Neurosurgery Coding Alert

Gain an extra $50 for urgent office visits and still save the payer money Medicare payers won't reimburse for "after-hours" codes 99050-99054, but you can persuade private payers to reimburse for the services by showing how after-hours visits -- on an emergency basis -- can benefit patients and, at the same time, reduce the cost of claims. Use After-Hours Only for 'Emergency' Visits You should report after-hours codes only in urgent situations. CPT includes 99050-99054 (see box, for complete code descriptors) to allow additional reimbursement for physicians who see patients at unusual (in other words, unscheduled) times, such as after posted office hours or on Sundays or holidays, says Richard H. Tuck, MD, FAAP, AAP representative to the AMA RBRVS Review Update Committee.

Example: A patient recently released from the hospital following low-back surgery calls the office at 5:45 p.m. - 15 minutes before closing - and asks to see the doctor immediately because of extreme back pain. The surgeon agrees to see the patient, who arrives at the office at 6:30. In this case, you are justified in choosing to report after-hours codes.

In another scenario, an established patient pages the surgeon at home on the July 4th holiday after injuring his back playing softball at a family picnic. The surgeon agrees to meet the patient at the office to evaluate his condition. Here again, because the surgeon did not pre-schedule the appointment and would not normally have been at the office during the time the visit takes place, you may select an after-hours code.

When NOT to claim after-hours: You should not, however, report after-hours codes for a prescheduled appointment after regular office hours. "Let's say the surgeon decides to stay open an extra hour on Friday because of the large number of patients who wish to see him that week," says David Davis, a medical policy analyst at iHealth Technologies Inc. in Atlanta. "If the surgeon preschedules the appointments, he's not really seeing patients 'after hours.' He's simply extending his office hours."

And, if the surgeon "overbooks" and does not see his final scheduled appointment of the day until after the posted office hours, you cannot report an after-hours service. "Insurers won't pay simply because the physician is running behind or overbooked," Davis says. Report After-Hours in Addition to Other Services Although CPT does not list 99050-99054 as "add-on" codes, the code descriptors clearly state "in addition to basic service." And, CPT Assistant (November 1997) clearly states that 99050-99054 "are an adjunct to the basic service(s) rendered" and "are intended to be reported in addition to the basic service(s) provided." Therefore, you should only report after-hours codes in addition to any other E/M service you report.

For example, in the above case [...]