Pathology/Lab Coding Alert

Question: Our pathologists sometimes "standby" during surgery to perform intraoperative consults for high-risk cases that occur outside their normal work hours. They want to code for their time, and we want to use 99360. How should they document their time to be able to charge 99360?

Texas Subscriber

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 your pathologist 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 pathologist has documented the standby service with something such as: I was requested by [DOCTOR'S NAME] to be on standby for frozen section and intraoperative consult for surgery performed on [PATIENT'S NAME] on [DATE]. I arrived at the facility at [ARRIVAL TIME] and departed at [DEPARTURE TIME].

Note: When standby care is requested, both the requesting physician and providing pathololgist 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 pathologist must not provide care to other patients during the standby period.
• The standby pathologist 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: Only report standby if the pathologist waits at the facility but isn't called to surgery for a consult. If the pathologist is called upon during the procedure to actually consult and perform frozen sections, you should bill for the service provided rather than reporting the standby service using 99360.