What is Qualifying Circumstances?
Qualifying circumstances are those factors such as extreme age, extraordinary condition of the patient, and unusual risk factors which may affect the anesthesia services. These procedures are considered add-on codes and would not be reported alone, but as additional procedures qualifying an anesthesia procedure or service. These procedures must be filed with the appropriate modifier. Codes without the appropriate modifier may be returned or rejected. Do not bill these procedures with physical status modifiers or anesthesia minutes. An additional fee will be reimbursed based on the allowed units for each circumstance:
99100 – Anesthesia for Patient of Extreme Age, Under 1 Year and Over 70 – 1 unit
99116 – Anesthesia Complicated By Utilization of Total Body Hypothermia – 5 units
99135 – Anesthesia Complicated By Utilization of Controlled Hypotension – 5 units
99140 – Anesthesia Complicated – 1 unit
Q. What defines medical direction?
For each anesthesia procedure, the anesthesiologist must perform all of the following seven services and they must be recorded in the anesthesia record:
1. Perform a pre-anesthetic examination and evaluation;
2. Prescribe the anesthesia plan;
3. Personally participate in the most demanding procedures of the anesthsia plan including, if
applicable, induction and emergence;
4. Ensure that any procedure in the anesthesia plan that he or she does not perform are performed
by a qualified anesthetist;
5. Monitor the course of anesthesia administration at frequent intervals;
6. Remain physically present and available for immediate diagnosis and treatment of
7. Provide all the indicated post-anesthesia care.