Podiatry Coding & Billing Alert

Question: Can we receive extra reimbursement for seeing a patient outside of normal office hours?

California Subscriber

Answer: If your podiatrist sees a patient in the office during hours when the practice would normally be closed, such as on weekends or after 6 p.m., CPT guidelines allow you to report 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) as long as the documentation supports the after-hours service.

Keep in mind: A patient is considered an after-hours patient only if he reports to the office after your normal office hours end -- not when he presents during normal office hours and the appointment runs past closing time. When your physician provides an E/M service in the office during regularly scheduled "evening, weekend, or holiday office hours," by contrast, you should bill 99051 (Service[s] provided in the office during regularly scheduled evening, weekend, or holiday office hours, in addition to basic service), according to CPT Assistant (Vol. 13, Issue 6, June 2003).

Scenario: If your practice normally closes at 4 p.m.on Fridays, but your podiatrist sees a patient at 7 p.m. and conducts a level-three established patient visit, you should bill 99213 (Office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: An expanded problem focused history; An expanded problem focused examination; Medical decision making of low complexity) for the E/M and 99050 for the after-hours visit.

If, however, your practice is normally open during evening hours (for instance, until 9 p.m.), and the podiatrist sees the patient for the same service, you would still bill 99213, but with 99051 to establish that although the service occurred after usual "business hours," the appointment was still within your practice's posted hours.

Don't miss: Whether you select 99050 or 99051,you would report the after-hours code in addition to the appropriate E/M service code for the visit. These codes are add-on codes and therefore require you to bill them in addition to the base E/M codes.