RFI Browser

Back  RFI # 1015: Loop 2300, New HI Segment

Formal vs. Informal Help Informal Formal

Submitter

Oscar Lerma

Description

The 5010 837 Professional specifications include new segment HI - Anesthesia Related Procedure in the 2300 Loop. The situational rule seems a bit ambiguous. With the given situational rule for this new segment, it seems an anesthesia professional could bill for services using the existing segments of the 4010A1. Could an example/situation of it's proper usage be provided? The example provided in the 837 Professional specifications as published by WPC does not make use of this new segment. Thank You.

Submitter Assigned Keywords

837P Anesthesia HI Segment

Response

This issue is explicitly addressed in guide 005010X222. The situational rule on the Anesthesia Related Procedure HI segment reads "Required on claims where anesthesiology services are being billed or reported when the provider knows the surgical code and knows the adjudication of the claim will depend on provision of the surgical code. If not required by this implementation guide, do not send."

Therefore, the segment is required and can only be sent when:

- the claim bills/reports anesthesia services
- the provider knows the surgical code
- the provider knows that adjudication depends upon provision of the surgical code

For example, the segment is required when a provider is billing for administering anesthesia when a patient is having an appendectomy and the provider was told this at scheduling and the payer's companion guide states "Surgical codes are required for adjudication of anesthesia claims".

Other anesthesia info must meet the requirements of the rest of the guide.
Submission 4/1/2010
Status Date 4/8/2010
Status F - Final
Primary References
Document 005010X222
Section2
Page239
Set ID837P
Table2
Loop2300
Segment Position2310
Segment IDHI
Industry NameAnesthesia Related Procedure