Otolaryngology Coding Alert

Question: Regarding CPT 2006's introduction of 99051, I have two questions:

1. Should we use 99051 in addition to the E/M code for that service (scheduled hours)?

2. What is the definition of -basic service-?


Oklahoma Subscriber


Answer: To answer your first question, yes--you should always report 99051 (Service[s] provided in the office during regularly scheduled evening, weekend, or holiday office hours, in addition to basic service) in addition to an E/M service. -Each of these codes is intended to be reported in addition to the service provided, as indicated in their descriptors,- according to CPT Changes 2006--An Insider's View.

In answer to your second question, codes 99050-99060 are often referred to as adjunct services, meaning you should report the codes in addition to the primary service. The basic service is the E/M service associated with the special service code.
 Some payers consider 99051 incidental to evaluation and management services, surgical services, and laboratory services, and therefore do not allow separate payment for the code. You should ask your insurer whether it reimburses 99051. 
 
You Be the Coder and Reader Questions were reviewed by Barbara J. Cobuzzi, MBA, CPC, CPC-H, CPC-P, CHBME, president of CRN Healthcare Solutions; and Charles F. Koopmann Jr., MD, MHSA, professor and associate chair at the University of Michigan's department of otolaryngology in Ann Arbor.