Anesthesia Coding Alert

Check documentation details before approaching carriers

CPT's E/M section includes one code for standby time: 99360. Only having one code to consider, however, doesn't make your claim a shoe-in.


Code for Availability, Not Care

Before submitting claims for standby service, be sure you know what you're reporting. 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, says Scott Groudine, MD, an anesthesiologist in Albany, N.Y.

Example 1: An obstetrician asks your anesthesiologist to stay by 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 like 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, however, you would code according to his service instead of with 99360.


Document 3 Key Factors 

Although CPT includes a standby code, Groudine says many carriers do not reimburse for the service. "You will probably have to appeal and send supporting documentation," he says.

Remember these documentation tips when coding 99360 for standby care:

1. Another physician or CRNA 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 (such as potential problems due to hypertension or during a multiple-birth or VBAC delivery).

2. The chart should include a note by the anesthesiologist documenting that his service would be helpful (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").


Some carriers, such as North Carolina Medicaid, publish policies on standby time. These carriers might not require you to submit complete documentation with the claim, but have it on hand in case the carrier requests it.


Watch Times and Locations 

Being able to report standby service hinges on two [...]