Using code 99051

sandyrivet

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I work in pediatrics and we want to begin using code 99051(services provided in the office during regularly scheduled evening, weekend or holiday office hours in addition to basic service.) First I was wondering if anyone has used this code in addition to an e&m and second has anyone gotten paid on this code. We have used it a couple of times, but have not received payment from Humana or Anthem so then my question is, do we need to use a modifier on either this code or the e&m?
Thanks for any help anyone can provide.
Sandy
 

daniel

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We use this code, I work for a Family Pratice and Peds office.

This is the a list of payments I kept, listing them down the line by the lowest to highest reimbursement.

99051- $2.02- PPO Great West

99051- $5.00- Aetna

99051-$7.00- Cigna

99051- $15.00- Insurance ?

99051- $20.00- Meritain Health

99051- $25.00- Blue Shield


But over all most of the time these charges get kicked back. So it depends on how you view it. Say out of 100 of these visits a month you only get 15 of these paid at $7.00, that's $105 bucks a month. And then $1260.00 a year, so that's some change you might want to consider. For the charges that get rejected, we just right them off.

Do some google searches on this, just punch in 99051. And you'll see other articles on this. Even on this site. There was a post on this a few months back. Look into it. Alot of good hits.

Respectfully
Daniel, CPC
 
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I wouldn't write them off

Daniel,
In my opinion I think your practice might be on a slippery slope if you are writing off the charges that don't get paid.

You should probably be billing this to the patient ... and should have signage and/or an ABN equivalent that the patient signs alerting them to their responsibility to foot the bill for this additional service.

The practice needs to treat all patients equally. You are providing a service by having extended hours. If the practice feels you should be compensated for this, then bill it to everyone (If insurance doesn't pay, it goes to the patient). If your practice feels it is simply good business to provide the extended hours even without being further compensated, then you shouldn't be billing it to anyone at all.

Just my opinion.

F Tessa Bartels, CPC, CPC-E/M
 

daniel

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I agree with everything wrote. But I don't do the billing here. But I was just giving a general overview of this code. The patients get's billed from my understanding if the insurance says it's the patients responsiblilty. But when the insurance says it's not the patient's responsiblility. Then I believe you can't bill the patient no matter what. So in over all it usally gets written off, because most insurance don't acknowlege this code.


Respectfully
daniel, CPC
 

ckkohler

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99051

I, too, agree with what has been said for the most part. I worked for BCBS-Nebraska for ~ 18 years in the auditing/claims payment/training areas. The codes for extended services, generally, were denied as global to the main E & M code ... which then would become the provider's responsibility to write off.

I also agree that from a billing standpoint - you can't treat people differently. In otherwords, if you write off the extra service because the insurance company considers it to be provider write-off, then it isn't appropriate to require a patient to pay for it if their insurance doesn't consider it provider write-off.:)
 

bhaskins1

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We use this code in our office, because we have regular office hours on Saturdays. We have pretty good luck in getting reimbursed... right now the only insurance we have that is not reimbursing is UHC. When they deny they are stating that it is not separately reimbursable and that it is a provider write-off. Therefore we write it off. If we have a claim that comes back and shows it as patient responsibility (due to deductible or co-insurance) we then bill that amount to the patient. As with anything else we only write off what our carrier contract states is not billable to the patient.

The extra that comes in from this code helps defray the cost of being open those extra hours and helps to keep our pediatric patients out of the urgent cares and emergency rooms. Most carriers are starting to see the wisdom in this and have started allow payment on this code.
 
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Provider Write Off

Daniel,
I misunderstood your original post as you were writing off balances that were legitimately patient responsibility.

Yes, if the denial indicates there is no patient responsibility, then of course you would write off that balance.

F Tessa Bartels, CPC, CPC-E/M
 
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