Pediatric Coding Alert

Question: We normally have office hours on a Sunday and bill 99051 for those services. We are now performing many of these services as telehealth. Should we continue to bill this way, or should we avoid this code and do it another way?

Codify Subscriber

Answer: CPT^® code 99051 (Service(s) provided in the office during regularly scheduled evening, weekend, or holiday office hours, in addition to basic service) is normally used for office visits during hours your office has posted on evenings, weekends, and holidays (as the descriptor states). So, your use of the code for the hours you mention is certainly appropriate for face-to-face visits.

Its use for telehealth visits, especially during this current public health emergency (PHE), is a little unclear, however. Payers may assume that 99421-3 (Online digital evaluation and management service …) and 99441-3 (Telephone evaluation and management service …) are being furnished outside the office setting, making the use of 99051 questionable. That would make 99201-99215 (Office or other outpatient visit for the evaluation and management of a new/established patient …) with modifier 95 (Synchronous telemedicine service …) and 99051 a more appropriate way to describe your circumstances.

But the recent guidelines issued by the American Academy of Pediatrics (AAP), “Coding for COVID-19 and Non-Direct Care,” while noting that “CPT^® has not yet addressed this issue,” goes on to state that “AAP does not believe that given the current environment their use is entirely inappropriate” (Source: https://downloads.aap.org/AAP/PDF/COVID 2020.pdf).

In other words, AAP’s suggestion is to continue to use the code as you have. However, you would do well to heed AAP’s final advice on 99051 and “check with your payers since it is not entirely consistent with the current CPT^® code descriptors.”