99051 -exactly does this code work

nauger

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I bill for a family practice that's open 6am-10pm, 7 day per week.
When can I use the 99051? Can I use it after 5:30pm and on the weekends and holidays? How exactly does this code work?

Thanks for any advice!
:)
 

daniel

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I use these codes over here in the practice I work for. It's for patients that walk in with no schedule appointment. You can use this during regular scheduled evening, weekend, or holiday office hours.

But I recommend you collect this money up front. Instead of billing the insurance for this. Meaning for example, patients pay like $15 to $25 extra outside of there co-pay, for seeing them on a walk in service. Because insurance companies aren't paying this to often. Don't get me wrong I seen payment on these. Anywhere from $5.00 to $20. So it depend on you how your practice would like to apply these codes.

Respectfully

Daniel
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Can you actually collect the $$ upfront for this? If you are participating in the patients insurance company, I don't think this is correct. Also - The insurance companies should be paying this code as long as the documentation specifies the interrupted schedule.
 

RebeccaWoodward*

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This code is intended for those situations in which a physician agrees:

-To stay after posted hours
-Agrees to come in before posted hours
-Agrees to come in on a weekend (not open during normal circumstances)
-Agrees to come in on a holiday.

As for reimbursement, this could become carrier specific. I would check with your carriers to determine who pays for this.
 

daniel

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The descrition given by Rebecca, is way off. Just looking at the CPT book, you can see this. This code is used for when a patient disrupts the physicians schedule. Like a patient seen on a walk in basis.
During regulary scheduled evening, weekend, or holiday office hours, in addition to basic services.

And about the other, respondent. Saying you can't collect the money up front for a walk in patient. Give me a source that tells me other wise. Why would this not be in compliance. You tell the patient up front when they come in, that they have to pay. $15.00 or $25.00 extra out of pocket, for seeing them on a walk in basis. Remember your providing a extra service for them.

Keep in mind, I still use this code 99051. But I recommend practices just collect this money up front.

Respectfully
Daniel
cpc
 

RebeccaWoodward*

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Daniel,

Your opinion is duly noted. This forum is to bounce ideas off to one another for guidance and direction. Not all opinions are going to be 100% accurate. It is also my belief that proctors opinions also vary from person to person. Some information is hit and miss. There are revisions made to CPT constantly. It can be difficult to keep up with the on-going changes. When I provided my opinion, it was only that. This was the information provided to me when this cpt code was implemented. Doing further research, I see that there have been modifications to this code. Like everyone does, I learn something new everyday.
 

Monika Liddle

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CPT code 99051 is for services that are provided in the office during regularly schedule evening, weekend, or holiday hours.

CPT code 99050 is for services that are provided in the office other than regularly scheduled office hours, or days that the office is normally closed.

I am not sure about collecting the extra money up front.

Monika
 

dmaec

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I use these codes over here in the practice I work for. It's for patients that walk in with no schedule appointment. You can use this during regular scheduled evening, weekend, or holiday office hours.

But I recommend you collect this money up front. Instead of billing the insurance for this. Meaning for example, patients pay like $15 to $25 extra outside of there co-pay, for seeing them on a walk in service. Because insurance companies aren't paying this to often. Don't get me wrong I seen payment on these. Anywhere from $5.00 to $20. So it depend on you how your practice would like to apply these codes.

Respectfully

Daniel
cpc
Daniel, does that mean where you work - walk-ins are charged "more" than patients with an appointment? :confused:
 

dmaec

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I bill for a family practice that's open 6am-10pm, 7 day per week.
When can I use the 99051? Can I use it after 5:30pm and on the weekends and holidays? How exactly does this code work?

Thanks for any advice!
:)
Why would you want to use this code? I don't see any RVU's attached to the 99051. In my opinion I doubt very many insurances would reimburse separately for this code. Per CMS this would be bundled with payment for other services. (like the normal E/M). Most insurances are leaning towards following CMS guidelines. Where I work, walk-in's are coded/billed just like scheduled appointments, according to services provided and supporting documentation - why wouldn't they be? UNLESS it's an emergency. (that's a whole different thing) We're open till 6:00pm also. No special codes attached to any E/Ms, even for the walk in's.
I don't read this code as specific to “patients who walk-in with no scheduled appointment”. I don't see mention of such in the description.
As for collecting payment up front -... I've never been to a medical facility that has made me pay for services up front other than my office co-pay (and more often than not they bill me for that even). And I'd be pretty upset if I was being charged “more” simply because I was walk-in!! At my facility, our sign says “walk-ins welcomed”!
Donna :)
 
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The descrition given by Rebecca, is way off. Just looking at the CPT book, you can see this. This code is used for when a patient disrupts the physicians schedule. Like a patient seen on a walk in basis.
During regulary scheduled evening, weekend, or holiday office hours, in addition to basic services.

And about the other, respondent. Saying you can't collect the money up front for a walk in patient. Give me a source that tells me other wise. Why would this not be in compliance. You tell the patient up front when they come in, that they have to pay. $15.00 or $25.00 extra out of pocket, for seeing them on a walk in basis. Remember your providing a extra service for them.

Keep in mind, I still use this code 99051. But I recommend practices just collect this money up front.

Respectfully
Daniel
cpc

Daniel,

As the 'other respondent' I would like clarify my opinion.
My post including "Can you..." and "think" should have been your first indication that I was offering an opinion about the subject... not identifying resources should have been your other.
I highly suggest contacting each insuance company in which you participate directly - they will be your most accurate 'source'. Some payers pay the 99051 - others do not.
Compliance with your individual contracts is the issue here. If the code is payable without any patient responsibility, then you are not following the regulations of your contract by collecting money upfront from the patient. Another question to ask your carrier would be, 'are we within our rights to bill a patient for this service knowing you do not cover the procedure/ service?"
Always be sure to cover yourself with each carrier before incurring penalties due to an audit!
Have a wonderful day!
:rolleyes:
 

daniel

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Rebeccawoodward.

Hey rebeccawoodward.
I meant no disrespect, in the way I posted my comment regarding your comment you made on CPT 99051. Just passionate about what I do at times. LOL.

Respectfully
Daniel
CPC
 

halebill

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It's really sweet that everybody is getting along now. Our practices are open until 8pm on weekdays and 5pm on weekends, during which time we are strictly "walk-in". We use code 99051 regularly, because it meets the description, "during regularly scheduled evening, weekend, or holiday office hours...". Many carriers pay it, many do not. We do not collect upfront for this charge (except of course, for self-pay). When the charge is disallowed by a carrier, we write it off. Otherwise, we collect the allowed amount by both the carrier and the patient. There may not be RVU's for this code, but it does pay, and the rates are carrier specific. If you are a practice who can charge this code, and you are not, YOU ARE LEAVING MONEY ON THE TABLE. Check with your carriers to see who will allow it and who will not. Forget about Medicare, Medicaid and Worker's Comp. Include this code in your contract negotiations with your payers. You are caring for their members at a time when most other practices are closed. Think of all the money they are saving by paying you this little 90551 code, rather than paying the ER!

Bill Hale, CPC :cool:
 

jhayes

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In urgent care we use 99051 quite often and are reimbursed for it. It is not meant to be used just because someone doesn't have an appointment - none of our patients had appoitments. It was designed to compensate the practice for additional costs in staying open extended hours (like labor costs). Never bill it to Medicare - they do not pay it but many other do. It sounds to me like you would qualify for the code after 5:30, weekends and the designated holidays outlined.
 
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You can not collect money up front for services such as 99051. You can also NOT charge extra for walk-ins over scheduled patients. This is ILLEGAL. You CAN however ask a patient to sign an advance beneficiary notice if you think their insurance will not pay for the services. This would hold them financially liable after the services are denied.
If you do charge extra in advance for the 99051, you would have to refund the money to the patient after insurance pays, as you are not legally able to charge the patient the difference between the allowed amount and the billed amount. So if the insurance pays 100%, there is no balance, and a refund must be issued. If an insurance company pays at 80% but has you adjust the balance to zero, stating patient responsibility zero, you still have to issue a refund. Also, if the insurance company states that the services are not billable (or what have you), and tell you to adjust to zero and issue no payment (and still state patient responsibility zero), you again would have to issue a refund to the patient.
The only kind of "extra" charges you are allowed to charge a patient for is for returned/bounced checks, and if your office has a no-show policy that results in a charge.
 

shivana

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I work the front desk on certain Saturdays at my office, and while looking at verification printouts, I have seen "$20-PCP During Hours, $25-PCP After Hours." Is that what you mean by charging the patient extra for it? I have charged the additional $5 if it is indicated on the printout.

OUt of curiosity, how do you guys use 99050 versus 99051?
 

MacksMom

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I totally agree

You can not collect money up front for services such as 99051. You can also NOT charge extra for walk-ins over scheduled patients. This is ILLEGAL. You CAN however ask a patient to sign an advance beneficiary notice if you think their insurance will not pay for the services. This would hold them financially liable after the services are denied.
If you do charge extra in advance for the 99051, you would have to refund the money to the patient after insurance pays, as you are not legally able to charge the patient the difference between the allowed amount and the billed amount. So if the insurance pays 100%, there is no balance, and a refund must be issued. If an insurance company pays at 80% but has you adjust the balance to zero, stating patient responsibility zero, you still have to issue a refund. Also, if the insurance company states that the services are not billable (or what have you), and tell you to adjust to zero and issue no payment (and still state patient responsibility zero), you again would have to issue a refund to the patient.
The only kind of "extra" charges you are allowed to charge a patient for is for returned/bounced checks, and if your office has a no-show policy that results in a charge.
I TOTALLY agree with Augustine here.

Jennifer L. Haney, CPC, CCC
 
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