Radiology Coding Alert

Question: We are working for a multi-specialty medical group with our own radiology department. If a patient is seen by a provider in our walk-in department during regularly scheduled evening, weekend or holiday office hours and is sent for a radiology study during that visit that will be read by one of our radiologists stat. Can both the walk-in provider and the radiologist report CPT^® code 99051, and additionally can the radiologist also report 99058 because it was ordered as stat?

Ohio Subscriber

Answer: Coverage of codes 99051 (Service[s] provided in the office during regularly scheduled evening, weekend, or holiday office hours, in addition to basic service) and 99058 (Service[s] provided on an emergency basis in the office, which disrupts other scheduled office services, in addition to basic service) is payer-specific. You will need to check with your payer for any guidelines. For instance, there may be rules about which codes are covered or that the codes may be used only in addition to E/M codes. Before coding 99058, review the intent of the code. You report code 99058 for only services to those patients whose condition, in the clinical judgment of the physician, warrants the physician’s interrupting his or her care of another patient to deal with the emergency. You do not report this code when your physician’s usual practice has time slots available in the schedule and the services provided to patients are fitting into that schedule.

Note that codes 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)-99051 are not limited to a specific type of services (e.g., preventive medicine, maintenance of chronic health issues, urgent care). You typically report these codes with only one code per encounter, there may be occasions in which you report more than one of the special services codes due to the dual nature of these codes, i.e., used in reporting unusual times and sites in providing services. An example of a situation when reporting more than one special services code would be appropriate is when the patient must be seen on an emergency basis in an office that has regularly scheduled evening, weekend, or holiday office hours. In this example, both codes 99051 and code 99058, service(s) provided on an emergency basis in the office, which disrupts other scheduled office services, in addition to basic service, would be reported, in addition to the code or codes for the services performed.

According to CPT^® guideline: “Codes 99050-99060 (Service[s] provided on an emergency basis, out of the office, which disrupts other scheduled office services, in addition to basic service) are reported in addition to an associated basic service. Do not append modifier 51 (Multiple procedures) to 99050-99060. Typically only a single adjunct code from among 99050-99060 would be reported per patient encounter. However, there may be circumstances in which reporting multiple adjunct codes per patient encounter may be appropriate.”