Otolaryngology Coding Alert

Question: When my physician does a frozen section during a procedure, we normally bill 99360 for the waiting time while pathology is being determined. Blue Shield has denied this, stating that the physician standby services for frozen section means pathology waiting for physician, not the other way around. How should we handle this?

Georgia Subscriber

Answer: You should report standby codes only when you bill nothing else.

Example: A thoracic surgeon asks your otolaryngologist to stand by in case the thoracic surgeon needs the ENT's skills. While the thoracic surgeon opens the patient, the otolaryngologist is available. If the thoracic surgeon finds he does not need the otolaryngologist, the ENT can charge standby with 99360 (Physician standby service, requiring prolonged physician attendance, each 30 minutes). If the thoracic surgeon does need the otolaryngologist and he does co-surgery or a parallel surgery, he does not bill the standby. The ENT instead bills what he did.

Waiting for frozen section is part of the surgery the otolaryngologist may participate in. Many times with frozen sections, the surgeon -- with the proper use of modifiers -- can bill staged surgeries and multiple surgeries, which CPT would normally consider integral to each other.