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Anesthesia Coding Alert

L&D Coding:

Yes, You Can Be Paid for Standby -- if You Follow the Rules

Published on Thu Mar 01, 2007

Check documentation details before approaching carriers

CPT's E/M section includes one code for standby time: 99360. Only having one code to consider, however, doesn't make your claim a shoe-in.


Code for Availability, Not Care

Before submitting claims for standby service, be sure you know what you're reporting. Code 99360 (Physician standby service, requiring prolonged physician attendance, each 30 minutes [e.g., operative standby, standby for frozen section, for cesarean/high-risk delivery, for monitoring EEG]) does not represent patient care -- rather, it represents availability, says Scott Groudine, MD, an anesthesiologist in Albany, N.Y.

Example 1: An obstetrician asks your anesthesiologist to stay by in the labor and delivery area in case a woman who is undergoing VBAC (vaginal birth after cesarean section) ruptures her uterus. The anesthesiologist stays nearby but doesn't provide service because the woman delivers vaginally without any problems.

Example 2: An interventional cardiologist requests a surgical suite with a pump and an anesthesiologist on standby for a procedure that could result in a devastating cardiac event like coronary artery rupture. The anesthesiologist isn't needed because the procedure goes well.

Example 3: A cardiologist requests anesthesia standby during a coronary angiogram, in case an emergency arises and the anesthesiologist needs to induce the patient. No complications arise, so your anesthesiologist doesn't provide services.

You can report standby service for any of these cases, if your anesthesiologist meets code-specific criteria. If your anesthesiologist had been involved with the cases, however, you would code according to his service instead of with 99360.


Document 3 Key Factors 

Although CPT includes a standby code, Groudine says many carriers do not reimburse for the service. "You will probably have to appeal and send supporting documentation," he says.

Remember these documentation tips when coding 99360 for standby care:

1. Another physician or CRNA must request that your anesthesiologist make himself available for standby time. You need this request in writing, along with justification for why the other physician requests anesthesia standby (such as potential problems due to hypertension or during a multiple-birth or VBAC delivery).

2. The chart should include a note by the anesthesiologist documenting that his service would be helpful (such as, "Dr. Smith asked me to be available for Ms. Jones for a possible emergency C-section because he is attempting a VBAC").

3. Information about the anesthesiologist's involvement in the case (such as, "I was available until 11:30 p.m. when Ms. Jones delivered a baby without incident").


Some carriers, such as North Carolina Medicaid, publish policies on standby time. These carriers might not require you to submit complete documentation with the claim, but have it on hand in case the carrier requests it.


Watch Times and Locations 

Being able to report standby service hinges on two more important factors: time and location.

Your anesthesiologist must be in attendance for standby for at least 30 minutes -- and he must document that time.

Here's why: "There has to be a time limit on this so the insurer isn't stuck paying for 10 minutes every time a doctor tells me, 'I might have something that needs you in the OR; let me check and I'll get right back to you,' " Groudine says. "Instead, this is reimbursement for being available for a good reason, and the minimal time carriers recognize is 30 minutes."

Note: Coding for standby time means your anesthesiologist does not have direct face-to-face contact with the patient. You should report his total time of availability, if it is 30 minutes or more. If your anesthesiologist is on standby for less than 30 minutes, document his availability but don't charge for the time.

"If no exam is done, the only thing you'll document is something like 'Anesthesia was standby for 22 minutes,' " says Barbara Johnson, CPC, MPC, owner of Real Code Inc. in Moreno Valley, Calif.

Waiting, but focused: Your anesthesiologist must be nearby because of the standby request. You cannot report standby services if your physician is already on-call, if he is medically directing other cases or if he is proctoring another physician during the same time.

"It is obvious that this code could be easily abused to compensate for anesthesia downtime," Groudine says.

Having strict documentation criteria helps avoid a potential mind-set of "I'm free for a half-hour; therefore, I was available to Ms. Jones during the time she was in labor."

"The anesthesiologist does not have to be present during standby, but must be close and available," Johnson adds. "Some hospitals write into their operating policies what 'close' and 'available' mean for their facility."

Educate yourself:Verify whether your hospital has specific definitions of "close" and "available." If so, be sure your anesthesiologists know and understand the guidelines so you report cases correctly.


Know the Difference Between Other Services

The meaning of "standby" has changed over the years, so be sure you and your carriers are following the same definitions when you discuss cases.

The old view: Twenty years ago, anesthesia services fell into three categories: general, regional and local standby. The American Society of Anesthesiologists later coined the term "monitored anesthesia care" (MAC) to replace "standby anesthesia."

Why the change? In many cases, people thought "standby" meant the anesthesiologist was available to provide care but was not providing face-to-face care. Experts believed "monitored anesthesia care" better described when an anesthesiologist provides care but the patient does not need general or regional anesthesia.

Today's take: In today's coding world, MAC and standby anesthesia are two different things rather than interchangeable terms. MAC refers to times when your anesthesiologist records face-to-face time and actually performs a service for the patient. Standby, however, refers to times when your anesthesiologist is readily available but not with the patient or is in the room but not monitoring the patient.

"Standby is now 'availability,' and MAC is 'care,' " Groudine says. "This distinction was important, and the term 'MAC' allows for that differentiation."


Don't Worry About 99436 

Some materials that teach about standby coding for labor and delivery (L&D) patients also mention 99436 (Attendance at delivery [when requested by delivering physician] and initial stabilization of newborn). Although it goes hand-in-hand with 99360 because it represents newborn care, Groudine says you won't use it as an anesthesia coder.

"We are called to care for the mother and not the baby," he says. "In fact, there are ASA policies that say the role of the anesthesiologist is to care for the mother and not the neonate. Another provider should be available to offer this care, and 99436 would be an appropriate billing code for them."

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