Gastroenterology Coding Alert

Question: My gastroenterologist saw a patient in the office on a weekend. How should I report this?

Michigan Subscriber

Answer: You should first report the appropriate E/M service code for the visit based on the level of service your gastroenterologist provided. Then report 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) to indicate that the visit occurred outside of your physician's regular office hours.
Downside: Medicare payers won't reimburse for "after-hours" codes 99050-99053, but you can often persuade private payers to reimburse for the services. You may be able to convince private carriers to pay by showing how after-hours visits -- on an emergency basis -- can benefit patients and, at the same time, reduce the cost of claims.

-- Clinical and coding expertise for this issue provided by Michael Weinstein, MD, a gastroenterologist in Washington, D.C., and former member of the AMA's CPT Advisory Panel; and Linda Parks, MA, CPC, CMC, CMSCS, an independent coding consultant in Atlanta.