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Back  RFI # 1058: 835 Usage of SVC07

Formal vs. Informal Help Informal Formal

Submitter

Louise Clark

Description

When reporting units of service paid for anesthesia minutes on an 835, we need clarification as to when the SVC07 should be used. It is stated in the HIPAA IG that the SVC07 is REQUIRED when the paid units of service provided in SVC05 is different from the submitted units of service from the original claim. This is NOT USED when the submitted units is the same as the value in SVC05.

We have the scenario where a provider submits an 837 with unit count = 60 and Units or Basis of Measurement = MJ (minutes). The Anesthesia minutes conversion used by the system is 15 minutes = 1 unit. Therefore in this example the paid units of service would = “4”. On the 835 the SVC05 would be populated with a value of “4”. Our question is do we need to populate the SVC07 with the original unit count from the claim of “60”? Or because of the Anesthesia minutes conversion, the paid units of “4” really equals “60” and therefore the SVC07 is not required?

Submitter Assigned Keywords

835 Usage of SVC07 when reporting Anesthesia Minutes

Response

If the unit measurement paid equals the minutes submitted then it is not reported in the SVC07.

Recommendation

If the anethesia came in as minutes but the payer pays based upon units then the payer should convert back to minutes going out and if they are the same then there is no difference to be reported in the SVC07 field. Due to the complexity and general non standard units measurement (5,15,20 min) it is impossible for multiple payers (COB) to understand the actual amount of anesthesia if it is not reported in minutes.
Submission 5/24/2010
Status Date 11/15/2010
Status F - Final
Primary References
Document 004010X091A1
Section3.1
Page145
Set ID835