P Posted Thu 31st of January, 2013 14:02:28 PM
Is 99050 to be billed by itself or in addition to an E/M code?
SuperCoder Answered Fri 01st of February, 2013 23:07:32 PM
Code 99050 represents services offered in the physician office during times when the office normally would be closed. For example, your posted closing time is 4 p.m., but a patient calls and asks if the physician can see him after work at 6 p.m. The patient comes and the physician sees him after hours, so you can report 99050.
Code 99050 does not apply if the patient is seen after normal office hours because the physician is running behind or because of similar office issues.
Remember to code any services the physician provides during the encounter. "In addition to basic service" lets you know other codes are allowed (such as the appropriate E/M code).
Don't base your billing of 99050 on the patient's diagnosis. Reporting 99050 simply requires that your office have posted hours that clearly designate times when the office is open versus closed.
Question 1: If our office hours are 8 a.m. to 5 p.m., Monday to Friday, but the surgeon runs late and sees patients until 8 p.m., may I report 99050? What if the surgeon sees patients on his day off?
Answer: Most likely, your payers won't think 99050 is appropriate in the scenarios you describe. And the reality is Medicare and many private payers aren't likely to offer coverage for this code no matter the scenario.
99050: CPT intends 99050 for use when the patient comes to the office during hours when the practice is normally closed.
For example, if your practice normally closes at 4 p.m. on Fridays, but your surgeon agrees to see a patient at 7 p.m. and conducts a level–three established patient visit, you would report 99213 (for the E/M) and 99050 (for the after–hours visit). This is different than if the patient is scheduled before 4 p.m., but the surgeon is running late and doesn't see the patient until after the office normally closes.
Similarly, you shouldn't report 99050 if the surgeon comes in on his day off to see a patient, but it's during regular hours for the office. The code requires that the surgeon provide a service at "times other than regularly scheduled office hours." You should report only the procedure or service in this case.
If your surgeons often provide services at times other than regularly scheduled hours, experts suggest negotiating payment for after–hours codes into your private payer contracts. You may have more luck if you can show payers that your after–hours charges will cost them less than an emergency department visit for the patient. You should be sure to post your regular office hours so you'll know for sure when 99050 applies.
P Posted Tue 05th of February, 2013 14:27:57 PM