Anesthesia Coding Alert

Question: Our practice has difficulty getting paid by Medicare and other carriers for emergencies that require anesthesia. Are there any modifiers or documentation that we can include with claims to provide us some reimbursement for emergency anesthesia services? Our physicians are on call 24 hours a day, but they are not required to be at the hospital.

Florida Subscriber
 
 Answer: 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 part." Medicare does not allow any additional payment for qualifying circumstances such as emergency conditions (+99140, anesthesia complicated by emergency conditions [specify] [list separately in addition to code for primary anesthesia procedure]) or for the patient's physical status (P1-P6). Medicare considers that the base anesthesia units incorporate the level of complexity, risk and skill required to perform the service. Commercial carriers may accept the add-on codes and physical status modifiers.
 
For example, surgery to repair a patient's liver that was lacerated in an auto accident might include a corresponding anesthesia code of 00792 (partial hepatectomy or management of liver hemorrhage [excluding liver biopsy]). Code 00792 has a base value of 13 units plus time units. If the patient has commercial insurance, you might try billing the anesthesia with 00792 with modifier -P5 (a moribund patient who is not expected to survive without the operation) plus +99140. Medicare will not recognize either modifier -P5 or the qualifying circumstances.
 
Your diagnosis and procedure codes must give an accurate picture of the patient's need for emergency surgery. With commercial carriers, this enhances your chances of being paid for the add-on code. If payment for +99140 is still denied, consider whether the time and effort involved in fighting for the extra units are worth the return.
 
With regard to the on-call anesthesiologist's handling the emergency case, no insurance company considers this a reason for additional reimbursement.