Wiki After Hours Care

[burneyatc]

My docs want to start billing for after-hours care. Our clinic hours would be from 8-5 and he wants to see "after hours" patients from 5:30-9:00. Can anybody help me with coding for this? Do we use an E/M code + the 99050? Also, do we have to do anything different with any of our payors? Any help would be appreciated.

 

[mitchellde]

They would not be afterhours if you schedule them they would be scheduled evening hours for use of the 99051. and yes you add it in addition to the E&M or whatever other service is provided. Now while I have had experience where payers do pay for the 99050 I have had had some drop the 99051 to patient responsibility. But be careful about the definition. If you are going to schedule regular evening hours then that would be the 99051.

 

[burneyatc]

Thank you. It will not be scheduled, it will be all walk-in basis...so would we then bill the 99050 or still do the 99051? And, did you have to notify your payors or did you just start using that code? Appreciate your help!

 

[mitchellde]

If your office is going to be scheduled to be open then it is not after hours it is regular scheduled evening hours. Scheduled on your part not the patients so it would be the 99051. Check your contract and see if extended hours are listed in your contract, if not you should contact your rep and ask if this needs to be revised.

 

[mjb5019]

I guess it would depend on whether you are contractually set up as an Urgent Care during the hours your office is closed and you use POS Code 20 as your POS instead of 11. I dont know whether you would need to have providers other than partners staffing those hours either.

 

[mitchellde]

But if the office is letting patients know they will be OPEN and available during those hours then they are not closed. And it does not have to be set up as urgent care a physician office can have extended office hours. The question is whether th payer will pay and additional amount for those visits.