Gastroenterology Coding Alert

Question: We report 99199 to payers to bill for no-show patients. We’ve been doing this for a while since our participating payers allow no-show billing. However, a new staff member told us that we can’t do this. Is she right?

Florida Subscriber

Answer: Yes, she is correct. If the office has determined it will pursue a billing policy for no-shows and the policy clearly states the terms, you must know who to bill. For situations like these, do not bill the payer. Instead, bill the patient directly.

You can only bill payers for rendered medical services and/or supplies utilized on the patient. No-show fees are not for medical services that your provider performed and, therefore, you cannot bill the payer. Therefore, the use of 99199 (Unlisted special service, procedure or report) is inappropriate in this type of situation.

In reality, you should create a practice policy about no-shows that the patient should sign when joining your practice. This shows that everyone is aware of the cancellation policy and the associated fees. If patients sign this document, then you can bill them when they breach the policy, rather than trying to find ways to bill payers for it.