Gastroenterology Coding Alert

Question: A Medicare patient arrived on a Friday when the office was closed. He was concerned that some medication the physician prescribed was having an adverse effect. The physician agreed to see the patient and performed an E/M service. May we report 99050 in addition to an office visit?

South Carolina Subscriber Answer: Code 99050 (Services provided in the office at times other than regularly scheduled office hours, or days when the office is normally closed, in addition to basic service) is a -Status B- code in the Medicare fee schedule. This means that CMS has not assigned any RVUs to the service, and it is always bundled. So Medicare will not pay for this code.
 
Some commercial insurance companies will reimburse for 99050, especially if you can prove that by recognizing -after-hours- codes they can avoid having to pay for much costlier emergency department visits. Physician practices will often negotiate for payment of after-hours codes as part of their fee schedule with commercial payers.