Wiki Special Services codes for after hour etc


Springville, NY
Best answers
I do work with a Provider who will often bring patients in during lunch time, after or even before his regularly scheduled hours At this point the office is not using special service codes CPT codes I would just like to confirm my understanding
If the pt is scheduled during the Providers lunch it would be appropriate to add 99050 to say a 99212
99051 would or could be used for evening ,weekend or holiday hours in addition to the E/M I understand that convenience hours might differ by 3rd party payers
99058 would/could be added to an E/M for an emergency visit that disrupts the Providers regularly scheduled patients
I do understand that if the provider is running late and that if the patient is seen outside of established/advertised hours that does not qualify as well the Providers hours must be posted I'm just looking for confirmation on the use
Feed back is appreciated
Good luck

First of all, good luck in getting paid for these codes. We've never been paid when those have been filed.

As I understand it, 99050 is for after hours emergency type visits, some carriers say between 5 p.m. and 8 a.m., so a visit during lunch time isn't covered with this.

99051 may be the more appropriate code to try since it can be used for visits during office hours. However, the couple of carrier sites I looked at said the hours had to be on weekends or holidays when the office was scheduled to be open anyhow, so I don't think it would apply to the examples you gave.

Tom Cheezum, O.D., CPC, COPC
After hours means before or after published opening/closing time. As stated above, most carriers will not pay separately. Remember not all CPT codes will have reimbursement attached to them and may be for tracking/statistical purposes only. For example, evaluating extending office hours.
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