Primary Care Coding Alert

Question: Our office has posted hours of 7 a.m. to 11 p.m. When may we use 99050 and 99052?

Connecticut Subscriber Answer: For clinics that have typical 9-5 business hours, 99050 (Services requested after office hours in addition to basic service) applies from 5 p.m. to 10 p.m., and 99052 (Services requested between 10:00 PM and 8:00 AM in addition to basic service) takes over from 10:00 p.m. to 8:00 a.m. Technically, you should use the after-hours codes in addition to the E/M code (such as 99201-99215, Office visit for the evaluation and management of a new or established patient ...) after your practice's published office hours. Therefore, in your case, you should report 99052 for services provided from 11:01 p.m. to 6:59 a.m.

Based on your contract negotiations, some payers may allow you to use 99050-99052 even if your practice has evening hours. If you explain the cost savings of having a patient come to the office instead of the emergency department, you may convince some private insurance carriers and managed- care organizations to include after-hours codes in your contracts. Because Medicare lists 99050-99052 as bundled services, other insurers may not pay for these codes.