Overview
The Concurrency Scheme: New and Concurrency Scheme: [name] pages are comprised of three tabs:
- General Concurrency Scheme Information Tab
- Excluded Procedure Codes Tab
- Physical Status Modifiers Tab
The Physical Status Modifiers tab allows you to record a custom modifier for each physical status modifier to appear on the claim for payers who require different modifiers than the standard unit values, for example, MediCal. The modifiers assigned to each physical status replace the physical status modifiers designated in the fee schedule when the claim is generated for that payer. The fees are calculated based on the billing units of the physical status modifier. The custom modifier only appears on the claim in place of the billing unit.
Field Definitions
Field | Type | Required | Description |
---|---|---|---|
Physical Status Modifiers | Two-Character Modifier Code | No | A custom modifier can be assigned to each physical status modifier (P1 through P5) by provider type. This modifier is shown on an anesthesia procedure on the claim to indicate the complexity of the procedure with regards to the physical status of the patient. The billing unit values assigned at the fee schedule are used to calculate anesthesia fees. By default, these values are set to the value of its respective physical status modifier, for example, P1 = P1, P2 = P2, P3 = P3, P4 = P4, and P5 = P5. |
Send Physical Status Modifiers when Units are Zero | Checkbox | No | If checked, claims will include physical status modifiers when their associated unit value is zero. By default, zero values are excluded on claims. |
Physical Status Modifiers
Modifier | Description |
---|---|
P1 | The modifier that indicates a normal healthy patient. By default, the modifier is P1. |
P2 | The modifier that indicates a patient with mild systemic disease. By default, the modifier is P2. |
P3 | The modifier that indicates a patient with severe systemic disease. By default, the modifier is P3. |
P4 | The modifier that indicates a patient with severe systemic disease that is a constant threat to life. By default, the modifier is P4. |
P5 | The modifier that indicates a moribund patient who is not expected to survive without the operation. By default, the modifier is P5. |