Ophthalmology and Optometry Coding Alert

Question: Our office regularly stays open until 8 p.m. one evening per week. (We usually close at 5:00 p.m.) We need to know the best way to bill for these patients. Should we use the after-hours codes?

Pennsylvania Subscriber

Answer:  After-hours codes come with a caveat they can only be reported if a service is provided outside of the practice's regular office hours.

You should use after-hours codes only when patients present after your office has closed for normal business hours. For example, if you normally close at 5:00 p.m., but a patient presents at 5:30 p.m. and is seen for an E/M visit, you would use an after-hours code. In your case, however, your office stays open one night per week on a regular basis, and the time on that night each week up to 8:00 p.m. is not considered to be after hours, so you would code usual and customary E/M codes for new or established patient visits. Don't use the special after-hours codes.

On the other evenings when you've closed at 5 p.m. and patients present after your normal practice hours, you should use after-hours code 99050 (Services requested after office hours in addition to basic service). Additional codes 99052 and 99054 cover visits from 10:00 p.m. to 8:00 a.m. and on Sundays and holidays, respectively.

These three codes are in your CPT manual under Special Services, Procedures and Reports, Miscellaneous Services. These are "adjunct" codes, which means you use them in addition to any basic E/M services you provide. For example, for providing E/M services for a new patient who presents at 5:30 p.m. after your normal business hours, you could use 99201 (Office or other outpatient visit for the evaluation and management of a new patient) and 99050.

Note: Before using after-hours codes, be certain to check with your insurance carrier, because some may not cover them.