Neurosurgery Coding Alert
Medicare Won't Recognize 'After-Hours' Codes
Question: Will Medicare pay extra for the surgeon seeing the patient for an unscheduled appointment on a holiday? We can count on this happening at least once every year between Thanksgiving and New Year. Answer: In a word: No.
Florida Subscriber
CPT does provide three codes to describe "after-hours" services, such as those provided on a holiday:
Medicare and Medicaid do not recognize after-hours codes. Rather, they consider such care to be part of any E/M service provided.
A typical local Medicare carrier policy states, "When services designated as bundled are denied, the physician may not collect from the patient or the patient's supplemental insurer for the denied service. This would represent either a limiting charge violation (if the claim is nonassigned) or an assignment violation (if the claim is assigned)." The carrier specifically includes 99050-99054 in this group.
Private payers may recognize the after-hours codes, however, but guidelines and reimbursement rates are inconsistent. To improve your chances for payment, you may wish to negotiate with private payers for payment of after-hours codes as part of any contractual agreement. Unlike Medicare, private payers may prefer that physicians use after-hours codes. The alternative to seeing the patient after-hours in the office is to send him to the emergency department - which will cost that insurer even more. Use this as leverage when negotiating with payers.
For payers that will allow 99050-99054, report the codes only if the physician sees a patient for an unscheduled appointment at a time when his office would otherwise be closed.
For 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 may appropriately report 99050.
Neurosurgery Coding Alert
- Laminectomy or Hemilaminectomy? Let Documentation Be Your Guide
Make sure you're not confusing spinal segments with interspaces To code correctly for laminectomy and [...] - 'Extended' Laminectomy Calls for Special Coding
You can report laminectomy and laminotomy together, if required If the surgeon extends a bilateral [...] - Here's Your Rx for Inpatient E/M Headaches
4 rules help you select between initial and subsequent visits You can take control of [...] - You Be the Coder:
Which Code Works for Gliadel Wafers?
Question: How can I code for placement of Gliadel Wafers? Is there a dedicated code [...] - 2005 Fee Schedule Update:
Count on Decent Laminoplasty, Reduced Vertebroplasty Fees
Along with a 1.5 percent across-the-board payment increase, the 2005 Physician fee schedule will [...] - Reader Questions:
Time, Documentation Critical to 99291 Payment
Question: In the afternoon, our surgeon saw an auto accident victim with internal head injuries [...] - Reader Questions:
Fight for 61795 Payment if Necessary
Question: I receive constant denials from Medicare for 61795. When I ask which codes are [...] - Reader Questions:
Medicare Won't Recognize 'After-Hours' Codes
Question: Will Medicare pay extra for the surgeon seeing the patient for an unscheduled appointment [...] - Reader Questions:
Turn to Twist Drill/Burr Hole for Monitor Placement
Question: What is the correct code for placement of right frontal Camino intracranial pressure monitor?
Arizona [...]
