SV6 Anesthesia Service

To specify the claim service detail for anesthesia

Position

Element

Name

Type

Requirement

Min

Max

Repeat

SV6-01 C003 Composite Medical Procedure Identifier Composite (composite) Mandatory

01 · 235 · Product/Service ID Qualifier · Identifier (ID) · Mandatory · 2 · 2 · -

Code identifying the type/source of the descriptive number used in Product/Service ID (234).

02 · 234 · Product/Service ID · String (AN) · Mandatory · 1 · 30 · -

Identifying number for a product or service.

03 · 1339 · 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.

04 · 1339 · 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.

05 · 1339 · 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.

06 · 1339 · 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.

07 · 352 · 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.

SV6-02 · 1332 · Facility Code Qualifier · Identifier (ID) · Conditional · 1 · 2 · -

Code identifying the type of facility referenced

P0203: If either SV6-02 or SV6-03 is present, then the other is required

SV6-03 · 1331 · Facility Code Value · String (AN) · Conditional · 1 · 2 · -

Code identifying the type of facility where services were performed; the first and second position of the uniform bill type or place of service from health care financing administration claim form, or place of treatment from the dental claim form

SV6-04 · 782 · Monetary Amount · Decimal number (R) · Optional · 1 · 15 · -

Monetary amount.

SV604 is the submitted charge.

SV6-05 C004 Composite Diagnosis Code Pointer Composite (composite) Optional

01 · 1328 · Diagnosis Code Pointer · Numeric (N0) · Mandatory · 1 · 2 · -

A pointer to the claim diagnosis code in the order of importance to this service

C004-01 identifies the primary diagnosis code for this service line.

02 · 1328 · Diagnosis Code Pointer · Numeric (N0) · Optional · 1 · 2 · -

A pointer to the claim diagnosis code in the order of importance to this service

C004-02 identifies the second diagnosis code for this service line.

03 · 1328 · Diagnosis Code Pointer · Numeric (N0) · Optional · 1 · 2 · -

A pointer to the claim diagnosis code in the order of importance to this service

C004-03 identifies the third diagnosis code for this service line.

04 · 1328 · Diagnosis Code Pointer · Numeric (N0) · Optional · 1 · 2 · -

A pointer to the claim diagnosis code in the order of importance to this service

C004-04 identifies the fourth diagnosis code for this service line.

SV6-06 · 380 · Quantity · Decimal number (R) · Optional · 1 · 15 · -

Numeric value of quantity.

SV606 is the number of anesthesia minutes.

SV6-07 · 1073 · Yes/No Condition or Response Code · Identifier (ID) · Optional · 1 · 1 · -

Code indicating a Yes or No condition or response.

SV607 is the CRNA supervision indicator. A ``Y'' value indicates that services were performed personally by a Certified Registered Nurse Anesthetist (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 Certified Registered Nurse Anesthetist (CRNA) who was medically directed by the operating surgeon, assistant surgeon, or attending physician.