Gastroenterology Coding Alert

Question: Our gastroenterologist's office is usually closed at 5:30 p.m. But once a week, we stay open till 8 at night to accommodate walk-ins. Can we bill these patients that come between 5:30 p.m. and 8 p.m. with after-hour codes?

New York Subscriber

Answer: Before you think about after hour codes, you should know that these codes are not recognized by Medicare. So if you are treating Medicare patients, you will only use the usual office visit codes.

You can consider using after-hour codes for non-Medicare patients. But you cannot use these codes for the scenario that you have described above. After-hour codes are used if your gastroenterologist sees a patient beyond normal working hours. Since it is a regular practice for your office to work on one particular day till the late hour of 8 p.m., it is still considered as normal working hours as this is routine and not done to benefit any particular patient. So, in this condition, you will only be able to bill the visits with new or established evaluation and management codes.

But if your gastroenterologist sees any patient on any day beyond normal specified schedule (5:30 p.m. on all working days and 8 p.m. on that one day), then it is possible for you to consider billing after-hour codes. You can use 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). You can also use this code if your gastroenterologist sees any patient on a holiday or a Sunday when your practice does not actually function.

Please note that you have to use 99050 in addition to the usual new patient or established patient evaluation and management codes that you will generally use to report the services that your gastroenterologist provided to the patient. But, prior to using after-hour codes, it is best to check with the insurance companies to know about their policy of providing coverage to these codes.