Im Not Supposed to Be Here!:
Getting Paid After-Hours
Published on Tue Apr 01, 2003
After-hours codes 99050-99054 are designed to reimburse physicians who see patients at unusual times, such as after regular office hours or on Sundays or holidays. Although using these codes can increase reimbursement, payment is not automatic and often requires that you negotiate special arrangements with insurers. 'After Hours'Can Vary by Practice CPT includes three codes to report after-hours services:
99050 Services requested after office hours in addition to basic service
99052 between 10:00 PM and 8:00 AM
99054 on Sundays and holidays. "CPToffers few guidelines for billing after-hours services," says Alice Church, CCS-P, coding and reimbursement analyst for Wolcott, Wood & Taylor Inc., chief billing officer for the University of Illinois Hospital physicians in Chicago. "And you won't find a lot of information about them elsewhere, either. That makes it tough to know exactly what 'after-hours'means." Nevertheless, there are times when you can use these codes. Do not report 99050-99054 for any service provided when the office is normally open, even if those hours fall outside "regular" 9-to-5, Monday-through-Friday business hours. For instance, if the office is open until 7:00 p.m., a 6:45 visit does not warrant 99050 in addition to the basic service. Likewise, if the physician office regularly holds office hours every second Sunday (from noon until 4:00 p.m., for instance), you should not report 99054 for any appointment scheduled during those hours. The same holds true if the office remains open on a holiday. Nor may you claim after-hours codes if scheduled patients remain in the waiting room after normal business hours due to delays or overbooking. For instance, a patient scheduled for a 4:45 appointment doesn't see the doctor until 5:15 15 minutes after the office normally closes. "No insurer will accept an after-hours claim because the physician was running behind," says Dari Bonner, CPC, CCS, CCS-P, president and owner of Xact Coding & Reimbursement Consulting in Port Saint Lucie, Fla.
You should use 99050-99054 only if the physician sees a patient for an unscheduled appointment at a time when his or her office would otherwise be closed. For instance, a patient with a scheduled hernia procedure calls 10 minutes before the office closes, complaining of extreme abdominal pain after a fall. Concerned that the patient may have seriously aggravated his condition, the surgeon advises the patient to come to the office immediately. The patient arrives 40 minutes later. In this case, you may appropriately report 99050. Note that in all cases the after-hours codes should be reported in addition to any other services provided, including E/M services. According to CPT Assistant, November 1997, "These codes [special services codes, including 99050-99054] are an adjunct to the basic service(s) rendered they are intended to be [...]
