Pediatric Coding Alert

Question: In the September issue of Pediatric Coding Alert, you addressed billing after-hours at the contract level. Does this apply only to offices that are closed in the evenings and on weekends?

Florida Subscriber

Answer: Although the editors added the statement "These suggestions assume you have posted office hours that do not include Sunday hours and substantiate your closing time for evenings," you can sometimes get the carrier to add 99050 as a covered service even if you have published evening and weekend hours, says Kim Kieke, CPC, Austin, Texas, who answered the "You Be the Coder" question.

Code 99050 (Services requested after office hours in addition to basic service) is commonly interpreted as being reserved for services provided outside of published office hours, Kieke explains. "However, in order to provide continuity of care and save money, many carriers are willing to overlook that restriction, and pay the fee for 99050 rather than what they would pay for the visit to the emergency department.

"Add a clause to your contract stating that 99050 is a covered service to be paid by the carrier in addition to any other services provided," she says. The contract should stipulate the hours that the practice considers outside the normal hours of operation, which the payer will cover with after-hours codes. "If the carrier refuses, add a clause stating that the patient is responsible for paying the 99050 fee as a noncovered service, in addition to any other copay, co-share or deductible.

"The biggest benefit is that you have it in writing within the contract," Kieke says. "If the carrier covers it, you have it in case they 'forget' to pay for it. If the carrier doesn't cover it, you have something to show the patient they are responsible."

The editors apologize for changing the intent of Kieke's response and appreciate the valuable real-world experience her answers provide.