Medicare Compliance & Reimbursement

Question: My doctors stand by for surgeons in some high-risk procedures/cases. They want to code for their time, and I have found code 99360 for this. Do they need to dictate something in order for me to charge for this?

Answer: CMS and many other payers don't pay for 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]), so the physician may not be able to charge for standby time.

Some payers might pay on 99360, however. If a third party payer does reimburse for 99360, then 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 the pacemaker implant performed on [PATIENT'S NAME] on [DATE]. I arrived at the operating room at [ARRIVAL TIME] and departed at [DEPARTURE TIME].

Note: When standby care is requested, both the requesting physician and providing physician must document the need for standby care regardless of whether a claim for reimbursement is submitted.

If you submit a claim, be sure to follow the CPT® guidelines for 99360, which include:

• Another physician must document in writing the request for the standby service.
• The standby physician must not provide care to other patients during the standby period.
• The standby physician should not submit 99360 for any service of less than 30 minutes total on that date of service. You may report an additional unit of 99360 for each additional 30 minutes, meaning another full 30 minutes of standby service.

Important: If the physician is called upon during the procedure to actually assist with or perform a procedure, you should bill for the service provided rather than reporting the standby service using 99360.