Neurosurgery Coding Alert

After-hours codes 99050-99054 are designed to reimburse physicians who see patients at unusual times, such as after regular office hours or on Sundays or holidays. Although these codes can increase reimbursement, payment is not automatic -- and often requires that special arrangements be made with insurers.
What Counts as "After Hours"?  
CPT includes three codes for after-hours services:
  99050 -- services requested after office hours in addition to basic service
  99052 -- ... between 10:00 p.m. and 8:00 a.m. ...
  99054 -- ... on Sundays and holidays ... .  
"CPT offers few guidelines for billing after-hours services," says Kathy Pride, CPC, CCS-P, coding supervisor for Martin Memorial Medical Group, a 55-physician group practice with two neurosurgeons, in Stuart, Fla. "And you won't find a lot of information about them elsewhere, either. That makes it tough to know exactly what 'after hours' means." Nevertheless, Pride says there are very specific instances in which these codes may be applied.
 
Codes 99050-99054 may not be reported for any service provided when the office is normally open, even if those hours fall outside "regular" 9-to-5, Monday-through-Friday business hours. For instance, if the office is open until 7 p.m., a 6:45 visit does not warrant 99050 in addition to the basic service. Likewise, if the physician office regularly holds hours every second Sunday (from noon until 4 p.m., for instance), it is improper to report 99054 for any appointment scheduled during those hours. The same is true if the office remains open on a holiday.
 
Neither may after-hours codes be claimed if scheduled patients remain in the waiting room after normal business hours due to delays or overbooking. For instance, a patient scheduled for a 4:45 appointment doesn't see the doctor until 5:15 -- 15 minutes after the office normally closes. "No insurer will accept an after-hours claim just because the physician was running behind," explains Dari Bonner, CPC, CCS, CCS-P, president and owner of Xact Coding & Reimbursement Consulting in Port Saint Lucie, Fla. Other consultants agree that this would be bad for patient relations as well. These codes should be used only in cases of patient need.
 
The only appropriate application of 99050-99054 is if a patient is seen for an unscheduled appointment at a time when the physician office would otherwise be closed. For instance, a Parkinson's patient with an implanted deep-brain stimulator calls 10 minutes before the office closes, complaining of dizziness and nausea. Concerned that the patient may be having problems with the stimulator, the neurosurgeon advises the patient to come to the office immediately. The patient arrives 40 minutes later. In this case, it is appropriate to report 99050.
 
Note that in all cases the after-hours codes should be reported in addition to any other services provided, including E/M services. [...]