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Segment
in
X12 Release 005040

SV6 Anesthesia Service

To specify the claim service detail for anesthesia
Sequence
Element
Name
Type
Requirement
Min
Max
Repeat
01
C003
Composite Medical Procedure Identifier
Composite (composite)
Mandatory
1
01
Product/Service ID Qualifier
Identifier (ID)
Mandatory
2
2
-
Code identifying the type/source of the descriptive number used in Product/Service ID (234)
C003-01 qualifies C003-02 and C003-08.
Codes (511)
02
Product/Service ID
String (AN)
Mandatory
1
48
-
Identifying number for a product or service
If C003-08 is used, then C003-02 represents the beginning value in the range in which the code occurs.
03
Procedure Modifier
String (AN)
Optional
2
2
-
This identifies special circumstances related to the performance of the service, as defined by trading partners
C003-03 modifies the value in C003-02 and C003-08.
04
Procedure Modifier
String (AN)
Optional
2
2
-
This identifies special circumstances related to the performance of the service, as defined by trading partners
C003-04 modifies the value in C003-02 and C003-08.
05
Procedure Modifier
String (AN)
Optional
2
2
-
This identifies special circumstances related to the performance of the service, as defined by trading partners
C003-05 modifies the value in C003-02 and C003-08.
06
Procedure Modifier
String (AN)
Optional
2
2
-
This identifies special circumstances related to the performance of the service, as defined by trading partners
C003-06 modifies the value in C003-02 and C003-08.
07
Description
String (AN)
Optional
1
80
-
A free-form description to clarify the related data elements and their content
C003-07 is the description of the procedure identified in C003-02.
08
Product/Service ID
String (AN)
Optional
1
48
-
Identifying number for a product or service
C003-08 represents the ending value in the range in which the code occurs.
09
Procedure Modifier
String (AN)
Optional
2
2
-
This identifies special circumstances related to the performance of the service, as defined by trading partners
C003-09 modifies the value in C003-02 and C003-08.
10
Procedure Modifier
String (AN)
Optional
2
2
-
This identifies special circumstances related to the performance of the service, as defined by trading partners
C003-10 modifies the value in C003-02 and C003-08.
11
Procedure Modifier
String (AN)
Optional
2
2
-
This identifies special circumstances related to the performance of the service, as defined by trading partners
C003-11 modifies the value in C003-02 and C003-08.
12
Procedure Modifier
String (AN)
Optional
2
2
-
This identifies special circumstances related to the performance of the service, as defined by trading partners
C003-12 modifies the value in C003-02 and C003-08.
02
Facility Code Qualifier
Identifier (ID)
Conditional
1
2
1
Code identifying the type of facility referenced
P0203
Codes (2)
03
Facility Code Value
String (AN)
Conditional
1
3
1
Code identifying where services were, or may be, performed; the National Uniform Billing Committee (NUBC) Facility Type Code for Institutional Services or the Place of Service Codes for Professional or Dental Services.
04
Monetary Amount
Decimal number (R)
Optional
1
18
1
Monetary amount
SV604 is the submitted charge.
05
Composite Diagnosis Code Pointer
Composite (composite)
Optional
1
01
Diagnosis Code Pointer
Numeric (N0)
Mandatory
1
2
-
A pointer to the diagnosis code in the order of importance to this service
C004-01 identifies the primary diagnosis code for this service line.
02
Diagnosis Code Pointer
Numeric (N0)
Optional
1
2
-
A pointer to the diagnosis code in the order of importance to this service
C004-02 identifies the second diagnosis code for this service line.
03
Diagnosis Code Pointer
Numeric (N0)
Optional
1
2
-
A pointer to the diagnosis code in the order of importance to this service
C004-03 identifies the third diagnosis code for this service line.
04
Diagnosis Code Pointer
Numeric (N0)
Optional
1
2
-
A pointer to the diagnosis code in the order of importance to this service
C004-04 identifies the fourth diagnosis code for this service line.
06
Quantity
Decimal number (R)
Optional
1
15
1
Numeric value of quantity
SV606 is the number of anesthesia minutes.
07
Yes/No Condition or Response Code
Identifier (ID)
Optional
1
1
1
Code indicating a Yes or No condition or response
SV607 is the Certified Registered Nurse Anesthetist (CRNA) supervision indicator. A "Y" value indicates that services were performed personally by a CRNA who was medically directed by a physician other than the operating surgeon, assistant surgeon, or attending physician; an "N" value indicates that the services were performed personally by a CRNA who was medically directed by the operating surgeon, assistant surgeon, or attending physician.
Codes (4)
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Stedi is a registered trademark of Stedi, Inc. Stedi's EDI Reference and Mapping Guides are provided for marketing purposes and are free of charge. All names, logos, and brands of third parties listed on our site are trademarks of their respective owners (including “X12”, which is a trademark of X12 Incorporated). Stedi, Inc. and its products and services are not endorsed by, sponsored by, or affiliated with these third parties. Our use of these names, logos, and brands is for identification purposes only, and does not imply any such endorsement, sponsorship, or affiliation.