Neurology & Pain Management Coding Alert

Question: A Medicare patient knocked on the door on a Friday when the office was closed. He was concerned that some pain medication the neurologists prescribed was having an adverse effect. The physician agreed to see the patient and performed an E/M service. May we report 99050 in addition to an office visit?

South Carolina Subscriber

Answer: Code 99050 (Services requested after posted office hours in addition to basic service) is listed as a "Status B" code in the Medicare fee schedule. This means that CMS has not assigned any relative value units to this service, and it is always a bundled service. Therefore, Medicare will not pay you for use of this code. Because Medicare is the payer in the scenario described, you may bill only the E/M code.
 But some commercial insurance companies will reimburse for 99050. Physician practices will often negotiate this code as part of their fee schedule with commercial payers.

 - Clinical and coding expertise for You Be the Coder and Reader Questions provided by Neil Busis, MD, chief of the division of neurology and director of the neurodiagnostic laboratory at the University of Pittsburgh Medical Center at Shadyside, and clinical associate professor in the department of neurology, University of Pittsburgh School of Medicine; and Laureen Jandroep, OTR, CPC, CCS-P, CPC-H, CCS, director and senior instructor for CRN Institute, an online coding certification training center based in Absecon, N.J.