Anesthesia Coding Alert

Documentation and length of time are crucial factors.

A surgeon asking an anesthesiologist to be on standby in case a patient needs their services is not unusual. Coding is simple if the anesthesiologist is needed. But how do you handle a situation that never shifts from standby? Read on for helpful tips to keep in mind.

Shift Your Mindset to ‘Availability,’ Not ‘Care’

Coding guidelines and payer policies make it clear that code 99360 (Standby service, requiring prolonged attendance, each 30 minutes (eg, operative standby, standby for frozen section, for cesarean/high risk delivery, for monitoring EEG)) represents the anesthesiologist’s availability – not actual patient care. Consider these examples of when 99360 might apply to a scenario.

Example 1: An obstetrician asks your anesthesiologist to remain in the labor and delivery area in case a woman who is undergoing vaginal birth after cesarean section (VBAC) 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 such as 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.

Solution: 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 case and provided service to the patient, however, you would code according to the anesthesia service instead of reporting 99360.

Support Your Claim with Solid Documentation

As with any other service your anesthesiologist provides, thorough documentation is paramount when filing a claim with 99360. Claims for standby service should always include:

• The request in writing from the physician who asked that your anesthesiologist make themself available for standby time. You also need written justification for why the other physician requests anesthesia standby.
• A note by the anesthesiologist documenting that their service might be necessary (such as, “Dr. Smith asked me to be available for Ms. Jones for a possible emergency C-section because he is attempting a VBAC”).
• 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”).

Times and locations are two additional documentation points that are important for standby claims.

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

“CPT^® indicates that if the time is less than 30 minutes, you don›t report it separately, says Kelly D. Dennis, MBA, ACS-AN, CAN-PC, CHCA, CPMA, CPC, CPC-I, owner of Perfect Office Solutions in Leesburg, Florida. “But it’s always a good idea to document patient care whether it’s billable or not.”

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

Caveat: Your anesthesiologist must be nearby because of the standby request, and the request must be the reason for their presence. You cannot report standby services if your physician is already on-call, if they are involved with or are medically directing other cases, or if they are proctoring another physician during the same time.

“Pay close attention to any specific payer requirements,” Dennis advises. “For example, California Medicaid United Healthcare Community Plan requires full-time attendance, the medical necessity for the physician’s immediate presence, a detailed report of the tasks performed, and the duration of the actual time spent with the patient, and because you can only bill Medicare for face-to-face time with the patient, you cannot charge Medicare for standby time.”

Don’t Count on Payment – But Don’t Give Up

CMS and many other payers don’t pay for 99360, so the physician may not be able to charge for standby time. If this was a cash pay patient and the anesthesiologist wanted to bill for the standby service time, the patient should sign a waiver accepting financial responsibility before services are provided.

Keep persisting: Some payers might reimburse for 99360, however. If a third-party payer does reimburse for 99360, be sure the physician has documented the standby service with something such as: I was requested by [DOCTOR’S NAME] to be on standby for [PROCEDURE] performed on [PATIENT’S NAME] on [DATE]. I arrived at the facility at [ARRIVAL TIME] and departed at [DEPARTURE TIME].