Anesthesia Coding Alert

Digging for buried reimbursement treasure pays offYou often see Medicare held up as the gold standard for coverage -- not to mention reimbursement. But you don't want to miss the hidden value in looking beyond Medicare for patients with other insurers.One situation where you may find some surprising -- and potentially profitable -- answers is qualifying circumstances. Let our experts tell you how to approach these add-on codes and why some extra legwork can lead to more reimbursement for you.Understand Special Qualifying CircumstancesCPT has four add-on codes to describe qualifying circumstances (QC). These cover complicating factors that can change how your anesthesiologist cares for a patient:• +99100 -- Anesthesia for patient of extreme age, younger than 1 year and older than 70 (list separately in addition to code for primary anesthesia procedure)• +99116 -- Anesthesia complicated by utilization of total body hypothermia (list separately in addition to code for primary anesthesia procedure)• +99135 -- Anesthesia complicated by utilization of controlled hypotension (list separately in addition to code for primary anesthesia procedure)• +99140 -- Anesthesia complicated by emergency conditions (specify) (list separately in addition to code for primary anesthesia procedure).Tip: Don't use these QC codes to replace physical status modifiers when you report complicating conditions. According to the CPT anesthesia guidelines, you should use these add-on codes to describe other conditions that "significantly affect the character of the anesthesia service."Keep in mind: You can use more than one QC add-on code if your case has multiple applicable circumstances.Also, as with all add-on codes, you should never report QC codes without the primary anesthesia procedure code.Pediatric QC Code Merits Extra AttentionYou should be cautious when using the "younger than 1 year" add-on code 99100 because payers include the risk of caring for a young child in the base value of many primary codes intended for young children.Anesthesia codes designated for young children that you shouldn't report with 99100 include the following:• 00326 -- Anesthesia for all procedures on the larynx and trachea in children younger than 1 year of age• 00561 -- Anesthesia for procedures on heart, pericardial sac, and great vessels of chest; with pump oxygenator, younger than 1 year of age• 00834 -- Anesthesia for hernia repairs in the lower abdomen not otherwise specified, younger than 1 year of age• 00836 -- Anesthesia for hernia repairs in the lower abdomen not otherwise specified, infants younger than 37 weeks gestational age at birth and younger than 50 weeks gestational age at time of surgery.Master Hypothermia, CABG Anesthesia CodingBundle up: When your anesthesiologist performs routine hypothermia for coronary artery bypass graft (CABG), traumatic brain injury, cerebral aneurysm or other neurological problems, you shouldn't report 99116 if your anesthesia code description already implies [...]