Orthopedic Coding Alert

CPT 2006 opens the door to capturing posted evening-hour surcharges

Because old rules for special service codes no longer ring true, now's the time to check out which 99050-99060 codes apply to your orthopedists- nontraditional services. CPT 2006 has revamped the special services, procedures and reports subsection.

-The new and revised codes give coders more options to describe the services their practices provide,- says Kim Kieke, CPC, a coding quality specialist at a multispecialty clinic in Austin, Texas. Changes include: Deletions:

- 99052--Services requested between 10:00 PM and 8:00 AM in addition to basic service

- 99054--Services requested on Sundays and holidays in addition to basic service. Additions:

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

- 99053--Service(s) provided between 10:00 PM and 8:00 AM at 24-hour facility, in addition to basic service

- 99060--Service(s) provided on an emergency basis, out of the office, which disrupts other scheduled
office services, in addition to basic service. Revisions:

- 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

- 99056--Service(s) typically provided in the office, provided out of the office at request of patient, in addition to basic service

- 99058--Service(s) provided on an emergency  basis in the office, which disrupts other scheduled office services, in addition to basic service.

1. Specify Extended Office Hours With 99051 This year you can use a new code for services your orthopedic surgeon provides during posted evening, weekend and holiday hours. -Some payers allowed coders to use 99050 when a clinic provided services outside traditional office hours,- Kieke says. Insurers sometimes understood the cost-saving benefit of treating a patient in an office setting as opposed to the emergency department  and applied 99050 more liberally.

CPT 2006's new code 99051 more appropriately describes the special service, however. -We never had a code to use for after traditional business hours,- Kieke says. In 2006, coders can use 99051.

How it works: A non-24-hour clinic is open evenings, Saturdays and holidays. When an orthopedist provides an E/M service during these times, you should report new code 99051 for a service -provided in the office during regularly scheduled evening, weekend, or holiday office hours, in addition to basic service.-

For instance, a mother presents with a 16-month-old on a Saturday afternoon to a local multispecialty clinic that is open 9 a.m. to 7 p.m. The child fell out of her highchair and injured her leg. The orthopedist performs a new patient office visit that involves a detailed history, detailed examination and low-complexity medical decision-making. She diagnoses the child with a leg sprain and advises the patient's mother to administer [...]