Pediatric Coding Alert

CPT Codes 2006 opens the door to capturing posted evening-hour surcharges

Because old special service code rules no longer ring true, now’s the time to check out which 99050-99060 codes apply to your pediatricians’ nontraditional services. CPT 2006 has revamped the special services, procedures and reports subsection. “The new and revised codes give coders more options to describe the services their practices provide,” says Kim Kieke, CPC, a coding quality specialist at a multispecialty clinic with more than 35 pediatricians in Austin, Texas. Changes include:

Deletions:

• 99052--Services requested between 10:00 PM and 8:00 AM in addition to basic service
• 99054--Services requested on Sundays and holidays in addition to basic service. Additions:

• 99051--Service(s) provided in the office during regularly scheduled evening, weekend, or holiday office hours, in addition to basic service

• 99053--Service(s) provided between 10:00 PM and 8:00 AM at 24-hour facility, in addition to basic service

• 99060--Service(s) provided on an emergency basis, out of the office, which disrupts other scheduled office services, in addition to basic service. Revisions:

• 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

• 99056--Service(s) typically provided in the office, provided out of the office at request of patient, in addition to basic service

• 99058--Service(s) provided on an emergency basis in the office, which disrupts other scheduled office services, in addition to basic service. 1. Specify Extended Office Hours With 99051 In the new year, you can look forward to a new code for services provided during posted evening, weekend and holiday hours. “Some payers allowed coders to use 99050 when a clinic provided services outside traditional office hours,” Kieke says. Insurers sometimes understood the cost-saving benefit of treating a patient in an office setting as opposed to the emergency department and applied 99050 more liberally.

CPT 2006’s new code 99051, however, more appropriately describes the special service. “We never had a code to use for after traditional business hours,” Kieke says. In 2006, coders can use 99051.

How it works: A non-24-hour clinic is open evenings, Saturdays and holidays. When a pediatrician provides an E/M service during these times, you should report new code 99051 for a service “provided in the office during regularly scheduled evening, weekend, or holiday office hours, in addition to basic service.”

For instance, a mother presents with a 16-month-old on a Saturday afternoon to a [...]