Anesthesia Coding Alert

Question: Should I bill for the anesthesiologist's time during a vaginal birth after cesarean (VBAC) delivery? Can I bill for the anesthesiologist's time when he is called in for a possible cesarean section, but a c-section is not performed?

Louisiana Subscriber

Answer: The American College of Obstetrics and Gynecology's (ACOG) guidelines require an anesthesiologist to be present anytime a VBAC patient is in labor. Medicare does not reimburse for standby service, but this isn't usually a big concern because most anesthesiologists see few Medicare deliveries. Many commercial carriers, however, will reimburse for standby time when you report 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]). Total the physician's standby time and bill it in 30-minute segments.

The anesthesiologist cannot bill for standby time if he or she cares for another patient at the same time. For example, you can bill standby service if the anesthesiologist is there for a single patient, but not if he starts and monitors another patient's epidural.

If the anesthesiologist is present and monitors the patient during delivery, bill the time prior to delivery as part of the procedure instead of as standby time (assuming the anesthesiologist placed an epidural or delivered some type of anesthesia). Many carriers want charges for actual face-to-face time in this situation the time spent placing the epidural, checking on the patient, refilling the pump, and attending the delivery.