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Reporting any qualifying circumstances (QC) codes for anesthesia can be a tricky affair. However knowing when to classify a situation as a true emergency can be a real challenge, unless of course you are equipped in the emergency conditions guidelines. Take a look at coding definitions and your provider's documentation to understand whether you can legitimately add two extra units for +99140 (Anesthesia complicated by emergency conditions [specify] [List separately apart from coding for primary anesthesia procedure]) to your claim. Clarify your 'emergency'definition CPT includes a note with +99140 stating that "an emergency is defined as existing when delay in treatment of the patient would lead to a major increase in the threat to life or body parts. Your key to knowing a case meets emergency conditions depends on your anesthesiologist's notes. Quite a few cases come in where the anesthesiologist marks 'emergency', however many times the 'emergency' isn't all that clear. Documentation aiding an emergency will depend on each case; therefore read the chart thoroughly when your provider indicates an emergency. Explanation: You should talk with your anesthesia providers to make clear what constitutes an emergency; your doctor should document the reason clearly. One more diagnosis code to indicate a problem (such as unstable angina, 411.1) could help show the payer you are reporting an unusual situation. The second diagnosis can also aid in an appeal if a payer that ordinarily recognizes +99140 denies the claim. An OB patient who comes in for a cesarean section is not automatically an emergency. But then a diagnosis of fetal distress and prolapsed cord virtually always implies an emergency that cannot wait. Under these situations, you could be justified in coding +99140. 'Unexpected' does not equal 'emergency' Some doctors tend to add 'emergency' to unexpected events such as after hours or weekend cases they get called to attend. Timing alone is not enough to merit +99140, according to the Relative Value Guide. Point to remember: When considering whether to report +99140, always enquire yourself whether delaying treatment would have led to a key increase in risk to the patient's life or limb. If not, you should not include +99140. For instance: An 80-year-old man is admitted to the hospital with a hip fracture. The cardiologist will not clear the patient for surgery until he has an echocardiogram the following day. Delaying surgery owing to the echocardiogram does not constitute an emergency. Any situation where you can wait eight hours for the patient's stomach to empty or one to two days for cardiac optimization isn't a true emergency. Toe the payer's guidelines Even if a case qualifies as an emergency, check the guidelines of the payer in question prior to automatically including +99140. Not every payer recognizes qualifying circumstances codes or pays additional units for their use. However for payers that reimburse, you can add two base units to the claim. Tip: Various state Medicaid plans pay for emergency circumstances; but then others won't. You cannot negotiate payment with Medicaid, either they cover qualifying circumstances codes or they do not. However you should certainly discuss qualifying circumstances when negotiating contracts with non-govt. payers. Take in a contractual clause stating whether the payer reimburses based on the ASA's RVG. If yes, you can include a copy of the RVG page to remind the payer of your expected payment. You can even include the RVG page or CPT guidelines stating that an emergency is separately billable if you get a denial and need to go through the appeal process. For more on this and for other specialty-specific articles to assist your anesthesia coding, sign up for a good medical coding resource like Coding Institute.
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