RFI Browser

Back  RFI # 2260: Anesthesia Related Procedure

Formal vs. Informal Help Informal Formal

Submitter

Reina Mendoza

Description

We need additional clarification on the situational rule for 837P 2300 HI BP for the Anesthesia Related Procedure. It states that it is 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 it is an anesthesia service or the provider knows the surgical code, should the condition that the surgical code will impact adjudication be met in order to satisfy the rule for the data to be submitted?

Submitter Assigned Keywords

837P 2300 HI Anesthesia Related Procedure

Response

As you stated, the 2300 HI – Anesthesia Related Procedure Situational usage rules states “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.”

The usage rule has two conditions that must be met to make the segment required.

1.The provider knows the surgical code for the anesthesiology services being billed or reported.
AND
2.The providers knows the adjudication of the claim depends on the surgical code being provided.

When both of these conditions are true, the segment must be sent.
Submission 12/12/2017
Status Date 1/19/2018
Status F - Final
Primary References
Document 005010X222
Section2.3.1
Page239
Set ID837
Table2
Loop2300
Segment IDHI
Industry NameAnesthesia Related Surgical Procedure