CPT code 99140: Qualifying circumstances for anesthesia

What is CPT Code 99140?

CPT code 99140 represents a qualifying circumstance add-on code used specifically when anesthesia services become complex due to emergency conditions. This code applies to situations requiring immediate anesthesia administration to prevent harm or death, significantly impacting the clinical decision-making process.

Anesthesiologists and certified nurse anesthetists use the 99140 CPT code alongside a primary anesthesia procedure when treating patients experiencing critical situations, such as severe cardiopulmonary disease, acute hemorrhage, or other life-threatening emergencies during markedly invasive surgical procedures like coronary artery bypass graft.

CPT code 99140 documentation requirements

Detailed and accurate documentation in the patient’s medical record is essential for justifying the use of CPT code 99140.

Description of the emergency

Clearly document the specific nature and severity of the emergency (e.g., "acute hemorrhage," "respiratory arrest," or "severe cardiopulmonary instability"). Explicitly stating the term "emergency" is required in notes to substantiate the urgent condition necessitating immediate anesthesia services.

Start time and rationale for urgency

Record the exact start time when emergency anesthesia care began, and include the clinical rationale for why the procedure was urgently required. This documentation should clearly show that immediate intervention was essential for patient safety.

Associated primary anesthesia code

Clearly indicate the primary anesthesia CPT code (from the range 00100-01999) to which the add-on code 99140 applies. Linking the emergency circumstances clearly to the primary anesthesia procedure helps clarify the complexity of care delivered.

Impact on anesthesia delivery or monitoring

Document how the emergency condition specifically impacted anesthesia services, such as adjustments in anesthesia techniques (e.g., controlled hypotension or management of low blood pressure), monitoring requirements, or additional clinical considerations due to advanced cardiopulmonary disease or patient instability.

CPT code 99140 billing guidelines

Adhering to correct billing practices for CPT 99140 is critical to ensure appropriate reimbursement for complicated anesthesia services.

Add-on code; not billed alone

CPT code 99140 is an add-on code and must be reported alongside the primary anesthesia procedure code (00100-01999). It cannot be billed independently as it specifically indicates an emergency complication.

Requires emergent documentation

To justify billing 99140, documentation must explicitly detail the emergency situation and its impact on anesthesia care. Notes lacking sufficient evidence of urgency or clinical decision making may result in claim denial.

Check first if payer considers it bundled

Certain insurance companies and payers consider code 99140 bundled into primary anesthesia services. Verify each payer’s policy regarding reimbursement for qualifying circumstances to avoid denials or payment issues.

No modifier needed

No anesthesia modifiers are required specifically for 99140. Standard modifiers applicable to the primary anesthesia procedure still apply; however, the 99140 CPT code itself does not require additional modifiers.

Related CPT Codes

• 99100 – Anesthesia for patients of extreme age (under 1 year or over 70 years old)
• 99116 – Anesthesia complicated by utilization of controlled hypotension
• 99135 – Anesthesia complicated by utilization of controlled hypothermia
• 01920 – Anesthesia for cardiac catheterization including coronary angiography
• 00567 – Anesthesia for coronary artery bypass graft with pump oxygenator