General Surgery Coding Alert

Medicare won't pay, but others may If your surgeon provides a service during "non-traditional" hours, CPT offers a way to gain additional compensation. The key to using these codes successfully is to create a win/win situation for your practice, your patients and your payers. Use Signs to Substantiate 99050-99051 Services If your surgeon sees a patient in the office during hours when the practice would normally be closed, such as on weekends or after 6 p.m., CPT guidelines allow you to report 99050 (Services provided in the office at times other than regularly scheduled office hours, or days when the office is closed [e.g., holidays, Saturday or Sunday], in addition to basic service). When your surgeon provides an E/M service in the office during regularly scheduled "evening, weekend, or holiday office hours," by contrast, you should report 99051 (Service[s] provided in the office during regularly scheduled evening, weekend, or holiday office hours, in addition to basic service), according to AMA guidelines outlined in the CPT Assistant (Vol. 13, Issue 6, June 2003). Important: Whether you select 99050 or 99051, you would report the after-hours code in addition to the appropriate E/M service code for the visit, says Tara L. Conklin, CPC, a Wesley Chapel, Fla.-based coding analyst with CodeRyte. Signage is the key to choosing the correct after-hours code. Practices should make sure to post their office hours. That way, when a physician provides services after those hours, you can use 99050. Or assign 99051 when your office regularly schedules evening, weekend or holiday appointments, and the physician provide services during those hours. For example: If your practice normally closes at 4 p.m. on Fridays, but your surgeon sees a patient at 7 p.m. and conducts a level-three established patient visit, you would report 99213 (for the E/M) and 99050 (for the after-hours visit). If, however, your practice is normally open during evening hours (say, until 9 p.m.), and the surgeon sees the patient for the same service, you would still report 99213, but with 99051 to establish that although the service occurred after usual "business hours," the appointment was still within your posted hours. Capture Late-Night Facility Services With 99053 When a 24-hour facility calls your surgeon in to provide a red-eye or early-bird service, you may report 99053 (Service[s] provided between 10:00 PM and 8:00 AM at 24-hour facility, in addition to basic service) in addition to the basic service. Remember, however, that place of service (POS) drives this after-hours code's applicability. Simply stated: To report 99053, the late-night service the physician provides must occur at a 24-hour facility -- such as an ambulatory surgical center (POS 24), urgent care facility (POS 20) or emergency department (POS 23). [...]