Pulmonology Coding Alert

Question: Our normal office hours are 8 a.m. to 5 p.m. Monday through Friday. Our pulmonologist provided a level 2 evaluation and management (E/M) service for a new patient that began at 6 p.m. on a Thursday (the patient could not schedule an appointment during normal office hours). Is there any way to account for after-hours services a pulmonologist provides?


Georgia Subscriber


Answer: There is an after-hours code on the books, but you'll likely have a devil of a time getting some payers to recognize it.

On the claim, you should report 99202 (Office or other outpatient visit for the evaluation and management of a new patient, which requires these three key components: an expanded problem focused history; an expanded problem focused examination; straightforward medical decision making.) for the E/M service.

When your physician provides after-hours services, it is possible to report 99050 (Service[s] 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) in addition to 99202 in rare instances. 

The lowdown: Medicare carriers will not reimburse for 99050. Private payers may accept 99050--if it is written into your contract.  If 99050 is not a covered service and the insurer allows it, the patient may receive a bill for this "extra" service.  Many physicians do not like to report 99050 for this reason. Answers for You Be the Coder and Reader Questions were reviewed by Carol Pohlig, BSN, RN, CPC, senior coding and education specialist at the University of Pennsylvania department of medicine in Philadelphia; and Alan L. Plummer, MD, professor of medicine, Division of Pulmonary, Allergy, and Critical Care at Emory University School of Medicine in Atlanta.