Ophthalmology and Optometry Coding Alert

Question: A patient presented to an ophthalmologist’s office after regular business hours for an eye examination. I’m new to coding and I can’t tell the difference between 99050 and 99051 to report the encounter.

Can you please break down the differences between the codes?

New Mexico Subscriber

Answer: The codes you mentioned, 99050 (Services provided in the office at times other than regularly scheduled office hours, or days when the office is normally closed (eg, holidays, Saturday or Sunday), in addition to basic service) and 99051 (Service(s) provided in the office during regularly scheduled evening, weekend, or holiday office hours, in addition to basic service), describe two different business hour scenarios.

Let’s start by establishing the practice’s standard operating hours. Suppose the office is open from 8:00 a.m. to 5:30 p.m. Monday through Friday, and 8:30 to 11:30 a.m. on Saturdays.

Scenario 1: A patient came in at 7:00 p.m. on a Wednesday for an examination following an accident at home and the provider came in special to see the patient.

In this scenario, you’ll assign 99050 along with the appropriate evaluation and management (E/M) code from 99202-99215 (Office or other outpatient visit for the evaluation and management of a new/established patient …) because the eye care provider saw the patient after the practice’s posted business hours.

Scenario 2: A patient came in at 9:00 a.m. on a Saturday for an eye exam.

In the second scenario, you’ll use 99051 along with an appropriate E/M code to report the visit since the physician provided the service during “regularly scheduled weekend office hours.”

You’ll also use 99051 for services provided during hours scheduled for holidays. For example, your office manager decides to open the practice on Independence Day from 8:00 a.m. to 3:00 p.m., and publicizes these hours on your practice website, social media, and signage around the building. You would use 99051 for any patients seen on that day, as posted holiday hours are regarded as a regular part of your schedule, even if that schedule is only temporary.

In addition, 99050 does not apply when providers see patients who arrive during posted hours but are not seen until after the posted hours conclude. So, if your office gets backed up, and your provider doesn’t see a patient scheduled for 5:45 p.m. until 6:30 p.m., and your office normally stops seeing patients at 6:00 p.m., you cannot use the code.

Mike Shaughnessy, BA, CPC, Development Editor, AAPC