Anesthesia Coding Alert

Question: I understand that 99100 should be used for extreme age either under 1 year or over 70 years. Some insurance companies may not cover this code, but I'm not sure if there are certain restrictions, or if there has been a guideline change that would prevent me from billing this code. Can I still use it if needed?

Oklahoma Subscriber

Answer: When the age qualifier is recognized in a code such as 00326 (Anesthesia for all procedures on the larynx and trachea in children less than 1 year of age), you cannot report it with a code such as 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]).

Keep in mind is that many commercial payers recognize the anesthesia guidelines listed in the CPT manual. An important guideline includes the ability to bill separately for as many qualifying circumstances as are applicable, unless a code description is already contained in the description of another code. This is the case with 99100, where the condition "in children less than 1 year of age" is included in the descriptor of 00326.

Tip: There may be several state Medicaid plans that pay for 99100, but you should check with your local state carriers to see if they publish a policy regarding payment.