Ophthalmology and Optometry Coding Alert

Question: A patient called and said she thought she had a detached retina, and we scheduled her to come in at 4:00. She ended up running late and didn’t show up until 4:45, and the doctor (who was also running late) didn’t see her until 5:15. Our practice closes at 5:00. Which code should we report to reflect the after-hours nature of the service? 

Hawaii Subscriber

Answer: The after-hours code 99051 (Service(s) provided in the office during regularly scheduled evening, weekend, or holiday office hours, in addition to basic service) applies to services outside of regular office hours or during holidays, and you can bill this code in addition to the appropriate E/M code such as 99201-99215 (Office or other outpatient visit for the evaluation and management of a new/established patient …).

Having said that, it’s unlikely that 99051 applies to your situation. You can only use 99051 for patients scheduled outside of your posted business hours. The patient was scheduled before your practice closed, and even though she was late, she arrived before you closed as well.

This code would instead be used in situations such as when a patient calls your office at 5:30 when the physician is getting ready to leave the office, and says she thinks she has a detached retina. If the physician tells the patient to come in immediately and sees her then —well after posted hours end — then you should be able to report 99051 with the applicable E/M code. Whether your payer reimburses you extra for 99051 is up to each payer, so you may want to contact the payer to ask.