Every year, it’s always the same. After the holidays, after the New Year, after vacations are over and routine has started, we wait for the spring. A small burst of warmth and sunlight leaves us clamoring for warm weather, even when there’s a month left of winter. Stay warm, and hang in there!
In the meantime, let’s look at an important qualifying circumstances code you might encounter in the chilly weather: +99116, or hypothermia. This is an important qualifying circumstance code that can be helpful in making you money, but only if it is reported correctly! When you add +99116 to the claim, it will add five units for your provider’s reimbursement. Don’t let this uncommon type of claim leave you frozen solid!
Four Circumstances to Remember:
Is coding the claim as hypothermia appropriate?
The “Qualifying Circumstances Codes for Anesthesia” section of CPT has a detailed description on when it is and isn’t appropriate to use the +99116 code. The two main points to remember are the term “utilization,” ie. that the patient’s hypothermia was purposeful instead of incidental, and the “+” symbol. Because hypothermia is an add-on code, you can only report it in conjunction with a comprehensive anesthesia code. It cannot stand alone on a claim.
It the code already included in the claim?
Some codes are all-inclusive, so hypothermia is already included with the coding. It is NOT appropriate to add-on +99116 to these claims! Common codes that include hypothermia are codes involving heart procedures. Because hypothermia is a necessary part of some procedures in order to protect the heart from injury, you explicitly cannot add on the additional +99116 code to 00561, 00562, and 00563. Keep this in mind!
Also, don’t make assumptions about procedures. In some surgeries, an anesthesiologist must induce hypothermia (like in intracranial procedures) to protect the patient. In this case, it is absolutely appropriate to add the +99116 code to your billing, as long as there is sufficient documentation.
Is the documentation clear?
In an ideal world, all physicians will leave such detailed documentations that coding is clear and straightforward. In the real world, however, sometimes such detailed documentation doesn’t exist. In these cases, simply charting a patient’s changing temperatures is not enough to call for the +99116 code. A surgeon or physician must provide sufficient documentation that not only was hypothermia medically necessary, but must note the degree of hypothermia. Simply dropping a couple of degrees is not enough; the insurer will look for a larger difference when evaluating this claim. Anesthesiologists must use phrases like “hypothermic state induced” or “temperature reduced to X degrees per surgeon request” in order for the documentation to be considered sufficient for the +99116 code.
Is the payer good to go?
If the payer is covered by Medicare, all these details are null and void. Simply put, billing separately for hypothermia when filing to Medicare is a no-go. Medicare does not pay any modifying units or qualifying circumstances, because they consider that work to be included in codes for other services. The good news is, most commercial insurance carriers WILL pay for code +99116, as long as you have satisfied the requirements above. So, as long as you are paying careful attention to this qualifying circumstance code, it won’t stop your claims cold!