Pediatric Coding Alert

Question: When billing 99360 (1-30 minute total duration time for physician requested services due to complications with a pediatric patient) and 99223 (once delivery has been performed), insurers keep denying 99360. Is there any way to get

them to pay for standby service? Should I use a modifier?

Texas Subscriber

Answer: Most insurers deny standby services (99360, Physician standby service, requiring prolonged physician attendance, each 30 minutes [e.g., operative standby for frozen section, for cesarean/high risk delivery, for monitoring EEG]),

regardless of whether the claim involves another same-day charge, such as 99223 (Initial hospital care, per day, for the evaluation and management of a patient ...). The Correct Coding Initiative edits do not bundle 99360 with 99223. Therefore,

you do not technically need modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of a procedure or other service). The Medicare Physician Fee Schedule, however, assigns

99360 a status indicator of "X," which means standby service is statutorily excluded. Any payer that uses these status codes as part of their claims processing will refuse to pay for 99360.