Neurology & Pain Management Coding Alert

Question: My neurologist returned to the office at midnight to see a patient. Because he provided the service at a non-24-hour facility, should I use 99050?

New York Subscriber

Answer: Yes, you should now use the after-hours code 99050 (Services provided in the office at times other than regularly scheduled office hours ...) instead of codes 99052-99054.
 
Old way: CPT previously delineated the after-hours codes based on time and day. For services provided after posted office hours, you used 99050.
 
When the neurologist provided late-night services, you used 99052 (Services requested between 10:00 p.m. and 8:00 a.m. in addition to basic service). For services that he performed on a holiday or on a Sunday, you used 99054 (Services requested on Sundays and holidays in addition to basic service).
 
New way: CPT now restricts the late-night service code, 99053 (Service[s] provided between 10:00 PM and 8:00 AM at 24-hour facility, in addition to basic service), to 24-hour facilities. CPT 2006 deleted 99052 and 99054, which leaves offices with two possible after-hours codes:

- 99050 -- Services provided in the office at times other than regularly scheduled office hours, or days when the office is normally closed (e.g., holidays, Saturday or Sunday), in addition to basic service

- 99051 -- Service(s) provided in the office during regularly scheduled evening, weekend, or holiday office hours, in addition to basic service.

When your physician provides services outside scheduled hours, as in your example, use 99050. When your office regularly schedules evening, weekend or holiday appointments and your neurologist provides services during those times, assign 99051.
 
You should not also use an emergency-service code. CPT 2006 clarifies that an emergency must disrupt other scheduled office services.
 
Because your office does not schedule late-night appointments, the midnight visit causes no service interruptions. Therefore, the encounter fails to meet the criteria for 99058 (Service[s] provided on an emergency basis in the office, which disrupts other scheduled office services, in addition to basic service). This code previously stipulated only -office service provided on an emergency basis.-
 
Bottom line: For the scenario you describe, you should report the after-hours emergency service with only special-service code 99050 and office visit code 9921x.