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 1

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 · 48 · -

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

Code identifying the type of facility where services were performed; the first and second positions of the Uniform Bill Type code or the Place of Service code from the Electronic Media Claims National Standard Format

SV6-04 · 782 · Monetary Amount · Decimal number (R) · Optional · 1 · 18 · 1

Monetary amount

SV604 is the submitted charge.

SV6-05 C004 Composite Diagnosis Code Pointer Composite (composite) Optional 1

01 · 1328 · 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 · 1328 · 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 · 1328 · 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 · 1328 · 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 · 380 · Quantity · Decimal number (R) · Optional · 1 · 15 · 1

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 · 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.