The physician standby services (CPT code 99360) coding appears to perplex and confuse many coders. It is important to understand the guidelines for coding the standby service. Code 99360 is used to report physician standby service that is requested by another physician and that involves prolonged physician attendance without direct (face-to-face) patient contact. The physician may not be providing care or services to other patients during this period.

CPT description

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)

Code 99360 is used to report the total duration of time spent by a physician on a given date on standby. Standby service of less than 30 minutes total duration on a given date is not reported separately.

AMA defines physician standby service as:

• Service requested by another physician
• Service involves prolonged physician attendance without direct (face-to-face) patient contact

Scenarios inappropriate to use physician standby service

Coders should not use code 99360 when the standby service results in:

• The standby physician performing a procedure that is part of a "surgical package"
• Another CPT service code more clearly represents the service provided by the standby physician
• The standby period is less than thirty minutes
• Time is spent proctoring another physician

One unit of physician standby service equals thirty minutes. Coders may report second and subsequent periods of standby beyond the first 30 minutes only if the physician provided a full 30 minutes of standby for each unit of service reported.

Recommended steps to deserve payments:

Documentation and coding requirement

• A document should have a request from the providing surgeon to another physician requesting his or her attendance as a standby provider during the operative session
• The medical necessity should be documented as to why the physician standby provider is being requested (e.g., physician standby requested for possible high risk OB cesarean delivery, critical or high risk intra-operative surgical session, or electroencephalogram monitoring during cardiac or trauma cases)
• The standby physician documents time in and time out of the operating room while on standby

Here is an example of documentation on physician standby service:

I was requested by Dr. Kate to be on standby for the high-risk cesarean section performed on patient Mrs. Krish on July 10, 2011. I arrived at the operating room at 11:57 a.m. and departed at 1:14 p.m.

In this case, I can bill for CPT code 99360 x 2 units.

Rationale: The above scenario has two complete 30 minute blocks of time. You are not allowed to bill a "partial unit" if less than 30 minutes.

Code is based on availability and not care

The first step to submit a claim for standby service is to know what is to be reported and what should not. It is vital to understand that code 99360 does not represent the patient care; in fact, it signifies the availability of the physician during the requested course of time.

Ascertain time and location

Time as well as location plays an imperative role for reporting the standby service. The physician must be in attendance for standby for at least 30 minutes and he/she must document that time. According to CPT Codes, if the time is less than 30 minutes, you do not report it separately. However, it is always a good idea to document patient care whether it is billable or not.

Reimbursement by the payers

Does CMS reimburse 99360??

CMS does not reimburse for physician standby services billed with code 99360. CMS considers the standby services to be included in the payment to a facility as part of providing quality care and are not separately reimbursable. CMS also does not post any relative value units to code 99360.

So what about commercial insurance and third-party payers?!

Conversely, many private insurance and third-party payers do reimburse for standby services.

Coders or the billing staff must contact the third-party payers to find out whether they reimburse and also inquire about the payer-specific documentation, and medical necessity policies and guidelines for standby services.

Reimbursement from third-party payers can differ. Some payers may reimburse based upon their own fee schedule. In few cases, the physician may have to submit the billing amount or the physician practice estimate of cost.

If the third-party payers state that they do not reimburse for this service, then one may need to appeal. If there is clear documentation from both the provider of standby services and the requesting physician in addition to the medical necessity, some payers will supersede their in-house policy guidelines to provide reimbursement or change their existing policy guidelines to incorporate payment for CPT code 99360.

As coders, we adhere to the golden rule of coding which states, "If it wasn't documented, it wasn't done." So, it is vital to understand the following in the case of code 99360:

• Get it documented
• Document the medical necessity
• Code and bill the service
• Appeal with the provider documentation if service is denied by the payer

If a coder of a physician's office believes strongly in coding and billing for the standby service code 99360, then certainly a coder can cause a change of policy from third-party payers and potentially increase the revenue for his or her physician practice.

By Meera Mohanakrishnan, MSc, CPC, CPC-H, CPC-P Manager Trainer |OptumInsight |United Health Group
Email - meera_mohanakrishnan@uhc.com