General Surgery Coding Alert

You should report after-hours codes only in urgent situations, never for a prescheduled appointment after regular office hours. If you extend your office hours to deal with an unexpected number of appointments, you are not really taking patients "after-hours," but simply extending your hours.

By the same token, if the surgeon "overbooks" and does not see his final scheduled appointment of the day until after the posted office hours, you cannot report an after-hours service. Insurers won't pay simply because the physician is running behind or overbooked.

The only appropriate application of 99050-99054 is if the physician sees a patient for an unscheduled appointment at a time when the physician 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.

Although CPT does not list 99050-99054 as "add-on" codes, the code descriptors clearly state "in addition to basic service." And, CPT Assistant (November 1997) states that 99050-99054 "are an adjunct to the basic service(s) rendered" and "are intended to be reported in addition to the basic service(s) provided." Therefore, you should only report after-hours codes in addition to any other E/M service you report.

Although Medicare won't recognize after-hours codes, you can and should negotiate with private insurers for payment of these services. In most cases, the alternative to the physician seeing the patient after hours is to send the patient to an  emergency department, which is probably going to cost the insurer a great deal more money. You should use the projected savings as leverage when negotiating contracts with private payers.