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"after hours" code 99051

Kathy Posted Wed 23rd of April, 2014 16:11:36 PM

Is there a standard time related to when evening hours begin? We have an urgent care center that is open weekdays from 12pm to 10pm. Would patients seen after 5pm be considered the beginning of evening hours?

SuperCoder Answered Wed 23rd of April, 2014 18:14:27 PM

If your physican/practice sees a patient in the office during hours when the practice would normally be closed, such as on weekends or after working office hours, CPT guidelines allow you to report 99050 (Services provided in the office at times other than regularly scheduled office hours, or days when the office is normally closed [e.g., holidays, Saturday or Sunday], in addition to basic service) as long as the documentation supports the after-hours service.

Keep in mind: A patient is considered an after-hours patient only if he reports to the office after your normal office hours end -- not when he presents during normal office hours and the appointment runs past closing time. When your physician provides an E/M service in the office during regularly scheduled "evening, weekend, or holiday office hours," by contrast, you should bill 99051 (Service[s] provided in the office during regularly scheduled evening, weekend, or holiday office hours, in addition to basic service), according to CPT Assistant (Vol. 13, Issue 6, June 2003).

Scenario: If your practice normally closes at 4 p.m.on Fridays, but your physician sees a patient at 7 p.m. and conducts a level-three established patient visit, you should bill 99213 (Office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: An expanded problem focused history; An expanded problem focused examination; Medical decision making of low complexity) for the E/M and 99050 for the after-hours visit.

If, however, your practice is normally open during evening hours (for instance, until 9 p.m.), and the physician sees the patient for the same service, you would still bill 99213, but with 99051 to establish that although the service occurred after usual "business hours," the appointment was still within your practice's posted hours.

Don't miss: Whether you select 99050 or 99051,you would report the after-hours code in addition to the appropriate E/M service code for the visit. These codes are add-on codes and therefore require you to bill them in addition to the base E/M codes.

Kathy Posted Thu 24th of April, 2014 09:01:36 AM

I understand your explanation however my question was when would "evening hours" begin if our posted hours are 12pm to 10pm Monday to Friday? Is there an industry-wide accepted usual time? Is it 6pm as stated in the 1st sentence of your response?

SuperCoder Answered Thu 24th of April, 2014 13:42:20 PM

Please ignore my 6pm note above. It was wrongly typed. There is no industry-wide accepted time. Your practice is open during evening hours (until 10 p.m.), and the physician sees the patient for the same service, you would still bill 99213, but with 99051 to establish that although the service occurred after usual "business hours," the appointment was still within your practice's posted hours.

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