Optometry Coding & Billing Alert

Question: The optometrist returned to the office at midnight to see a patient with an emergency. Because he provided the service at a non-24-hour facility, should we report 99050?

Georgia Subscriber

Answer: Yes, you should now use the after-hours code 99050 instead of the late-night code 99053.
 
CPT previously delineated the after-hours codes based on time and day. For services provided after posted office hours, you used 99050 (Services requested after posted office hours in addition to basic service).
 
When you provided late-night services, you used 99052 (Services requested between 10:00 PM and 8:00 AM in addition to basic service ...).
 
For services that you performed on a holiday or on a Sunday, you used 99054 (Services requested on Sundays and holidays in addition to basic service).
 
But CPT now restricts the late-night service code -- 99053 (Service[s] provided between 10:00 PM and 8:00 AM at 24-hour facility, in addition to basic service) -- to 24-hour facilities.
 
CPT 2006 deletes 99052 and 99054, which leaves offices with two possible after-hours codes:

- 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

- 99051 -- Service(s) provided in the office during regularly scheduled evening, weekend, or holiday office hours, in addition to basic service.

When you provide services outside scheduled hours, as in your example, use 99050. But if your office regularly schedules evening, weekend or holiday appointments and you provide services during those times, report 99051.