Neurosurgery Coding Alert

Trauma can happen at any time. Neurosurgeons may receive calls at two in the morning because a patient has been in a car accident and suffered massive head injuries that require immediate surgical attention. Or a neurosurgeon may be pulled into the operating room on a Sunday afternoon because an athletes spine has been severely damaged during a sporting event. Conditions requiring treatment by a neurosurgeon tend to have a quick onset and require immediate care.

There are three basic codes that can be used for after- hours patient encounters:

99050 services requested after office hours in addition to basic service;

99052 services requested between 10:00 p.m. and 8:00 a.m. in addition to basic service, and;

99054 services requested on Sundays and holidays in addition to basic service.

Know When to Use the Codes

Appropriate use of these codes hinges on the definition of the phrase after-hours. If your practice is always open until 9:00 p.m., you cant bill the after-hours codes for a patient who comes in at 8:30, says Sue Magalnick, president of Doctors Resource Specialists, a medical practice management and reimbursement consulting firm in Phoenix. You can only bill the after- hours codes if it is actually after-hours for your practice.

For example, a patient who has been implanted with a deep brain stimulator to help regulate the debilitating symptoms of Parkinsons disease (332.0) receives an adjustment of the stimulator in the office at 10:00 a.m. and goes home at 11:15. At 5:00 p.m., as the neurosurgeons office is about to close, the patient calls and says she is suddenly dizzy (780.4) and experiencing nausea (787.02), and she is worried that these symptoms could be a result of some defect in the stimulator. She is told to come back to the office, and she arrives at 5:30, when the office is closed. The neurosurgeon performs an evaluation and determines that the patient is suffering from heart palpitations (785.1), which he does not believe are associated with the deep brain stimulator. The neurosurgeon bills 99213 (office or other outpatient visit for the evaluation and management of an established patient) with a modifier -25 (significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) to indicate that the visit is not associated with the neurostimulator adjustment, and then also bills 99050.

The after-hours codes are add-on codes, says Magalnick. Its common for practices to make the mistake of billing just the 99050 and not billing it as an add-on.

Magalnick advises that the Sunday code (99054) is an exception because it can be billed on Sundays and holidays, even if the neurosurgery practice has published office hours on Sundays and/or holidays. Even if youre open on [...]