Primary Care Coding Alert

Question: Our office is open on Saturdays. What ICD-9 codes would the claim require to use 99051?

Texas Subscriber

Answer: Code 99051 (Service[s] provided in the office during regularly scheduled evening, weekend, or holiday office hours, in addition to basic service) is not diagnosis-related. The code simply requires that your office have posted evening, weekend, and holiday hours and the physician provide the basic service (such as 99201-99215, Office or other outpatient visit ...) during those times.

For instance, you have posted hours of 9 a.m. to 12 p.m. on Saturday. On Sat., Sept. 22, the FP provides a level-four new-patient office visit for an infant with otitis media (382.9, Unspecified otitis media) and high fever (780.6), a level-three established-patient office visit for a teenager with acute upper respiratory infection (465.9), a level-three established-patient office visit for a toddler with a swollen foot from an insect bite (917.4, Superficial injury of foot and toe[s]; insect bite, nonvenomous, without mention of infection) (E906.4, Bite of nonvenomous arthropod), as well as two 99212s, one 99203, five additional 99213s, and two 99204s. You could code 99051 as a separate line item in addition to the E/M service on all these claims.

Catch this:  If a patient's condition requires the physician to interrupt his schedule to provide emergent care, you could report 99058 (Service[s] provided on an emergency basis in the office, which disrupts other scheduled office services, in addition to basic service) in addition to the office visit code. Possible diagnoses that could require emergency care include open wound (870-897), asthma attack (493.12, Intrinsic asthma; with [acute] exacerbation), anaphylactic shock (995.0, Other anaphylactic shock) due to bee sting (989.5, Toxic effect of other substances, chiefly nonmedicinal as to source; venom; E905.3, Venomous animals and plants as the cause of poisoning and toxic reactions; hornets, wasps, and bees), or head injury (959.01, Injury, other and unspecified; head injury, unspecified).

You could report two special services codes on the same claim. For instance, for a 40-year-old female established patient who fell from her bike, an FP assesses a head injury and repairs a 2.3 cm leg laceration that requires the physician to interrupt his schedule on Saturday morning to treat. You could report these codes:

- 99213-25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) with 959.01 for the head injury evaluation and E826.1 (Pedal cycle accident; pedal cyclist).

- 12031 (Layer closure of wounds of scalp, axillae, trunk, and/or extremities [excluding hands and feet]; 2.5 cm or less) linked to 891.0 (Open wound of knee, leg [except thigh], and ankle; without mention of complication) and E826.1

- 99051 with 959.01, 891.0, E826.1 for the Saturday treatment

- 99058 linked to 891.0 and E826.1 for the emergency-based service.

Beware: Not all insurers, however, will pay for multiple special service codes reported on the same claim, and some insurers may not pay for any special services codes at all.