Anesthesia Coding Alert

Refresh your knowledge on 4 key points to +99116.

Qualifying circumstances codes can help boost your bottom line, but only if you report them correctly. One prime example of this is hypothermia, which has several important criteria to keep in mind before filing your claim. Follow these four areas of advice to keep your claims in check.

Verify That Coding Hypothermia Is Appropriate

CPT^® includes one add-on code for anesthesia affected by hypothermia: +99116 (Anesthesia complicated by utilization of total body hypothermia [List separately in addition to code for primary anesthesia procedure]). You'll find +99116 in the "Qualifying Circumstances Codes for Anesthesia" section of CPT^®. Taking a close look at the descriptor raises two key details:

• The term "utilization" alerts you that the patient's hypothermic state was induced – purposeful – instead of incidental.
• The "+" symbol designates +99116 as an add-on code. Because of that, you can only report it in conjunction with a comprehensive anesthesia code.

Big bonus: When you're allowed to include +99116 on the claim, it will add five units to your provider's reimbursement.

Be Sure Hypothermia Is Not Already Included

Some anesthesia codes in CPT^® already include hypothermia, which means it's invalid to append +99116 to the claim. The distinction is easier to note with some procedures than with others.

Example 1: Hypothermia inclusion is obvious with some codes, such as 00561 (Anesthesia for procedures on heart, pericardial sac, and great vessels of chest; with pump oxygenator, younger than 1 year of age). The code's descriptor doesn't spell it out, but the associated note does: "Do not report 00561 in conjunction with +99100, +99116, and +99135."

"Coders must remember that for most heart cases, hypothermia is already included in the base of the anesthesia code," explains Kelly Dennis, MBA, ACS-AN, CAN-PC, CHCA, CPC, CPC-I,  owner of Perfect Office Solutions in Leesburg, Fl.

Example 2: Other anesthesia codes also include hypothermia, though it's less obvious by the descriptor. Check out these examples:

• You can't report +99116 with 00562 (... with pump oxygenator, age 1 year or older, for all non-coronary bypass procedures [e.g., valve procedures] or for reoperation for coronary bypass more than 1 month after original operation); the key terminology is "with pump oxygenator." Look at the service this represents. Explanation: When your anesthesiologist uses a pump oxygenator during cardiac surgery, no blood circulates through the coronary arteries. Therefore, the myocardium (or heart muscle) is ischemic (meaning there is restricted blood supply). Hypothermia is a routine part of the procedure to help protect the heart from ischemic injury.
• Also, steer clear of reporting +99116 with 00563 (... with pump oxygenator with hypothermic circulatory arrest). The mention of a pump oxygenator sends you away from +99116, as does the hypothermic circulatory arrest. Your anesthesiologist induces hypothermic circulatory arrest to significantly slow cellular activity levels and stop blood circulation. Bringing the patient to that state allows the surgeon to safely complete procedures when he can't use clamps to contain the blood flow.

These situations could take place during an aortic arch case as the physician cannot "clamp off" because the patient would have a stroke, for example. The anesthesiologist must bring the patient's temperature down to about 18 degrees Centigrade and the patient is in hypothermic circulatory arrest.

Don't make assumptions:  Your anesthesiologist will often induce hypothermia during intracranial surgeries to treat aneurysms, cerebral AV malformations, and other cerebrovascular procedures, but it's not considered routine. In these cases, you can safely report +99116 in addition to the anesthesia code and garner your physician a well-deserved boost in pay (assuming you have solid supporting documentation).

Encourage Clear Documentation

As with any claim, you can code based only on your physician's documentation. Simply charting the patient's temperatures or noting "warming" in her notes won't justify the use of +99116.

Documentation should include notes on why hypothermia is medically necessary and the temperature line across the anesthesia record that is truly "hypothermia." There are degrees of hypothermia, and if a physician is charging extra for hypothermia the insurer will look for a larger difference than simply a degree or two below normal.

Instead, teach your anesthesiologist to include phrases such as "hypothermic state induced," "surgeon's request for hypothermia initiated," or "temp reduced to 34.5 degrees C per surgeon request." Then you'll have what you need to legitimately add +99116 to your claim when the corresponding anesthesia code allows.

Know That +99116 Is a No-go for Some Payers

The question of whether you can bill separately for hypothermia when filing to Medicare is answered quite simply: no.

Here's why: Medicare does not pay any modifying units or qualifying circumstances codes. This is because Medicare considers code +99116 to be included in the work of other codes for other services.

Silver lining: Some commercial insurers, such as Blue Cross/ Blue Shield for Virginia and North Carolina, will pay for code 99116 with CABG or some other procedures, Dennis says. "Medicare doesn't pay for hypothermia, but most commercial carriers do," she says. "Ninety percent of our CABG patients have hypothermia, and we bill the correct CPT® code (such as 33512, Coronary artery bypass, vein only; 3 coronary venous grafts) with +99116. Some payers request the anesthesia record for payment. As long as it's documented in the anesthesia record, we don't usually have any problems with reimbursement for hypothermia."

Final note: One other example of a procedure you see in conjunction with code +99116 is 93505 (Endomyocardial biopsy).