ED Coding and Reimbursement Alert

Question: If a radiologist asks one of our ED physicians to render standby services during a computed tomography (CT) scan on a non-ED patient, like a sick intensive care unit (ICU) patient, how should I code the ED physician's work? Should I use 99360?

New York Subscriber

Answer: In this situation, you should probably use a consult code. If your ED physician meets all the requirements for a consult including a clear request from another physician, a history, physical exam and written report back to the initiating physician then a code from the initial inpatient consult series (99251-99255) might get paid. But the code you suggested, 99360 (Physician standby service, requiring prolonged physician attendance, each 30 minutes), typically describes scenarios quite different from the one you outlined.

If you opt for the standby code, make sure your case meets the 99360 requirements: that the physician provided 30 minutes of prolonged attendance time and did so at the request of another physician. Also, because your situation is different from typical standbys, assess your case and determine if it captures the concept behind using 99360. The standby code makes up for lost productivity when your physician is available for the care of another physician's patient and is unable to provide care or services to any other patient. An example of the proper use of 99360 is when a pathologist, at the request of a surgeon, stands by for a frozen-section breast biopsy, or when a pediatrician stands by during a high-risk delivery. Make sure your scenario and documentation adhere to that line of reasoning.

You might consider not reporting any code for your ED physician. Many physician groups provide this type of service as a courtesy.