Neurosurgery Coding Alert

Question: Should we always submit code 99051 in addition to the E/M code for that service (scheduled hours)? How do we describe a basic service? How are payer policies different for reimbursement of 99051?

Oklahoma Subscriber

Answer: You should always report 99051 (Service[s] provided in the office during regularly scheduled evening, weekend, or holiday office hours, in addition to basic service) in addition to an E/M service. Each of these codes is intended to be reported in addition to the service provided, as indicated in their descriptors. Codes 99050-99060 are often referred to as adjunct services, meaning you should report the codes in addition to the “basic” service. 

Basic service: The basic service is the E/M service associated with the special service code. Because 99051 describes office services, you would assign 99051 in addition to the performed and documented E/M service, such as 99212-99215 (Office or other outpatient visit for the evaluation and management of an established patient ...).

 Many insurers cite 99051’s inclusion in the basic service as a “nonpayment” reason for the special service code. For instance, Blue Cross Blue Shield of North Carolina considers 99051 “incidental to evaluation and management services, surgical services, and laboratory services, and separate reimbursement is not allowed.” Several Medicaid policies have similar rules, and Medicare does not reimburse the code.

Several E/M service codes were developed to recognize physician activities outside of the normal time when they are performed. Most payers do not acknowledge additional reimbursement for these.