Pulmonology Coding Alert

Question: Our pulmonologist usually sees patients only till 6 p.m. everyday. But, on Wednesdays, our pulmonologist continues to see patients till 9 p.m. This additional working hours on Wednesdays has been advertised on our site also. Can we use after-hour codes to bill patients that our pulmonologist sees on Wednesdays beyond 6 p.m.?

Maryland Subscriber

Answer: No, you cannot use after-hour codes 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) to report the services provided by your pulmonologist to patients seen after 6 p.m. on Wednesdays.

As you have said that you have advertised on your site that your pulmonologist's office will remain open beyond 6 p.m. on Wednesdays, it will be considered as regular work hours and cannot be billed using the after-hour code.

You can only consider billing the after-hour code if your pulmonologist happens to provide services to any patient beyond the normal working hours of 6 p.m. on any other working day and after 9 p.m. on Wednesdays. You can also use this code to report services provided by your pulmonologist on any holiday or a Sunday when your practice is generally closed.

Note that you will have to report 99050 in addition to the evaluation and management codes or to the procedural codes that you will be reporting for the services provided to the patient.

Reminder: You cannot use 99050 for after-hour services provided to a Medicare patient as these codes are not recognized by Medicare. So you will not be able to get additional reimbursements if you use 99050 to report any after-hour services provided to Medicare patients. For all other commercial insurance carriers, it is best to check with the company policy on after-hour codes prior to making claims using the code.