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lab tests after hours

Town & Country Pediatrics & Posted Wed 15th of January, 2014 15:30:36 PM

Our office is open on Sundays and we add '99051' to all Sunday appointments. If a patient drops off a urine sample on a Sunday to be tested, but does not actually get seen, can we add '99051' to the '81002' that we are billing to test the specimen?

SuperCoder Answered Thu 16th of January, 2014 06:44:35 AM

Yes. You should always report 99051 (Service[s] provided in the office during regularly scheduled evening, weekend, or holiday office hours, in addition to basic service) in addition to an E/M service. -Each of these codes is intended to be reported in addition to the service provided, as indicated in their descriptors,- according to CPT Changes 2006 -- An Insider's View.

Town & Country Pediatrics & Posted Thu 16th of January, 2014 10:43:46 AM

I'm not sure if I made myself clear: we are not billing an E/M service in this case, because the patient was not seen. We are only billing the lab code '81002'. Can we still add '99051'?

Town & Country Pediatrics & Posted Tue 21st of January, 2014 14:46:17 PM

Hi, I was wondering when I can expect a response to my latest post in this thread? Thank you.

SuperCoder Answered Thu 23rd of January, 2014 09:48:06 AM

No, you should not charge 99051 in addition to 81002 for a dropped-off urine specimen. Further, you shouldn’t add 88051 for every appointment on Sunday. See the relevant published Q/A below.

OB/Gyn Coding Alert:
Reader Question: Code 99051 is Not an Automatic Weekend Add-On
- Published on Thu, Dec 15, 2011
________________________________________
Question: Can you report 99051 in addition to an E/M code for a Saturday visit? The description states adjunct to basic services rendered for services provided during posted evening, weekend, or holiday office hours.
Wyoming Subscriber
Answer: No. Ask yourself, what exactly is the additional special service? Code 99051 (Service[s] provided in the office during regularly scheduled evening, weekend, or holiday office hours, in addition to basic service) is not an automatic add-on code for seeing a patient on the weekend. If weekend hours are the posted hours for the practice, then the ob-gyn has provided the basic service.
Now if the ob-gyn sees the patient and the visit goes beyond the posted hours, a payer might consider that a special service. Another scenario is the patient comes in without an appointment and disrupts the scheduled appointments.
Payment, however, is another matter. By the way, if your practice is tacking on this "surcharge" to be open on Saturdays, then you better be informing your patients that they will more than likely have an out of pocket expense for this as many payers do not reimburse for code 99051.

Town & Country Pediatrics & Posted Thu 23rd of January, 2014 11:21:04 AM

Thanks for your answer about adding '99051' to lab codes. As for your suggestion that this code may not be added to our Sunday appointments, I read the Q & A that you quoted, and I believe it is incorrect. I'm wondering if you can back this up with any documentation. The writer states that if the patient disrupts the schedule or goes beyond posted hours, perhaps that is when this code can be billed. I firmly disagree. There are other codes for when patients disrupt the schedule, but the CPT clearly states that '99051' is for when you scheduled your office hours at times when most businesses are usually closed. So if we were closed on Sunday, like most practices, our patients would have more ER visits, which are very costly to the insurance companies. Instead, we are open on Sundays, and this prevents our patients from going to the ER. This is the additional special service that we are providing that the writer asked about. Therefore, I think it is justifiable to bill '99051' for every Sunday appointment.

Town & Country Pediatrics & Posted Wed 29th of January, 2014 14:31:23 PM

Hi, I was wondering if you can please comment on the above. Thank you.

SuperCoder Answered Wed 05th of February, 2014 05:09:30 AM

Our sincere apology. I have informed the editor of the Coding Alert that the answer to the question was incorrect and they will print the correct answer in the next Coding Alert. I just found a CPT Assistant article that indicates that 99051 can be used with any visit during regular hours on a weekend. However, 99051 can only be used with E/M services (preventive, problem, urgent care, etc), not for dropping off a lab sample.

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