Primary Care Coding Alert

Our normal office hours are:

Monday, Wednesday, Friday: 8 a.m. to 5 p.m.

Tuesday, Thursday: 8:30 a.m. to 5 p.m.

Saturday: 8 a.m. to 11 a.m.

Are we able to bill 99051 for appointments made during the Saturday hours? Also, it is my understanding that this code should be used with office/outpatient evaluation and management (E/M) codes. Is there a modifier to use if reporting either of these codes together?

AAPC Forum Participant

Answer: Yes, you can report 99051 (Service(s) provided in the office during regularly scheduled evening, weekend, or holiday office hours, in addition to basic service) for the very reason described, and yes, it needs to be paired with an appropriate service code.

CPT^® codes 99050 (Services provided in the office at times other than regularly scheduled office hours, or days when the office is normally closed (eg, holidays, Saturday or Sunday), in addition to basic service) and 99051 are adjunct codes, and according to CPT^® guidelines, “codes 99050-99060 are reported in addition to an associated basic service.” This is consistent with your understanding that you must report the codes with the other service(s) performed at the time, such as an evaluation and management (E/M) service code from 99202-99215 (Office or other outpatient visit for the evaluation and management of a new/established patient …).

For example: Let’s say your primary care practitioner (PCP) sees a patient during your practice’s normal Saturday hours at 10 a.m. Because the visit falls within regularly scheduled business hours, you’d use 99051 with the appropriate E/M service code. This would also be the code to use for any services provided during regularly scheduled holiday hours or other temporary office hours, so long as those hours were adequately posted and publicized online and around the building. In other words, as long as temporary hours are reasonably known, they count as regularly scheduled hours.

On the other hand, if a patient comes in at 5:05 p.m. on a Friday and the doctor agrees to stay after hours, 99050 would be appropriate in addition to the appropriate E/M service code. Keep in mind though, that if a patient were to come in at 4:45 p.m. that day for an appointment scheduled at that time, and the appointment ran later than 5 p.m., that visit would likely not qualify for the use of 99050.

Modifier myth: There is a common misconception that modifier 51 (Multiple procedures) is required in these situations. However, this is not true. CPT^® guidelines for this series of codes instruct you not to append modifier 51 to 99050-99060. The guidelines for modifier 51 in Appendix A of the American Medical Association (AMA) 2022 CPT^® code book also instruct not to use modifier 51 with E/M services. Because codes 99050-99060 are always reported in addition to an associated basic service, no modifier should be necessary to report either 99050 or 99051 with an appropriate E/M service code.

Whether the patient’s insurance company will cover and pay for these adjunct codes is, of course, a separate question. Many payers, such as Medicare, consider 99050 and 99051 to be “bundled” services for which separate payment is not made because the payer considers payment for them to already be bundled into the payment of other services.