Anesthesia Coding Alert

If you find +99140 to be one of the more troublesome codes to use correctly, you aren't alone. Correctly coding emergency room visits and working with physicians to specify what counts as an emergency can frazzle any coder's nerves.

Last month we looked at the other codes for qualifying circumstances (or QC) for anesthesia. Now take a closer look at 99140, and how it can be a help rather than a hindrance.

CPT includes a note with 99140 (Anesthesia complicated by emergency conditions [specify] [List separately in addition to code for primary anesthesia procedure]) stating that "an emergency is defined as existing when delay in treatment of the patient would lead to a significant increase in the threat to life or body parts."

Problem: "I find that quite a number of cases come in where the anesthesiologist marks off 'emergency' but neglects to include what makes the case an emergency," says Leslie Johnson, CCS-P, CPC, a coding and compliance consultant and education and research director for DR Management in Indiana.

Solution: The first step in clarifying 99140 use is to have an open dialogue with the anesthesiologist. "The coder needs to sit down and have a heart-to-heart with the anesthesiologist regarding the emergency anesthesia circumstances," Johnson says.

For example: Johnson gives this hypothetical, but quite common, scenario. "There are times when a patient with abdominal pain will be found to have appendicitis, and is considered an emergency case, yet the patient was in observation or has been admitted for a time prior to the surgery," she says.

Pitfall: There are times when you'll see an anesthesiologist report a case as an emergency because the patient was admitted via the emergency room (ER), Johnson says.

A classic example of this is labor and delivery services. "Sometimes the anesthesiologist marks off 'emergency' on the record because of the route [the patient] entered into the hospital, not because it's an actual life-threatening event which requires action at this particular moment," Johnson says.

In other words, you shouldn't add QC code 99140 automatically in cases involving diagnosis 650 (Normal delivery) just because the patient entered through the ER.

Why: If there is a real reason for reporting an emergency, your physician should document that reason, and you should report another diagnosis code telling the carrier that the delivery was not routine, such as any of the 661.XX (Abnormality of forces of labor) ICD-9 codes.

Some physicians maintain that unexpected events qualify as emergencies. "In our audits we find that providers indicate emergency for after hours or weekends," says Debbie Farmer, CPC, ACS-AN, coder with Auditing for Compliance & Education in Leawood, Kan. "This is not the descriptor according to the RVG [Relative Value Guide]," she adds.

Remember: For the purposes of reporting code 99140, an emergency is defined as delay in treatment of the patient would lead to a significant increase in the risk to the patient's life or limb.

Best bet: Talk to the anesthesiologist directly for a more thorough account of the encounter you are reporting to determine whether the encounter merits 99140.

For 99140 as well as other QC codes, consider that you will add one, two or five extra units to your procedure code, depending on which code applies. Knowing which payers recognize these services definitely provides more then enough payoff.

Tip: Always discuss qualifying circumstances when you're negotiating contracts with Medicaid or non-government payers.

Good idea: Include a contractual clause stating whether your specific payer reimburses based on the ASA RVG. That way you can provide a copy of the RVG page and remind the representative of your contract in case you receive a denial.

Experts note: Carriers won't reimburse -- or they may pay at a lower rate -- based on their perception of how others in the same specialty are performing. If no one bills for a service, such as 99140, eventually the carrier will no longer allow the particular code. If billing continues for the procedure, however, carriers will see the procedure as a viable and billable service and may consider allowing it.

There are exceptions to this coding rule. You should not automatically add QC codes to your claim when Medicare and Medicare-following carriers explicitly state that a specific code is not payable under any circumstances.