When should +99100 not be reported?

The correct answer, which indicates when +99100 should not be reported, focuses on the specific circumstances surrounding anesthesia coding. The +99100 add-on code is utilized to indicate that a service was performed on a patient with extreme age, which is defined as a patient under one year old or over 70 years old.

When the surgery or procedure being reported already includes a description that incorporates the concept of extreme age — for instance, if the anesthesia code itself specifies an age-related criterion in its description — there is no need to separately report +99100. This is because the anesthesia provider has already accounted for the increased complexity or risk associated with the patient’s age in that particular anesthesia code.

In contexts such as surgeries performed under local anesthesia or outpatient procedures, the decision to report +99100 typically lies more within the parameters of the anesthesia technique and the facility type rather than the demographic considerations that are directly relevant to the add-on code. Similarly, patient age alone, unless it falls within the parameters sets for extreme age, does not inherently disqualify the reporting of this code. Thus, the situation where the extreme age is already encompassed in the primary anesthesia CPT code indeed negates the necessity for the additional reporting of +99100.