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Overview

The Procedures & Provider Time tab collects the detailed information of the procedure and provider time related to anesthesia procedures.

When viewing a case in read-only mode, you can only view information and cannot change any related information on this tab.

How to Get Here?

From the Home Page:From the Menus:Via Shortcut Keys:
  1. Click Charge Batches from the Manage list.
  2. Double-click the charge batch to review.
  3. Double-click the case to review.
  4. Click the Procedure & Provider Time tab.
  1. Open the Manage menu and select Charge Batches.
  2. Double-click the charge batch to review.
  3. Double-click the case to review.
  4. Click the Procedure & Provider Time tab.
  1. Press [Alt] + [M] + [C].
  2. Double-click the charge batch to review.
  3. Double-click the case to review.
  4. Press [Alt] + 3 to navigate to the  Procedure & Provider Time tab.

 


 

Field Definitions

Field

Type

Required

Description

Procedure Table

 

 The table contains a list of all procedures added to the case.
Type of Serv

Display Only

(Pulled from added/updated Procedure)


Yes

The type of service provided. When the CPT code is any of the following, this value will be as indicated:

  • 00100-01999 Anesthesia
  • 99100-99140 Anesthesia
  • 10021-69990 Surgery
  • 70010-79999 Diagnostic Radiology
  • 80048-89356 Diagnostic Laboratory
  • 90281-99099 Medical Care
  • 99141-99199 Medical Care
  • 99201-99499 Medical Care
Code

Display Only

(Pulled from added/updated Procedure)

YesThe procedure that was performed on the case. If the procedure can be mapped to an anesthesia code, the ASA column contains that anesthesia code. If procedure in the Code column is an anesthesia procedure, the ASA column contains that procedure code.
ASA

Display Only

(Pulled from added/updated Procedure)

No

The corresponding anesthesia code of the procedure.

  • If the procedure in the Code column cannot be mapped to an anesthesia code, this column is blank.
  • If the procedure in the Code column can be mapped to an anesthesia code, the ASA column contains that anesthesia procedure code.
  • If the procedure in the Code column is an anesthesia procedure, the ASA column contains that procedure code.
  • If more than one anesthesia code can be mapped to a CPT code, a list of possible anesthesia codes are listed.
Description

Read-only

YesThe description of the procedure. This column contains information only and is updated when a procedure is selected in the Code column.
Modifiers

Display Only

(Pulled from added/updated Procedure)

NoThe two-character code used to describe the services associated with a procedure. A procedure can have up to four modifiers.
Diagnosis Codes

Display Only

(Pulled from added/updated Procedure)

YesThe diagnosis codes of the procedure. Each diagnosis code is represented in the priority of the relating diagnosis codes for the procedure. Diagnosis codes are ranked according to the primary diagnosis (1), secondary diagnosis (2), etc.
Qty

Display Only

(Pulled from added/updated Procedure)

YesThe number of units for the service being rendered, for example, the number of treatments. For an anesthesia procedure, this value is 1.
NDC

Display Only

(Pulled from added/updated Procedure)

NoThe National Drug Code of the drug administered by injection, as indicated by the J-Code procedure.
Provider

Display Only

(Pulled from added/updated Procedure)

No

The name of the provider who performed the general procedure on the case.

For an anesthesia procedure, this column is blank.

Provider ID is required when the case includes a Directed CRNA.

Place of Serv

Display Only

(Pulled from added/updated Procedure)

YesThe designated place of service for the facility.
DOS

Display Only

(Pulled from added/updated Procedure)

Yes

The date of service for the procedure. For anesthesia procedures, this column will be updated from the provider time after it has been recorded in the Anesthesia Case Provider Time section.

The DOS column contains the actual date the service began. For anesthesia procedures that span more than one day, the DOS is calculated based on the date and end time recorded for the provider in Anesthesia Case Provider Time and will be reported in the 837 at the service line level.

Fee

Read-only

(Calculated based on the Billing Fee Schedule)

Yes

The dollar amount for the service fee of the procedure calculated by the billing fee schedule.

  • For general procedures, this column contains the calculated dollar amount that will be billed for the procedure.
  • For anesthesia procedures, this column contains the calculated amount for that procedure unless there is another anesthesia procedure that has a greater fee amount. In this case, dashes are displayed in the Fee column for the procedures with the lesser values.
  • For anesthesia procedures with an add-on code, this column contains the fee for that add-on, regardless of whether that fee is less than another anesthesia procedure on the case.
When rebilling a service line item without fee changes, you cannot change this value.
Procedure Details Section  This area provides information about the currently selected procedure in the procedure list.
Code

Display Only

(pulled from the Billing Fee Schedule)

YesThe procedure code of the currently selected procedure in the procedure list.
PSUs

Display Only

(pulled from the Billing Fee Schedule)

NoThe Physical Status Units (PSUs) for the currently selected anesthesia procedure in the procedure list. If a different physical status modifier is selected on the procedure, this value will be updated, which might cause fees to be recalculated. For a general procedure, dashes will be displayed for this value.
Base Units

Display Only

(pulled from the Billing Fee Schedule)

YesThe standard base units on the currently selected procedure in the procedure list. If the procedure has an override value on the base unit, that value will also be displayed. Override values will appear in red. Dashes indicate that an override is not present.
Billing Fee

Read-only

(calculated from the Billing Fee Schedule and Anesthesia Provider Time)

YesThe dollar amount calculated from the billing fee schedule for the currently selected procedure in the procedure list. This value is dynamic and will be updated as changes to the procedures are applied. For example, the Physical Status modifier is changed on an anesthesia procedure. If an override has been applied, the dollar amount of the override will be displayed in red. If an override has not been applied, dashes will be displayed.
Expected Fee

Read-only

(calculated from the Expected Fee Schedule and Anesthesia Provider Time)

YesThe reimbursement amount expected from the payer or plan for the currently selected procedure in the procedure list. 
CMS Status

Read-only

(pulled from CMS)

No

The value assigned by CMS for the currently selected procedure code. 

The values that can be displayed include:

  • Active Code
  • Bundled Code
  • Carriers price the code
  • Deleted Codes
  • Excluded from Physician Fee Schedule by regulation
  • Deleted / Discontinued Codes
  • Not Valid for Medicare Purposes
  • Deleted Modifier
  • Not Valid for Medicare Purposes
  • Anesthesia services
  • Measurement Code - Reporting only
  • Noncovered Services
  • Bundled/Excluded Codes
  • Restricted Coverage
  • Injections
Billing Fee Schedule

Drop Down

YesThe current billing fee schedule used for calculating procedure fees. The field is a drop down which allows users to override the default fee schedule, as necessary. Fee schedules available from the drop down are only those that are active and affiliated with the current practice.
Expected Fee Schedule

Display Only

(pulled from the Insurance assigned to case)

Drop Down

The expected fee schedule used for calculating the expected fee amount.

The default fee schedule can be overridden by selecting another fee schedule from the drop down list.

Case Fee Summary Section  This area provides information about the provider time on the anesthesia procedure. The information is updated as the provider time is completed.
Minutes

Read-only

(calculated from the Anesthesia Provider Time)

No

A breakdown of the total minutes tied to the procedure split between Directing and Directed. The maximum number of minutes allowed for the procedure is defined in the fee schedule.

Uncapped Minutes

Read-only

(calculated from the Anesthesia Provider Time)

No

The Uncapped Minutes fields are populated with the true minutes required for the procedure, including those minutes above the capped amount, as defined in the fee schedule.

Billed Time Units

Read-only

(calculated from the Anesthesia Provider Time)

YesThe billed units for all procedures on the case split between Calculated, Override, and Add-On Override units.
Add-On Minutes

Read-only

(calculated from the Anesthesia Provider Time)

NoA breakdown of the total minutes tied to an ancillary procedure split between Directing and Directed.
Uncapped Add-On Minutes

Read-only

(calculated from the Anesthesia Provider Time)

NoThe Uncapped Add-On Minutes fields are populated with the true minutes required for an ancillary procedure, including those minutes above the capped amount, as defined in the fee schedule.
Expected Time Units

Read-only

(calculated from the Anesthesia Provider Time)

YesThe units expected to be paid for all procedures on the case split between Calculated, Override, and Add-On Override units.
Bill Amount

Read-only

(calculated from the Billing Fee Schedule and Anesthesia Provider Time)

YesThe amount that was billed for total charges for each procedure. It should match the Billing Fee.
Expected

Read-only

(calculated from the Expected Fee Schedule and Anesthesia Provider Time)

NoThe expected amount of payment from the responsible party for the amount billed, which is determined by the expected fee schedule configured at the practice configuration.
Total Billed Units

Read-only

(calculated from the Billing Fee Schedule)

YesThe total of all base + time + physical status units.
Anesthesia Case Provider Time Section   
Provider Role

Display Only

(pulled from Provider Type field on Add Provider Time window)

Yes

The role the provider performed while administering anesthesia: Directing, Directed, or Observing.

Provider Name

Display Only

(pulled from Provider field on Add Provider Time window)

YesThe last, first, and title of the provider who performed the anesthesia procedure specified.
Start Time

Display Only

(pulled from Start Time field on Add Provider Time window)

Yes

The date and time the provider started the anesthesia procedure as specified.

The provider time can span days within a time range for an individual provider. For example, a procedure started on 09-14-2014 at 19:00 and ended on 09-15-2014 at 00:52 for a solo provider. This time can be entered as one start and end time entry as 09-14-2014 19:00 (start time) and 09-15-2014 00:52 (end time). If the procedure includes an add-on procedure (for example, 01967 and 01968), the time can be entered as a single entry with the start time for the add-on procedure entered in the Add-On Begin Time field.
End Time

Display Only

(pulled from End Time field on Add Provider Time window)

Yes

The date and time the provider ended the anesthesia procedure as specified.

The provider time can span days within a time range for an individual provider. For example, a procedure started on 09-14-2014 at 19:00 and ended on 09-15-2014 at 00:52 for a solo provider. This time can be entered as one start and end time entry as 09-14-2014 19:00 (start time) and 09-15-2014 00:52 (end time). If the procedure includes an add-on procedure (for example, 01967 and 01968), the time can be entered as a single entry with the start time for the add-on procedure entered in the Add-On Begin Time field.
Exclude

Display Only

(pulled from checkbox on Add Provider Time window)

No

To exclude the time segment from concurrency checking, the Exclude from Concurrency Checking checkbox is selected in the Add Provider Time window when adding time. If selected, the Exclude column is checked.

This differs from the Exclude from Concurrency Checking option to the right of the table, which excludes the entire case from concurrency checking validation.

Anesthesia MethodDrop DownYes

The method used to administer the anesthesia. The options include::

  • CSE - Combined Spinal Epidural
  • EPI - Epidural       
  • GEN - General      
  • LOC - Local Anesthesia      
  • MAC - Monitored Anesthesia Care      
  • G8 - MAC for Deep Complex or Markedly Invasive Procedure     
  • G9 - MAC for Patient with History of Severe Cardiopulmonary Condition     
  • REG - Regional      
  • SPI - Spinal 
  • TIA - Total Intravenous Anesthesia     
  • UNK - Unknown
If you change the Physical Status field value, the data displayed in the PSUs column under Procedure Details will be updated, which might cause the fees to be recalculated.

When rebilling a service line item without fee changes, you cannot change this value.

Add-On Begin Time

Calendar Date and Time

(mm/dd/yyyy hh:mm)

No

The time at which the transition from a primary procedure to a secondary procedure occurred on the case, if applicable. For example, suppose the primary procedure started as anesthesia for a vaginal delivery, but then evolved into a secondary procedure as anesthesia for a C-section. In this case, you would enter the start time of the secondary procedure, which is the anesthesia related to the C-section.  

The Add-On Begin Time option is only available when procedures 01968 and 01969 are entered in the procedure details table. The primary procedure and the add-on procedure must be entered in the procedure details table. In addition, both the primary procedure and the add-on procedure must be included in the current billing fee schedule.

If either 01968 or 01969 procedure (anesthesia add-on procedure) is included in the procedure details table, the add-on begin time is required. By default, this information is blank.

Physical StatusDrop DownYes

The billing unit value added to an anesthesia procedure to indicate the complexity of the procedure regarding the physical status of the patient. The billing unit values are used to calculate anesthesia fees. The supported physical status modifiers are P1 through P6. This information is required if the procedure is an anesthesia procedure. By default, this option is blank. Select a value from P1 to P6 for the physical condition of the patient.

The following table contains the description of each modifier according to the American Society of Anesthesiologists (ASA) ranking of patient physical status:

Physical Status ModifierDescription

P1

A normal healthy patient. The unit value for this modifier is 0.

P2

A patient with mild systemic disease. The unit value for this modifier is 0.

P3

A patient with severe systemic disease. The unit value for this modifier is 1.

P4

A patient with severe systemic disease that is a constant threat to life. The unit value for this modifier is 2.

P5

A moribund patient who is not expected to survive without the operation. The unit value for this modifier is 3.

P6A declared brain-dead organ donor.
Override Bill AsDrop DownNoThe option for overriding the billing provider to bill as a different provider than the one who performed the anesthesia procedure. For example, the physician instead of the CRNA who actually performed the anesthesia procedure. By default, this information is blank. To bill as a different provider, choose the provider from the list. The provider you choose will be listed on the claim instead of the provider who performed the service.
Exclude from Concurrency CheckingCheckboxNo

Indicates if the case will not be validated for concurrency exceptions. This option is specific to anesthesia and can only be selected if the procedure includes anesthesia. Use caution when selecting this option as concurrency exceptions will not be reported, which could result in fraudulent billing. By default, this option is blank. To exclude the case from concurrency validation, click the checkbox.

If you click this option, the following message appears: Excluding this case from concurrency checking may result in fraudulent billing.

Click No to close the message without activating this option. Click Yes to stop concurrency validation on this case.

When rebilling a service line item without fee changes, you cannot change this value.

Force Team SupervisionCheckboxNo

Indicates that not all medical supervision conditions might have been met for medical direction on the case. The case will be billed as medical supervision. At least one Directing provider and one Directed provider must be specified in the Anesthesia Case Provider Time section. Not following the medical direction criteria may result in an audit. By default, this option is blank. Click this option to apply the supervising modifier on the case.

If you click this option, the following message appears: Enabling team supervision will cause the case to be billed as medical supervision. This indicates that not all medical supervision conditions have not been met for medical direction.

Click No to close the message without activating this option. Click Yes to apply the supervising modifier to this case.

When rebilling a service line item without fee changes, you cannot change this value.

Errors and Warning Section  

This section reports problems detected through the Error Check validation process. Use the Display options to select the validations to verify.

In addition to errors and warnings, the date and time the last error check occurred is reported. If an error check has never been performed on a charge batch or case, the text displayed will be Last Check: (pending). Each time an error check is completed, this text is updated and displayed in the following format: Last Check: mm/dd/yyyy, hh:mm:ss AM/PM, for example, Last Check:  07/08/2013, 4:35:14 PM.

Display FiltersCheckboxesNo

This filter determines the type of errors or warnings listed in the Error Check list. Errors must be corrected before a case or charge batch can be submitted and claims can be generated. Warnings may or may not cause rejection of a claim and are not required to be corrected. A checkmark next to the display filter indicates that the filter is selected.

The filter options dynamically affect the contents of the error checklist. When you clear a checkbox, the list hides the applicable errors or warnings. When you click the checkbox again, the list refreshes, showing the hidden errors or warnings.

Type

Read-only

(system-generated)

Yes

The classification of the problem detected in a category during the Error Checking process. Cases in the charge batch are validated for certain conditions reported as errors or warnings.

TypeDescription
ErrorsConditions on a case that affect claims generation. Errors must be corrected before cases can be submitted and claims can be created.
WarningsConditions on a case that may cause the claim to be rejected by a payer. Warnings do not have to be corrected before cases can be submitted and claims can be created.
Category

Read-only

(system-generated)

Yes

The component that may contain an error or warning when either condition is detected during error check validation, for example, Concurrency or Data. By default, all categories are selected and all errors and warnings are displayed on the Charge Batch Error Check tab. Errors must be corrected before a claim can be created. Warnings do not have to be corrected before a claim can be created.

The categories listed in the error check table are controlled by the Display filters on the Charge Batch Error Check tab. The following categories are available:

CategoryDescription
ConcurrencyExceptions reported on anesthesia provider time for violations that occur across multiple cases. In most cases, concurrency exceptions are reported as errors unless concurrency validation is excluded on the case. If concurrency is excluded on the case, exceptions are reported as warnings.
CCIExceptions reported on code auditing for detecting discrepancies between the diagnosis code and the procedure code. CCI edit warnings are not required to be resolved before a claim can be created, but if not correct, the problems may result in claim rejections by the payer.
ICD-9/ICD-10Exceptions reported on diagnosis codes for authenticating that the diagnosis is appropriate for a particular age or gender. ICD-9 edit warnings are not required to be resolved before a claim can be created, but if not correct, the problems may result in claim rejections by the payer.
PayerExceptions reported on payers or plans for evaluating claim filing rules specific to a payer or plan, for example, provider identification numbers, or date of service of procedure occurs after provider effective date.
DataExceptions reported on data for identifying primary data elements (for example, primary diagnosis code) that are missing, are required for all cases, or are required based on specific conditions within a case. Required data must be entered before a claim can be created.
Message

Read-only

(system-generated)

YesThe description of the error or warning.
Related CasesLinkNoA direct link to cases related to the case that has a warning or error. To go to a related case, click the direct link. If the related case has a warning or error that is corrected, the Error Check validation process will verify the case and remove it from the Charge Batch Error Check tab

Button Descriptions

Button

Shortcut Keys

Description

Step-By-Step Guides

Add[Alt] + [D]To add a procedure.

Creating Cases

See Steps 43-58

Update[Alt] + [U]To modify a procedure.

Updating Cases

See Steps 44-59

Remove[Alt] + [R]To delete a procedure.
  1. Select the procedure from the list to delete.
  2. Click Remove.
  3. Click OK.

The procedure is deleted unless one or more of the following conditions apply:

  • There is only one anesthesia procedure and it is deleted, the provider time for that procedure is discarded and the options for Anesthesia Case Provider Time become unavailable.
  • The procedure being deleted has add-on codes, the add-on codes must be deleted first. For example, procedure 01967 is the parent to the add-on codes 01968 and 01969. The 01967 procedure cannot be deleted before procedures 01968 and 01969. If you attempt to delete a parent procedure, the following message is displays: Cannot delete this procedure without first deleting the dependent add-on procedure. Click OK to close the message. Delete procedures 01968 and 01979, and then delete procedure 01967.
Override[Alt] + [O]To apply override values to a procedure.

Updating Cases

See Step 44 Additional Information

Payment[Alt] + [Y]To apply a guarantor payment against a procedure(s) on the case.
  1. From the Case / Procedures & Provider Time tab, click the Payment button. The Add Distribution window opens.
  2. Enter the payment information in the Check Information section.
  3. Enter the payment or adjustment amount for each procedure in the Service Line section.

    The payment can be applied against one or more than one procedure in the list.
  4. Confirm the Amount entered in the Check Information section balances with the amounts entered in the Service Line section via the Balance Information box.
  5. Click Save to close the window.
The payments can only be applied from this page to the case prior to it's submission.
If the payment has already been created against this case, the Payment button opens the Add Distribution window in read only format to view the payment information.
Anesthesia Case Provider Time Section   
Add Time[Alt] + [T]To record provider time on an anesthesia procedure.

Creating Cases

See Steps 59-70

Update[Alt] + [P]To modify provider time.

Updating Cases

See Steps 60-71

Remove[Alt] + [E]To delete provider time.
  1. Select the provider time to remove.
  2. Click Remove. The Remove Provider Time window opens.

  3. Click OK to delete and continue.
Error and Warnings Section   
Error Check[Alt] + [K]To run the Error Check validation for either a charge batch or a case in a charge batch.Running Error Check Validation

 

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