How To Use CPT Code 99100

CPT 99100 is an anesthesia add-on code used for patients of extreme age, either younger than 1 year or older than 70 years. This article will cover the description, procedure, qualifying circumstances, when to use the code, documentation requirements, billing guidelines, historical information, similar codes, and examples of CPT 99100 procedures.

1. What is CPT 99100?

CPT 99100 is an add-on code used in conjunction with primary anesthesia procedure codes to indicate that the patient receiving anesthesia services is of extreme age, either younger than 1 year or older than 70 years. This code is used to account for the additional risks and complexities associated with providing anesthesia to patients in these age groups.

2. 99100 CPT code description

The official description of CPT code 99100 is: “Anesthesia for patient of extreme age, younger than 1 year and older than 70 (List separately in addition to code for primary anesthesia procedure)”.

3. Procedure

The 99100 CPT code procedure involves the following steps:

  1. Identify the primary anesthesia procedure code for the service being provided.
  2. Verify the patient’s age in the medical record.
  3. If the patient is younger than 1 year or older than 70 years, add CPT 99100 to the primary anesthesia procedure code.
  4. Document the patient’s age and any additional risks or complexities associated with their age in the medical record.
  5. Submit the claim with both the primary anesthesia procedure code and CPT 99100.

4. Qualifying circumstances

Patients eligible to receive CPT code 99100 services are those who are either younger than 1 year or older than 70 years at the time of the anesthesia service. These age groups are considered to be at higher risk for complications during anesthesia due to factors such as immature or declining organ function, increased susceptibility to infection, and altered responses to medications. The use of CPT 99100 acknowledges the additional care and attention required when providing anesthesia services to patients in these age groups.

5. When to use CPT code 99100

It is appropriate to bill the 99100 CPT code when providing anesthesia services to a patient who is either younger than 1 year or older than 70 years. This code should be used in conjunction with the primary anesthesia procedure code to accurately reflect the additional risks and complexities associated with providing anesthesia to patients in these age groups. It is important to verify the patient’s age in the medical record and document any additional risks or complexities related to their age before billing CPT 99100.

6. Documentation requirements

To support a claim for CPT 99100, the following information should be documented in the patient’s medical record:

  • Patient’s age at the time of the anesthesia service
  • Primary anesthesia procedure code
  • Any additional risks or complexities associated with the patient’s age
  • Physician’s or anesthesiologist’s notes detailing the patient’s condition and any age-related factors that may impact the anesthesia service

7. Billing guidelines

When billing for CPT code 99100, it is important to follow these guidelines:

  • Use CPT 99100 as an add-on code in conjunction with the primary anesthesia procedure code.
  • Verify the patient’s age in the medical record and document any additional risks or complexities related to their age.
  • Submit the claim with both the primary anesthesia procedure code and CPT 99100.
  • Note that Medicare does not pay for CPT 99100.

8. Historical information

CPT 99100 was added to the Current Procedural Terminology system on January 1, 1990. There have been changes to the descriptor of the code over the years, with the most recent change occurring on January 1, 2007.

9. Similar codes to CPT 99100

Five similar codes to CPT 99100 and how they differentiate are:

  1. CPT 99116: This code is used for anesthesia complicated by utilization of total body hypothermia, rather than extreme age.
  2. CPT 99135: This code is used for anesthesia complicated by utilization of controlled hypotension, rather than extreme age.
  3. CPT 99140: This code is used for anesthesia complicated by emergency conditions, rather than extreme age.
  4. CPT 99170: This code is used for anesthesia for intracranial procedures in patients with increased intracranial pressure, rather than extreme age.
  5. CPT 99190: This code is used for anesthesia for patients with severe systemic disease, rather than extreme age.

10. Examples

Here are 10 detailed examples of CPT code 99100 procedures:

  1. Anesthesia for a 75-year-old patient undergoing hip replacement surgery
  2. Anesthesia for a 6-month-old infant undergoing repair of a congenital heart defect
  3. Anesthesia for an 80-year-old patient undergoing cataract surgery
  4. Anesthesia for a 9-month-old infant undergoing repair of a cleft palate
  5. Anesthesia for a 71-year-old patient undergoing a colonoscopy
  6. Anesthesia for a 1-year-old infant undergoing a hernia repair
  7. Anesthesia for an 85-year-old patient undergoing a lumbar laminectomy
  8. Anesthesia for a 4-month-old infant undergoing a pyloromyotomy
  9. Anesthesia for a 78-year-old patient undergoing a cholecystectomy
  10. Anesthesia for a 10-month-old infant undergoing a craniotomy for craniosynostosis repair

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