Anesthesia Coding Alert

Question: What are “qualifying circumstances for anesthesia,” and when are they reported?

California Subscriber

Answer: Codes 99100-99140 are add-on codes that describe circumstances that significantly affect the character of the anesthesia service provided. Report these codes in addition to the applicable anesthesia code; you can submit more than one qualifying circumstances code on a claim, if applicable.

The options are:

• 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)
• 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).

The Medicare Physician Fee Schedule assigns a status indicator of “B” (bundled code) to codes 99100 – 99140, which means they are not eligible for separate reimbursement under Medicare guidelines. Other insurers, however, sometimes allow additional payment for qualifying circumstances if the services are deemed reasonable and necessary. The value of the additional codes is significant (up to 5 base units for 99116 and 99135), which can mean higher payment for the anesthesiologist or CRNA. Proper documentation plays a key role in substantiating such claims.

Tip: Make sure the procedure doesn’t already include an allowance for qualifying circumstances. For example, 00326 (Anesthesia for all procedures on the larynx and trachea in children younger than 1 year of age) has a comment indicating the patient’s age is already considered in the base value assignment.