Pediatric Coding Alert

Question: We routinely see sick patients on Sunday mornings. May we use 99054 for these patients, or must we reserve the code for opening a closed office?

Illinois Subscriber

Answer: You may submit 99054 (Services requested on Sundays and holidays in addition to basic service) when you treat patients on Sundays. Unlike 99050 (Services requested after posted office hours in addition to basic service), 99054 doesn't specify that you can report it only outside posted office hours.

Here's how each of these special service codes works: Suppose your office is open Monday through Friday from 8:30 a.m. until 4:00 p.m., but you agree to schedule a patient at 5:30 p.m. Because you scheduled the service outside your posted hours, you may report 99050 in addition to the office visit code.

In contrast, to qualify for 99054, you must simply provide the service on a Sunday. Whether you routinely see patients on Sundays or offer limited morning hours doesn't matter.

In fact, many practices that provide this extra service routinely submit 99054. If insurers don't cover the code, you may charge parents the additional fee. You'll probably find that most parents are happy to pay a Sunday surcharge rather than incurring emergency-department fees.

-- Information for You Be the Coder and Reader Questions provided by Kim Kieke, CPC, a coding quality specialist at a multi-specialty clinic with more than 30 pediatricians in Austin, Texas; Kevin Perryman, practice administrator at Primary Pediatric Medical Association in Kerrville, Texas; Julia Pillsbury, DO, FAAP, pediatrician at Center for Pediatric Medicine in Dover, Del.; and Richard H. Tuck, MD, FAAP, pediatrician at Primecare of Southeastern Ohio in Zanesville.