Anesthesia Coding Alert

Question: I know that +99116 can be added to some claims to represent hypothermia but am not sure of specific guidelines. What do I need to know so that I report it correctly?

Florida Subscriber

Answer: A few anesthesia codes already include hypothermia, which means it’s invalid to include +99116 (Anesthesia complicated by utilization of total body hypothermia (List separately in addition to code for primary anesthesia procedure)) on the claim. The distinction is easier to note with some procedures than with others.

Example 1: Hypothermia inclusion is obvious with some codes, such as 00561 (Anesthesia for procedures on heart, pericardial sac, and great vessels of chest; with pump oxygenator, younger than 1 year of age). The code’s descriptor doesn’t spell it out, but the associated note does: “Do not report 00561 in conjunction with +99100, +99116, and +99135.”

Tip: Remember that for most heart cases, hypothermia is already included in the base of the anesthesia code.

Example 2: Other anesthesia codes also include hypothermia, though it’s less clear. Check out these examples:

• You can’t report +99116 with 00562 (... with pump oxygenator, age 1 year or older, for all noncoronary bypass procedures (eg, valve procedures) or for re-operation for coronary bypass more than 1 month after original operation); the key terminology is “with pump oxygenator.” Hypothermia is a routine part of the procedure to help protect the heart from ischemic injury while there is restricted blood supply.
• Also, steer clear of reporting +99116 with 00563 (... with pump oxygenator with hypothermic circulatory arrest). The mention of a pump oxygenator sends you away from +99116, as does the hypothermic circulatory arrest.

Also important: Your anesthesiologist will often induce hypothermia during intracranial surgeries to treat aneurysms, cerebral AV malformations, and other cerebrovascular procedures, but it’s not considered routine. In these cases, you can safely report +99116 in addition to the anesthesia code and may garner your physician a well-deserved boost in pay. Just remember, traditional Medicare does not allow payment for physical status or qualifying circumstances.