Anesthesia Coding Alert

Question: There’s some confusion in our office regarding coding for controlled hypotension during shoulder and knee procedures. How should we do this? 

Michigan Subscriber 

Answer: Some anesthesiologists administer controlled hypotension during certain procedures at the surgeon’s request. You should report the situation with +99135 (Anesthesia complicated by utilization of controlled hypotension [List separately in addition to code for primary anesthesia procedure]). Be sure to also submit the correct anesthesia code representing the surgery itself because +99135 is an add-on code and must be reported in conjunction with another code. 

Payment: Some payers won’t increase the anesthesiologist’s reimbursement because of hypotension unless you specify it up front. Also remember that primary code(s) that can be billed with add-on codes is at an insurer’s discretion. Consider negotiating for a higher dollar amount in your contracts and include documentation of the agreement with your claim. The anesthesiologist should document in the anesthesia record that the hypotension was at the surgeon’s request.

Definition: When a chart mentions controlled hypotension, the anesthesiologist closely monitored the patient’s blood pressure while it dropped drastically and then leveled off. The low blood pressure allows the surgeon to work in a virtually bloodless field.