Anesthesia Coding Alert

Question: Can we report an emergency status for labor epidural patients, and if so, is this done via a modifier or an anesthesia code?

Nevada Subscriber

Answer: Only under certain circumstances. It is not appropriate to bill an emergency status for all laboring patients. “An emergency is defined as existing when delay in treatment of the patient would lead to a significant increase in the threat to life or body part,” per the notes in CPT^®.

An example of an emergency for a patient with a labor epidural would be if the baby or mother is at risk (i.e., fetal distress, decreased heart rate, pre-eclampsia, etc.). Clues indicative of an emergency C-section include an unplanned surgery; the procedure was not originally scheduled. The diagnosis may help point you in the right direction, too — for example, a previous C-section doesn’t indicate an emergency.

The physician must document the emergent condition and the reason for the emergency clearly in the patient’s medical record. When an emergency is documented and justified, the extra units, (two to four units) are obtained by reporting add-on code 99140 (Anesthesia complicated by emergency conditions (specify) …), depending on the circumstances and payer.

Note: Medicare does not pay for emergency code 99140.

“There is not a modifier associated with an emergency qualifying circumstance, although the patient’s physical status may be reported with a P3 (A patient with severe systemic disease), P4 (… that is a constant threat to life), or P5 (A moribund patient who is not expected to survive without the operation) modifier, when a payable and documented modifier applies,” notes Kelly Dennis, MBA, ACS-AN, CAN-PC, CHCA, CPMA, CPC, CPC-I, owner of Perfect Office Solutions in Leesburg, Florida.