Internal Medicine Coding Alert

Question: In what instances should we bill after-hours codes 99050, 99052 and 99054? Should we report them in addition to other E/M codes?

Oregon Subscriber

Answer: Although you should use 99050-99054 as add-ons to other E/M codes (for example, 99201-99215), you can report them only when the internist provides services after scheduled office hours. This does not include times when the physician is running behind and sees patients after normal hours. Instead, you should report these codes when the physician has to open the office to see a patient.
 
For example, a patient calls your internist on Saturday, needing treatment for an acute problem. The physician believes the problem can't wait until Monday, yet it isn't serious enough to send the patient to the emergency department.
 
So, the physician sees the patient in his office, which requires additional expense to the physician but ultimately saves the insurance company and the patient from paying for expensive emergency department costs that are unnecessary.
 
To get your internist paid for the above visit in addition to the appropriate E/M code, you'd report one of the following: