Ob-Gyn Coding Alert

Question: Do carriers ever reimburse for the holiday, after-hours codes in addition to the basic service codes? Are these used for ER visits as well as office visits?

Maryland Subscriber

 
Answer: Although the CPT book has codes for holiday, after-hours and emergency services (99050-99058), most are rarely reimbursed by the payer. Code 99058, office services provided on an emergency basis, may be reimbursed by some payers (but the allowable is usually small). These codes were designed for office service E/M and are not appropriate for emergency department services for example, if a doctor was called to his or her office to meet a patient. Carriers dont usually pay for these codes when an obstetrician delivers a baby at night or in the early morning.