Private Payers May Pay for After-Hours Visits
Published on Tue Sep 09, 2003
After-hours codes are supposed to boost your reimbursement, but payment is not always automatic - and it often requires negotiation with your private payer.
After-hours codes 99050-99054 are designed to reimburse physicians who see patients at unusual times, such as after regular office hours or on Sundays or holidays. Although Medicare and Medicaid do not reimburse for after-hours codes, some private payers do. Blue Cross and Blue Shield of Louisiana, for example, changed its policy in March 2003 to allow payment for the after-hours codes reported with E/M codes 99201-99215 (Office or other outpatient visit) and 99241-99245 (Office or other outpatient consultations). 'After Hours' Can Vary by Practice CPT includes three codes to report after-hours services:
99050 - Services requested after office hours in addition to basic service
99052 - ... between 10:00 PM and 8:00 AM
99054 - ... on Sundays and holidays.
"After hours is defined as 'after your practice's scheduled time to close or before your practice opens,' " says David Davis, a medical policy analyst at iHealth Technologies Inc. in Atlanta. Do not report 99050-99054 for services you perform when the office is normally open, even if those hours fall outside "regular" 9-to-5, Monday-through-Friday business hours. For instance, if the office is open until 7 p.m., a 6:45 visit does not warrant 99050 in addition to the basic service.
"Therefore, if your office is scheduled to be open every other Saturday, you would not be allowed to use the after-hours codes on those Saturdays," Davis says. "However, if you were called in on the alternate Saturday when your practice is not scheduled to open, you would be able to use them at that time." Overbooked Practices May Not Count You should not report after-hours codes if scheduled patients remain in the waiting room after normal business hours due to delays or overbooking. For instance, if a patient scheduled for a 4:45 p.m. appointment doesn't see the orthopedist until 5:15 - 15 minutes after the office normally closes - you can't report the service as an "after-hours" visit.
No insurer will accept an after-hours claim just because the physician was running behind, Davis says. "If you make an extended effort to keep the doors open for the patient, then use the codes." The physician overbooking his schedule, however, does not warrant the use of after-hours codes.
You should use 99050-99054 only if the physician sees a patient for an unscheduled appointment at a time when his or her office would otherwise be closed. For instance, a patient with a scheduled spinal fusion procedure calls 10 minutes before the office closes, complaining of extreme back pain after a fall. Concerned that the patient may [...]
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