labor epidural to EMERGENCY c-section

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Muncie, IN
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What qualifies for this to be an emergency?
The anesthesiologist almost always marks the emergency on our billing sheets for this even when it was just a failure to progress.
01967
01968
99140

If anyone has a reference to diagnosis codes acceptable for use with 99140 that would be a tremendous help! The only one I am seeing that consistently pays with a c-section is breech presentation. Any additional info on the 99140 is appreciated!
Is there anything that I can tell our anesthesiologists to document more clearly for this to be payable?

I don't have problems getting this paid for other procedures.

Thank you!
~Melissa, CPC :)
 

meganrveach

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Local Chapter Officer
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Here is some information I found that I go by when determining if the case qualifies for additional charge of the 99140.

•99140 Postoperative complications that mean a return to surgery can qualify for 99140 as can post-partum complications or trauma cases. Even so many coders are careful about reporting 99140 because of the need for clear documentation of an emergency. “We're really careful about how and when cases qualify for 99140 â€� Mehlbauer says. “We have lots of hand cases that are obviously emergencies (such as when the patient's finger has been cut off) so we definitely use 99140 then. But our physicians won't always classify post-op bleeding as an emergency if the bleeding doesn't complicate the anesthesia.â€�

The second note in the QC section relates to code 99140 and defines an “emergency� as “existing when delay in treatment of the patient would lead to a significant increase in the threat to life or body part.� That looks great on paper but quantifying “significant increase in threat� can be challenging for providers and coders alike.

�The diagnosis procedure and patient's condition quantify 'significant increase in threat to life of the patient ‘ � Isom says. Factors including abnormal blood pressure infection surgical complications blood loss and problems involving the vascular cardiac or neurological systems help determine whether a condition is a “threat to life.� Spinal fractures; skull fractures with subdural epidural or intracranial hemorrhage; and other conditions that the physician must deal with immediately all qualify as emergencies.

�Some physicians believe that deliveries should all be billed as emergency procedures but the insurance carriers do draw the line for billing emergency conditions during deliveries � Isom says.

Even if the case is obviously an emergency (such as a liver transplant 47135 Liver allotransplantation; orthotopic partial or whole from cadaver or living donor any age) the anesthesiologist must document “emergency� on the patient's chart before you can use 99140.

Also check the terminology of your carrier policies some pay for “unusual hours� rather than “emergency � which can be easier to document and justify. A note from the surgeon indicating the potential for life or limb impairment with delayed surgery also helps justify using 99140
 
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