Emergency modifier
Hello there,
As mentioned in previous post by Ms. Hannon, the time a procedure is performed is not an indicator of whether or not an emergency service can be billed.
If your anesthesia provider has indicated that the procedure was complicated by emergency situations (such as possible loss of life/limb to the patient) then depending on the payer, you may bill CPT 99140.
The next question you ask is: "will I get paid for this?"
The answer will depend on the payer. I've been studying payers lately & have found that most will pay 2 units for 99140. There are some, however, that will only pay a single unit. Some payers will carve out a specific dollar amount for 99140 - and this will be specified within the payer/provider contract. Of course, I'll have to mention also that some payers don't recognize 99140 at all, so even if you bill for it, you'll have to adjust the charge off when the EOB comes. The final kicker: if you're billing for a client in California, some payers there require an ET modifier on the ASA code to indicate emergency services and they won't allow 99140.
How will you know? Great question - 1.) if you are a participating provider, read your contract(s). The answer is generally in there in the reimbursement section. 2.) Look at the payer's website & find their anesthesia policy manual. Unfortunately, some payers put this very USEFUL & NEEDED information behind a lock & key and a sledgehammer is needed to get at it, but it's not always impossible. 3.) When in doubt, contact a provider rep, they can & will help if they're able.
L J
