Anesthesia Coding Alert

CPT's E/M section includes only one code for standby time, but limited choices don't guarantee payment. Watch four areas our experts recommend, and don't leave your claims hanging in the wings.

Your first step in preparing to submit a claim for standby service is to understand what you're reporting " and what you're not. 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.

Example 1: An obstetrician asks your anesthesiologist to remain 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 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.

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 and provided service to the patient, however, you would code according to his service instead of reporting 99360.

Although CPT includes a standby code, many payers do not reimburse for the service, says Kelly Dennis, MBA, ACS-AN, CANPC, CHCA, CPC, CPC-I, owner of Perfect Office Solutions in Leesburg, Fla. . Thorough documentation of your provider's service is paramount since you might be faced with an appeal. Remember these documentation tips when coding 99360 for standby care:

1. Another physician 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.

2. The chart should include a note by the anesthesiologist documenting that his 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").

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").

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. "CPT indicates that if the time is less than 30 minutes, you don't report it separately," Dennis says. "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 faceto-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.

Caveat: Your anesthesiologist must be nearby because of the standby request, and the request must be the reason for his presence. 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.

"Pay close attention to any specific payer requirements," Dennis advises. "For example, Alabama Medicaid requires that the standby physician must be in the operating or delivery room."

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.

Some materials that teach about standby coding for labor and delivery (L&D) patients also mention 99464 (Attendance at delivery [when requested by  delivering physician] and initial stabilization of newborn). Although 99464 goes hand-in-hand with 99360 because it represents newborn care, you won't report 99464 as an anesthesia coder.

Rationale: Anesthesia providers care for the mother, not the baby. The American Society of Anesthesiologists even has policies to this effect. Another provider should be available to offer neonate care, so 99464 applies to that professional.