Wiki Anesthesia emergency modifier

[drparamesh28@hotmail.com]

Hi,

Can anyone guide me, is there any emergency after hours modifier for anesthesia which provides additional payment to provider, time performed is 23:45 PM to 01:45 AM.


Regards,
Paramesh

 

[Michele Hannon]

The only emergency modifier is an add-on: +99140
After hours does not constitute an emergency unless there is a threat to life or limb. i.e. open fracture or fracture with neurovascular compromise, non-reassuring fetal monitor, ruptured viscus, etc.

 

[drparamesh28@hotmail.com]

Emergency modifier

Thank you michelle, but the procedure performed was 00400 for breast, kindly clarify whether this 99140 will increase the payment to the provider.


Regards,
Paramesh

 

[Michele Hannon]

What emergency surgical procedure was performed?

 

[drparamesh28@hotmail.com]

It is Evacuation of breast hematoma but since procedure was performed in late night 23:45 PM to 01:45 AM .as emergency services. I wanna know whether any extra payment has to be billed for this service to provider.

 

[LeslieJ]

Emergency modifier

Hello there,

As mentioned in previous post by Ms. Hannon, the time a procedure is performed is not an indicator of whether or not an emergency service can be billed.

If your anesthesia provider has indicated that the procedure was complicated by emergency situations (such as possible loss of life/limb to the patient) then depending on the payer, you may bill CPT 99140.

The next question you ask is: "will I get paid for this?"

The answer will depend on the payer. I've been studying payers lately & have found that most will pay 2 units for 99140. There are some, however, that will only pay a single unit. Some payers will carve out a specific dollar amount for 99140 - and this will be specified within the payer/provider contract. Of course, I'll have to mention also that some payers don't recognize 99140 at all, so even if you bill for it, you'll have to adjust the charge off when the EOB comes. The final kicker: if you're billing for a client in California, some payers there require an ET modifier on the ASA code to indicate emergency services and they won't allow 99140.

How will you know? Great question - 1.) if you are a participating provider, read your contract(s). The answer is generally in there in the reimbursement section. 2.) Look at the payer's website & find their anesthesia policy manual. Unfortunately, some payers put this very USEFUL & NEEDED information behind a lock & key and a sledgehammer is needed to get at it, but it's not always impossible. 3.) When in doubt, contact a provider rep, they can & will help if they're able.

L J