Anesthesia Coding Alert

Question: An obstetrician called one of our CRNAs for standby service during a twin delivery due to the chance of a cesarean section. The physician delivered the babies vaginally, however, so the CRNA completed only standby service. Can we bill an E/M code or another service for her time?

Michigan Subscriber

Answer: You describe a difficult coding situation because 99360(Physician standby service, requiring prolonged physician attendance, each 30 minutes [e.g., operative standby, standby for frozen section, for cesarean/high risk deliver, for monitoring EEG]) specifies "physician" services but doesn't mention other providers such as CRNAs.

The answer depends on a few factors, including the type of insurance, whether the patient is self pay, and the existing documentation. Verify the payer and compare any documentation from the CRNA with your contract guidelines.

Once you assess the documentation, you might need to contact the payer to learn whether a CRNA can bill for standby service.

Bonus: Anesthesia care includes a pre-anesthesia assessment. You can't report an anesthesia code since the CRNA didn't participate in the delivery. If the CRNA performed and documented a pre-anesthesia assessment, however, you might have the elements supporting an E/M code.

-- Answers to You Be the Coder and Reader Questions were provided by Kelly Dennis, MBA, ACSAN, CANPC, CHCA, CPC, CPC-I, president of Perfect Office Solutions in Leesburg, Fla.