Optometry Coding & Billing Alert

Question: Can we report 99050 for a walk-in patient who came to our clinic after we closed? The optometrist saw the patient and treated her for a scratched cornea.

Codify Subscriber

Answer: This situation will typically qualify for reporting 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) in addition to the main service, such as an office visit (99201-99215, “Office or Other Outpatient Services”). If a patient walks in after your normally posted office hours are over and the optometrist documents an office visit, you may use 99050, plus 99201-99215. To use 99050 for scheduled appointments, the appointment must be scheduled after your normal office hours.

Example: A mother presents to your office with her child who has been complaining of eye pain. Although your office has posted hours of “9 to 5 Monday to Friday,” you stay after hours to see the patient, who arrives at 5:30 to avoid the established patient having to go to an urgent care center or emergency department (ED) for what you ultimately diagnose as a scratched cornea.

In this case, you could add 99050 to 9921x. Keep in mind, however, that you should never use 99050 because a patient arrived later than her scheduled visit or because your office treated the patient late for an appointment that was scheduled during normal office hours. These codes only apply if the patient is scheduled after hours or presents after you’ve closed for an unscheduled visit.