Although accurate coding is necessary for proper billing, the process is not easy to comprehend or master. Healthcare professionals who have billed their services on their own and faced denials may understand this frustration. However, we have some good news! And that is, you can still handle billing difficulties on your own despite the intricacy. All you have to do is thoroughly comprehend each code’s coding rules.
In this guide, we will assist you in finding the correct way to bill CPT code 99140 (an add-on code for emergency anesthesia). Discover how to accurately bill this add-on code, so you can prevent denials for your anesthesia services.
CPT Code 99140 – Description
CPT code 99140 is an add-on code applied to the primary anesthesia code. It describes to the payer that the anesthesia was complicated and administered under emergency conditions. It indicates extra work, such as when anesthesia becomes complex due to immediate threats to a patient’s life or body part, requiring special management for severe trauma or urgent surgical needs, and necessitating detailed documentation of the emergency.
However, you must document the emergency condition and the reason for the emergency at the time of providing anesthesia service in the medical record.
Appropriate Use Cases for CPT Code 99140
The following are some examples where the application of CPT code 99140 becomes medically accurate.
Anesthesia for a Patient with Respiratory Distress
Let’s say a 67-year-old male has developed an acute respiratory distress syndrome (ARDS) due to sepsis. He arrives at the emergency department with severe shortness of breath and bluish colored fingernails and lips due to low oxygen level in the blood. Despite initial medical management, the patient’s health rapidly deteriorated and developed acute respiratory failure, necessitating urgent tracheostomy to create an airway for emergency ventilatory support.
The anesthesia provider must proceed immediately, with limited patient history and minimal time for optimization. Because anesthesia is administered in a critical, life-threatening respiratory emergency, CPT code 99140 is appropriately billed with the primary code to reflect the extraordinary circumstances and increased anesthetic risk.
Anesthesia for Serious Trauma Patient
Imagine a 20-year-old male who is brought to the emergency department following a high-speed motor vehicle collision. He presents with multiple injuries, including internal bleeding and decreased level of consciousness, which are the signs of hemorrhagic shock. Imaging confirms a ruptured spleen, so the anesthesia provider must initiate anesthesia immediately while the patient remains hemodynamically unstable. There is no opportunity for a complete preoperative assessment, and rapid blood transfusion, invasive monitoring, and aggressive fluid resuscitation are required throughout the procedure. The risk of sudden cardiovascular collapse is high.
In this case, the anesthesia service is clearly provided under severe emergency conditions, making CPT code 99140 appropriate to report alongside the primary anesthesia procedure code.
Modifiers to Append with CPT Code 99140
Since CPT code 99140 is an add-on code, you cannot apply any modifier to this code. However, modifiers must be applied to the primary code when necessary.
Reimbursement Guidelines for CPT Code 99140
The following guidelines can help you secure accurate payments for CPT code 99140.
Ensure Appropriate Use of 99140
CPT code 99140 is only used for anesthesia application in emergencies. However, some professionals confuse anything outside of normal office hours as an “emergency.” Not every medical procedure performed at night or out of office hours is an emergency case. You can apply this code in situations highlighted in our examples or where the delay in treatment can significantly risk a patient’s health or lead to death.
Follow the Documentation Guidelines
Since the procedure was performed in an emergency, your documents must provide valid proof of the medical necessity of the procedure. You should prepare detailed documents explaining the patient’s history, explaining the medical condition, the potential risks, the time and dose of anesthesia, and other important details justifying the use of this emergency code. Furthermore, if there was any delay in the action, you may not meet the definition of emergency for CPT code 99140 to be valid.
Read the Payer’s Policies
Before filing your claims, you must check with the respective payer and understand their payment policies. Medicare does not separately reimburse this code. It bundles its payment with the primary code. However, you may check the payment policies of commercial payers and how they reimburse emergency cases.
Final Thoughts on CPT Code 99140
Before we conclude our read, let’s recap some important points:
- CPT code 99140 is used for anesthesia in emergencies.
- You can use this code for respiratory distress or a traumatic injury causing blood loss.
- You cannot apply any modifier to this add-on code.
- Medicare bundles the payment of this code with the primary code.
- You must check the commercial payer’s guidelines for reimbursement policies.
However, if you are still facing confusion in filling claims with CPT code 99140, then we will sincerely advise you to opt for expert anesthesia billing services from NeuraBill. Their certified billers offer specialty-specific solutions to medical professionals who suffer from billing stress and denial frustrations.
