Pulmonology Coding Alert

Find out which of these new codes you should use to gain reimbursement

If your pulmonology practice stays open every evening, you're in luck. CPT 2006 opens the door to coding special services when a physician has scheduled evening or Saturday hours, as well as when he provides late-night services at a 24-hour facility.

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. Changes include: Deletions • 99052--Services requested between 10:00 PM and 8:00 AM in addition to basic service

• 99054--Services requested on Sundays and holidays in addition to basic service. Additions • 99051--Service(s) provided in the office during regularly scheduled evening, weekend, or holiday office hours, in addition to basic service

• 99053--Service(s) provided between 10:00 PM and 8:00 AM at 24-hour facility, in addition to basic service

• 99060--Service(s) provided on an emergency basis, out of the office, which disrupts other scheduled office services, in addition to basic service. Revisions • 99050--Services provided in the office at times other than regularly scheduled office hours, or days when the office is normally closed (e.g., holidays, Saturday or Sunday), in addition to basic service

• 99056--Service(s) typically provided in the office, provided out of the office at request of patient, in addition to basic service

• 99058--Service(s) provided on an emergency basis in the office, which disrupts other scheduled office services, in addition to basic service. Use 99051 for Posted Nontraditional Hours You can now use 99051 for services provided during posted evening, weekend and holiday hours. "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.

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 a pulmonologist 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."

Old way: Because the office had posted Saturday hours, 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 [...]