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Back  RFI # 1110: Anesthesia Claim Definition

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Submitter

Lisa Doyle

Description

With the change in reporting anesthesia claims from the 837 Professional 4010A1 and the 5010 versions, clarification on the definition of ‘an Anesthesia Claim’ is needed. It is the understanding of the WEDI SNIP 837 sub workgroup that anesthesia claims are claims with anesthesia procedure codes that do not have a specific time period defined in the description of the code. In legacy and 004010A1 (4010A1) formats, anesthesia services could be reported as either minutes or units. In 5010, anesthesia claims must be reported as minutes. There is nothing in the 837P or 837I TR3's that allow for distinguishing between, and reporting differently for, an anesthesia procedure that is time-based in its description. A change to the Anesthesia reporting in SV103 is proposed for 837 v6020, but this proposed v6020 notes change cannot be applied by WEDI (in opposition to the guide) in v5010.

Submitter Assigned Keywords

837P - Anesthesia Claim Definition

Response

In 5010 note SV103, “Required for Anesthesia Claims,” the workgroup intended that anesthesia procedures which can logically be reported in minutes must be reported in minutes. The workgroup considers codes in the Anesthesia section (currently 00100 to 01999) to be anesthesia procedures. The change in the situational rule between 5010 and 6020 is only for clarification, not a change in requirements. At the time of writing 5010, the workgroup was unaware of any anesthesia procedures having descriptions with time periods already included or whose time is assigned to a primary code (see examples below). There was no intention of overruling the attributes built into the HCPCS description, but to fill the void where it is nondescript. There was also concern that implementers might interpret codes in the Moderate Sedation Services section as anesthesia.The proposed rule for 6020 would clarify that those codes would not be reported with minutes, since those codes also have time as part of the description.

Recommendation

Following the situational rule proposed for 6020 would not oppose the rule for SV103 in 5010.

Example of time included in description: 01996 – DAILY HOSP MGMT EDRL/SARACH CONT DRUG ADMN

Example of add-on code with time assigned to primary code: 01953 - ANES 2/3 DGR BRN EXC/DBRDMT +-GRF, each additional 9% total body surface area
Submission 7/21/2010
Status Date 8/27/2010
Status F - Final
Primary References
Document 005010X222
SectionSV1
Page355
Set IDSV103