Wiki Qualifying Circumstance Add-on services 99140 ER

[dmengla1]

According to the 2016 Relative value guide the add-on code for 99140 has a base unit of 2. My provider is billing this out at two units even though reimbursement is not figured with the anesthesia TIME factor. The commercial payors are paying for only 1 unit. should we be appealing for the second unit? or should we only be billing out at 1 unit in the first place. just like for example the ER intubation we bill one unit and fee for service even though the relative value guide states 6 base units. confused as to how these add-ons should be billed out.

Thank you,
Anesthesia coder Joplin MO.,

 

[CodingKing]

My understanding is its billed 1 unit, It maybe be worth more than 1 base unit but that is calculated when priced by the payer (at least for the ones I've worked for). If units are missing from the payment amount you would want to check with the payer. Where I work we don't pay extra for physical status modifiers nor do we pay for the extenuating circumstances add on codes.

 

[djt123]

dt123

99140 has a value of 2 units but should be billed with a qty of 1. All of the anesthesia add on codes should be billed with qty 1. Your billing software likely applies the fee that would be calculated for the 2 base units and the payer will pay based on the contracted rate for that code.