Don't Miss Out On Extended-Hours Payments
Published on Thu Aug 10, 2006
Your point of service determines which 2006 CPT codes are right for you
When you offer services at nontraditional hours, CPT 2006 provides special codes to fit your situation. Just remember, the code you use depends on whether you provide standard office hours or are open evenings and weekends.
CPT revamped the special services, procedures and reports subsection. "The new and revised codes give coders more options to describe the services their practice provides," says Kim Kieke, CPC, a coding quality specialist at a multi-specialty clinic with over 60 physicians in Austin, Texas. Here are four tips to putting these new tools to good use. 1. Use 99051 for Posted Nontraditional Hours You can now use code 99051 for services provided during posted evening, weekend and holiday hours.
Old way: "Some payers allowed coders to use 99050 when a clinic provided services outside traditional office hours," Kieke says. Insurers sometimes understood the cost-saving benefit of treating a patient in an office setting as opposed to the emergency department and applied 99050 more liberally.
Now: CPT 2006's new code 99051, however, more appropriately describes the special service. "We never had a code to use for after traditional business hours," Kieke says.
How it works: A non-24-hour practice is open evenings, Saturdays and holidays. When your ophthalmologist provides an E/M service during these times, you should report new code 99051 for a service "provided in the office during regularly scheduled evening, weekend, or holiday office hours, in addition to basic service."
Before: Because the office had posted Saturday hours, in the past, 99050 would not have accurately described the special service. "CPT's creation of 99051 recognizes medical care's move toward more extended hours of operation," Kieke says.
Alternative: If your office operates on a traditional schedule--Monday through Friday 9 a.m. to 5 p.m.--you can report services provided outside those hours and days with revised code 99050.
2. Capture Late-Night Facility Services With 99053 You can use another new special-service code when your physician is called in to provide a red-eye or early-bird service at a 24-hour facility.
What it is: "Code 99053 replaces deleted code 99052 and adds the facility stipulation," says Tina Landskroener, CCS-P, CPC, senior director of compliance at Quincy Medical Group in Illinois.
Code 99053's inclusion of "24-hour facility" imposes a new limit on the late-night service code.
If an ophthalmologist met a patient in the office between 10 p.m. and 8 a.m., you could previously report a special service with 99052, Landskroener says. "CPT attached no place of service (POS) to the code."
New method: The POS drives the after-hours code's applicability. For you to report 99053, the service must occur at a 24-hour facility, such as an ambulatory surgical center (POS 24), urgent [...]
