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Qualifier 99100

  1. #1
    Question Qualifier 99100
    Medical Coding Books
    I have two items I am trying to discover about this code. First, at what point is a person considered over 70, at the 70th birthday plus one day or not until the 71st birthday? Second, are there any clinical considerations for the application of this code to an anesthesia case and the patient is of the qualifying age? In other words, should the otherwise healthy 80 year old be coded with 99100 or must there be other age-related frailties that impact the administration of anesthesia to the patient for the code to be assigned?

    I would appreciate any light on this subject. If anyone has information from the CPT Assistant or a contact at the AMA for the question, that would be very much appreciated. There does not seem to be much in print regarding this code other than if payers allow it or not.
    S Young

  2. #2
    Greater Knoxville TN Chapter
    Default Qualifier 99100
    First of all, 99100 is an anesthesia qualifying circumstance that can only be billed if the patient is over 70 and does NOT have Medicare as primary. Otherwise you cannot bill 99100 to Medicare products as they won't pay for this. Our software bills it out when we are charging so I really have never noticied as to whether the patient was 70 + 1 day or not. But you should be able to get your computer person to load this so that it and (ex: 99140 emergency) all qualifying circumstances would bill when appropriate.
    Hope this helps.
    Dottie G

    New at this, first time.

  3. #3
    Thanks for the reply, Dottie. It is helpful to know it is not looking for certain diagnosis to be present for assignment of the code. It would be interesting to find out if the patient must have reached the 71st birthday before it is assigned. Does the software you use carry any kind of CPT/AMA stamp of approval? If so, it would entirely clear up my questions on this code.
    S Young

  4. #4
    Greater Knoxville TN Chapter
    Default Qualifier 99100
    youngs1- checked today -our software is adding 99100 to anyone over 70 -so if they have surgery on the day after their birthday and they are not on Medicare our system is adding the qualifying circumstance to their charge.
    Hope to explains a little more.

  5. #5
    I am wondering why you cant bill 99100 to Medicare? I have been searching the database and cant come up with anything saying you cant? Also our facility is not charging 99140 in emergencies either. Are there any rules on that for Medicare?

  6. #6
    Medicare does not pay for any Qualifying Circumstaces. As long as your MC carrier accepts them, doesn't cause rejection of the claim, you can bill it. You are not going to get paid for it. What happens on a patient that has Medicare secondary and you billed a 99100 or 99140 - your secondary claim to Medicare probably contains this line of service. Was the claim accepted by Medicare?

    Some practices bill the Qualifying Circumstances to every payer so that they have true Medicare write off comparison versus other payers. In addition, what if the patient's insurance is wrong and, for example, the patient only has MC Part A and you are, in fact, billing a commercial insurance company that would have paid these charges. Does your billing program easily allow you to add these charges?

    I know I sound like we bill them to Medicare, but unfortunely, we do not and my billing program is unforgiving so if we have an insurance correction it's a messy charge reversal and re-entry.


  7. #7
    Default CPT Code 99100
    I understand that Medicare does not cover CPT code 99100, but does anyone have any advice/information on the non-Medicare patient under age 1? We are getting denials from Medicaid.

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