Pediatric Coding Alert

Question: Regarding CPT 2006's introduction of CPT 99051 , I have three questions:
 
1. Should we use 99051 in addition to the E/M code for that service (scheduled hours)?
 
2. What is the definition of "basic service"?

 3. Can you provide any references for using this code?

Pennsylvania Subscriber

Answer: The answers to your first two questions are easy. The third is not.
 
1. Yes. You should always report 99051 (Service[s] provided in the office during regularly scheduled evening, weekend, or holiday office hours, in addition to basic service) in addition to an E/M service. "Each of these  codes is intended to be reported in addition to the service provided, as indicated in their descriptors," according to CPT Changes 2006 -- An Insider's View.
 
2. Codes 99050-99060 are often referred to as adjunct services, meaning you should report the codes in addition to the primary service. The basic service is the E/M service associated with the special service code. Because 99051 describes office services, you would assign 99051 in addition to the performed and documented E/M service, such as 99212-99215 (Office or other outpatient visit for the evaluation and management of an established patient ...).
 
3. Many insurers site 99051's inclusion in the basic service as a "nonpayment" reason for the special service code. For instance, Blue Cross Blue Shield of North Carolina considers 99051 "incidental to evaluation and management services, surgical services, and laboratory services, and separate reimbursement is not allowed." Several Medicaid policies have similar policies.
 
Arkansas Medicaid lists 99051 as a nonpayable code "because the services are covered by another CPT procedure code," and Maryland Medicaid pays 99051 at $0.00.
 
One insurer, North Carolina Medicaid, says that 99051 is billable but offers no payment amounts or details. In addition, the AMA does not include an example of the code's use in CPT Changes 2006.