General Surgery Coding Alert

Test your coding knowledge.  Determine how you would code this situation before looking at the box below for the answer.
Question: Emergency department physicians often call our surgeons in the middle of the night or on holidays to consult on a possible surgical problem. When and how should surgeons report miscellaneous service codes?

Florida Subscriber

Answer: Report the appropriate outpatient consult code and, in the "middle of the night" and holiday cases mentioned, either 99052 (Services requested between 10:00 p.m. and 8:00 a.m. in addition to basic service) or 99054 (Services requested on Sundays and holidays in addition to basic service).
 
As the descriptors state, these codes are not meant to be used on their own; rather, they are used in addition to the service that is being provided.
 
Physicians use miscellaneous services codes to identify "the completion of special reports and services that are an adjunct to the basic services rendered."
 
Although 99050 (Services requested after office hours in addition to basic service) is perhaps used most often for after-hours visits, other codes are available that are more specific to time and circumstance:

  99052 Services requested between 10:00 PM and 8:00 AM in addition to basic service

  99054 Services requested on Sundays and holidays in addition to basic service

  99056 Services provided at request of patient in a location other than physician's office which are normally provided in the office

  99058 Office services provided on an emergency basis.
 
Note: Code 99058 is used when a physician sees an unscheduled patient in the office. Some practices have a flat fee they charge carriers (or patients) for such situations.
Payers rarely reimburse these codes. For example, Medicare considers most of these codes (including 99050) to be bundled codes, which means they are included in the primary service (in this case, the consult) and will not be paid separately.
 
The one exception is 99082 (Unusual travel [e.g., transportation and escort of patient), which is priced at the discretion of the carrier, according to the Medicare fee schedule. Virtually all private carriers do not pay for this service.
 
The codes may be useful for tracking or other information, so it may be a good idea to code the services internally.
 
They should not, however, be billed to Medicare carriers.
 
Some coding specialists have reported that some private payers reimburse these procedures more readily for pediatric surgeons than for other specialists.
 
Note: To ensure consistency of coding, if you report these codes to one private carrier, you should report to all commercial payers.