Wiki CPT 99050 & 99051

[mworm2018]

I work at a Family Practice and my doctor has come across CPT codes 99050 (services provided in the office at times other than regularly scheduled office hours, or days when the office is normally closed for example holidays, Saturdays or Sundays in addition to basic services) and 99051 (services provided in the office during regularly scheduled evenings, weekend, or holiday office hours in addition to basic services) and is under the impression that we should be able to bill for 99051 for our Saturday visits because it falls on a weekend during regular office schedule.

Our normal office hours are:

M,W,F 8am-5pm
T,TH 8:30am-5pm
Saturday 8am-11am

Are we able to bill for this?? Also it is my understanding that this code be used with E&M codes? Is there a modifier that is required with either of these codes if used together?

 

[renee dustman]

In the Feb. 21, 2022, Gastroenterology Coding Alert, a Reader Questions answers this. It states, in part:

Use 99050 when your GI provider sees a patient outside of those regularly scheduled hours. For example, on Thursday evening, a patient comes in at 6:15 p.m., and your physician decides to stay late and see them.

In this case, you would use 99050 along with the appropriate evaluation and management (E/M) service code from 99202-99215 (Office or other outpatient visit for the evaluation and management of a new/established patient …).

99050 does not apply when providers see patients who arrive during posted hours but are not seen until after them. So, if your office gets backed up, and your provider doesn’t see a patient scheduled for 5:45 p.m. until 6:30 p.m., and your office normally stops seeing patients at 6:00 p.m., you cannot use the code.

Use 99051 when your doctor sees a patient during evening, weekend, or holiday hours that the practice has posted. For example, the doctor sees a patient at 9:00 a.m. on Saturday. Even though this was a scheduled office hour, in this case, you’d use 99051 along with the appropriate E/M service code because it is a service provided during a “regularly scheduled weekend office hour.”

You’ll also use 99051 for services provided during hours scheduled for holidays. For example, your office manager decides to open the practice on Thanksgiving Day from 8:00 a.m. to 3:00 p.m., and publicizes these hours on your practice website, social media, and signage around the building. You would use 99051 for any patients seen on that day, as posted holiday hours are regarded as a regular part of your schedule, even if that schedule is only temporary.

 

[mworm2018]

I went ahead and billed a few of these out to a variety of different insurance companies. I got a few back from BCBS and they are bundling 99051 with 99213. Does this mean I should of put a 25 modifier on office call?