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Anesthesia Qualifying Circumstances

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  • August 28, 2017
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Anesthesia Qualifying Circumstances

When reporting anesthesia services, there are several “qualifying circumstances” that may be submitted to the insurance company, when those services are reasonable and necessary. These qualifying circumstances are all add-on codes (meaning that they cannot be billed, alone), and include:
+99100 Anesthesia for patient of extreme age, younger than 1 year and older than 70 (List separately in addition to code for primary anesthesia procedure)
Example: A three-month-old female undergoes hernia repair. For proper reimbursement, this add-on code will allow the additional 1 unit of anesthesia to the base units to calculate a higher reimbursement.
+99116 Anesthesia complicated by utilization of total body hypothermia (List separately in addition to code for primary anesthesia procedure)
Example: The patient undergoes removal of subdural hematoma. The physician feels it necessary to put the patient is a complete, deliberate state of hypothermia to decrease blood flow to the region of the brain. This is an effective way to decrease the oxygen-level requirements during surgery and decrease the incidence of postoperative neurological injury after neurosurgery.
+99135 Anesthesia complicated by utilization of controlled hypotension (List separately in addition to code for primary anesthesia procedure)
Example: The patient undergoes clipping of an aneurysm. The physician deems it necessary, due to potential blood loss, that the patient is placed into hypotension to decrease blood flow to the areas in which the work will be performed. This is also used in cases of the head, face, upper thorax, or hip replacement surgeries, as the need for a blood transfusion is greatly reduced.
+99140 Anesthesia complicated by emergency conditions (specify) (List separately in addition to code for primary anesthesia procedure)
You must specify the emergency along with the submission of this code.
Example: A 56-year-old male falls from a ladder while cutting a tree limb. He sustained massive joint injury to his elbow and is now cutting of the blood supply to his lower arm. The emergency department (ED) physician deems it necessary for the patient to undergo “emergency surgery” to place the joint back into place to restore blood flow to the region.

Anesthesia and Pain Management CANPC

Amy Pritchett
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Amy C. Pritchett, BSHA, CPC, CPMA, CPC-I, CANPC, CASCC, CEDC, CRC, CDEO, CCS, ICDCT-CM/PCS, C-AHI, has been a coder/auditor for over 20 years with her most recent position being held at Change Healthcare as a Manger of the Facility Coding Services Division. She has many years of experience in several different areas of coding and serves as an interim instructor in her hometown of Mobile, Ala. She shares her expertise in publications and as a lecturer at conferences such as Coding-Con for The Coding Institute. She has served as President and Vice President of the Mobile, Ala., local chapter and serves as Secretary for the 2017 year.

No Responses to “Anesthesia Qualifying Circumstances”

  1. Tami Jones says:

    We have a local health plan that is denying our claims stating that 99100 and 99140 require HCPCS modifier for billing. They are stating CMS requires the AA modifier. As CMS doesn’t recognize 99100 and 99140 there is no guidance. I’ve attempted to explain that it is a qualifying circumstance to the anesthetic and is in essence a type of modifier in itself. Do you have any guidance you can provide on this?

  2. Melody says:

    I am looking for guidance to whether or not both the anesthesiologist and the CRNA can both bill the qualifying circumstance code? I have claims that are getting a duplicate denial on the CRNA claim due to the line paid on the anesthesiologist claim. I have not been able to locate documentation that states that both providers should not bill this code. In my state Medicaid does reimburse separately for the qualifying circumstance code. Thank you.