Internal Medicine Coding Alert

Question: A Medicare patient knocked on the door on a Friday when the office was closed. He was worried that his blood pressure was elevated. The physician took a history and performed an exam, counseled the patient and prescribed blood-pressure medication. We coded the visit with 99213 and 99050. Is that right?

South Carolina Subscriber

Answer: Code 99050 (Services requested after office hours in addition to basic service) is listed as a "Status B" code in the Medicare fee schedule. This means that CMS has not assigned any relative value units (RVUs) to this service, and it is always considered a bundled service. So Medicare will not pay for this code. Because Medicare is the payer in the scenario described, you may bill only the E/M code.

You should note that some commercial insurance companies, however, do reimburse for 99050. Physician practices will often negotiate this code as part of their fee schedule with commercial payers.