Anesthesia Coding Alert

Plus, here’s your refresher on when to possibly include +99100.

Providing anesthesia for pediatric patients carries specific risks and includes coding issues unlike those for adults. Read on for how to handle two situations common for your children’s cases – plus an important reminder about anesthesia codes for younger patients.

Scenario 1: Sedation During Common Procedures

Most adults (and even some children) undergo MRIs, CT scans, biopsies, and other everyday procedures without needing anesthesia. In some cases, however, the ordering physician might request anesthesia for the patient because of special circumstances (such as the patient’s age or an underlying medical condition).

Example: A 3-year-old girl is scheduled for an MRI of her neck (without contrast) following a car accident. Her parents ask if she can be sedated to help keep her calm during the procedure, and the physician agrees it would be helpful, so requests anesthesia services.

Code it: Start by verifying that your anesthesia provider has a request in writing from the other physician for her services, and the reason why anesthesia is necessary, advises Kelly D. Dennis, MBA, ACS-AN, CANPC, CHCA, CPC, CPC-I, owner of Perfect Office Solutions in Leesburg, Fla. The ordering physician will report 70540 (Magnetic resonance [e.g., proton] imaging, orbit, face, and/or neck; without contrast material[s]). Your anesthesia provider will submit 01992 (Anesthesia for non-invasive imaging or radiation therapy) and append QS (Monitored anesthesia care service) for the sedation. You could also append modifier 23 (Unusual anesthesia) and include the supporting documentation to justify its use.

Past problem: In years past, you might have been tempted to report 99141 (Sedation with or without analgesia [conscious sedation]; intravenous, intramuscular or inhalation) or 99142 (…oral, rectal and/or intranasal) for the sedation. These codes were deleted from CPT^® in 2006, however, so have not been valid for a number of years. The deletion didn’t matter much to anesthesiologists because the codes were intended for surgeons who provided conscious sedation during the procedure. Many payers ignored the conscious sedation codes even when they were still in effect.

CPT^® does include several codes for moderate sedation services (99143-99150). As with the older conscious sedation codes, anesthesiologists rarely are in a situation where reporting a moderate sedation code is more appropriate than an anesthesia code (00100-01999).

Scenario 2: Pre-op Workups or Standby Service

If a pediatric patient is scheduled for an invasive procedure, such as a cardiac catheterization (cath), the anesthesiologist and treating physician may study the child’s medical history and current condition prior to the procedure to determine whether he or she will need a general anesthetic, monitored anesthesia care (MAC), or no anesthesia. If a decision is made not to use anesthesia, an anesthesiologist may or may not be nearby during the procedure due to other patient cases. That means appropriate anesthesia assistance may not be readily available if the child’s situation calls for it once the procedure begins. Because it’s even more crucial to have the appropriate help nearby with pediatric patients than with adults, some hospitals have implemented procedures that have an anesthesiologist on hand for all pediatric invasive procedures. But it’s better to head off problems than handle them, so pre-op workups are getting even more attention.

Standby option: Providing standby service means that the anesthesiologist or another member of the anesthesia team (an attending or a fellow) is actually present in the room during the child’s procedure. An anesthesiologist is available during similar procedures with adults, but not usually in the same room unless needed. The staffs at many children’s hospitals have established the standby protocol to ensure that help is close at hand in case they need to anesthetize emergently.

Code 99360 (Standby service, requiring prolonged attendance, each 30 minutes [e.g., operative standby, standby for frozen section, for cesarean/high risk delivery, for monitoring EEG]) is used for physician standby services that involve prolonged physician attendance without direct (face-to-face) patient contact. The physician may not be providing care or services to other patients during this period. The code is used to report the total amount of time spent by a physician on a given day on standby. It is billed at a flat fee in 30-minute increments.

Check Whether Qualifying Circumstances Code Applies

CPT^® includes several add-on codes that anesthesiologists can report in addition to the procedure code to help explain special circumstances that can affect anesthesia care. The one that pertains to the very youngest patients is +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]).

You should be cautious when using the “younger than 1 year” add-on code, however, 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.

If you’re reporting anesthesia for a different procedure for a child under one year of age, include +99100 on the claim with supporting documentation. “The payer might allow extra units for +99100,” Dennis says.