Orthopedic Coding Alert

Question: When can code 99050 be used? Can that be added to all services (e.g., emergency room, etc.) requested outside office hours? Can it be used in addition to 99052, 99054?

Charles T. Beemer, MD
Sanford Surgical Clinic
Sanford, N.C.

Answer: As attractive as they look, miscellaneous services codes such as 99050 (services requested after hours in addition to basic service), are unlikely to bring any extra reimbursement, explains Susan Callaway-Stradley, CPC, CCS-P, an independent coding consultant and educator in North Augusta, S.C.

As an example, consider 99058 (office services provided on an emergency basis). Callaway-Stradley says, Emergency services will be recognized only if the physician had to drop everything to treat the patient and it completely disrupted the practice. The bill will become the responsibility of the patient. (A bus accident outside the door of a practice that brought patients inside the office would be a good example.)

But Callaway-Stradley adds that coding for after hours, overnight and off-location services might be useful if the physician wants to make a point to the patient regarding the true cost of the service. Over the long-term, the physician might also want to illustrate the real cost of services to third-party payers when negotiating contracts. The record will be useful then. And although no payment from the insurance company should be expected, the codes can be stacked. For example, if services are requested at 2:00 a.m. on a Sunday, use codes 99052 (services requested between 10:00 p.m. and 8:00 a.m. in addition to basic service) and 99054 (services requested on Sundays and holidays in addition to basic services). If the physician does not have regular office hours at 2:00 a.m. on a Sundayfor example, and is not operating a 24-hour walk-in clinicthe physician can also use the code 99050.