Saturday, August 14, 2010

Physician Services: “standby” CPT Code 99360

Stand By Physician Policy (R3003) -->
Standby services seems to be a very confusing code for many in the coding field. Don't be afraid to code for standby, you just need to know the rules. This should help you determine if you should bill for code 99360 or not.
In many specialties a physician is called to be on “stand-by” for the operating room/procedure room. These specialties include Orthopedics, OB/GYN, Opthalmology, Family Practice, Newborn Care and many others.
CPT defines physician standby service(s) as a service that is requested by another physician and that involves prolonged physician attendance without direct (face-to-face) patient contact. The physician may not provide care or services to other patients during this period. A physician cannot use code 99360 to report time spent proctoring another physician. It is also not to be used if the period of standby service ends with the performance of a procedure that is part of a “surgical package” performed by the physician who was on standby.
Standby services code 99360 is used to report the total duration of time spent on standby, by a physician on a given date. Standby service of less than 30 minutes total duration on a given date is not separately reported. Second and subsequent periods of standby beyond the first 30 minutes may be reported only if a full 30 minutes of standby was provided for each unit of service reported.
At this time, there are no “official” documentation requirements for this code. But the list below will help in making standby very clear if you are requested to provide documentation for payment.
§ A documented request from the surgeon to the physician that they want on standby
§ The reason standby is being requested – such as a high risk OB cesarean delivery, Operative surgical session or even EEG monitoring.
§ The Standby physician documents time in/time out while on standby
From personal experience, I have a physician that is very good at documenting standby services. An example of his documentation looks like this….
I was requested by Dr. Smith to be on standby for the high-risk cesarean section performed on patient Jane Jones on August 9, 2010. I arrived at the OR at 10:57 a.m., and departed at 12:14 p.m.
In this case, I can bill for CPT code 99360 x 2 units. Rationale: 2 complete 30 minute blocks of time. You are not allowed to bill a “partial unit” if less than 30 minutes.
CMS (The Center for Medicare/Medicaid Services) DOES NOT REIMBURSE for physician standby services – billed with code 99360. These services are considered by CMS to be included in the payment to a facility as part of providing quality care and are not separately reimbursable. However, you can check with your private insurance/3rd party payors if they reimburse for these services. When I contacted some 3rd party payors in my area, they were reimbursing these services at an RVU value between 1.10 and 1.75.
If you have other ??’s or concerns, feel free to e-mail me… HAPPY CODING!!!

IMPORTANT!!!! Changes to the Medicare Timely Filing Limits!

"Timely Claims Filing: Additional Instructions"

In January 2010 Medicare changed their rules regarding timely filing of claims, and again has updated and clarified those rules. Below is a link to that Med-learn matters article. I've also listed the highlights of the article.

Key Points

Claims with dates of service on or after January 1, 2010, received later than one calendar year beyond the date of service will be denied by Medicare.

 …New changes …

 Institutional claims that include span dates of service (i.e., a “From” and “Through” date span on the claim), the “Through” date on the claim will be used to determine the date of service for claims filing timeliness.

 Professional claims (CMS-1500 Form and 837P) submitted by physicians and other suppliers that include span dates of service, the line item “From” date will be used to determine the date of service and filing timeliness. (This includes supplies and rental items).

 BE AWARE: If a line item “From” date is not timely, but the “To” date is timely, Medicare contractors will split the line item and deny untimely services as not timely filed.

 Claims having a date of service of February 29th must be filed by February 28th of the following year to be considered as timely filed. If the date of service is February 29th of any year and is received on or after March 1st of the following year, the claim

• Be sure your billing staff is aware of these changes!!!!