Orthopedic Coding Alert

Question: If our office hours are 8 a.m. to 5 p.m., Monday to Friday, but the surgeon runs late and sees patients until 8 p.m., may I report 99050? What if the surgeon sees patients on his day off?
New York Subscriber

Answer: Most likely, your payers won’t think 99050 (Services provided in the office at times other than regularly scheduled office hours, or days when the office is closed [e.g., holidays, Saturday or Sunday], in addition to basic service) is appropriate in the scenarios you describe. And the reality is Medicare and many private payers aren’t likely to offer coverage for this code no matter the scenario.

99050: CPT® intends 99050 for use when the patient comes to the office during hours when the practice is normally closed.

For example, if your practice normally closes at 4 p.m. on Fridays, but your surgeon agrees to see a patient at 7 p.m. and conducts a level-three established patient visit, you would report 99213 (for the E/M) and 99050 (for the after-hours visit). This is different than if the patient is scheduled before 4 p.m., but the surgeon is running late and doesn’t see the patient until after the office normally closes.

Similarly, you shouldn’t report 99050 if the surgeon comes in on his day off to see a patient, but it’s during regular hours for the office. The code requires that the surgeon provide a service at “times other than regularly scheduled office hours.” You should report only the procedure or service in this case.

Tip: If your surgeons often provide services at times other than regularly scheduled hours, experts suggest negotiating payment for after-hours codes into your private payer contracts. You may have more luck if you can show payers that your after-hours charges will cost them less than an emergency department visit for the patient. You should be sure to post your regular office hours so you’ll know for sure when 99050 applies.