fee of
$200.00 and
30 minutes.
Paper Claim:
Only the billable face-to-face time is included on the claim with a total fee of
$200.00 and
30 minutes.
