Bump Up Reimbursement With Qualifying Circumstances Codes
Published on Fri Aug 01, 2003
" Medicare Won't Pay, but Others Might If Medicare covers the bulk of your patients, you might not think to add qualifying circumstances (QC) codes to claims when it's appropriate because Medicare doesn't reimburse for them. But leaving QC codes off claims you submit to non-Medicare carriers which do reimburse for qualifying circumstances is a mistake you don't want to make.
Many anesthesiologists provide services in particularly difficult circumstances, such as during a liver transplant for a patient with end-stage liver disease. The qualifying circumstances codes reflect some of that added difficulty and help the anesthesia provider receive more appropriate reimbursement for services.
The anesthesia-related QC codes include:
+CPT 99100 Anesthesia for patient of extreme age, under 1 year and over 70 (list separately in addition to code for primary anesthesia procedure)
+CPT 99116 Anesthesia complicated by utilization of total body hypothermia (list separately in addition to code for primary anesthesia procedure)
+CPT 99135 Anesthesia complicated by utilization of controlled hypotension (list separately in addition to code for primary anesthesia procedure)
+CPT 99140 Anesthesia complicated by emergency conditions (specify) (list separately in addition to code for primary anesthesia procedure). Since these are classified as add-on (or secondary) codes, you report them in addition to the anesthesia code for the procedure. You can also use QC codes with surgical CPT codes (whether you're using surgical codes because the carrier requires them or because the anesthesiologist performed a surgical-type procedure such as a pain relief injection), says Emma LeGrand, CCS, CPC, office manager for New Jersey Anesthesia Associates in Florham Park. Just be sure to submit the claim with 7"" (anesthesia) as the type of service if you're reporting anesthesia care with surgical codes.
In what real-life situations can the QC codes be used? LeGrand; Darlene Isom" billing supervisor in the anesthesia department of Northwestern Medical Faculty Foundation Inc. in Chicago; and Lori Mehlbauer an anesthesia coder in Louisville Ky. offer these examples for when you're dealing with non-Medicare carriers.
99100 Use this code for any case on a patient younger than 1 year of age or older than 70 provided it isn't a hernia-related case (reported with 00834 or 00836 instead) or a larynx/trachea case (reported with 00326) on the infant (see below for more information). "You should report 99100 when the record clearly documents unusual risk factors associated with the patient's age condition and anesthesia risk " Isom says.
99116 Deliberate hypothermia is an effective way to decrease oxygen-level requirements during surgery and decrease the incidence of postoperative neurological injury after neurosurgical and cardiac procedures. Anesthesiologists often induce total [...]
