Oncology & Hematology Coding Alert

Question: Should we report after-hours codes for oncology services we provide after normal office hours?


Nevada Subscriber

Answer: Medicare carriers won't reimburse you for after-hours codes, but private payers may.

Rule: Only report an after-hours code if the patient presents after your normal office hours end--not when a patient presents during normal office hours and the appointment runs past -closing time.-

Example 1: The office closes at 5:30 p.m., and an established patient reports at 5:45 p.m. and requires a level-four E/M visit.

You should report:

- 99214--Office or other outpatient visit for the evaluation and management of an established patient, which requires at least two of these three key components: a detailed history; a detailed examination; and medical decision-making of moderate complexity

- 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.

Example 2: The office closes at 5:30 p.m., and the oncologist takes until 6:00 performing a level-four E/M service on a new patient.

You should report:

- 99204--Office or other outpatient visit for the evaluation and management of a new patient, which requires these three key components: a comprehensive history; a comprehensive examination; medical decision-making of  moderate complexity.

The 2006 CPT manual revised code 99050 and replaced two deleted after-hours codes with 99051 (Service[s] provided in the office during regularly scheduled evening, weekend, or holiday office hours, in addition to basic service) and 99053 (Service[s] provided between 10:00 PM and 8:00 AM at 24-hour facility, in addition to basic service).

You must have posted office hours and render the services after the posted hours to report after-hours codes.

Make sure to contact the insurance company before filing after-hours codes. Some private payers have followed Medicare's lead and won't accept the codes.

The answers for You Be the Coder and Reader Questions were reviewed by Cindy C. Parman, CPC, CPC-H, RCC, co-owner of Coding Strategies Inc. in Powder Springs, Ga., and president, American Academy of Professional Coders National Advisory Board.