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Coding/charging for "holiday" and after hours

  1. Question Coding/charging for "holiday" and after hours
    Medical Coding Books
    Can anyone tell me if you can charge the "holiday" code if this day in question is a day you are open anyway? Example: Monday the 16th is a holiday, our facility is NOT closed, can you charge them the "holiday" cpt code in addition to
    an E&M code? I think if it was like Thanksgiving or X-Mas when you would normally be closed and you open due to patient need, then yes but there seems to be some confusion within the facility as to what "qualifies" as a "holiday". Any commets would be helpful!:

  2. #2
    Milwaukee WI
    Default We dont use these codes
    Our practice does not use these codes at all, but ...

    If we were to use them, I'd only apply them to those holidays where the majority of practices are typically closed on that day ... New Year's Day, Easter, Memorial Day, 4th of July, Labor Day, Thanksgiving, (possibly day after Thanksgiving), Christmas (possibly Christmas Eve as well).

    Most offices are not typically closed on Martin Luther King Day, President's Day, or Veteran's Day, so I wouldn't apply the codes to services on those dates.

    Just my opinion.

    F Tessa Bartels, CPC, CEMC

  3. #3
    I agree with FTessa.

    I think it would be unethical to charge and or punish a patient/insurance carrier (by charging extra) because you chose to stay open on a holiday. That is your practices' choice.

    I think the codes were designed for those emergent situations where a patient injures themself, calls the oncall doc, and the doc sees them in his office on an emergent basis...then its justified.

    If your practice does this, do you tell the patient ahead of time "Oh, and, by the way, I'm going to make your appointment for Monday 2-16, and since its a holiday that day, and we are going to charge extra that day". Thats just not right!

    This is strictly my opinion
    Mary, CPC,COSC

  4. #4
    I agree with the two other post. I am operations manager of a peds clinic and if we did that it would really put our parents on edge.

    Those codes are used when the doc's office is not open. I would be like if a patient calls the physician on call and then the physician agreed to meet them at the office. Then we would use those codes.

    Hope that helps.

    Cissy Mangrum, CMPE, CPC
    Operations Manager

  5. #5
    I agree this code can be misused/abused, but make sure you check your insurance contracts. Some payers in my area have decided to reimburse these codes. They've done so to help incentivize providers to stay open during "off hours".

    If the provider office isn't open, the patient may go to the ER instead. Most carriers would rather pay a provider for a visit + after hours charge, than to pay a hospital for an ER charge.

    Also, keep in mind that for some providers there is an extra cost to staying open. For example, our office pays time and a half to employees who work on some holidays, and a shift differential for weekends and evenings.

    I hope this helps.


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