3 criteria signal when +99116 is OK.
Before you can capture qualifying circumstances pay for hypothermia, pay attention to certain documentation details and requirements. Checking the details in your provider’s notes and paying close attention to the applicable anesthesia code can help you ward off any fears of incorrect reporting.
To find the code for hypothermia, you’ll need to flip to the back of your CPT book to “Qualifying Circumstances for Anesthesia.” The code you’ll focus on is +99116 (Anesthesia complicated by utilization of total body hypothermia [List separately in addition to code for primary anesthesia procedure]).
1. Ensure Hypothermia Is Induced
Dissecting the hypothermia code descriptor tells you two important things about correctly reporting +99116:
• The term “utilization” lets you know that the patient’s hypothermic state was induced (that is, on purpose), not incidental.
• Because it’s an add-on code (designated by the “+” sign), you know you can report it only in conjunction with a comprehensive anesthesia code. That doesn’t mean it applies each time a chart mentions hypothermia, however.
2. Bill +99116 When Hypothermia’s Not Inherent
“There are certain anesthesia codes which include hypothermia,” Samantha Mullins, CPC, PMCC, MCS-P, ACS-AN, director of compliance with Medac Anesthesiology Billing Associates in Birmingham, Ala., taught in the national conference session “Qualifying Circumstances Coding, Physical Status, and Billing for Other Medical Services” for The Coding Institute. “Therefore, it’s invalid to append +99116,” she says.
Simple to see: Hypothermia inclusion is obvious with some codes, such as 00561 (Anesthesia for procedures on heart, pericardial sac, and great vessels of chest; with pump oxygenator, younger than 1 year of age). The code’s descriptor doesn’t spell it out, but the associated note does: “Do not report 00561 in conjunction with 99100, 99116, and 99135.”
“Coders must remember that for most heart cases, hypothermia is already included in the base of the anesthesia code,” explains Judy A. Wilson, CPC, CPC-H, CPC-P, CPC-I, CANPC, CMBSI, CMRS. business administrator for Anesthesia Specialists, PTR, in Virginia Beach.
Harder to catch: Other anesthesia codes also include hypothermia, though it’s less clear. Check out these examples:
• You can’t report +99116 with 00562 (… with pump oxygenator, age 1 year or older, for all non-coronary bypass procedures [e.g., valve procedures] or for reoperation for coronary bypass more than 1 month after original operation); the key term is “with pump oxygenator,” because of the service it represents. Explanation: When your anesthesiologist uses a pump oxygenator during cardiac surgery, no blood circulates through the coronary arteries; therefore, the myocardium (or heart muscle) is ischemic (meaning there is restricted blood supply). Hypothermia is a routine part of the procedure to help protect the heart from ischemic injury.
• Also steer clear of reporting +99116 with 00563 (… with pump oxygenator with hypothermic circulatory arrest). The mention of a pump oxygenator sends you away from +99116, as does the hypothermic circulatory arrest. Your anesthesiologist induces hypothermic circulatory arrest to significantly slow cellular activity levels and stop blood circulation. Bringing the patient to that state allows the surgeon to safely complete procedures when he can’t use clamps to contain the blood flow. “This would take place during an aortic arch case as you cannot clamp off because the patient would surely have a stroke, for example,” Wilson says. “The temperature must be brought down to about 18 degrees Centigrade and the patient is in hypothermic circulatory arrest.”
Common, not a given: Your anesthesiologist will often induce hypothermia during intracranial surgeries to treat aneurysms, cerebral AV malformations, and other cerebrovascular procedures, but it’s not considered routine. In these cases, you can safely report +99116 in addition to the anesthesia code and garner your physician a well-deserved boost in pay.
3. Encourage Good Documentation
As with any claim, you can code based only on your physician’s documentation. Simply charting the patient’s temperatures or noting “warming” in his notes won’t justify the use of +99116.
Instead, teach your anesthesiologist to include phrases such as “hypothermic state induced,” “surgeon’s request for hypothermia initiated,” or “temp reduced to 34.5 degrees C per surgeon request.” Then you’ll have what you need to legitimately add +99116 to your claim when the corresponding anesthesia code allows.
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