Pediatric Coding Alert

Question: We have posted office hours from 8 a.m. to 4:30 p.m. When may we use CPT 99050 ?


Ohio Subscriber

Answer: Technically, you should report 99050 (Services requested after posted office hours in addition to basic service) when a patient calls and requests your services after 4:30 p.m. until 10 p.m. You would then use 99052 (Services requested between 10:00 pm and 8:00 am in addition to basic service) from 10 p.m to 8 a.m.

Code 99050's descriptor clearly indicates that the code applies "after posted office hours," so you should only apply 99050 after your office's posted closing time, according to CPT.

Example: After picking up her son from day care, a mother finds out he has a high fever. She calls and asks to see the pediatrician at 5 p.m.

In this case, you may report the special service code 99050 in addition to the appropriate-level office visit code (such as 99212-99215, Office or other outpatient visit for the evaluation and management of an established patient ...). The requested appointment occurs after your posted office hours.

You may, however, negotiate with payers to cover 99050 further. For instance, one pediatric practice has posted hours until 6 p.m. Technically, the practice shouldn't report 99050 until a patient requests an appointment after 6 p.m.

But the pediatricians negotiated to use 99050 starting at 5 p.m. The practice showed insurers that the extended hours benefited them financially by keeping treatment in the office for an extra hour, rather than in the emergency department.