Anesthesia Coding Alert

Don't forget add-on codes for non-Medicare carriers

As an experienced anesthesia coder, you know that Medicare doesn't reimburse for qualifying circumstances codes 99100-99140. But don't overlook this chance for additional reimbursement--and more accurate claims--when your anesthesia provider's service is "above and beyond" the norm. Review the Special Circumstances    Complicating factors such as patient age, total body hypothermia, and emergency conditions can change how your anesthesiologist cares for a patient. CPT includes four add-on codes that describe these situations, known as qualifying circumstances (QC):

• +99100--Anesthesia for patient of extreme age, under 1 year and over 70 (list separately in addition to code for primary anesthesia procedure)

• +99116--Anesthesia complicated by utilization of total body hypothermia (list separately in addition to code for primary anesthesia procedure)

• +99135--Anesthesia complicated by utilization of controlled hypotension (list separately in addition to code for primary anesthesia procedure)

• +99140--Anesthesia complicated by emergency conditions (specify) (list separately in addition to code for primary anesthesia procedure). Remember that CPT classifies these as "add-on" codes, which means you must report them with another code for the main procedure, says Leslie Johnson, CCS-P, CPC, a coding consultant in Houston. 

"These QC codes are essentially 'added risk' codes that are inherent to the case at hand (such as emergency and age)," Johnson adds. "These extraordinary risks won't necessarily be found within the provider's written documentation as being actually present; they exist by virtue of the condition and circumstance happening all at the same time."

Age note: CPT and ASA guidelines state that you cannot report 99100, 99116 and 99135 with 00561 (Anesthesia for procedures on heart, pericardial sac and great vessels of chest; with pump oxygenator, under one year of age). The descriptor and base units for 00561 already account for the patient's age and associated risk factors, so you don't need additional QC codes to explain the circumstances.

Wade Through Carrier Guidelines for QCs  Carriers often follow Medicare's lead on whether to reimburse for certain codes or diagnoses, but that's not always the case with qualifying circumstances codes. Consider the following examples of times when insurers might reimburse you for QC codes.

• United Healthcare and some Medicaid carriers accept 99140 when you report it with certain diagnoses. 

- First-time patient: A patient presents with a traumatic amputation of her leg. She is at risk for shock and decrease in body temperature, which means the anesthesiologist might need to provide additional care to keep the patient stable. Your carrier might accept 99140 along with diagnosis 897.x (Traumatic amputation of leg[s] [complete] [partial]). 

- Follow-up patient: Sometimes patients have postoperative bleeding (998.11, Hemorrhage complicating a procedure), shock (998.0, Postoperative shock) or other problems that require a return trip to the operating room (OR). These [...]