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99051 code

Lori Posted Tue 27th of November, 2012 20:27:51 PM

IF WE BILL FOR THE 99051 AFTER HRS CAN WE BILL IT FOR SICK ONLY PATIENTS?? WE ALSO SEE WELL PATIENTS IN THE PM ...
WE ONLY WANT TO BILL THE INSURANCE CO'S FOR SICK PTS NOT THE WELL PATIENT?? CAN WE DO THIS?? THKS

SuperCoder Answered Wed 28th of November, 2012 01:52:20 AM

There is no as such guideline I could find which allows to use 99051 only for sick patients and not well patients.

The medical record should reflect the medical necessity and services rendered. Codes 99050-99051 are not limited to a specific type of services (eg, preventive medicine, maintenance of chronic health issues, urgent care). Although it would be expected that code 99050 would typically be used for more urgent services, it is code 99051 that includes expanded hours for preventive services.

The guidelines to the Special Services, Procedures, and Reports subsection indicate that while these codes are typically reported with only one code per encounter, there may be occasions in which more than one of the Special Services codes can be appropriately reported due to the dual nature of these codes, ie, used in reporting unusual times and sites in providing services.

An example of a situation when reporting more than one Special Services code would be appropriate is when the patient must be seen on an emergency basis in an office that has regularly scheduled evening, weekend, or holiday office hours. In this example, both codes 99051 and code 99058, Service(s) provided on an emergency basis in the office, which disrupts other scheduled office services, in addition to basic service, would be reported, in addition to the code or codes for the services performed.

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