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  1. FHIR Specification Feedback
  2. FHIR-35070

Professional profile - modify anesthesiaRelated

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    • Icon: Change Request Change Request
    • Resolution: Not Persuasive
    • Icon: Medium Medium
    • US Da Vinci Patient Cost Transparency (PCT) (FHIR)
    • 0.1.0 [deprecated]
    • Financial Mgmt
    • STU
    • (NA)
    • 7.7.1
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      Will leave slices on procedure.

      Per Comment from Reporter: 

      The claim level procedure code is so the provider billing for anesthesia related to the surgery can send the surgical procedure code to support matching the surgical claim to the anesthesia claim in the payer’s system. Its not saying that the procedure at the claim level is what is being billed for on that claim.  Since the claim level procedure code conveys the surgery performed, the Value Set at the header level should be CPT / HCPCS, not only HCPCS

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      Will leave slices on procedure. Per Comment from Reporter:  The claim level procedure code is so the provider billing for anesthesia related to the surgery can send the surgical procedure code to support matching the surgical claim to the anesthesia claim in the payer’s system. Its not saying that the procedure at the claim level is what is being billed for on that claim.  Since the claim level procedure code conveys the surgery performed, the Value Set at the header level should be CPT / HCPCS, not only HCPCS
    • Rachel Foerster/Rick Geimer: 11-0-0

    Description

      The professional claim allows for the submission of up to two procedures when the claim contains anesthesia services and the surgical code is known and known to be needed. The professional claim however reports it using the HCPCS code not an ICD-10-PCS procedure code.  On the professional profile, 

      Remove all slices from .procedure

      Define two slices on item.productOrService, one with required binding to the Value Set Procedure Codes - AMA CPT - CMS HCPCS and another, anesthesiaRelated, to an external Value Set, Procedure Codes - CMS HCPCS

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            taylorpatriciab Patricia Taylor
            Patricia Taylor
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              Updated:
              Resolved: