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Look at 3 areas before expecting 2 extra units for emergency reporting. When you are reporting any qualifying circumstances (QC) codes for anesthesia, the situation could be a tricky one for you. However, knowing when to categorize a situation as a true emergency can be a real challenge unless you're well acquainted with the emergency conditions guidelines. Confirm coding definitions as well as your provider's documentation to identify whether you can lawfully add two extra units for +99140 (Anesthesia complicated by emergency conditions [specify] [List separately in addition to code for primary anesthesia procedure]) to your claim. Read on this expert anesthesia billing service insight and for perfect anesthesia claims and maximized reimbursements. Simplify Your 'Emergency' Definition CPT has a note with +99140 saying that an emergency exists when delay in treatment of the patient would result in a noteworthy increase in the threat to life or body parts. Your answer to knowing a case meets emergency conditions exists in your anesthesiologist's notes. A lot of cases come in where the anesthesiologist marks 'emergency' although many times the 'emergency' isn't all that apparent. Documentation backing an emergency will rest on each case, thus read the chart in detail when your provider points out an emergency. Solution: Have a word with your anesthesia providers to clarify what represents an emergency and when you can include +99140. In case there's am actual reason to report an emergency (for instance a ruptured appendix, 540.0), your physician should evidently document the reason. Another diagnosis code to specify a problem (for instance unstable angina, 411.1) could help explain the payer you're reporting an odd situation. The second diagnosis can moreover help in an appeal in case a payer that normally recognizes +99140 denies the claim. Keep in mind 'Unexpected' Doesn't Mean 'Emergency' Several physicians have a tendency to add "emergency" to unexpected events, like after hours or weekend cases they get called to attend. Only timing isn't sufficient to merit +99140, as per the Relative Value Guide (RVG). When taking into account whether to report +99140, at all times inquire yourself whether delaying treatment would have resulted in a noteworthy increase in risk to the patient's life or limb. If this is not the case, you shouldn't include +99140. Follow the Payer's Guidelines Even though a case meets the criteria of an emergency, check the payer in question's guidelines prior to automatically including +99140. Not all payers (including Medicare) recognize qualifying circumstances codes or pay further units for their use. However for payers that reimburse, you are allowed to add two base units to the claim. Tip: Several state Medicaid plans pay for emergency circumstances but others won't. You can't negotiate payment with Medicaid -- either they cover qualifying circumstances codes or they don't -- but make sure that you do discuss qualifying circumstances when negotiating contracts with non-government payers. Include a contractual clause stating whether the payer reimburses based on the ASA's RVG. If this is the case, you can include a copy of the RVG page to remind the payer of the payment that you are expecting. You can furthermore include the RVG page or CPT guidelines maintaining that an emergency is independently billable in case you receive a denial and require going through the appeal process. Want to get more expert advice like this for perfect anesthesia billing service and know everything about anesthesia CPT Codes ? Click here to read the entire article and to get access to our monthly Anesthesia Coding Alert newsletter: Your practical adviser for ethically optimizing anesthesia billing service, coding, payment and gaining expertise on anesthesia CPT codes
http://www.supercoder.com/articles/articles-alerts/aca/qualifying-circumstances-turn-to-99140-for-true-emergencies-tips-help-you-decide/
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