Coding & Billing for Physicians’ After-Hours Services

Posted on 13. Jul, 2009 by Editor in Hot Coding Topics

Show your payer the cost of not paying on after-hours codes.

If your practice is open during “non-traditional” hours, or your physician provides after-hours services to a patient, and you aren’t billing for those “extra” services, your practice may be missing out on additional reimbursement.

To make sure you’re bringing in every dollar your physicians deserve, you need to know the proper codes to bill for after-hours services, as well as what qualifies as “after-hours.”

Let the Clock Determine 99050 vs. 99051

If your physician sees a patient in the office during hours when the practice would normally be closed, such as on weekends or after 6 p.m., CPT guidelines allow you to bill 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) as long as the documentation supports the after hours service, says Jetton Torix, CCS-P, CPC-H, course director of Knowledge Source Seminars in Star, Idaho.

Keep in mind: A patient is considered an after-hours patient only if he reports to the office after your normal office hours end — not when he presents during normal office hours and the appointment runs past closing time.

When your physician provides an E/M service in the office during regularly scheduled “evening, weekend, or holiday office hours,” by contrast, you should bill 99051 (Service[s] provided in the office during regularly scheduled evening, weekend, or holiday office hours, in addition to basic service), according to AMA guidelines outlined in the CPT Assistant (Vol. 13, Issue 6, June 2003).

Key: Whether you select 99050 or 99051, you would report the after-hours code in addition to the appropriate E/M service code for the visit. These codes are add-on codes and therefore require you to...

Tags: +99058, 12031, 891.0, 959.01, 99050, 99051, 99213, after-hours, contract, E826, evening, holiday, modifier 25, payer, weekend