AIMS · Source of Truth · Distributed Across Case Tabs

AIMS Billing — Source of Truth

Purpose. The billing sheet source of truth defines every field needed to produce a clean anesthesia claim. This document takes that locked field list and places each field on the tab where the provider will naturally capture it — Medical History, Pre-op, Intra-op, Post-op — with field type (Required / Optional / Calculated / System-generated), gate behavior, and a note on why it sits where it sits.

Scope reminder. AIMS stops at producing the data. Christy's existing RCM system handles claim submission, the 837P / 999 / 277CA / 835 lifecycle, and remediation. The billing fields in AIMS are captured at the point of clinical reality and exported on case close.

Field-type legend

Required

Must be present to advance — hard block on stage gate.

Optional

Captured if available; affects completeness score, no block.

Calculated

Derived by the system from other fields. Read-only in UI.

System-generated

Auto-stamped, never manually edited. Read-only, audit-logged.

Conditional

Required only when a triggering condition is met.

Required attestation

One-tap attestation acceptable; gates downstream stage.

Tab 0Case Creation

Upstream of Medical History. These fields are set when the case is scheduled or checked in — pre-populated from QGenda, facility config, and Christy's surgeon/provider directories. They render in the patient banner and case banner that sit above all four tabs.

Patient demographics

Field	Type	Source	Notes
Last name	Required	QGenda / check-in	Legal name exactly as on insurance card
First name	Required	QGenda / check-in	—
Middle initial	Optional	Check-in	—
Date of birth	Required	QGenda	Drives CPT 99100 if < 1 yr or > 70 yr
Sex (M / F / X)	Required	QGenda	AIMS-PRE-001 — add this field
MRN	Required	Facility EMR	Displayed as tokenized `···4821`, never raw
Weight (kg)	Required	Check-in	Drives pediatric dosing and body-habitus coding
Height (cm)	Required	Check-in	BMI calc drives obesity ICD-10
BMI	Calculated	weight / height²	Read-only
Pregnancy status	Optional	Check-in	If applicable

Encounter identifiers

Field	Type	Source	Notes
Case ID (C-xxxx)	System-generated	AIMS	Primary key for the case record
Facility	Required	QGenda	Filters OR room selector
OR room	Required	Facility config	AIMS-PRE-003 — bind to selected facility
Scheduled start time	Required	QGenda	—
Insurance / payer	Required	Check-in	Drives payer rounding rule display
Authorization #	Optional	Check-in	—
Estimated anesthesia time	Required	Scheduler	AIMS-PRE-007 — drives worklist sorting

Provider assignments

Field	Type	Source	Notes
Surgeon + NPI	Required	Surgeon pairs list	AIMS-PRE-005
Attending anesthesiologist + NPI	Required	Providers list	AIMS-PRE-006
CRNA / AA	Optional	Providers list	Drives supervision modifier
Staff MPI	Required	Scheduler	AIMS-SCH-001
Staff abbreviation	Required	Scheduler	AIMS-SCH-001

Planned procedure

Field	Type	Source	Notes
Surgical CPT	Required	CPT database	AIMS-PRE-004 — typeahead, auto-populates ASA crosswalk
Anesthesia CPT	Calculated	CPT → ASA crosswalk	Drives base units
Base units	Calculated	Anesthesia CPT lookup	Reason-code required if overridden
Primary ICD-10	Required	ICD-10 database	AIMS-PRE-004 — typeahead
Secondary ICD-10s	Optional	ICD-10 database	Support ASA class assignment
Laterality / site	Required	Check-in	—
Urgency (elective / urgent / emergent)	Required	Scheduler	Emergent drives E modifier and CPT 99140

Case-creation stage gate. Demographics + facility + ≥ 1 provider + ≥ 1 surgical CPT + primary ICD-10 must all be present before the case is released to Medical History and Pre-op.

Tab 1Medical History

The longitudinal patient record. Most fields are not billing-required at the field level, but comorbidities captured here justify the ASA physical status class assigned on Pre-op — one of the most heavily audited claim fields. If Dr. Moreno assigns ASA III and the ICD-10 list shows no supporting comorbidity, the claim gets challenged.

Fields that feed billing from this tab

Field	Type	Where it feeds	Notes
Documented allergies	Required	Claim + clinical	Must be present (or explicit NKA attestation) before Pre-op gate closes
Allergen screen (anesthesia-relevant)	Required attestation	Clinical	One-tap attestation acceptable if nothing flagged
Active medications	Required	Claim + clinical	Anticoagulant hold-time, SGLT2 / GLP-1 flags drive Pre-op red-flag section
Cardiovascular findings	Optional	ASA support	CAD, MI, CIED, arrhythmia → supports ASA III / IV
Pulmonary findings	Optional	ASA support	OSA, COPD, home O₂ → supports ASA III / IV
Airway history	Optional	Pre-op exam context	Prior difficult airway, C-spine, TMJ
Endocrine (T2DM · HbA1c · obesity · steroid use)	Optional	ASA support	HbA1c + obesity ICD-10 drive secondary codes
Renal · Hepatic · Hematologic · Neuro · MSK findings	Optional	ASA support	Any positive finding is a candidate secondary ICD-10
Past anesthetic complications	Required attestation	Clinical + claim	MH, pseudocholinesterase, awareness, PONV — attestation required before Pre-op closes
Family anesthetic history	Required attestation	Clinical	MH family hx is a hard red flag
Social history (tobacco · alcohol · substance)	Optional	ASA support	Smoking status → secondary ICD-10 options
Functional capacity (METs)	Optional	ASA support	ACC/AHA guideline for perioperative risk

Claim-export behavior

Every positive finding in Medical History is eligible to flow to the claim as a secondary ICD-10 if Christy's RCM rules match it. The mapping table (finding → ICD-10) is a separate config layer owned by Christy's team — AIMS stores the structured finding, the RCM system applies the code.

Medical history has no stage gate of its own. It is updated per encounter and propagates forward. The Pre-op gate requires an attestation that Medical History has been reviewed this encounter.

Tab 2Pre-op

The plan for this case. Where the majority of billing-required fields get captured — provider commits to a plan, payer rule confirmed, three hardest-to-fix fields (ASA, consent, pre-anesthesia eval) signed. The billing section is embedded here because the provider is the only person who can attest to these items.

Safety red flags (today's screen)

Field	Type	Notes
MH history confirmed today	Required	Carries from Med Hx + today's re-confirmation
Pseudocholinesterase deficiency	Required	Same pattern
NPO status	Required	Time + contents · drives emergency modifier if violated
GLP-1 agonist last 14 d	Required	Aspiration risk flag
Active infection / URI	Required	Case cancellation trigger
Pregnancy	Required	β-hCG if indicated
Code status confirmed today	Required	DNR intra-op suspension decision captured
Advance directives acknowledged	Required	—

Pre-op exam (holding)

Field	Type	Notes
Pre-op vitals (BP · HR · SpO₂ · temp)	Required	Baseline for intra-op deviation monitoring
Mallampati class	Required	Supports airway management plan
Thyromental distance	Required	—
Mouth opening	Required	—
Neck ROM	Required	—
Dentition assessment	Required	Documents baseline for medico-legal protection
Beard / mask seal	Required	—
IV access secured	Required	—
Regional block site assessment	Conditional	Required if regional on plan

Labs · ECG · CXR (for this case)

Field	Type	Notes
CBC	Required if indicated	—
BMP / CMP	Required if indicated	—
Coags (PT · INR · PTT)	Required if indicated	If on anticoagulant
Type & screen	Conditional	Required if T&S ordered for the procedure
β-hCG	Conditional	Required for female of child-bearing potential
HbA1c	Conditional	Required if diabetic
ECG	Conditional	Per age / cardiac history
CXR	Conditional	Per pulmonary history

Anesthetic plan

Field	Type	Notes
Anesthetic technique (GA · MAC · neuraxial · regional · local)	Required	Drives anesthesia CPT family
Planned airway device	Required if GA	—
Induction agents	Optional plan	Captured in Intra-op
Maintenance plan	Optional plan	Captured in Intra-op
Lines (PIV · arterial · central · PA · TEE)	Optional plan	Invasive lines are separately billable CPTs
Neuromonitoring (BIS · SSEP · MEP)	Optional	NMB restrictions if MEP/SSEP
Positioning	Required	—
Blood product plan (T&S · T&C · cell saver)	Required	—
Regional block for post-op pain	Optional	Separately billable if at surgeon's request and distinct from primary anesthetic

Post-op plan (committed in Pre-op)

Field	Type	Notes
Disposition (PACU → floor · step-down · ICU · direct home)	Required	—
Extubation location	Required	—
PONV prophylaxis tier (Apfel)	Required	—
Multimodal pain plan	Required	—
VTE prophylaxis	Required	—

Required billing data (embedded in Pre-op)

The 11 required billing items below sit in a red-bordered section of the Pre-op tab because they must be captured before the provider can sign off and release the case to OR. Missing any one of these is a hard block.

Field	Type	Source	Notes
ASA physical status (I–VI)	Required	Provider selection	Manual; supported by Med Hx findings
Emergency modifier (E)	Required	Provider selection	Appends to ASA; drives CPT 99140
Qualifying circumstances	Required	CPT selection	99100 age · 99116 hypothermia · 99135 controlled hypotension · 99140 emergency
Physical status units	Calculated	ASA class lookup	0 (I–II) / 1 (III) / 2 (IV) / 3 (V)
QC units	Calculated	QC code sum	Read-only
Medical direction modifier	Required	Provider role + supervision	AA · QK · QY · QX · QZ · QS · G8 · G9 — reason code required if overridden (see AIMS-040)
Pre-anesthesia eval signed	Required	Attending attestation	CMS requires within 48 h pre-op
Anesthesia consent signed	Required	Patient signature + date/time	—
Informed consent attestation	Required	Attending	—
H&P reviewed and updated today	Required	Attending attestation	—
Attending NPI on record	System-generated	Provider profile	Read-only, locked

Pre-op stage gate. All 11 required billing fields + all safety red flags + airway exam + ASA class must be present and signed before the case advances to Intra-op. Backend enforcement, not UI warning.

Tab 3Intra-op

Where the clock runs and the bulk of time-dependent billing math happens. Nearly every field here is system-generated (auto-captured from the monitor) or calculated (derived from captured events). Provider interactions are limited to high-frequency actions: scan/admin drugs, confirm times, log events, document airway management.

Anesthesia time — core billing inputs

Field	Type	Notes
Anesthesia start time	System-generated	First provider-patient contact · correctable with reason code
Anesthesia end time	System-generated	PACU handoff · correctable with reason code
Induction time	System-generated	Event-triggered
Surgical incision time	System-generated	Event-triggered
Closure time	System-generated	Event-triggered
Extubation time	System-generated	Event-triggered
Total anesthesia minutes	Calculated	End − start · never manually typed
Time units	Calculated	Minutes / payer-rule increment · payer-specific rounding applied here

Medication administration

Field	Type	Notes
Drug name	Required	From preset grid or scan
NDC code	Required	One NDC per administration event — this is a claim field
Dose	Required	—
Units (mg · mcg · mL)	Required	—
Route	Required	—
Admin time	System-generated	Auto-stamped on commit
Administering provider	System-generated	Auto-stamped on commit
Wastage (controlled substances)	Required for CII–IV + propofol	DEA compliance
Countersign (wastage)	Required for CII–IV	—

Vitals capture

Field	Type	Notes
BP · HR · SpO₂ · EtCO₂ · temp	System-generated	Streamed from monitor, minimum 5-min cadence
Manual vitals entry	Optional	Reason required (monitor gap)
Deviation flags	Calculated	Against case preset thresholds

Events timeline

Field	Type	Notes
Positioning event	Required	—
Induction event	Required	—
Block placement	Required if regional	—
Surgical incision	Required	—
Hemodynamic events	Optional	Captured as they occur
Transfusion events	Required if any	Drives type & cross requirement
Closure event	Required	—
Extubation event	Required	—
Emergence event	Required	—

Fluids · blood products · EBL · UOP

Field	Type	Notes
Crystalloid in	Required	Running total
Colloid in	Optional	—
Blood products transfused	Conditional	Unit counts by product type
Cell saver returned	Conditional	—
EBL (estimated blood loss)	Required	Blocks post-op sign-off if blood given without EBL
UOP	Required if > 1h case	—

Airway management

Field	Type	Notes
Device used (ETT · LMA · natural · trach)	Required	—
Size	Required	—
Cormack-Lehane grade	Required	—
Attempts	Required	> 1 triggers difficult airway flag
Adjuncts (stylet · bougie · glide · fiberoptic)	Optional	—
Rescue technique	Conditional	—

Separately billable procedures

Field	Type	Notes
Arterial line placement	Optional	Separately billable CPT if documented
Central venous catheter	Optional	Separately billable CPT
PA catheter	Optional	Separately billable CPT
TEE	Optional	Separately billable CPT
Ultrasound guidance	Optional	Add-on CPT, requires image documentation
Post-op pain block	Optional	Separately billable only if distinct from primary anesthetic and at surgeon's request — both must be documented

Intra-op stage gate. Anesthesia start + end time, ≥ 1 NDC-coded medication, all required event markers, EBL (if transfusion), and provider signature required before advancing to Post-op.

Tab 4Post-op

Where the chart closes, the math locks, and the case releases to Christy's RCM system. The CMS-required post-anesthesia evaluation is the final signature that commits everything.

PACU handoff

Field	Type	Notes
SBAR summary	Required	—
Vitals at transfer	System-generated	—
Pain score (0–10)	Required	—
PONV status	Required	—
Active issues	Required	—
Orders acknowledged by PACU RN	System-generated	—

Post-anesthesia evaluation (CMS-required)

Field	Type	Notes
Cardiovascular status	Required	CMS-required element
Respiratory status	Required	CMS-required element
Mental status	Required	CMS-required element
Pain assessment	Required	CMS-required element
Nausea / vomiting	Required	CMS-required element
Temperature	Required	CMS-required element
Attending signature + timestamp	Required	Must be signed within 48 h post-op per CMS

Discharge criteria

Field	Type	Notes
Modified Aldrete or PADSS	Required	—
Criteria-met time	System-generated	—
Discharge escort confirmed	Required if outpatient	—

Post-op note

Field	Type	Notes
Post-op note	Required	Smart-phrase expansion supported
Complications documented	Required if any	—

Final billing commits

Field	Type	Notes
Base units	Calculated (locked)	From anesthesia CPT
Time units	Calculated (locked)	From intra-op total minutes × payer rounding rule
Physical status units	Calculated (locked)	From Pre-op ASA class
Qualifying circumstance units	Calculated (locked)	From Pre-op QC selections
Total anesthesia units	Calculated (locked)	Base + Time + PS + QC
Place of service	Required	Reason code recommended if overridden
Final claim payload	System-generated	837P-compatible export to Christy's RCM
Attending final signature	Required	Locks the record · all calculated fields become immutable
Submission timestamp	System-generated	—

Post-op stage gate. Complete PACU handoff + all six CMS post-anesthesia eval elements + attending final signature required before the case releases to RCM. Once signed, the calculated billing fields are locked and any change requires a formal RTP (Return to Provider) workflow.

Field count by tab

Tab	Required	Optional	Calculated	System-generated	Total
Case creation banner	15	4	2	1	22
Medical history	3 attestations	~60 clinical	0	0	~63
Pre-op	28	6	2	1	37
Intra-op	15	8	4	12	39
Post-op	15	3	5	4	27
Total billing-relevant fields	76	~21	13	18	~128

Six-stage enforcement mapping

The billing sheet source of truth is organized in six enforcement stages. Here is how those stages map to the four AIMS case tabs:

Stage	Maps to tab	Enforcement model
1 · Case creation	Case banner (pre-tab)	Gate: demographics + facility + provider + CPT + ICD-10
2 · Pre-op	Med Hx (attestation) + Pre-op tab	Gate: 11 required billing fields + airway exam + ASA + all signatures
3 · Intra-op	Intra-op tab	Gate: start + end times + ≥ 1 NDC med + events + EBL (if transfusion)
4 · Post-op	Post-op tab	Gate: PACU handoff + post-anesthesia eval + attending signature
5 · Billing review	Christy's RCM system	Automated claim edits · AIMS does not host this UI
6 · Submission	Christy's RCM system	AIMS exports · RCM submits

Denial loop (first-class return arc). If Christy's RCM system receives a denial that requires a documentation fix, a formal RTP drops the case back into the Post-op tab with the denial reason surfaced, the affected fields unlocked, and an audit trail of the change on resubmit.

Open enforcement tickets (from AIMS-040)

Fields currently marked "Reason Required: Not currently" in the source of truth that Christy's audit exposure requires before going live:

Field	Current state	Required state	Urgency
Modifiers (AA / QK / QX / QY / QZ)	Override allowed without reason code	Reason code required on any override	● Tier 1 · FCA exposure
Base units	Override allowed without reason code	Reason code required	● Tier 1
Time units	Blocked (AIMS-T-20260412-6b3yu)	Unblock first; reason code on override	● Tier 1 · most frequent correction
CPT	Override allowed without reason code	Reason code recommended	● Tier 2
ICD-10	Override allowed without reason code	Reason code recommended	● Tier 2
Qualifying circumstances	Override allowed without reason code	Reason code recommended	● Tier 2
Place of service	Override allowed without reason code	Reason code recommended	● Tier 2