99360 Is Certainly Payable If You Follow The Rules

Take a look at documentation of four areas prior to submitting claims. Also keep an anesthesia code crosswalk handy to assist you in your coding.

CPT's evaluation & management section includes only one code for standby time, however limited choices do not ensure payment. Here are four areas our experts suggest and do not leave your claims hanging in the wings.

You should code based on availability and not care

Your first step in gearing up to submit a claim for standby service is to know what you are reporting and what you are not. Code 99360 doesn't represent patient care, rather it represents availability.

You should document three key factors

Even though CPT includes a standby code, many payers don't reimburse for the service. Comprehensive documentation of your provider's service is key as you might be faced with an appeal. Here are three documentation tips you should heed to when coding 99360 for standby care.

Another doctor 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.

The chart should cover a note by the anesthesiologist documenting that his service might be necessary.

Know how about the anesthesiologist's involvement in the case.

Check times and locations twice

Being able to report standby service hinges on two more important factors: time and location.

Your anesthesiologist must be in attendance for standby for at least 30 minutes - and he must document that time. According to CPT, if the time is less than half an hour, you do not report it separately. However, it is always a good idea to document patient care whether it is billable or not.

Pay no attention to 99464 for your claims

Some materials that teach about standby coding for labor and delivery (L&D) patients also mention 99464. Even though 99464 goes hand-in-hand with 99360, since it represents newborn care, you will not report 99464 as an anesthesia coder.

Rationale: Anesthesia providers care for the mother and not the baby. The American Society of Anesthesiologists even has policies to this effect. One more provider should be available to offer neonate care, so 99464 applies to that professional.

For further details on this and for other specialty-specific articles to assist your anesthesia coding, sign up for a good medical coding resource like TCI. Such a site comes with products like Anesthesia Analyst that comes with anesthesia code crosswalk to assist your coding.

00918 is primary anesthesia code for procedures 52352-52355

However don't make it your automatic choice.

While coding for your anesthesia practice, you may find yourself in various tight situations such as this: Say for instance you may find yourself asking: How should I code for anesthesia during a cystourethroscopy with lithotripsy for a diagnosis of kidney or ureteral stones?

Answer: Well, the anesthesia code crosswal lists   00918 (anesthesia for transurethral procedures [including urethrocystoscopy]; with fragmentation, manipulation and/or removal of ureteral calculus) as the primary anesthesia code for procedures 52352-52355 (Cystourethroscopy, with ureteroscopy and/or pyeloscopy …) however you should not make that your automatic choice.

Notes below each code from 52352-52355 state that you should report 00862 (Anesthesia for extraperitoneal procedures in lower abdomen, inclusive of urinary tract; renal procedures, including upper one-third of ureter, or donor nephrectomy) when lithotripsy involves the kidney or upper one-third of the ureter. Owing to this ‘upper one-third' distinction, you will need a copy of the operative report to code properly.

Many a medical coder gauge their condition by the stone's location. They submit 00910 (Anesthesia for transurethral procedures [including urethrocystoscopy]; not otherwise specified) for a bladder stone, 00918 for a ureter stone, and 00862 for a kidney stone.

For more on this and for other specialty-specific articles to assist your anesthesia coding, sign up for a good coding resource like TCI. Onboard such a site, you can have access to the anesthesia analyst that provides you with anesthesia codes, tools, and resources you need for successful coding. It also comes with an anesthesia code crosswalk to help you choose the proper anesthesia code for each CPT procedure code in the record. Basically, the anesthesia crosswalk is a listing of CPT procedure codes and their corresponding anesthesia codes.