12/21/2018 – Emergency or Not? Code 99140 – Don’t miss out on capturing an extra two base units!

Question: Under what circumstances is it appropriate to use emergency code 99140?

Answer: The extra two units you could receive for 99140 (Anesthesia complicated by emergency conditions) might be justified, but check these areas first.

Know the Correct Definition of ‘Emergency’

CPT and the ASA Relative Value Guide agree on what constitutes an emergency. Guidelines in both resources state that “an emergency is defined as existing when delay in treatment of the patient would lead to a significant increase in the threat to life or body parts.” If there’s a real reason to report an emergency (such as a ruptured appendix, K35.20), a physician should clearly document the reason.

Don’t Assume ED Equals Emergency

Most patients who are admitted to the hospital through the Emergency Department (ED) are experiencing emergency situations – but not everyone is.

Example: Just because a mom-to-be enters the hospital through the ED or needs a cesarean delivery doesn’t make her case an emergency. Circumstances such as fetal distress or prolapsed cord, however, nearly always imply an emergency that needs immediate attention.

Ignore the Timing

Some physicians believe that unexpected events – especially those that occur after normal business hours or on weekends – qualify as emergencies. That’s not the case, according to the emergency definition in CPT and the Relative Value Guide that doesn’t mention the time of service.

Tip: When considering whether to report 99140, always ask yourself whether delaying treatment would have led to a significant increase in risk to the patient’s life or limb. If not (or if you don’t have enough documentation to support that claim), don’t submit 99140.

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