Neurology & Pain Management Coding Alert

Gain an additional $50 for urgent visits and still save the payer money Payers frequently ignore claims for after-hours services 99050-99054. But with a little persuasion, you can convince non-Medicare insurers that after-hours services provide a benefit to both patients and payers. Use After-Hours Only for 'Emergency' Visits You should only report after-hours codes in urgent situations. CPT includes 99050-99054 to allow additional reimbursement for physicians who see patients at unusual (in other words, unscheduled) times, such as after posted office hours or on Sundays or holidays, says Richard H. Tuck, MD, FAAP, AAP, representative to the AMA RBRVS Review Update Committee.

Example: A patient who recently received implanted neurostimulators calls the office at 5:45 p.m. -- 15 minutes before closing -- and asks to see the doctor immediately because of mild seizure-like episodes. Fearing problems with the neurostimulator settings, the neurologist agrees to see the patient, who arrives at the office at 6:30 p.m. In this case, you are justified in reporting after-hours codes.

When NOT to claim after-hours: You should not, however, report after-hours codes for a prescheduled appointment after regular office hours. "Let's say the neurologist decides to stay open an extra hour on Friday because of the large number of patients who wish to see him that week," says David Davis, a medical policy analyst at iHealth Technologies Inc. in Atlanta. "If the neurologist preschedules the appointments, he's not really seeing patients after-hours. He's just extending his hours."

By the same token, if the neurologist "overbooks" and does not see his final scheduled appointment of the day until after the posted office hours, you cannot report an after-hours service. "Insurers won't pay because the physician is running behind or overbooked," Davis says. Report After-Hours in Addition to Other Services Although CPT does not list 99050-99054 as after-hours codes, the code descriptors clearly state "in addition to basic service." And CPT Assistant November 1997 clearly states that 99050-99054 "are an adjunct to the basic service(s) rendered" and "are intended to be reported in addition to the basic service(s) provided." Therefore, you should only claim after-hours codes in addition to any other E/M service you report.

CPT includes three codes to report after-hours services:

  99050 -- Services requested after posted office hours in addition to basic service
  99052 -- ... between 10:00 PM and 8:00 AM
  99054 -- ... on Sundays and holidays.

For example, in the case of the neurostimulator patient who arrives at 6:30 p.m., you should claim the E/M service level supported by documentation (for example, 99213, Office or other outpatient visit for the evaluation and management of an established patient ...) along with 99050. Don't Use After-Hours for Hospitals, Medicare You should never report after-hours codes for patients the [...]