Primary Care Coding Alert

Question: A physician was treating a newborn who was jaundiced. He received the lab results from the serum bilirubin at about 10:30 p.m., past regular office hours. He asked the parents to meet him in the emergency room to conduct another test and examine the baby. He met them at the hospital at about 11:30 and spent 90 minutes examining the child, reassuring the parents and waiting for the lab results. He sent the baby home and arranged for home phototherapy. We charged a code for an emergency department visit. Can we also charge an after-hours code (99050-99054)?

Nevada Subscriber
 
 Answer: Yes, the after-hours codes are adjunct codes, meaning they are used in addition to codes for other procedures or services the physician performs. For the above case, report the appropriate emergency department code (99281-99285) with 99052 (services requested between 10:00 p.m. and 8:00 a.m. in addition to basic service). If the same situation occurred on a Sunday or holiday, you could bill both codes above and 99054 (services requested on Sundays and holidays in addition to basic service).
 
Code 99050 (services requested after office hours in addition to basic service) specifically refers to service after office hours. It would most commonly be used as an adjunct to services provided after a physician offices normal hours but outside the 10 p.m. to 8 a.m. window covered by 99052 and the Sundays/holidays window covered by 99054. For example, at 5 p.m. on Friday as the office is getting ready to close, a patient calls and asks if he can be seen that day for a certain condition. He can be there in 30 minutes. Rather than refer the patient to the ER, the physician agrees to stay in the office and see the patient at 5:30 p.m., and bills an E/M service (e.g., 99213) with 99050 to indicate that the service was after normal office hours.
 
Medicare does not pay separately for the after-hours codes. Medicare considers payment for these codes to be bundled into the payment for the basic code in each circumstance. However, some private payers reimburse for the after-hours codes, and you should bill them whenever appropriate.