EM Coding Alert

Question: When it comes to billing after-hours or evening codes, is it true that there’s no difference between 99050 and 99051? If it is true, how do we know which to report in which circumstance?

Rhode Island Subscriber

Answer: While the two codes look similar, 99050 (Services provided in the office at times other than regularly scheduled office hours, or days when the office is normally closed (eg, holidays, Saturday or Sunday), in addition to basic service) and 99051 (Service(s) provided in the office during regularly scheduled evening, weekend, or holiday office hours, in addition to basic service) describe two very different scenarios.

Let’s suppose the provider’s office’s regularly posted hours are 8:00 a.m.-6:00 p.m. Monday through Friday, and 8:00 a.m.-2:00 p.m. on Saturdays.

Use 99050 when your provider sees a patient outside of those regularly scheduled hours. For example, on Thursday evening, a patient comes in at 6:15 p.m., and your physician decides to stay late and see them.

In this case, you would use 99050 along with the appropriate evaluation and management (E/M) service code from 99202-99215 (Office or other outpatient visit for the evaluation and management of a new/established patient …).

Use 99051 when your doctor sees a patient during evening, weekend, or holiday hours that the practice has posted. For example, the doctor sees a patient at 9:00 a.m. on Saturday. Even though this was a scheduled office hour, in this case,you’d use 99051 along with the appropriate E/M service code because it is a service provided during a “regularly scheduled weekend office hour”.

You’ll also use 99051 for services provided during hours scheduled for holidays. For example, your office manager decides to open the practice on Thanksgiving Day from 8:00 a.m. to 3:00 p.m., and publicizes these hours on your practice website, social media, and signage around the building. You would use 99051 for any patients seen on that day, as posted holiday hours are regarded as a regular part of your schedule, even if that schedule is only temporary.

In addition, 99050 does not apply when providers see patients who arrive during posted hours but are not seen until after them. So, if your office gets backed up, and your provider doesn’t see a patient scheduled for 5:45 p.m. until 6:30 p.m., and your office normally stops seeing patients at 6:00 p.m., you cannot use the code.