Gastroenterology Coding Alert

Question: Our office regularly stays open until 8 p.m. one evening per week for walk-ins. (We usually close at 5:15 p.m.) We need to know the best way to bill for these patients. Should we use the after-hours codes?

                                                                                  Wisconsin Subscriber

 Answer: After-hours codes are not payable by Medicare. For non-Medicare patients, you should use after-hours codes only when patients present after your office would have closed for normal business hours. For example, if you normally close at 5:15 p.m., but a patient presents at 5:30 p.m. and is seen for an E/M visit, you would then use an after-hours code. In your case, however, your office stays open one night per week regularly, and the time on that night each week up to 8:00 p.m. is not considered to be after-hours, so you would use usual and customary E/M codes for new or established patient visits. Don't use the special after-hours codes.

However, on other evenings, for patients who present after your normal practice hours, you should use after-hours code 99050 (Services requested after office hours in addition to basic service). Additional codes 99052 and 99054 cover visits from 10:00 p.m. to 8:00 a.m. and on Sundays/holidays, respectively. These three codes are in your CPT manual under Special Services, Procedures and Reports, Miscellaneous Services. These are "adjunct" codes, which means that you use them in addition to any basic E/M services you provide. For example, for providing E/M services for a new patient who presents at 5:30 p.m. after your normal business hours, you could use 99201 (Office or other outpatient visit for the evaluation and management of a new patient) and 99050. Note: Before using after-hours codes, be certain to check with your carriers, because some may not cover them.