Practice Management Alert

Question: I bill for a pediatrician who wants to use the 99050 add on code for our Saturday hours. Those Saturday hours are posted and advertised. Do you think we should expect reimbursement from the insurance companies for this code?

California Subscriber

Answer: If your practice is advertising Saturday hours, those hours should be considered part of your normal business hours because you are not normally closed during that time. In order to bill 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). Code 99050 comes into play when the physician sees the patient in the office during hours when the office normally would be closed.

Example: Your practice usually closes at 4 p.m. on Wednesday, but the pediatrician sees a patient at 6 p.m. If your posted closing time is 4 p.m., you can report 99050 for the 6 p.m. visit along with the appropriate treatment codes.

Caveat: You can only consider reporting 99050 if the patient can only come after your normal office hours end. If your physicians is running behind, for example, and sees the patient at 4:15 when the office is supposed to close at 4, that appointment isn't considered "after hours."

Correct billing: Your practice should look at 99051 (Service[s] provided in the office during regularly scheduled evening, weekend, or holiday office hours, in addition to basic service). If your practice has routine hours for seeing patients in the evenings or on weekends or holidays, 99051 is an option.

Example: Your office stays open until 9 p.m. on Thursday evenings. A patient who comes at 7 p.m. is still within your posted office hours, but outside "usual business hours." Explain the situation to your payer by including 99051 on the claim. The catch is that many major payers do not accept or pay on 99051.