Wiki CPT code 99050 vs CPT code 99051

[Rperry]

I need you subject matter expert Coding opinion on the following information:

Per the 2011 CPT code Book Professional Edition from the AMA the definition of the CPT codes 99050 and 99051 are as follows:

99050-Services provided in the office at times other than regularly scheduled office hours, or days when the office is normally closed (eg, holidays, Saturday or Sunday), in addition to basic service.

99051-Service(s) provided in the office during regularly scheduled evening, weekend, or holiday office hours, in addition to basic service.

For example Primary care on Mon,Wed, & Friday per the FCHW web site hous of Operation are 8:00-5:00pm. If a patient was seen at 6:00pm in the Primary care department after the department was closed On Monday we could use CPT code 99050.

Example two Primary care on Tues & Thursday per the FHCW web site the hours of operation are 8:00am-8:30pm. If the patient was seen at 6:00pm we could not use CPT code 99050 we could use CPT code 99051.

These specific CPT codes are based upon hours of operations correct??

Thank you and have pleasant day.

 

[mitchellde]

yes you are correct, do not use the 99050 because you are running behind, only if you agree to stay late per the patient request for a visit at that time. Also remeber these codes do not stand alone there must be other CPT codes on the claim such as a visit level or a surgical code or injection codes.

 

[Mramos1974]

99051

Does it require a modifier 25 to the E/M code if adding CPT 99051?

 

[ccr888]

No Modifier is Used

Both are add-on codes, are never first listed, and require no modifier.

Best,
Cheryl Roskam, CCA