Optometry Coding & Billing Alert

Published on Thu Mar 04, 2004 PDF

Question: I saw a patient at 5 a.m. on a holiday for a corneal ulcer. We billed an office visit code and an after-hours code. The carrier paid for the office visit but denied the after-hours code. If I had referred the patient to an emergency department, the insurance company would have had a whopper bill to pay, so I really did them a big favor. What should I have done?
      
Illinois Subscriber

Answer: Although Medicare carriers, some private carriers and Medicaid never reimburse after-hours codes, some private carriers do.

If the carrier that denied your claim is private and does not have a policy against reimbursing after-hours codes, consider appealing the denial.

Blue Cross and Blue Shield of Louisiana, for example, changed its policy in March 2003 to allow payment for the after-hours codes reported with E/M codes 99201-99215 (Office or other outpatient visit ...) and 99241-99245 (Office or other outpatient consultations ...).

After-hours codes 99050-99054 are designed to reimburse physicians when they see patients at unusual times, like after regular office hours, Sundays or holidays.

CPT has three codes to report after-hours services: