SV6 Anesthesia Service

To specify the claim service detail for anesthesia

Position
Element
Name
Type
Requirement
Min
Max
Repeat
SV6-01
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.
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.
SV6-02
Facility Code Qualifier
Identifier (ID)
Conditional
1
2
1
Code identifying the type of facility referenced
P0203: If either SV6-02 or SV6-03 is present, then the other is required
SV6-03
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.
SV6-04
Monetary Amount
Decimal number (R)
Optional
1
18
1
Monetary amount
SV604 is the submitted charge.
SV6-05
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.
SV6-06
Quantity
Decimal number (R)
Optional
1
15
1
Numeric value of quantity
SV606 is the number of anesthesia minutes.
SV6-07
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.

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