Anesthesia Coding Alert

Remember the situation is the determinant, not the location.

Certain circumstances can sometimes affect how the anesthesiologist, Certified Registered Nurse Anesthetist (CRNA), or Anesthesia Assistant (AA) provides services for a patient. That’s why the anesthesia section of the CPT^® book includes four add-on codes representing various situations.

Some of these codes, 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]) are easy to understand because the descriptor specifically outlines the parameters for usage. Others, such as +99140 (Anesthesia complicated by emergency conditions (specify) (List separately in addition to code for primary anesthesia procedure)), are a bit more open to interpretation or can be confusing for coders to fully understand. If that’s the case for your office, read on for some tips on real-world usage.

Get Clear on the Definition

The detail that sets code +99140 apart is the term “emergency.” But what constitutes an emergency?

The ASA Relative Value Guide 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.” For example, a patient with a burst appendix presents an overwhelming risk of infection and complications if treatment is delayed. That qualifies as an emergency by the ASA’s definition.

Samantha Fowler, CPC, ACS-AN, AAPC Approved Instructor, senior implementation manager for Bizmatics, Inc., in San Jose, Calif., shares a few common scenarios that would warrant reporting +99140:

• Severe chest trauma
• Uncontrollable hemorrhage
• Compromised breathing or gasping breathing pattern
• Head, brain or spine injury
• Pneumothorax
• Sudden organ failure
• Any trauma that complicates airway management. 

“Be sure the anesthesia provider documents the details of the emergency including his consideration of how it may affect his ability to manage the airway and hemodynamic stability,” Fowler adds.

Report it correctly: If the emergency conditions are documented on the anesthesia record, have that information available to provide to the insurer if they require documentation for support of payment and/or consideration. List the applicable anesthesia procedure code on the first line of the claim, then +99140 on the second line (because +99140 must be reported in conjunction with another CPT® anesthesia code instead of as a stand-alone code).

Don’t Assume That ‘ER’ Means ‘Emergency’

Many patients who are admitted to the hospital through the emergency room are in an emergent situation. But that’s not always the case, so don’t jump to report +99140 just because you see notations about the ER.

Prime example: Pregnant women typically come in through the ER, but they are triaged in the birthing ward. You might also see ‘emergency’ on the chart if the patient has had food within a specified amount of time. This can present an elevated risk, but doesn’t ratchet the situation to emergency level.

Instead: If there is a qualifying reason for reporting an emergency, your physician should document that reason, and you should report a more descriptive diagnosis code telling the carrier that the situation was not routine. For example, any of the conditions under ICD-10 categories O62 (Abnormality of forces of labor), O65 (Obstructed labor due to maternal pelvic abnormality), or O66 (Other obstructed labor) could help support classifying a delivery as an emergency – not the fact that the mom-to-be was admitted through the ER.

“Fetal distress is another common emergency circumstance,” Kelly Dennis, MBA, ACS-AN, CAN-PC, CHCA, CPC, CPC-I, owner of Perfect Office Solutions in Leesburg, Fla.

Another possibility: There are times when a patient presents, such as in respiratory distress or serious trauma, when there’s no time to gather all the data and anesthesia and/or intubation is necessary. Get whatever documentation you can and trust your provider to make the best decision.

Differentiate Between ‘Unexpected’ and ‘Emergency’

Some physicians maintain that unexpected events qualify as emergencies. For example, they might indicate “emergency” for any service provided after normal hours or on weekends. Remember, however, that the time of day doesn’t determine an emergency.

Best bet: Talk to the anesthesiologist directly for a more thorough account of the encounter you are reporting to determine whether the encounter merits +99140.

Bottom line: These are true emergency situations where a lack of action could have serious consequences. It’s not the same as when a person has a broken leg in the ED and may require some sort of sedation to keep still during a reduction or manipulation.