Anesthesia Coding Alert

Imminent danger means its time to call on 99140.

Whats the difference between an unexpected procedure and an emergency? It could be a matter of supporting +99140 third-party payments.

Although Medicare and commercial carriers that follow Medicare guidelines consider +99140 a bundled and non-separately payable service, third-party payers may reimburse the emergency code. Before getting a revenue boost from this add-on code, follow these principles to avoid payback requests for improper +99140 use.

Restrict 99140 to CPT Defined Emergency

Make sure you dont incorrectly select +99140 (Anesthesia complicated by emergency conditions [specify] [List separately in addition to code for primary anesthesia procedure]) to indicate an unanticipated, unexpected procedure that a physician performed. The word emergency distinguishes +99140 from anesthesia that needs to be performed on the fly.

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. But this is not the descriptor you should use, according to the Relative Value Guide (RVG).

Key: To report +99140, CPT 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 parts.

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.

Encourage Specifying Reason in Chart

If there is a real reason for reporting an emergency, your physician should document that reason clearly in the patients medical record, says Susan West, RHIT, also with Auditing for Compliance and Education, Inc., in Leawood, Kan.

Do not let your anesthesiologist get away with marking emergency on his documentation simply because the patient was admitted through an emergency room. For example, an expectant mother about to give birth who arrives via the ER is not an emergency -- unless there is something about the delivery that is clearly a threat to the mothers safety.

Combat Usage Restrictions With Clause

Before adding +99140, check your payers guidelines for reporting emergency anesthesia services. If the insurer follows Medicare guidelines that always consider +99140 a bundled service or the payer specifically states that +99140 is not payable under any circumstances, do not bill them for +99140.

All is not lost. If possible, include a contractual clause stating whether your specific third-party payer reimburses based on the American Society Anesthesiologists Relative Value Guide, West advises. That way, if necessary, you can provide a copy of the ASA RVG page and remind the representative of your contract in case you receive a denial.