After-hours Codes:
Optimize Reimbursement For Emergency Services
Published on Fri Sep 01, 2000
Emergencies can happen at any time. Neurologists may receive calls at two in the morning because an at-risk stroke patient has had a new stroke. Or a neurologist may be pulled into the emergency room on a Sunday afternoon because of an acute worsening of an Alzheimers patients mental status.
There are three basic codes that can be used for after-hours patient encounters:
99050 services requested after office hours in addition to basic service;
99052 services requested between 10:00 p.m. and 8:00 a.m. in addition to basic service; and
99054 services requested on Sundays and holidays in addition to basic service.
Know When to Use the Codes
Appropriate use of these codes hinges on the definition of the phrase after-hours. If your practice is always open until 9:00 p.m., you cant bill the after-hours codes for a patient who comes in at 8:30, says Sue Magalnick, president of Doctors Resource Specialists, a medical practice management and reimbursement consulting firm in Phoenix. You only can bill the after-hours codes if it is actually after hours for your practice.
For example, a patient who has been implanted with a deep brain stimulator to help regulate the debilitating symptoms of Parkinsons disease (332.0) receives an adjustment of the stimulator in the office at 10:00 a.m. and goes home at 11:15. At 5:00 p.m., as the neurologists office is about to close, the patient calls and says she is suddenly dizzy (780.4) and experiencing nausea (787.02), and she is worried that these symptoms could be a result of some defect in the stimulator. She is told to come back to the office, and she arrives at 5:30, when the office is closed. The neurologist performs an evaluation, and determines that the patient is suffering from heart palpitations (785.1), which he does not believe are associated with the deep brain stimulator. The neurologist bills 99213 with a modifier -25 (significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) to indicate that the visit is not associated with the neurostimulator adjustment, and then also bills 99050.
The after-hours codes are add-on codes, says Magalnick. Its common for practices to make the mistake of billing just the 99050 and not billing it as an add-on.
Magalnick advises that the Sunday code (99054) is an exception in that it can be billed on Sundays and holidays, even if the neurology practice has published office hours on Sundays and/or holidays. Even if youre open on Sundays, you can still bill 99054, says Magalnick. Its the only exception to the rule.
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