Question: Is hypothermia care included in 00561?
Answer: Yes, code 00561 (Anesthesia for procedures on heart, pericardial sac, and great vessels of chest; with pump oxygenator, younger than 1 year of age) does include hypothermia. Though the code’s descriptor doesn’t explicitly spell it out, the associated note does: “Do not report 00561 in conjunction with 99100, 99116, and 99135.”
Remember: Generally, hypothermia is already included as part of the base anesthesia code in most heart cases.
Not a routine: There are some cerebrovascular procedures where you can safely report +99116 (Anesthesia complicated by utilization of total body hypothermia [List separately in addition to code for primary anesthesia procedure]) in addition to the anesthesia code, when your anesthesiologist induces hypothermia during intracranial surgeries. However, these are not routine.
Get clear documentation: Only having documentation of “warming” in the patient’s temperature note is not enough to justify coding +99116. Prompt your physicians to use phrases such as “hypothermic state induced,” to support your claim.