Pediatric Coding Alert

Question: We have evening hours from 5 to 8 p.m. on weekdays, and weekend morning hours from 8 a.m. to noon. These hours are not posted but are described as after-hours care in our welcoming brochure. The hours are staffed only by the on-call pediatrician, one nurse and one receptionist. They are specifically for acutely ill children, not for well child physicals or routine follow-up of problems. We have been charging the after-hours charge for patients seen during these hours using the 99050 code. Is this appropriate coding?

Colorado Subscriber

Answer: Code 99050 is for services requested after office hours in addition to basic services. Because you included the times in your welcoming brochure, they are considered office hours and therefore 99050 is not appropriate. You should not post or state specific hours of operation for your after-hours care, but instead indicate your regular office hours only. You can state in your welcoming brochure that a physician is available appropriately for care after regular hours for acutely ill children without specific times and could then use code 99050 or 99054 (services requested on Sundays and holidays in addition to basic service), depending on the day and time that the patients were seen.