Pediatric Coding Alert

Answer: Either situation may qualify for reporting 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) in addition to the basic service, such as an office visit (99201-99215, "Office or Other Outpatient Services"). If a patient walks in after your normally posted office hours are over and the pedia-trician performs an office visit, you may use 99050, plus 99201-99215. To use 99050 for scheduled appointments, the appointment must be scheduled after your normal office hours.

Example: A working mother calls in for an office visit for her child who has been complaining of throat pain and is now running a fever. The mother says she can't make it to your office until 5:30. Although your office has posted hours of "9 to 5 M-F", you agree to schedule the appoint-ment for 5:30 to avoid the established patient having to go to an urgent care center or emergency department (ED).

In this case, you could add 99050 to 9921x. You may be able to negotiate for additional payment for after-hours services by showing the insurer the cost savings compared to a trip to an urgent care center or ED.

Do not use 99050 because the patient arrived late or because your office treated the patient late for an appointment that was scheduled during normal office hours.