Anesthesia Coding Alert

Question: I am new to anesthesia billing and have learned that Medicare and Medicaid do not give any additional reimbursement for the physical status modifiers or for the qualifying circumstances add-on codes. Should we still be putting them on our claims to these payers?

Pennsylvania Subscriber

Answer: Yes, you should still include any details about the patient’s physical status and any applicable qualifying circumstances codes even if you won’t receive additional reimbursement. These modifiers and add-on codes help paint a complete picture of the situation your provider addressed and are valuable components of documentation.

Exception: If your Medicare carrier denies payment for the anesthesia services based on invalid modifiers or add-on codes, you will need to suppress reporting physical status modifiers on the electronic or paper claims. This is based on a Texas Medicare glitch that denied anesthesia services when physical status modifiers were reported. Although this is unlikely to happen now since Texas has a different MAC, it’s a good lesson for coders everywhere to heed.

A physical status modifier should be part of every claim:

• P1, A normal healthy patient
• P2, A patient with mild systemic disease
• P3, A patient with severe systemic disease
• P4, A patient with severe systemic disease that is a constant threat to life
• P5, A moribund patient who is not expected to survive without the operation
• P6, A declared brain-dead patient whose organs are being removed for donor purposes

The four add-on codes for qualifying circumstances document additional factors that might affect how the anesthesia provider administers care:

• +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).