CPT 99100, CPT 99116, CPT 99135, CPT 99140, CPT code 99100, CPT code 99116, CPT code 99135, CPT code 99140, 99100 CPT code, 99116 CPT code, 99135 CPT code, 99140 CPT code

CPT 99100, CPT 99116, CPT 99135 & CPT 99140 | Qualifying Circumstances

Anesthesia services are provided under difficult circumstances which may affect the condition of the patient, or present unusual operative conditions and / or risk factors are billed with add-on codes CPT 99100, CPT 99116, CPT 99135 & CPT 99140.

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  1. CPT 99100
    1. Procedure
    2. Billing Guidelines
  2. CPT 99116
    1. Procedure
    2. Billing Guidelines
  3. CPT 99135
    1. Procedure
    2. Billing Guidelines
  4. CPT 99140
    1. Procedure
    2. Billing Guidelines

1. CPT 99100

CPT code 99100 is described by the CPT manual as: “Anesthesia for patient of extreme age, younger than 1 year and older than 70.”

1.1 Procedure

The goal of CPT 99100 is to report anesthesia for patients younger than 1 or older than 70 years old.

A physician must document the age of the patient in the medical records. The physician or the anesthesiologist performs the anesthetic procedure and notes details about the patient’s condition in the medical charts.

The various notable operative conditions, patient’s conditions, and risk factors play a vital role in the anesthesia service provided.

While coding for any anesthesia service, the physician or the coder must make a note of the patient’s age; if the age is in the extreme range (< 1 year or > 70 years), this code can be used for billing, citing the “extraordinary age condition of the patient.”

1.2. Billing Guidelines

CPT 91000 is an add-on code and has to be listed separately in addition to a CPT code for primary anesthesia procedure (CPT 00100 to CPT 01999).

For procedure performed on infants younger than one year of age at time of surgery, see CPT 00326, CPT 00561, CPT 00834, or CPT 00836.

Medicare does not pay for code CPT code 99100.

2. CPT 99116

CPT code 99116 is described by the CPT manual as: “Anesthesia complicated by utilization of total body hypothermia.”

2.1 Procedure

The goal of CPT 99116 is to describe the use of total body hypothermia.

During a procedure in which an anesthesia provider administers anesthesia to the patient, the provider induces hypothermia in the patient, affecting the complexity of the anesthesia service.

The provider most commonly induces hypothermia during intracranial surgeries. The provider must document inducing the hypothermic state at the time of providing the anesthesia service to support using CPT code 99116.

Examples include:

  • hypothermic state induced;
  • surgeon’s request for hypothermia initiated; or
  • temperature reduced to 34.5 degrees C per surgeon request.

2.2 Billing Guidelines

CPT 99116 is an add-on code and needs to be listed separately in addition to codes for primary anesthesia procedures.

Report this code only in case the health provider induces hypothermia in the patient during a procedure and the hypothermia makes the administration of anesthesia more difficult.

Because CPT 99116 is an add–on code, payers will not reimburse you if you report it without an appropriate primary anesthesia code.

Many heart procedures already include hypothermia in the base of the anesthesia code. Do not report CPT 99116 in those cases.

3. CPT 99135

CPT code 99135 is described by the CPT manual as: “Anesthesia complicated by utilization of controlled hypotension.”

3.1 Procedure

The goal of CPT 99135 is to describe the use of controlled hypotension.

An anesthesia provider administers anesthesia to the patient during a procedure and maintains controlled hypotension. The patient’s blood pressure is monitored while it drops drastically and levels off.

The anesthesia provider must document inducing the controlled hypotension at the time of providing the anesthesia service to support using CPT code 99135.

3.2 Billing Guidelines

CPT 99135 is an add-on code and needs to be listed separately in addition to codes for primary anesthesia procedures.

Report his add-on code only in cases when the provider induces controlled hypotension during surgical procedures.

Because CPT 99135 is an add–on code, payers will not reimburse you if you report it without an appropriate primary anesthesia code.

4. CPT 99140

CPT code 99140 is described by the CPT manual as: “Anesthesia complicated by emergency conditions (specify).”

4.1 Procedure

The goal of the 99140 CPT code is to describe emergency conditions.

The physician must document the “emergency condition” and the reason for emergency clearly in the medical record of the patient.

The physician or the anesthesiologist performs the anesthesia procedure on the patient, and during that time, if any emergency situation emerges (such as fast heartbeat, high or low BP, or other health risk factors) that can affect the anesthesia service, the emergency condition is noted down in the medical document.

The emergency situation can be billed while billing for the anesthesiologist or other valid anesthesia service provider.

4.2 Billing Guidelines

CPT 99140 describes emergency conditions and is used along a primary anesthesia procedure code.

It can only be reported when the application of anesthesia has become complex because of an emergency condition. Documentation of this emergancy condition with the reason and time of providing anesthesia is required.

Medicare does not pay for the emergency CPT code 99140.

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